Challenges in Promoting Health Equity and Reducing Disparities in Access Across New and Established Technologies

Hoagland, Alex; Kipping, Sarah

doi:10.1016/j.cjca.2024.02.014

Cited by 7 publications

(1 citation statement)

References 108 publications

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“…The economic strain exacerbates existing stressors and compromises patients' access to essential healthcare services, perpetuating health inequities and exacerbating disparities in disease outcomes. Studies have highlighted the inconsistent impact of chronic illness on socio-economically disadvantaged populations, necessitating policy interventions to improve access to affordable healthcare and essential medications [17].…”

Section: Discussionmentioning

confidence: 99%

Exploring the Rehabilitation Needs of Patients with Coronary Artery Diseases: An Effort to Design A Contextual Home-based Cardiac Rehabilitation through A Qualitative Enquiry

Yaqoob,

Barolia,

Ladak

et al. 2024

Preprint

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Background Cardiovascular diseases (CVDs) continue to be a major global public health concern, accounting for a considerable portion of the burden of morbidity and mortality. The CAD in Pakistan imposes a substantial economic and social burden on individuals, families, and the healthcare system. Despite advances in medical interventions and therapies, comprehensive cardiac rehabilitation programs in Pakistan remain underdeveloped and inaccessible to many patients, particularly those residing in rural or underserved areas. Aim This study aims to explore the needs of Pakistani patients with heart disease in helping to design contextual home-based cardiac rehabilitation. Methods Based on the data saturation, 20 individuals were interviewed using a qualitative descriptive exploratory approach. Semi-structured, in-depth interviews that lasted 40 to 50 minutes were used to gather the data. NVIVO software was used to conduct a thematic analysis of qualitative data. Results The qualitative data obtained from participants revealed five themes: Understanding heart disease, Cardiac anxiety, Challenges faced by patients, Difficulties in behavior change, and Patient readiness for home-based cardiac rehabilitation. Conclusion The findings uncover the importance of tailored interventions that address patients' preferences for guidance, support, and lifestyle modification.

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Section: Discussionmentioning

confidence: 99%

Exploring the Rehabilitation Needs of Patients with Coronary Artery Diseases: An Effort to Design A Contextual Home-based Cardiac Rehabilitation through A Qualitative Enquiry

Yaqoob,

Barolia,

Ladak

et al. 2024

Preprint

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Social Determinants of Health and Insurance Claim Denials for Preventive Care

Hoagland,

Yu,

Horný

2024

JAMA Netw Open

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ImportanceThe Patient Protection and Affordable Care Act (ACA) eliminated out-of-pocket cost-sharing for recommended preventive care for most privately insured patients. However, patients seeking preventive care continue to face cost-sharing and administrative hurdles, including claim denials, which may exacerbate inequitable access to care.ObjectiveTo determine whether patient demographics and social determinants of health are associated with denials of insurance claims for preventive care.Design, Setting, and ParticipantsThis cohort study of patients insured through their employers or the ACA Marketplaces used claims and remittance data from Symphony Health Solutions’ Integrated DataVerse from 2017 to 2020; analysis was completed from January to July 2024.ExposureSeeking preventive care.Main Outcomes and MeasuresThe primary outcome was the frequency of insurer denials for preventive services across 5 categories: specific benefit denials, billing errors, coverage lapses, inadequate coverage, and other. Subgroup analysis was performed across patient household income, education, and race and ethnicity. Secondary outcomes included charges for denied claims, approximating patients’ remaining financial responsibility for care.ResultsA total of 1 535 181 patients received 4 218 512 preventive services in 2 507 943 unique visits (mean [SD] age at visits, 54.02 [13.19] years; 1 804 637 visits for female patients [71.96%]); 585 299 patients (23.30%) had an annual household income $100 000 or higher, and 824 540 patients had some college education (32.88%). A total of 20 658 individuals (0.82%) were Asian, 139 950 (5.58%) were Hispanic, 219 646 (8.76%) were non-Hispanic Black, 1 372 223 (54.72%) were non-Hispanic White, and 25 412 (1.0%1) were other races and ethnicities not included in the other 4 groups. Of preventive claims, 1.34% (95% CI, 1.32%-1.36%) were denied, consisting mainly of specific benefit denials (0.67%; 95% CI, 0.66%-0.68%) and billing errors (0.51%; 95% CI, 0.50%-0.52%). The lowest-income patients had 43.0% higher odds of experiencing a denial than the highest-income patients (odds ratio, 1.43; 95% CI, 1.37-1.50; P &lt; .001). The least educated enrollees had a denial rate of 1.79% (95% CI, 1.76%-1.82%) compared with 1.14% (95% CI, 1.12%-1.16%) for enrollees with college degrees. Denial rates for Asian (2.72%; 95% CI, 2.55%-2.90%), Hispanic (2.44%; 95% CI, 2.38%-2.50%), and non-Hispanic Black (2.04%; 95% CI, 1.99%-2.08%) patients were significantly higher than those for non-Hispanic White patients (1.13%; 95% CI, 1.12%-1.15%).Conclusions and RelevanceIn this cohort study of 1 535 181 patients seeking preventive care, denials of insurance claims for preventive care were disproportionately more common among at-risk patient populations. This administrative burden potentially perpetuates inequitable access to high-value health care.

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