Suchergebnisse

The proportion of the United States population without health insurance continues to grow. How will this affect the health of the nation? Prior research suggests that the uninsured are at risk for poor health outcomes. They use fewer medical services and have higher mortality rates than do insured persons. The episodic nature of uninsurance and its prevalence among disadvantaged groups makes it difficult to ascertain the health effects of uninsurance. The goal of this review is to assist researchers and policy makers in choosing methodologies to assess the effects of uninsurance. It provides a compendium of methods that have been used to examine the health consequences of uninsurance, the populations in which these methods have been used, and the strengths and weaknesses of different approaches. The review highlights the need for more longitudinal studies that focus on community-based samples of the uninsured.

This study assesses whether Minnesota's high-risk insurance pool is successful at insuring those denied health insurance coverage because of preexisting medical conditions. Eight hundred and twenty-nine individuals who had been denied health insurance coverage were interviewed. At the time of the survey, 80 percent of the sample had obtained coverage, 22 percent through the state's high-risk insurance pool. Seventeen percent remained uninsured. Logistic regression was used to identify correlates of remaining uninsured. Younger age and less education were significantly associated with being uninsured versus enrolling in the high-risk pool. Younger age, less education, unemployment, being non-White, and having worse mental health were significantly associated with being uninsured versus having non-high-risk pool insurance. Despite the presence of a large high-risk pool in Minnesota, specific groups are identified as being at risk for remaining uninsured after being denied health insurance.

AbstractAdministratively complex and politically sensitive issues can arise when mentally ill persons who are public program beneficiaries are enrolled in existing HMOs. The experiences of a demonstration program undertaken in Minnesota illustrate these issues.

Inadequate access and poor quality care for immigrants could have serious consequences for their health and that of the overall U.S. population. The authors conducted a systematic search for post-1996, population-based studies of immigrants and health care. Of the 1,559 articles identified, 67 met study criteria of which 77% examined access, 27% quality, and 6% cost. Noncitizens and their children were less likely to have health insurance and a regular source of care and had lower use than the U.S. born. The foreign born or non-English speakers were less satisfied and reported lower ratings and more discrimination. Immigrants incurred lower costs than the U.S. born, except emergency department expenditures for immigrant children. Policy solutions are needed to improve health care for immigrants and their children. Research is needed to elucidate immigrants' nonfinancial barriers, receipt of specific processes of care, cost of care, and health care experiences in nontraditional U.S. destinations.

AbstractCapitation reduced Medicaid costs but had limited effects on most measures of process and outcome. Clients under capitation with the poorest mental health at baseline performed more poorly over time on some measures.