Your browser doesn't support javascript.
Show: 20 | 50 | 100
Results 1 - 20 de 21
Filter
1.
Clin Orthop Relat Res ; 479(7): 1417-1425, 2021 07 01.
Article in English | MEDLINE | ID: covidwho-1511052

ABSTRACT

BACKGROUND: Healthcare disparities are well documented across multiple subspecialties in orthopaedics. The widespread implementation of telemedicine risks worsening these disparities if not carefully executed, despite original assumptions that telemedicine improves overall access to care. Telemedicine also poses unique challenges such as potential language or technological barriers that may alter previously described patterns in orthopaedic disparities. QUESTIONS/PURPOSES: Are the proportions of patients who use telemedicine across orthopaedic services different among (1) racial and ethnic minorities, (2) non-English speakers, and (3) patients insured through Medicaid during a 10-week period after the implementation of telemedicine in our healthcare system compared with in-person visits during a similar time period in 2019? METHODS: This was a retrospective comparative study using electronic medical record data to compare new patients establishing orthopaedic care via outpatient telemedicine at two academic urban medical centers between March 2020 and May 2020 with new orthopaedic patients during the same 10-week period in 2019. A total of 11,056 patients were included for analysis, with 1760 in the virtual group and 9296 in the control group. Unadjusted analyses demonstrated patients in the virtual group were younger (median age 57 years versus 59 years; p < 0.001), but there were no differences with regard to gender (56% female versus 56% female; p = 0.66). We used self-reported race or ethnicity as our primary independent variable, with primary language and insurance status considered secondarily. Unadjusted and multivariable adjusted analyses were performed for our primary and secondary predictors using logistic regression. We also assessed interactions between race or ethnicity, primary language, and insurance type. RESULTS: After adjusting for age, gender, subspecialty, insurance, and median household income, we found that patients who were Hispanic (odds ratio 0.59 [95% confidence interval 0.39 to 0.91]; p = 0.02) or Asian were less likely (OR 0.73 [95% CI 0.53 to 0.99]; p = 0.04) to be seen through telemedicine than were patients who were white. After controlling for confounding variables, we also found that speakers of languages other than English or Spanish were less likely to have a telemedicine visit than were people whose primary language was English (OR 0.34 [95% CI 0.18 to 0.65]; p = 0.001), and that patients insured through Medicaid were less likely to be seen via telemedicine than were patients who were privately insured (OR 0.83 [95% CI 0.69 to 0.98]; p = 0.03). CONCLUSION: Despite initial promises that telemedicine would help to bridge gaps in healthcare, our results demonstrate disparities in orthopaedic telemedicine use based on race or ethnicity, language, and insurance type. The telemedicine group was slightly younger, which we do not believe undermines the findings. As healthcare moves toward increased telemedicine use, we suggest several approaches to ensure that patients of certain racial, ethnic, or language groups do not experience disparate barriers to care. These might include individual patient- or provider-level approaches like expanded telemedicine schedules to accommodate weekends and evenings, institutional investment in culturally conscious outreach materials such as advertisements on community transport systems, or government-level provisions such as reimbursement for telephone-only encounters. LEVEL OF EVIDENCE: Level III, therapeutic study.


Subject(s)
Health Services Accessibility , Healthcare Disparities/statistics & numerical data , Minority Groups/statistics & numerical data , Orthopedic Procedures/statistics & numerical data , Telemedicine/statistics & numerical data , Adult , Female , Health Plan Implementation , Healthcare Disparities/ethnology , Humans , Insurance Coverage/statistics & numerical data , Language , Male , Medicaid , Middle Aged , Odds Ratio , Retrospective Studies , Telemedicine/methods , United States
2.
Hastings Cent Rep ; 50(5): 3-4, 2020 Sep.
Article in English | MEDLINE | ID: covidwho-1361187

ABSTRACT

Our health care system in the United States reflects the inequities that are part of the larger society, which is why our system for financing access to needed and effective health care is so complicated and unfair.


Subject(s)
African Americans , Anemia, Sickle Cell/ethnology , Health Services Accessibility/organization & administration , Health Status Disparities , Anemia, Sickle Cell/economics , COVID-19/ethnology , Health Services Accessibility/economics , Humans , Insurance Coverage/statistics & numerical data , Insurance, Health/statistics & numerical data , SARS-CoV-2 , United States
3.
J Prev Med Public Health ; 54(3): 161-165, 2021 May.
Article in English | MEDLINE | ID: covidwho-1259659

ABSTRACT

OBJECTIVES: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) spreads heterogeneously, disproportionately impacting poor and minority communities. The relationship between poverty and race is complex, with a diverse set of structural and systemic factors driving higher rates of poverty among minority populations. The factors that specifically contribute to the disproportionate rates of SARS-CoV-2 infection, however, are not clearly understood. METHODS: We evaluated SARS-CoV-2 test results from community-based testing sites in Los Angeles, California, between June and December, 2020. We used tester zip code data to link those results with United States Census report data on average annual household income, rates of healthcare coverage, and employment status by zip code. RESULTS: We analyzed 2 141 127 SARS-CoV-2 test results, of which 245 154 (11.4%) were positive. Multivariable modeling showed a higher likelihood of SARS-CoV-2 test positivity among Hispanic communities than among other races. We found an increased risk for SARS-CoV-2 positivity among individuals from zip codes with an average annual household income

Subject(s)
COVID-19/ethnology , Poverty/statistics & numerical data , Adolescent , Adult , Aged , Asian Americans/statistics & numerical data , COVID-19/epidemiology , COVID-19 Testing/statistics & numerical data , Cross-Sectional Studies , Employment/statistics & numerical data , Female , Humans , Insurance Coverage/statistics & numerical data , Insurance, Health/statistics & numerical data , Los Angeles/epidemiology , Male , Middle Aged , Pandemics , SARS-CoV-2 , Young Adult
4.
Surgery ; 170(3): 962-968, 2021 09.
Article in English | MEDLINE | ID: covidwho-1182704

ABSTRACT

BACKGROUND: The rapid spread of coronavirus disease 2019 in the United States led to a variety of mandates intended to decrease population movement and "flatten the curve." However, there is evidence some are not able to stay-at-home due to certain disadvantages, thus remaining exposed to both coronavirus disease 2019 and trauma. We therefore sought to identify any unequal effects of the California stay-at-home orders between races and insurance statuses in a multicenter study utilizing trauma volume data. METHODS: A posthoc multicenter retrospective analysis of trauma patients presenting to 11 centers in Southern California between the dates of January 1, 2020, and June 30, 2020, and January 1, 2019, and June 30, 2019, was performed. The number of trauma patients of each race/insurance status was tabulated per day. We then calculated the changes in trauma volume related to stay-at-home orders for each race/insurance status and compared the magnitude of these changes using statistical resampling. RESULTS: Compared to baseline, there was a 40.1% drop in total trauma volume, which occurred 20 days after stay-at-home orders. During stay-at-home orders, the average daily trauma volume of patients with Medicaid increased by 13.7 ± 5.3%, whereas the volume of those with Medicare, private insurance, and no insurance decreased. The average daily trauma volume decreased for White, Black, Asian, and Latino patients with the volume of Black and Latino patients dropping to a similar degree compared to White patients. CONCLUSION: This retrospective multicenter study demonstrated that patients with Medicaid had a paradoxical increase in trauma volume during stay-at-home orders, suggesting that the most impoverished groups remain disproportionately exposed to trauma during a pandemic, further exacerbating existing health disparities.


Subject(s)
COVID-19 , Insurance Coverage/statistics & numerical data , Quarantine , Trauma Centers/statistics & numerical data , Wounds and Injuries/ethnology , California/epidemiology , Health Status Disparities , Humans , Retrospective Studies
5.
Cancer ; 127(14): 2545-2552, 2021 07 15.
Article in English | MEDLINE | ID: covidwho-1162537

ABSTRACT

BACKGROUND: Early discontinuation is a substantial barrier to the delivery of endocrine therapies (ETs) and may influence recurrence and survival. The authors investigated the association between early discontinuation of ET and social determinants of health, including insurance coverage and the neighborhood deprivation index (NDI), which was measured on the basis of patients' zip codes, in breast cancer. METHODS: In this retrospective analysis of a prospective randomized clinical trial (Trial Assigning Individualized Options for Treatment), women with hormone receptor-positive, human epidermal growth factor receptor 2-negative breast cancer who started ET within a year of study entry were included. Early discontinuation was calculated as stopping ET within 4 years of its start for reasons other than distant recurrence or death via Kaplan-Meier estimates. A Cox proportional hazards joint model was used to analyze the association between early discontinuation of ET and factors such as the study-entry insurance and NDI, with adjustments made for other variables. RESULTS: Of the included 9475 women (mean age, 55.6 years; White race, 84%), 58.0% had private insurance, whereas 11.7% had Medicare, 5.8% had Medicaid, 3.8% were self-pay, and 19.1% were treated at international sites. The early discontinuation rate was 12.3%. Compared with those with private insurance, patients with Medicaid (hazard ratio [HR], 1.53; 95% confidence interval [CI], 1.23-1.92) and self-pay patients (HR, 1.65; 95% CI, 1.25-2.17) had higher early discontinuation. Participants with a first-quartile NDI (highest deprivation) had a higher probability of discontinuation than those with a fourth-quartile NDI (lowest deprivation; HR, 1.34; 95% CI, 1.11-1.62). CONCLUSIONS: Patients' insurance and zip code at study entry play roles in adherence to ET, with uninsured and underinsured patients having a high rate of treatment nonadherence. Early identification of patients at risk may improve adherence to therapy. LAY SUMMARY: In this retrospective analysis of 9475 women with breast cancer participating in a clinical trial (Trial Assigning Individualized Options for Treatment), Medicaid and self-pay patients (compared with those with private insurance) and those in the highest quartile of neighborhood deprivation scores (compared with those in the lowest quartile) had a higher probability of early discontinuation of endocrine therapy. These social determinants of health assume larger importance with the expected increase in unemployment rates and loss of insurance coverage in the aftermath of the coronavirus disease 2019 pandemic. Early identification of patients at risk and enrollment in insurance optimization programs may improve the persistence of therapy.


Subject(s)
Antineoplastic Agents, Hormonal/therapeutic use , Breast Neoplasms/drug therapy , Insurance Coverage/classification , Insurance Coverage/statistics & numerical data , Treatment Adherence and Compliance/statistics & numerical data , Aged , Female , Humans , Kaplan-Meier Estimate , Middle Aged , Prospective Studies , Randomized Controlled Trials as Topic , Residence Characteristics , Retrospective Studies , United States
9.
PLoS One ; 15(10): e0240151, 2020.
Article in English | MEDLINE | ID: covidwho-868672

ABSTRACT

As of August 2020, the United States is the global epicenter of the COVID-19 pandemic. Emerging data suggests that "essential" workers, who are disproportionately more likely to be racial/ethnic minorities and immigrants, bear a disproportionate degree of risk. We used publicly available data to build a series of spatial autoregressive models assessing county level associations between COVID-19 mortality and (1) percentage of individuals engaged in farm work, (2) percentage of households without a fluent, adult English-speaker, (3) percentage of uninsured individuals under the age of 65, and (4) percentage of individuals living at or below the federal poverty line. We further adjusted these models for total population, population density, and number of days since the first reported case in a given county. We found that across all counties that had reported a case of COVID-19 as of July 12, 2020 (n = 3024), a higher percentage of farmworkers, a higher percentage of residents living in poverty, higher density, higher population, and a higher percentage of residents over the age of 65 were all independently and significantly associated with a higher number of deaths in a county. In urban counties (n = 115), a higher percentage of farmworkers, higher density, and larger population were all associated with a higher number of deaths, while lower rates of insurance coverage in a county was independently associated with fewer deaths. In non-urban counties (n = 2909), these same patterns held true, with higher percentages of residents living in poverty and senior residents also significantly associated with more deaths. Taken together, our findings suggest that farm workers may face unique risks of contracting and dying from COVID-19, and that these risks are independent of poverty, insurance, or linguistic accessibility of COVID-19 health campaigns.


Subject(s)
Coronavirus Infections/epidemiology , Pneumonia, Viral/epidemiology , Socioeconomic Factors , COVID-19 , Coronavirus Infections/mortality , Demography/statistics & numerical data , Emigrants and Immigrants/statistics & numerical data , Farmers/statistics & numerical data , Humans , Insurance Coverage/statistics & numerical data , Pandemics , Pneumonia, Viral/mortality , United States
10.
Health Aff (Millwood) ; 39(11): 2018-2028, 2020 11.
Article in English | MEDLINE | ID: covidwho-841997

ABSTRACT

The annual Kaiser Family Foundation Employer Health Benefits Survey is the benchmark survey of the cost and coverage of employer-sponsored health benefits in the United States. The 2020 survey was designed and largely fielded before the full extent of the coronavirus disease 2019 (COVID-19) pandemic had been felt by employers. Data collection took place from mid-January through July, with half of the interviews being completed in the first three months of the year. Most of the key metrics that we measure-including premiums and cost sharing-reflect employers' decisions made before the full impacts of the pandemic were felt. We found that in 2020 the average annual premium for single coverage rose 4 percent, to $7,470, and the average annual premium for family coverage also rose 4 percent, to $21,342. Covered workers, on average, contributed 17 percent of the cost for single coverage and 27 percent of the cost for family coverage. Fifty-six percent of firms offered health benefits to at least some of their workers, and 64 percent of workers were covered at their own firm. Many large employers reported having "very broad" provider networks, but many recognized that their largest plan had a narrower network for mental health providers.


Subject(s)
Benchmarking , Coronavirus Infections , Cost Sharing/statistics & numerical data , Health Benefit Plans, Employee , Insurance Coverage/statistics & numerical data , Pandemics , Pneumonia, Viral , COVID-19 , Health Benefit Plans, Employee/organization & administration , Health Benefit Plans, Employee/statistics & numerical data , Humans , Surveys and Questionnaires , United States
11.
Health Aff (Millwood) ; 39(10): 1743-1751, 2020 Oct.
Article in English | MEDLINE | ID: covidwho-814644

ABSTRACT

Expansion of Medicaid and establishment of the Children's Health Insurance Program (CHIP) represent a significant success story in the national effort to guarantee health insurance for children. That success is reflected in the high rates of coverage and health care access achieved for children, including those in low-income families. But significant coverage gaps remain-gaps that have been increasing since 2016 and are likely to accelerate with the coronavirus disease 2019 (COVID-19) pandemic and the associated recession. Using National Health Interview Survey data, we found that the proportion of uninsured children was 5.5 percent in 2018. Children continue to face coverage interruptions, and Latino, adolescent, and noncitizen children continue to face elevated risks of being uninsured. Although we note the benefits of a universal, federally financed, single-payer approach to coverage, we also offer two possible reform pathways that can take place within the current multipayer system, aimed at ensuring coverage, access, continuity, and comprehensiveness to move the nation closer to the goal of providing the health care that children need to reach their full potential and to reduce racial and economic inequalities.


Subject(s)
Child Health Services/economics , Child Health , Children's Health Insurance Program/economics , Healthcare Disparities/economics , Insurance Coverage/statistics & numerical data , Adolescent , COVID-19 , Child , Child, Preschool , Coronavirus Infections/economics , Coronavirus Infections/epidemiology , Female , Humans , Male , Medicaid/statistics & numerical data , Needs Assessment , Pandemics/economics , Pandemics/statistics & numerical data , Pneumonia, Viral/economics , Pneumonia, Viral/epidemiology , Poverty , Socioeconomic Factors , United States
12.
Health Aff (Millwood) ; 39(10): 1752-1761, 2020 Oct.
Article in English | MEDLINE | ID: covidwho-814643

ABSTRACT

Safety-net programs improve health for low-income children over the short and long term. In September 2018 the Trump administration announced its intention to change the guidance on how to identify a potential "public charge," defined as a noncitizen primarily dependent on the government for subsistence. After this change, immigrants' applications for permanent residence could be denied for using a broader range of safety-net programs. We investigated whether the announced public charge rule affected the share of children enrolled in Medicaid, the Supplemental Nutrition Assistance Program, and the Special Supplemental Nutrition Program for Women, Infants, and Children, using county-level data. Results show that a 1-percentage-point increase in a county's noncitizen share was associated with a 0.1-percentage-point reduction in child Medicaid use. Applied nationwide, this implies a decline in coverage of 260,000 children. The public charge rule was adopted in February 2020, just before the coronavirus disease 2019 (COVID-19) pandemic began in the US. These results suggest that the Trump administration's public charge announcement could have led to many thousands of eligible, low-income children failing to receive safety-net support during a severe health and economic crisis.


Subject(s)
Child Health Services/organization & administration , Coronavirus Infections/prevention & control , Food Assistance/statistics & numerical data , Healthcare Disparities/economics , Medicaid/economics , Pandemics/prevention & control , Pneumonia, Viral/prevention & control , Poverty/statistics & numerical data , Adolescent , COVID-19 , Child , Child Health , Child, Preschool , Cohort Studies , Coronavirus Infections/epidemiology , Databases, Factual , Fear , Female , Health Policy/legislation & jurisprudence , Humans , Insurance Coverage/statistics & numerical data , Male , Organizational Innovation , Pandemics/statistics & numerical data , Pneumonia, Viral/epidemiology , Policy Making , Retrospective Studies , Safety-net Providers/organization & administration , United States
15.
Health Aff (Millwood) ; 39(10): 1822-1831, 2020 Oct.
Article in English | MEDLINE | ID: covidwho-695660

ABSTRACT

The recent coronavirus disease 2019 (COVID-19) global pandemic has resulted in unprecedented job losses in the United States, disrupting health insurance coverage for millions of people. Several models have predicted large increases in Medicaid enrollment among those who have lost jobs, yet the number of Americans who have gained coverage since the pandemic began is unknown. We compiled Medicaid enrollment reports covering the period from March 1 through June 1, 2020, for twenty-six states. We found that in these twenty-six states, Medicaid covered more than 1.7 million additional Americans in roughly a three-month period. Relative changes in Medicaid enrollment differed significantly across states, although enrollment growth was not systemically related to job losses. Our results point to the important effects of state policy differences in the response to COVID-19.


Subject(s)
Coronavirus Infections/epidemiology , Eligibility Determination/statistics & numerical data , Employment/statistics & numerical data , Insurance Coverage/statistics & numerical data , Medicaid/statistics & numerical data , Pandemics/statistics & numerical data , Pneumonia, Viral/epidemiology , COVID-19 , Cohort Studies , Coronavirus Infections/prevention & control , Databases, Factual , Eligibility Determination/methods , Employment/economics , Female , Humans , Incidence , Insurance, Health/organization & administration , Male , Medically Uninsured/statistics & numerical data , Needs Assessment , Pandemics/prevention & control , Pneumonia, Viral/prevention & control , Retrospective Studies , Risk Assessment , Time Factors , United States
16.
Int J Health Serv ; 50(4): 408-414, 2020 10.
Article in English | MEDLINE | ID: covidwho-628695

ABSTRACT

Four decades of neoliberal health policies have left the United States with a health care system that prioritizes the profits of large corporate actors, denies needed care to tens of millions, is extraordinarily fragmented and inefficient, and was ill prepared to address the COVID-19 pandemic. The payment system has long rewarded hospitals for providing elective surgical procedures to well-insured patients while penalizing those providing the most essential and urgent services, causing hospital revenues to plummet as elective procedures were cancelled during the pandemic. Before the recession caused by the pandemic, tens of millions of Americans were unable to afford care, compromising their physical and financial health; deep-pocketed corporate interests were increasingly dominating the hospital industry and taking over physicians' practices; and insurers' profits hit record levels. Meanwhile, yawning class-based and racial inequities in care and health outcomes remain and have even widened. Recent data highlight the failure of policy strategies based on market models and the need to shift to a nonprofit social insurance model.


Subject(s)
Coronavirus Infections/epidemiology , Delivery of Health Care/organization & administration , Pneumonia, Viral/epidemiology , Betacoronavirus , COVID-19 , Costs and Cost Analysis , Delivery of Health Care/economics , Health Services Accessibility/organization & administration , Health Status Disparities , Humans , Insurance Coverage/economics , Insurance Coverage/statistics & numerical data , Insurance, Health/economics , Insurance, Health/statistics & numerical data , Medicare/economics , Pandemics , Politics , SARS-CoV-2 , Socioeconomic Factors , United States/epidemiology
17.
Health Aff (Millwood) ; 39(9): 1605-1614, 2020 Sep.
Article in English | MEDLINE | ID: covidwho-615681

ABSTRACT

As a result of the coronavirus disease 2019 (COVID-19) pandemic, virtually all in-person outpatient visits were canceled in many parts of the country between March and May 2020. We sought to estimate the potential impact of COVID-19 on the operating expenses and revenues of primary care practices. Using a microsimulation model incorporating national data on primary care use, staffing, expenditures, and reimbursements, including telemedicine visits, we estimated that over the course of calendar year 2020, primary care practices would be expected to lose 67,774 in gross revenue per full-time-equivalent physician (the difference between 2020 gross revenue with COVID-19 and the anticipated gross revenue if COVID-19 had not occurred). We further estimated that the cost at a national level to neutralize the revenue losses caused by COVID-19 among primary care practices would be $15.1 billion. This could more than double if COVID-19 telemedicine payment policies are not sustained.


Subject(s)
Coronavirus Infections/epidemiology , Health Expenditures , Insurance Coverage/economics , Pandemics/statistics & numerical data , Pneumonia, Viral/epidemiology , Primary Health Care/economics , COVID-19 , Coronavirus Infections/economics , Coronavirus Infections/prevention & control , Delivery of Health Care/organization & administration , Female , Humans , Insurance Coverage/statistics & numerical data , Male , Models, Economic , Pandemics/economics , Pandemics/prevention & control , Pneumonia, Viral/economics , Pneumonia, Viral/prevention & control , Primary Health Care/statistics & numerical data , United States
18.
Health Aff (Millwood) ; 39(7): 1253-1262, 2020 Jul.
Article in English | MEDLINE | ID: covidwho-327330

ABSTRACT

As the novel coronavirus disease (COVID-19) pandemic spreads throughout the United States, evidence is mounting that racial and ethnic minorities and socioeconomically disadvantaged groups are bearing a disproportionate burden of illness and death. We conducted a retrospective cohort analysis of COVID-19 patients at Sutter Health, a large integrated health system in northern California, to measure potential disparities. We used Sutter's integrated electronic health record to identify adults with suspected and confirmed COVID-19, and we used multivariable logistic regression to assess risk of hospitalization, adjusting for known risk factors, such as race/ethnicity, sex, age, health, and socioeconomic variables. We analyzed 1,052 confirmed cases of COVID-19 from the period January 1-April 8, 2020. Among our findings, we observed that compared with non-Hispanic white patients, non-Hispanic African American patients had 2.7 times the odds of hospitalization, after adjustment for age, sex, comorbidities, and income. We explore possible explanations for this, including societal factors that either result in barriers to timely access to care or create circumstances in which patients view delaying care as the most sensible option. Our study provides real-world evidence of racial and ethnic disparities in the presentation of COVID-19.


Subject(s)
Coronavirus Infections/epidemiology , Healthcare Disparities/economics , Healthcare Disparities/ethnology , Insurance Coverage/statistics & numerical data , Pandemics/statistics & numerical data , Pneumonia, Viral/epidemiology , Poverty/statistics & numerical data , Adult , Age Factors , Aged , COVID-19 , California/epidemiology , Cohort Studies , Coronavirus Infections/prevention & control , Databases, Factual , Female , Humans , Male , Middle Aged , Minority Groups/statistics & numerical data , Pandemics/prevention & control , Pneumonia, Viral/prevention & control , Prevalence , Retrospective Studies , Risk Assessment , Sex Factors , Socioeconomic Factors , Survival Analysis
SELECTION OF CITATIONS
SEARCH DETAIL
...