Measles resurgence in southern Africa: challenges to measles elimination.

INTRODUCTION: In seven southern African countries (Botswana, Lesotho, Malawi, Namibia, South Africa, Swaziland and Zimbabwe), following implementation of a measles mortality reduction strategy starting in 1996, the number of annually reported measles cases decreased sharply to less than one per million population during 2006-2008. However, during 2009-2010, large outbreaks occurred in these countries. In 2011, a goal for measles elimination by 2020 was set in the World Health Organization (WHO) African Region (AFR). We reviewed the implementation of the measles control strategy and measles epidemiology during the resurgence in the seven southern African countries. METHODS: Estimated coverage with routine measles vaccination, supplemental immunization activities (SIA), annually reported measles cases by country, and measles surveillance and laboratory data were analyzed using descriptive analysis. RESULTS: In the seven countries, coverage with the routine first dose of measles-containing vaccine (MCV1) decreased from 80% to 65% during 1996-2004, then increased to 84% in 2011; during 1996-2011, 79,696,523 people were reached with measles vaccination during 45 SIAs. Annually reported measles cases decreased from 61,160 cases to 60 cases and measles incidence decreased to <1 case per million during 1996-2008. During 2009-2010, large outbreaks that included cases among older children and adults were reported in all seven countries, starting in South Africa and Namibia in mid-2009 and in the other five countries by early 2010. The measles virus genotype detected was predominantly genotype B3. CONCLUSION: The measles resurgence highlighted challenges to achieving measles elimination in AFR by 2020. To achieve this goal, high two-dose measles vaccine coverage by strengthening routine immunization systems and conducting timely SIAs targeting expanded age groups, potentially including young adults, and maintaining outbreak preparedness to rapidly respond to outbreaks will be needed.

Mortality amenable to health care in the United States: the roles of demographics and health systems performance.

This article examines associations of socio-demographic and health-care indicators, and the statistic 'mortality amenable to health care' (amenable mortality) across the US states. There is over two-fold variation in amenable mortality, strongly associated with the percentages of state populations that are poor or black. Controlling for poverty and race with bi- and multi-variate analyses, several indicators of health system performance, such as hospital readmission rates and preventive care for diabetics, are significantly associated with amenable mortality. A significant crude association of 'uninsurance' and amenable mortality rates is no longer statistically significant when poverty and race are controlled. Overall, there appear to be opportunities for states to focus on specific modifiable health system performance indicators. Comparative rates of amenable mortality should be useful for estimating potential gains in population health from delivering more timely and effective care and for tracking the health outcomes of efforts to improve health system performance.

Young adults and the Affordable Care Act of 2010.

The Patient Protection and Affordable Care Act includes several provisions that promise to stem the rapidly rising tide of uninsured young adults, one of the largest uninsured segments of the population. These include the ability to enroll in a parent's health plan up to age 26, beginning in September 2010; significant expansion in eligibility for Medicaid, beginning in 2014; and the creation of health insurance exchanges with subsidized private insurance for people with low and moderate incomes, also beginning in 2014. Of the 14.8 million uninsured young adults, up to 12.1 million may gain subsidized insurance once all the law's provisions go into effect in 2014: 7.2 million may gain coverage under Medicaid and 4.9 million may gain subsidized private coverage through the insurance exchanges. In addition, about 1 million uninsured young adults are expected to join their parents' policies over the next three years.

Small businesses and the Affordable Care Act of 2010.

The Patient Protection and Affordable Care Act (ACA) includes several short- and long-term provisions designed to help small businesses pay for and maintain health insurance for their workers, and to allow workers without employer coverage to gain access to affordable, comprehensive health insurance. Provisions include a small business tax credit to offset premium costs for firms that offer coverage starting this taxable year, establishment of state-based insurance exchanges that promise to lower administrative costs and pool risk more broadly, and creation of new market rules and an essential benefit standard to protect small firms and their workers. Analysis shows that up to 16.6 million workers are in firms that would be eligible for the tax credit in 2010 to 2013. Over the next 10 years, small businesses and organizations could receive an estimated $40 billion in federal support through the premium credit program.

Rite of passage: young adults and the Affordable Care Act of 2010.

Young adults between the ages of 19 and 29 represent one of the largest segments of the uninsured; approximately 13.7 million were uninsured in 2008. The problem is linked to critical transition points in young adults' lives: aging off parents' coverage when they graduate from either high school or college, and losing eligibility for public programs like Medicaid and the Children's Health Insurance Program when they turn 19. Health reform, however, has the potential to cover millions of uninsured young people. This issue brief describes critical provisions in the new law that will help, including the ability to enroll in a parent's health plan up to age 26 beginning in September 2010; significant expansion in eligibility for Medicaid, beginning in 2014; and the creation of state or regional health insurance exchanges with subsidized private insurance for people with low and moderate incomes, also beginning in 2014.

Out of options: why so many workers in small businesses lack affordable health insurance, and how health care reform can help. Findings from the Commonwealth Fund Biennial Health Insurance Survey, 2007.

Although employer-sponsored health insurance forms the backbone of the health insurance system in the United States, small businesses are finding it increasingly difficult to provide their workers with comprehensive coverage. In 2007, only 25 percent of employees in small businesses had coverage through their own employers, compared with 74 percent of workers in large firms. Because there are few sources of affordable coverage outside the employer-based system, millions of employees in small businesses are uninsured or have inadequate health insurance. In 2007, 52 percent of workers in small businesses were uninsured or underinsured during the year, compared with half as many employees in large businesses. Congressional bills to reform the health system include provisions specifically aimed at helping small businesses and their employees gain access to affordable, comprehensive coverage.

Rite of passage? Why young adults become uninsured and how new policies can help, 2009 update.

Young adults ages 19 to 29 are one of the largest segments of the U.S. population without health insurance: 13.2 million, or 29 percent, lacked coverage in 2007. They often lose coverage at age 19 or upon high school or college graduation: nearly two of five (38%) high school graduates who do not enroll in college and one-third of college graduates are uninsured for a time during the first year after graduation. Twenty-six states have passed laws to expand coverage of dependents to young adults under parents' insurance policies. Congressional proposals to reform the health system could help uninsured young adults gain coverage and prevent others from losing it. This is the seventh edition of Rite of Passage, first published by The Commonwealth Fund in 2003.

Failure to protect: why the individual insurance market is not a viable option for most U.S. families: findings from the Commonwealth Fund Biennial Health Insurance Survey, 2007.

Between 2001 and 2007, an increasing share of adults with private insurance--whether employer-based coverage or individual market plans--spent a large amount of their income on premiums and out-of-pocket medical costs, were underinsured, and/or avoided needed health care because of costs. Those with coverage obtained in the individual market were the most affected. Over the last three years, nearly three-quarters of people who tried to buy coverage in this market never actually purchased a plan, either because they could not find one that fit their needs or that they could afford, or because they were turned down due to a preexisting condition. Even people enrolled in employer-based plans are spending larger amounts of their income on health care and curtailing their use of needed services to save money. The findings underscore the need for an expansion of affordable health insurance options, particularly during a time of mounting job losses.

Young, uninsured, and seeking change: health coverage of young adults and their views on health reform. Findings from the Commonwealth fund Survey of Young Adults (2009).

Young adults are one of the largest uninsured segments of the population. This analysis of new survey data from The Commonwealth Fund finds almost half are without insurance at some time during the year. As they hit milestones like high school or college graduation, they face loss of coverage as they are dropped from parents' plans or public insurance programs. In the current economic climate, young adults are less likely to find jobs, and when they do, are frequently offered positions that come without benefits. Provisions in the health reform bills could help young adults by expanding Medicaid eligibility, creating a health insurance exchange with premium subsidies, and requiring insurers and employers to allow young adults to remain on parents' plans up to age 26 or 27. These provisions could help young adults obtain and keep affordable, comprehensive coverage through transitions from school to work and from job to job.