scholarly journals Australia's pharmaceutical cost sharing policy: reducing waste or affordability?

2009 ◽  
Vol 33 (2) ◽  
pp. 231 ◽  
Author(s):  
Evan Doran ◽  
Jane Robertson
Keyword(s):  
Moral Hazard ◽  
Health Outcomes ◽  
Common Sense ◽  
Low Income ◽  
Cost Sharing ◽  
Negative Impact ◽  
Insurance Coverage ◽  
Explanatory Power ◽  
Good Health ◽  
Pharmaceutical Cost

In this paper we argue that Australia?s pharmaceutical cost sharing policy has been applied as if cost sharing is unproblematic for medicine affordability and good health outcomes. Australian and international experience with pharmaceutical cost sharing strongly suggests a negative impact on affordability and quality use of medicines, disproportionately affecting low income patients. We argue that Australia?s use of cost sharing reflects the currency of a cognitively powerful and morally charged idea ? moral hazard. Moral hazard refers to the change in behaviour induced by insurance coverage. Applied to pharmaceuticals, this means that low out-of-pocket cost will lead to waste. Moral hazard mixes the explanatory power of price with the intuitively cogent notion that if people do not experience consequences they will behave irresponsibly. Cost sharing policy has gone unscrutinised and uncontested not because cost sharing is unproblematic, but because in the light of the idea of moral hazard it has all the question-deadening weight of common sense.

Physical and Mental Health Outcomes of Women in Nonviolent, Unilaterally Violent, and Mutually Violent Relationships

2005 ◽  
Vol 20 (3) ◽  
pp. 335-359 ◽  
Author(s):  
Jeff R. Temple ◽  
Rebecca Weston ◽  
Linda L. Marshall
Keyword(s):  
Health Status ◽  
Health Outcomes ◽  
Women’S Health ◽  
Women's Health ◽  
Low Income ◽  
Mexican American ◽  
Negative Impact ◽  
Phase 1 ◽  
Physical And Mental Health ◽  
Two Phases

Despite equivocal findings on whether men or women are more violent, the negative impact of violence is greatest for women. To determine how gender asymmetry in perpetration affects women’s health status, we conducted a study in two phases with 835 African American, Euro-American, and Mexican American low-income women in Project HOW: Health Outcomes of Women. In Phase 1, we used severity and frequency of women’s and male partners’ violence to create six groups: nonviolent (NV), uni-directional male (UM) perpetrator, uni-directional female (UF) perpetrator and, when both partners were violent, symmetrical (SYM), male primary perpetrator (MPP), and female primary perpetrator (FPP). The MPP group sustained the most threats, violence, sexual aggression, and psychological abuse. They also reported the most fear. Injury was highest in the MPP and FPP groups. In Phase 2, we examined group differences in women’s health status over time for 535 participants, who completed five annual interviews. Surprisingly, women’s health in the MPP and FPP violence groups was similar and generally worse than if violence was uni-directional.

Health Communication: Implications for Diverse Populations

2011 ◽  
Vol 18 (1) ◽  
pp. 12-19
Author(s):  
Amy Hasselkus
Keyword(s):  
Health Care ◽  
Health Communication ◽  
Negative Impact ◽  
Linguistically Diverse ◽  
Good Health ◽  
The United States ◽  
Poor Health ◽  
Health Care Decisions ◽  
Diverse Backgrounds ◽  
Health Related

The need for improved communication about health-related topics is evident in statistics about the health literacy of adults living in the United States. The negative impact of poor health communication is huge, resulting in poor health outcomes, health disparities, and high health care costs. The importance of good health communication is relevant to all patient populations, including those from culturally and linguistically diverse backgrounds. Efforts are underway at all levels, from individual professionals to the federal government, to improve the information patients receive so that they can make appropriate health care decisions. This article describes these efforts and discusses how speech-language pathologists and audiologists may be impacted.

scholarly journals Using Prospective Methods to Identify Fieldwork Locations Favourable to Understanding Divergences in Health Care Accessibility

2021 ◽  
Vol 10 (8) ◽  
pp. 506
Author(s):  
Jan Ketil Rød ◽  
Arne H. Eide ◽  
Thomas Halvorsen ◽  
Alister Munthali
Keyword(s):  
Health Care ◽  
Low Income ◽  
Access To Health Care ◽  
Health Care Services ◽  
Good Health ◽  
Low Income Countries ◽  
Care Services ◽  
Health Care Accessibility ◽  
Barriers To Health ◽  
Walking Time

Central to this article is the issue of choosing sites for where a fieldwork could provide a better understanding of divergences in health care accessibility. Access to health care is critical to good health, but inhabitants may experience barriers to health care limiting their ability to obtain the care they need. Most inhabitants of low-income countries need to walk long distances along meandering paths to get to health care services. Individuals in Malawi responded to a survey with a battery of questions on perceived difficulties in accessing health care services. Using both vertical and horizontal impedance, we modelled walking time between household locations for the individuals in our sample and the health care centres they were using. The digital elevation model and Tobler’s hiking function were used to represent vertical impedance, while OpenStreetMap integrated with land cover map were used to represent horizontal impedance. Combining measures of walking time and perceived accessibility in Malawi, we used spatial statistics and found spatial clusters with substantial discrepancies in health care accessibility, which represented fieldwork locations favourable for providing a better understanding of barriers to health access.

scholarly journals Assessing Cardiometabolic Health Risk Among U.S. Children Who Live in Grandparent-Headed Households

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 524-524
Author(s):  
MinKyoung Song ◽  
Karen Lyons ◽  
Laura Hayman ◽  
Nathan Dieckmann ◽  
Carol Musil
Keyword(s):  
Health Outcomes ◽  
Insurance Coverage ◽  
Change Agents ◽  
Indirect Evidence ◽  
Health Insurance Coverage ◽  
Cardiometabolic Health ◽  
Steady Increase ◽  
Childhood Experiences ◽  
Grandparent Caregivers ◽  
Age Appropriate

Abstract Many interventions have been designed to leverage parent-caregivers as change agents for improving children’s cardiometabolic health (CMH), however very few have been designed to leverage grandparent-caregivers for that purpose. This is surprising since there has been a steady increase in children living in grandparent-headed households. As a first step in assessing the potential impact of interventions with grandparent-caregivers, we used data from the National Survey of Children’s Health (2018) to compare CMH measures in children living in grandparent-headed households with CMH measures in children living in parent-headed households. Our hypothesis was that CMH risk might be higher in grandparent households – given that research shows that grandparents taking over caregiving from parents is associated with worse overall health outcomes for both grandparents and their grandchildren. Additionally, since research indicates that children who experience ≥ 4 adverse childhood experiences (ACEs) have significantly worse health outcomes, we assessed levels of ACEs. Our analytic sample included children aged 10-17 years (n=14,941). Adjusting for age, sex, race/ethnicity, and health insurance coverage status, children living in grandparent households were more likely to be obese (Adjusted Odds Ratio [95% confidence interval]= 2.04 [1.02, 4.09]), exposed to secondhand smoke (2.32 [1.49, 3.59]), and less likely to meet recommended age-appropriate standards for sleep (0.42 [0.27, 0.67]). The children living in grandparent households were more likely to experience ≥ 4 ACEs (8.59 [5.42, 13.62]). Our results provide indirect evidence that interventions with grandparent-caregivers may be particularly critical for improving CMH risk in families.

scholarly journals The convergence of racial and income disparities in health insurance coverage in the United States

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
De-Chih Lee ◽  
Hailun Liang ◽  
Leiyu Shi
Keyword(s):  
Health Insurance ◽  
Low Income ◽  
Insurance Coverage ◽  
Health Insurance Coverage ◽  
The United States ◽  
Combined Effect ◽  
Medical Expenditure ◽  
The Us ◽  
Race Ethnicity ◽  
Vulnerability Measure

Abstract Objective This study applied the vulnerability framework and examined the combined effect of race and income on health insurance coverage in the US. Data source The household component of the US Medical Expenditure Panel Survey (MEPS-HC) of 2017 was used for the study. Study design Logistic regression models were used to estimate the associations between insurance coverage status and vulnerability measure, comparing insured with uninsured or insured for part of the year, insured for part of the year only, and uninsured only, respectively. Data collection/extraction methods We constructed a vulnerability measure that reflects the convergence of predisposing (race/ethnicity), enabling (income), and need (self-perceived health status) attributes of risk. Principal findings While income was a significant predictor of health insurance coverage (a difference of 6.1–7.2% between high- and low-income Americans), race/ethnicity was independently associated with lack of insurance. The combined effect of income and race on insurance coverage was devastating as low-income minorities with bad health had 68% less odds of being insured than high-income Whites with good health. Conclusion Results of the study could assist policymakers in targeting limited resources on subpopulations likely most in need of assistance for insurance coverage. Policymakers should target insurance coverage for the most vulnerable subpopulation, i.e., those who have low income and poor health as well as are racial/ethnic minorities.

scholarly journals Examining social determinants by locale to inform community linkages

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
J Davis
Keyword(s):  
Social Determinants ◽  
Low Income ◽  
Negative Impact ◽  
Rank Order ◽  
Disabled Persons ◽  
Behavioral Risk ◽  
Exploratory Research ◽  
Frequency Distributions ◽  
Individual Level ◽  
Negative Impacts

Abstract Achieving a long-lasting impact on health outcomes requires focus not just on patient care, but also on community approaches aimed at improving population health through addressing gaps in Social Determinants of Health (SDOH). SDOH have been found to disproportionately affect those in low-income brackets and the disabled to varying degrees based on locale. The purpose of this exploratory research was to determine 1) which SDOH have the greatest negative impact on disabled and elderly populations within four targeted states (Iowa, Ohio, Minnesota, Wisconsin) and 2) if there is a difference in negative SDOH impact between metro and non-metro locales. Individual-level data were obtained from disabled persons aged 65 years or older who responded to the Centers for Disease Control and Prevention's 2017 Behavioral Risk Factor Surveillance System (BRFSS) survey. Utilizing these data, frequency distributions were obtained using SPSS. Rank order variation in SDOH was observed among four Midwestern states and between metro vs. non-metro geographic regions. Frequency distributions assisted in identifying the greatest negative impacting SDOH on elderly disabled populations. An examination of the rank order tables allowed the investigator to accurately assess the rank of negative impacts. There were variabilities in responses to questions with moving two or more times within 12 months having the lowest negative impact. When regrouped based upon SDOH negative impacts, were you able to pay your bills was the most frequent SDOH across all states. Feeling unsafe or extremely unsafe in your neighborhood was the highest negatively impacted SDOH within states. Cited determinants in three categories were highest in Ohio. Ohio also had the highest proportion of negatively impacted SDOH across all states. No money for balanced meals was a close second SDOH across states. Key messages Social Determinants Impacting Elderly Disabled. Impact of Social Determinants by Geography.

Longitudinal Links between Income Dynamics and Young Adult Socioeconomic and Behavioral Health Outcomes

2021 ◽  
pp. 0044118X2199638
Author(s):  
Kendra Whitfield ◽  
Laura Betancur ◽  
Portia Miller ◽  
Elizabeth Votruba-Drzal
Keyword(s):  
Young Adult ◽  
Health Outcomes ◽  
Behavioral Health ◽  
Low Income ◽  
Family Income ◽  
Adult Outcomes ◽  
Income Volatility ◽  
Income Loss ◽  
Socioeconomic Outcomes ◽  
Young Adult Outcomes

Longitudinal links between childhood family income and adult outcomes are well documented. However, research on childhood income volatility and young adult outcomes is limited. This study utilizes data from the NLSY ( N = 6,410) to examine how childhood family income and income volatility relate to socioeconomic outcomes and mental/behavioral health in emerging adulthood. Results show that lower childhood income was associated with young adult socioeconomic and behavioral health outcomes. Higher income volatility was associated with increased depression and teen parenthood during young adulthood. Additional analyses examining trajectories of income volatility illustrated that children in families with unstable income trajectories (i.e., frequent income losses and gains) showed higher depression scores than those with stable trajectories. These findings suggest that income volatility, not just income level or income loss, is important to consider when studying economic disparities in young adult outcomes. Implications for policies and programs for low-income, high-volatility households are discussed.

Measuring pedestrian volume by land use mix: Presenting a new entropy-based index by weighting walking generation units

2019 ◽  
Vol 47 (7) ◽  
pp. 1219-1236 ◽  
Author(s):  
Ha Na Im ◽  
Chang Gyu Choi
Keyword(s):  
Land Use ◽  
Urban Studies ◽  
Negative Impact ◽  
Explanatory Power ◽  
Built Environments ◽  
Estimation Model ◽  
Land Use Types ◽  
Land Use Mix ◽  
The Relationship ◽  
The Empirical Analysis

This study proposes an alternative to the conventional entropy-based land use mix index, which is generally used to measure the diversity of land use. Pedestrian volume was selected as the dependent variable as it represents the vitality of districts, which many recent urban studies now consider important. The study investigates an entropy-based weighted land use mix index, which is weighted by different land use types. For the index, different areas are needed to generate a unit of pedestrian volume, whose measure is m2/person/day. The study demonstrates that this alternative is more effective than the existing conventionally used entropy-based land use mix index for explaining pedestrian volume. The research confirms that the conventionally used entropy-based land use mix index can have a positive or negative impact depending on the land use characteristics of the survey points because the conventionally used entropy-based land use mix index has a non-linear relationship with pedestrian volume. By analysing 9727 surveyed locations of pedestrian volume in Seoul, Korea, the study demonstrates that the weighted land use mix index, rather than the conventionally used entropy-based land use mix index, can improve the explanatory power of the estimation model for the relationship between pedestrian volume and built environments, showing consistent results throughout the empirical analysis. In future built-environment studies, the utility of the weighted land use mix index is expected to improve if studies include how to find the accurate weighting of the land use in estimating the pedestrian volume.

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