Income Inequities and Medicaid Expansion are Related to Racial and Ethnic Disparities in Delayed or Forgone Care Due to Cost

Clark, Cheryl R.; Ommerborn, Mark J.; Coull, Brent A.; Pham, Do Quyen; Haas, Jennifer S.

doi:10.1097/mlr.0000000000000525

Cited by 33 publications

(31 citation statements)

References 18 publications

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“…Patients who participated in the survey were more likely to be white and less likely to be Hispanic/Latino compared to those who did not participate. Given prior studies reporting similar findings [11,22], a higher proportion of non-white and Hispanic/Latino individuals in the study sample would likely have amplified disparities and barriers already observed in the study. Additional socioeconomic indicators that may contribute to access to insurance were not assessed.…”

Section: Discussionmentioning

confidence: 67%

Insurance Coverage and Utilization at a Sexually Transmitted Disease Clinic in a Medicaid Expansion State

et al. 2017

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Background In Rhode Island, the Patient Protection and Affordable Care Act (ACA) has led to over 95% of the state’s population being insured. We evaluated insurance coverage and barriers to insurance use among patients presenting for services at the Rhode Island STD Clinic. Methods We analyzed factors associated with insurance coverage and utilization among patients presenting for STD services between July and December 2015. Results A total of 692 patients had insurance information available; of those, 40% were uninsured. Patients without insurance were more likely than those with insurance to be non-white (50% among uninsured, compared to 40% among insured; p = 0.014) and Hispanic or Latino/a (25%, compared to 16%; p = 0.006), and less likely to be MSM (27%, compared to 39%; p = 0.001). Of those with health insurance, 26% obtained coverage as a result of the ACA, and 56% of those were previously uninsured. Among uninsured individuals, barriers to obtaining health insurance included cost and unemployment. Among those with insurance, 43% reported willingness to use insurance for STD services. Barriers to insurance use included concerns about anonymity and out-of-pocket costs. Conclusions Despite expanded insurance access, many individuals presenting to the Rhode Island STD Clinic were uninsured. Among those who were insured, significant barriers still existed to using insurance. STD clinics continue to play an important role in providing safety-net STD services in states with low uninsured rates. Both public and private insurers are needed to address financial barriers and optimize payment structures for services.

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Section: Discussionmentioning

confidence: 67%

Insurance Coverage and Utilization at a Sexually Transmitted Disease Clinic in a Medicaid Expansion State

et al. 2017

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“…Together with the present results on inequality and access to care, this research would clarify the mechanisms underlying patterns seen in aggregate county-, year-, or nation-level data. 37 …”

Section: Discussionmentioning

confidence: 99%

Local Income Inequality, Individual Socioeconomic Status, and Unmet Healthcare Needs in Ohio, USA

et al. 2018

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Purpose: Income inequality has been implicated as a potential risk to population health due to lower provision of healthcare services in deeply unequal countries or communities. We tested whether county economic inequality was associated with individual self-report of unmet healthcare needs using a state health survey data set.Methods: Adults residents of Ohio responding to the 2015 Ohio Medicaid Assessment Survey were included in the analysis. Ohio's 88 counties were classified into quartiles according to the Gini coefficient of income inequality. The primary outcome was a composite of self-reported unmet dental care, vision care, mental healthcare, prescription medication, or other healthcare needs within the past year. Unmet healthcare needs were compared according to county inequality quartile using weighted logistic regression.Results: The analytic sample included 37,140 adults. The weighted proportion of adults with unmet healthcare needs was 28%. In multivariable logistic regression, residents of counties in the highest (odds ratio [OR]=1.13, 95% confidence interval [CI]: 1.01–1.26; p=0.030) and second-highest (OR=1.16, 95% CI: 1.04–1.30; p=0.010) quartiles of income inequality experienced more unmet healthcare needs than residents of the most equal counties.Conclusion: Higher county-level income inequality was associated with individual unmet healthcare needs in a large state survey. This finding represents novel evidence for an individual-level association that may explain aggregate-level associations between community economic inequality and population health outcomes.

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“…A prior study showed that income difference may be associated with delayed and forgone health care. 38 Thus, lack of Medicaid expansion may be a potential factor underlying income-based inequalities. In addition, southern counties have higher proportions of black people, which may relate to other county-level factors (eg, health behaviors, health care access, and physical environment).…”

Section: Jama Network Open | Health Policymentioning

confidence: 99%

Factors Associated With County-Level Variation in Premature Mortality Due to Noncommunicable Chronic Disease in the United States, 1999-2017

et al. 2020

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IMPORTANCE Progress against premature death due to noncommunicable chronic disease (NCD) has stagnated. In the United States, county-level variation in NCD premature mortality has widened, which has impeded progress toward mortality reduction for the World Health Organization (WHO) 25 × 25 target.OBJECTIVES To estimate variations in county-level NCD premature mortality, to investigate factors associated with mortality, and to present the progress toward achieving the WHO 25 × 25 target by analyzing the trends in mortality. DESIGN, SETTING, AND PARTICIPANTSThis cross-sectional study focused on NCD premature mortality and its factors from 3109 counties using US mortality data for cause of death from the Centers for Disease Control and Prevention WONDER databases and county-level characteristics data from multiple databases. EXPOSURES County-level factors, including demographic composition, socioeconomic features, health care environment, and population health status. MAIN OUTCOMES AND MEASURES Variations in county-level, age-adjusted NCD mortality in the US residents aged 25 to 64 years and associations between mortality and the 4 sets of countylevel factors.RESULTS A total of 6 794 434 deaths due to NCD were recorded during the study period (50.58% women; 16.49% aged 65 years or older). Mortality decreased by 4.30 (95% CI, −4.54 to −4.08) deaths per 100 000 person-years annually from 1999 to 2010 (P < .001) and decreased annually at a rate of 0.90 (95% CI, −1.13 to −0.73) deaths per 100 000 person-years annually from 2010 to 2017 (P < .001). Mortality in the county with the highest mortality was 10.40 times as high as that in the county with the lowest mortality (615.40 vs 59.20 per 100 000 population) in 2017. Geographic inequality was decomposed by between-state and within-state differences, and within-state differences accounted for most inequality (57.10% in 2017). County-level factors were associated with 71.83% variation in NCD mortality. Association with intercounty mortality was 19.51% for demographic features, 23.34% for socioeconomic composition, 16.40% for health care environment, and 40.75% for health-status characteristics. CONCLUSIONS AND RELEVANCEGiven the stagnated trend of decline and increasing variations in NCD premature mortality, these findings suggest that the WHO 25 × 25 target appears to be unattainable, which may be related to broad failure by United Nations members to follow through on (continued)

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Income Inequities and Medicaid Expansion are Related to Racial and Ethnic Disparities in Delayed or Forgone Care Due to Cost

Cited by 33 publications

References 18 publications

Insurance Coverage and Utilization at a Sexually Transmitted Disease Clinic in a Medicaid Expansion State

Insurance Coverage and Utilization at a Sexually Transmitted Disease Clinic in a Medicaid Expansion State

Local Income Inequality, Individual Socioeconomic Status, and Unmet Healthcare Needs in Ohio, USA

Factors Associated With County-Level Variation in Premature Mortality Due to Noncommunicable Chronic Disease in the United States, 1999-2017

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