The Affordable Care Act: implications for health-care equity

Gaffney, Adam; McCormick, Danny

doi:10.1016/s0140-6736(17)30786-9

Cited by 133 publications

(65 citation statements)

References 58 publications

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“…Some research has shown improved healthcare access and some health metrics following the implementation of the ACA, particularly in states that expanded Medicaid . However, the results of other studies highlight residual inequities in access to care due to structural issues ranging from the reluctance of some providers to accept Medicaid patients and inability to afford coinsurance, particularly among the working poor, to lack of transportation, childcare, and employer‐provided time off for preventive care visits . The results of alternate analyses adjusting for income in the current study suggest that increased wages among the patient care workforce could ameliorate the high prevalence of some adverse health metrics observed among these groups, but that other types of intervention would be needed to address residual differences in outcomes, particularly those stemming from work activities, rather than work arrangements, such as arthritis.…”

Section: Discussionmentioning

confidence: 62%

Patient care aides: Differences in healthcare coverage, health‐related behaviors, and health outcomes in a low‐wage workforce by healthcare setting

Silver

Boiano

2019

American J Industrial Med

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Objectives: Patient care aides, who provide basic care to patients in a variety of healthcare settings, have been observed to have higher prevalences of adverse health metrics than the general US workforce. However, few studies have examined how healthcare access and health behaviors and outcomes among patient care aides differ by work setting (home health, nursing home, and hospital).Methods: Data from the 2013 to 2016 Behavioral Risk Factor Surveillance System were used to assess the prevalences of healthcare access, health-related behaviors, and health outcomes among patient care aides in different work settings, and among nurses (licensed vocational/practical and registered). Adjusted prevalence ratios were used to compare prevalences for healthcare workers to those for nonhealthcare clerical workers.Results: Overall, patient care aides are a low-wage workforce with high prevalences of multiple adverse health metrics and low prevalences of positive health behaviors compared to clerical workers. Results differed by work setting. Home health aides had the lowest income levels and most adverse results for multiple metrics; nursing home aides had better healthcare access and somewhat better health outcomes.Most metrics were best (though still quite poor) for hospital aides, who showed few significant differences from clerical workers. Conclusions:These results show the need to focus resources on the patient care aide workforce, particularly those in home health. While some needs of nursing home aides, such as improving influenza vaccination coverage and reducing the prevalence of arthritis-related conditions, would benefit from standardized workplace interventions, alternate, workplace-specific approaches are needed for home health aides.

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Section: Discussionmentioning

confidence: 62%

Patient care aides: Differences in healthcare coverage, health‐related behaviors, and health outcomes in a low‐wage workforce by healthcare setting

Silver

Boiano

2019

American J Industrial Med

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“…Also, a recent review paper commissioned by the King's Fund suggested that the National Health Service, the public healthcare system in the United Kingdom, can be better designed to tackle poverty through its impact on health, income distribution, employment and service commissioning [8]. Without strengthened healthcare and welfare systems, the "21 st century health-poverty trap", as coined by Bor et al [9], is expected to emerge and subsequently widen inequalities in health [9][10][11]. In view of these fundamental differences, understanding whether, how and why the poverty-health vicious cycle operates in developed settings may go beyond delineating the mechanisms but inform the inadequacies of existing policies or interventions and hence alternative strategic directions to further alleviate the vicious cycle.…”

Section: Introductionmentioning

confidence: 99%

Perceived poverty and health, and their roles in the poverty-health vicious cycle: a qualitative study of major stakeholders in the healthcare setting in Hong Kong

Chung

Dong

Wong

et al. 2020

Int J Equity Health

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Background: Poverty and ill-health are closely interrelated. Existing studies on the poverty-health vicious cycle focus mainly on less developed countries, where the identified mechanisms linking between poverty and ill-health may not fit the situations in developed Asian regions. This study aims to qualitatively explore the perceived mechanisms and drivers of the poverty-health vicious cycle among major stakeholders in the healthcare setting in Hong Kong. Methods: Data were collected via focus group interviews with social workers (n = 8), chronically ill patients (n = 8), older adults (n = 6), primary care doctors (n = 7) and informal caregivers (n = 10). The transcribed data were then closely read to capture key themes using thematic analyses informed by social constructivism. Results: In this highly developed Asian setting with income inequality among the greatest in the world, the povertyhealth vicious cycle operates. Material and social constraints, as a result of unequal power and opportunities, appear to play a pivotal role in creating uneven distribution of social determinants of health. The subsequent healthcare access also varies across the social ladder under the dual-track healthcare system in Hong Kong. As health deteriorates, financial hardship is often resulted in the absence of sufficient and coordinated healthcare, welfare and labour policy interventions. In addition to the mechanisms, policy drivers of the cycle were also discussed based on the respondents' perceived understanding of the nature of poverty and its operationalization in public policies, as well as of the digressive conceptions of disease among different stakeholders. Conclusions: The poverty-health vicious cycle has remained a great challenge in Hong Kong despite its economic prosperity. To break the cycle, potential policy directions include the adoption of proportionate universalism, social integration and the strengthening of medical-social collaboration.

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“…Its passage helped decrease the gap between insured and uninsured/underinsured particularly for economically disadvantaged groups, and is anticipated to lower costs [5]. Although, data from the initial years after the law's implementation show large reductions in the rates of uninsurance/underinsurance among low-income groups [6][7][8][9][10][11][12][13], significant inequities and disparities in health remain [14][15][16]. Under this law, several other initiatives such as new payment models, more streamlined quality metrics and population health, have been introduced.…”

Section: Introductionmentioning

confidence: 99%

“…Given that the impact of coverage expansion has been comprehensively addressed in other literature, the purpose of this paper is to present a concise perspective on the current state of inequities and disparities in the US health care system as it relates to these other initiatives in an era of health care reform, and present possible recommendations to further improve the outlook of achieving health equity. To ensure a comprehensive analysis of the topic, both terms-inequities and disparities-are applied in the context of this paper [16]. demonstrations calling for alternative payment models ought to strategically link inequities and disparities reduction to payment.…”

Section: Introductionmentioning

confidence: 99%

Achieving Health Equity through Health Care Reform: Current State and Outlook

Inneh¹

2018

Health Care Current Reviews

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Despite advances in medicine and health care reform in the United States (US), inequities and disparities whether in health status and/or care persist(s) for certain vulnerable or disadvantaged groups. This paper presents a perspective on the current state of inequities and disparities in US health care system as it relates to certain initiatives in an era of health care reform, and possible recommendations to further improve the outlook of achieving health equity

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The Affordable Care Act: implications for health-care equity

Cited by 133 publications

References 58 publications

Patient care aides: Differences in healthcare coverage, health‐related behaviors, and health outcomes in a low‐wage workforce by healthcare setting

Patient care aides: Differences in healthcare coverage, health‐related behaviors, and health outcomes in a low‐wage workforce by healthcare setting

Perceived poverty and health, and their roles in the poverty-health vicious cycle: a qualitative study of major stakeholders in the healthcare setting in Hong Kong

Achieving Health Equity through Health Care Reform: Current State and Outlook

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