Implications of the initial braidwood v. Becerra ruling for colorectal cancer outcomes: a modeling study.

The Affordable Care Act (ACA) eliminated patient cost-sharing for USPSTF recommended services. However, if the US Court of Appeals for the Fifth Circuit fully upheld a US District Court ruling in Braidwood Management v. Becerra, 666 F. Supp. 3d 613 (N.D. Tex 2023), cost-sharing for USPSTF recommendations made after ACA passage would have been reinstated for over 150 million people. The case could still reinstate cost-sharing for colorectal cancer (CRC) screening for ages 45-49 years and for polyp removal during (diagnostic) colonoscopy across all ages. Using the MISCAN-Colon model, we simulated the potential impact on CRC outcomes, assuming early-onset CRC trends, and lower screening participation. An 8-percentage-points decline in screening participation could increase CRC incidence by 5.1%, and CRC mortality by 9.1%, with slightly lower costs due to increased cost-sharing. Larger decreases in screening participation can result in higher costs from increased incidence and delayed diagnoses.

Out-of-pocket medical expenditures, remittances and health outcomes in China.

This study examines the relationship between out-of-pocket medical expenditures, remittances and health outcomes in China using Ordinary Least Squares (OLS) and Propensity Score Matching (PSM) methods. The analysis is based on data from the Global Financial Inclusion database by the World Bank (2021), encompassing a sample of 3,446 individuals. The results indicate that out of-pocket expenditure has a negative impact on health outcomes, while remittance shows a positive association across all age groups, including reproductive and non-reproductive populations. These findings suggest that high out-of-pocket medical costs may hinder access to healthcare services and lead to poorer health outcomes. Conversely, remittance plays a beneficial role in improving health outcomes, highlighting the potential of financial support to positively impact the well-being of individuals.

Cette étude examine la relation entre les dépenses médicales directes, les envois de fonds et les résultats de santé en Chine à l'aide des méthodes des moindres carrés ordinaires (OLS) et de l'appariement des scores de propension (PSM). L'analyse est basée sur les données de la base de données Global Financial Inclusion de la Banque mondiale (2021), portant sur un échantillon de 3 446 personnes. Les résultats indiquent que les dépenses directes ont un impact négatif sur les résultats en matière de santé, tandis que les envois de fonds montrent une association positive dans tous les groupes d'âge, y compris les populations reproductrices et non reproductrices. Ces résultats suggèrent que des frais médicaux élevés peuvent entraver l'accès aux services de santé et conduire à de moins bons résultats en matière de santé. À l'inverse, les envois de fonds jouent un rôle bénéfique dans l'amélioration des résultats en matière de santé, soulignant le potentiel du soutien financier à avoir un impact positif sur le bien-être des individus.

Evaluation of a Quality Measure for Multiple Sclerosis Care: Disease-Modifying Therapy Initiation at the University of North Carolina's Outpatient Neurology Clinic.

BACKGROUND: Multiple sclerosis (MS) is a neurological condition leading to significant disability and challenges to quality of life. To slow progression and reduce relapses, it is critical to rapidly initiate disease-modifying therapy (DMT) after diagnosis. Patient demographics may play a role in timely DMT initiation. Financial barriers may also result in delays in DMT access. METHODS: This retrospective, single-center, cross-sectional study included patients seen at a neurology clinic at a large academic medical center for an initial evaluation of MS between January 1, 2022, and June 30, 2022. As an indicator of the quality of care, the primary study outcome was whether patients were offered DMT initiation on their first clinic visit. Secondary outcomes evaluated the time to DMT initiation, including differences in care based on demographic factors and financial coverage. RESULTS: Of the 49 eligible individuals studied, 45 (91.8%) were offered DMT at their initial MS visit. Descriptive statistics appeared to demonstrate that demographic factors did not impact whether DMT was offered. However, the majority of patients experienced access barriers relating to prior authorization requirements (80.0%) and/or the need for co-pay assistance (52.0%). CONCLUSIONS: DMT was appropriately offered to a majority of patients at their initial MS visit, regardless of demographic considerations. No offer of DMT and delays in initiation were primarily due to the need for imaging and specialty referrals, as well as financial barriers. Medication assistance teams may play a crucial role in limiting delays and financial hurdles associated with insurance coverage and co-pay assistance.

Economical Impact of Integration of Mental Health Services to Primary Care - A Review.

There are numerous people all across the world who are struggling with mental health (MH) conditions. There is a growing recognition of the significance of MH as a primary cause of disability with substantial effects on daily functioning. The Ministry of Health's financial division oversees money with the Ministry of Finance's approval. Thus, this review explores the economics of integrating MH services in a primary healthcare center (PHC) in Saudi Arabia (SA). The incorporation of MH services into basic medical care is required as it ensures that the general population has access to the necessary MH care and the likelihood of better health outcomes is raised when receiving treatment in PHCs. The majority of funds that are now allocated to the provision of MH care are used to pay the wages of MH professionals and paramedical staff members who are employed in mental hospitals, as well as to invest in the development of infrastructure and education of MH experts. A report found that MH expenditures accounted for 4% of the entire budget for health care. The expenditure for mental hospitals was 22% of the total for MH hospitals. The allocation of funds is integral for the PHCs to perform at their maximum potential in the MH domain. Thus, this review explores the economics of integrating MH services in a PHC in S SA.

Preventative dental practices and cardiometabolic health in adolescents.

OBJECTIVE: The aim of this study was to identify the relationship between preventative dental practices and cardiometabolic health in adolescents. METHODS: Analysis included children aged 13-17 years enrolled in the National Health and Nutrition Examination Survey (NHANES) from 2011-2018 who completed an Oral Health Examination and Questionnaire. Deferred dental care was defined as not having a dental visit in the past year. Financial barriers to seeking dental care (vs. no financial barriers) were assessed among those with deferred dental care in the past year. Primary cardiometabolic outcomes included obesity, elevated blood pressure and hypertensive blood pressure. Secondary outcomes included dyslipidemia, glucose intolerance, uric acid, glomerular hyperfiltration, and albuminuria. Regression models adjusted for age, sex, ethnicity, household income, food insecurity, health insurance status, household education, and body mass index z-score examined associations using complex survey design procedures. RESULTS: Of 2,861 adolescents, 17.6% (SE 0.9%) did not receive dental care in the past year and 20.2% (SE 1.9%) had a financial barrier to accessing dental care. In adjusted regression models, adolescents with deferred dental care had higher odds of dyslipidemia (OR= 1.51, 95% CI 1.07, 2.11 p = 0.020). Having a financial barrier was associated with a lower odd of dyslipidemia (OR=0.35, 95% CI 0.14, 0.89 p = 0.03). Financial barriers were associated with lower non-HDL (b=-7.95, 95% CI -14.87, -1.05 p=0.03) and higher HDL (b=3.06, 95% CI 0.37, 5.75 p=0.03) in adjusted models. Deferred dental care and financial barriers were not associated with any other cardiometabolic parameters. CONCLUSION: In this nationally representative cohort of adolescents, there was an association between lack of preventative dental care and the cardiometabolic health marker of dyslipidemia. However, financial barriers to dental care were surprisingly associated with higher HDL levels and lower odds of dyslipidemia.

Analysis of financial barriers experienced by prospective genetic counseling students.

PURPOSE: High costs of applying to genetic counseling graduate programs (GCGPs) are likely a barrier to workforce diversification. We sought to determine application costs and assess differences between individuals of historically underrepresented racial and ethnic backgrounds in medicine (hURM) and non-hURM applicants. METHODS: Applicants to GCGPs between 2005 to 2020 were surveyed about application history, related expenses, volunteer hours, and financial resources; 383 responses were analyzed. RESULTS: Median total application costs (MTAC) were $2634, $4762, and $5607 (1, 2, and 3 or more application cycles, respectively). Interview-related items (which includes travel) had the highest median cost (1 application cycle: $879). Among those who applied to multiple cycles, hURM respondents had higher MTAC than those of non-hURM ($6713 versus $4762, P = .03) and lower median total volunteer hours (246 versus 381, P = .03). Parental education level differed by hURM status (P = .04). Median financial contribution from parents with and without advanced degrees varied significantly (60% versus 2%, P = .0009). CONCLUSION: Significant costs are incurred during the GCGP application process, but notable differences in costs and resources were observed between hURM and non-hURM applicants. Stakeholders within the profession should implement strategies to reduce financial barriers and the resulting inequities in the application process.

Journey Through Healthcare of People With Complications of Type 2 Diabetes: A Qualitative Study of Lived Experiences.

Background: Despite its overall good performance, the Belgium healthcare system scores less well in providing equal access to healthcare compared to other European countries. This increases the risk of people worse off to receive late diagnosis and to get complications of chronic diseases. Methods: This study aims to achieve a deeper understanding of how people with complications of a chronic disease - diabetes type 2 - experience care in the Belgium health system through semi-structured interviews with extreme case study sampling of people with advanced diabetes, and inductive analysis. Results: The results show that most respondents were diagnosed late in the course of their disease. There are variations in treatment and type of provider. People appreciate the personal and long-lasting contact with a medical doctor, while the contact with and role of paramedical providers was less recognized. Disease management has a significant impact on their financial budget and some respondents experienced barriers to obtain additional financial support. Discussion: Non-medical costs are not reimbursed, presenting a high burden to people. Self-management is tedious and hampered by other worries that people may have, such as financial constraints and coping with important life events. To conclude this study highlighted the need to improve diabetes screening. We suggest to enhance the role of paramedical professionals, integrate a social care worker, reduce financial constraints, and increase health literacy through more patient-centered, goal-oriented care.

Eating Disorder Treatment Access in the United States: Perceived Inequities Among Treatment Seekers.

OBJECTIVE: Although eating disorders are associated with high rates of psychological and physical impairments and mortality, only about 20% of individuals with eating disorders receive treatment. No study has comprehensively assessed treatment access for those with these disorders in the United States. The authors examined access to eating disorder treatments and how it might vary among some populations. METHODS: Seekers of treatment for eating disorders (N=1,995) completed an online assessment of clinical demographic and anthropometric characteristics, barriers to eating disorder treatment access, and eating disorder symptomatology. Analyses were conducted to identify treatment access barriers, compare barriers to treatment access across demographic groups, and investigate relationships between barriers to treatment access and eating disorder symptoms. RESULTS: Financial barriers (e.g., lack of insurance coverage) were the most frequently reported barrier to treatment access. Participants with historically underrepresented identities and with a diagnosis of other specified feeding or eating disorder (OSFED) reported more barriers related to financial challenges, geographic location, eating disorder identification, sociocultural factors, and treatment quality compared with those with historically represented identities (e.g., White and cisgender persons). Higher frequencies of reported barriers to treatment access were associated with more severe eating disorder symptoms and poorer illness trajectories. CONCLUSIONS: Financial barriers were the most significant impediment to accessing treatment among individuals seeking eating disorder treatment. Barriers to treatment access disproportionally affected underrepresented groups and those with an OSFED diagnosis.

Use of in-network insurance benefits is critical for improving retention in telehealth-based buprenorphine treatment.

An empiric evidence base is lacking regarding the relationship between insurance status, payment source, and outcomes among patients with opioid use disorder (OUD) on telehealth platforms. Such information gaps may lead to unintended impacts of policy changes. Following the phase-out of the COVID-19 Public Health Emergency, states were allowed to redetermine Medicaid eligibility and disenroll individuals. Yet, financial barriers remain a common and significant hurdle for patients with OUD and are associated with worse outcomes. We studied 3842 patients entering care in 2022 at Ophelia Health, one of the nation's largest OUD telehealth companies, to assess associations between insurance status and 6-month retention. In multivariable analyses, in-network patients who could use insurance benefits were more likely to be retained compared with cash-pay patients (adjusted risk ratio [aRR]: 1.50; 95% CI: 1.40-1.62; P < .001). Among a subsample of 882 patients for whom more detailed insurance data were available (due to phased-in electronic health record updates), in-network patients were also more likely to be retained at 6 months compared with insured, yet out-of-network patients (aRR: 1.86; 95% CI: 1.54-2.23; P < .001). Findings show that insurance status, and specifically the use of in-network benefits, is associated with superior retention and suggest that Medicaid disenrollment and insurance plan hesitation to engage with telehealth providers may undermine the nation's response to the opioid crisis.

Barriers and delays in access to abortion care: a cross-sectional study of people traveling to obtain care in England and the Netherlands from European countries where abortion is legal on broad grounds.

INTRODUCTION: This study characterized the extent to which (1) financial barriers and (2) abortion care-seeking within a person's country of residence were associated with delays in abortion access among those travelling to England and the Netherlands for abortion care from European countries where abortion is legal on broad grounds in the first trimester but where access past the first trimester is limited to specific circumstances. METHODOLOGY: We drew on cross-sectional survey data collected at five abortion clinics in England and the Netherlands from 2017 to 2019 (n = 164). We assessed the relationship between difficulty paying for the abortion/travel, acute financial insecurity, and in-country care seeking on delays to abortion using multivariable discrete-time hazards models. RESULTS: Participants who reported facing both difficulty paying for the abortion procedure and/or travel and difficulty covering basic living costs in the last month reported longer delays in accessing care than those who had no financial difficulty (adjusted hazard odds ratio: 0.39 95% CI 0.21-0.74). This group delayed paying other expenses (39%) or sold something of value (13%) to fund their abortion, resulting in ~ 60% of those with financial difficulty reporting it took them over a week to raise the funds needed for their abortion. Having contacted or visited an abortion provider in the country of residence was associated with delays in presenting abroad for an abortion. DISCUSSION: These findings point to inequities in access to timely abortion care based on socioeconomic status. Legal time limits on abortion may intersect with individuals' interactions with the health care system to delay care.

This paper explores delays in accessing abortion care associated with financial and medical system barriers. We focus on residents of countries in Europe where abortion is available on broad grounds in the first trimester seeking abortion care outside of their country of residence. This study demonstrates an association between difficulty covering abortion costs for people facing financial insecurity and in-country care seeking and delays in accessing abortion abroad. Policy barriers, medical system barriers, as well as financial barriers may interact to delay access to care for people in European countries with broad grounds for abortion access in the first trimester but restrictions thereafter, especially for people later in pregnancy.

Overcoming financial and social barriers during COVID-19: A medical student-led medical education innovation.

Background: Underrepresented minorities in medicine (URMM) may face financial and social limitations when applying to medical schools. The computer-based assessment for sampling personal characteristics (CASPER) test is used by many medical schools to assess the nonacademic competencies of applicants. Performance on CASPER can be enhanced by coaching and mentorship, which URMMs often lack, for affordability reasons, when applying to medical schools. Methods: The CASPER Preparation Program (CPP) is a free, online, 4-week program to help URMM prepare for the CASPER test. CPP features free medical ethics resources, homework and practice tests, and feedback from tutors. Two of CPPs major objectives include relieving URMM of financial burdens and increasing their accessibility to mentorship during the COVID-19 pandemic. A program evaluation was conducted using anonymous, voluntary postprogram questionnaires to assess CPPs efficacy in achieving the aforementioned objectives. Results: Sixty URMMs completed the survey. The majority of the respondents strongly agreed or agreed that CPP relieves students of financial burden (97%), is beneficial for applicants with low-socioeconomic statuses (98%), provides students with resources they could not afford (n = 55; 92%), and enables access to mentors during the pandemic (90%). Discussion: Pathway coaching programs, such as the CASPER Preparation Program, have the potential to offer URMMs mentorship and financial relief, and increase their confidence and familiarity with standardized admission tests to help them matriculate into medical schools.

Community-based participatory research to improve alumni transition from an intensive research training program for historically underrepresented undergraduates.

Various initiatives for undergraduates from historically underrepresented backgrounds attempt to address disparities in the completion of science, technology, engineering, mathematics (STEM) degrees and the pursuit of careers in scientific research. Intensive research training programs for historically underrepresented undergraduates may include multiple components, such as authentic research experiences, advising and mentoring, supplemental curriculum, and financial assistance. Following comprehensive support during program participation, the post-program transition may present a vulnerable period in students' career trajectories. This study used a community-based participatory research (CBPR) approach to investigate the experiences of students completing an intensive research training program to understand and develop recommendations for the post-program transition process. As a team of program alumni, academic researchers, and program staff, we developed, conducted, and analyzed semi-structured, open-ended interviews of recent program alumni and students approaching program completion (n=11; 55% female, 55% non-White). Applying thematic analysis at semantic and latent levels through a critical paradigm revealed the transition as a bittersweet experience, with feelings of pride and accomplishment mixed with sadness and anxiety. Findings also suggested the transition is described as a narrative influenced by preceding program experiences and adaptations. Financial concerns were prominent, and specific barriers and facilitators of successful transition included: aligned mentoring, negotiation of continued research employment, consideration of culture, planning for next steps, and engagement with the scholar community. Collaboratively, we developed recommendations for program improvements potentially relevant to similarly intensive STEM diversity programs. We also highlight the value of a CBPR approach that includes students equitably as co-researchers in program research and evaluation.

Facing financial barriers to healthcare: patient-informed adaptation of a conceptual framework for adults with a history of cancer.

Background: Cancer-related financial hardship is associated with negative clinical outcomes, which may be partially explained by cost-related delayed or forgone care in response to financial barriers. We sought to understand patient experiences facing financial barriers to medical care following a cancer diagnosis. Methods: We conducted virtual, semi-structured interviews in Fall 2022 with 20 adults with a history of cancer who had experienced cancer-related financial hardship in the prior year. We used template analysis within a pragmatic paradigm, combining constructivist and critical realist theoretical perspectives, to analyze interview transcripts and adapt an existing conceptual framework of financial barriers to care. Results: The majority of interviewees identified as women (70%), non-Hispanic white (60%), and reported an annual household income of <$48,000 (60%). As interviewees sought to overcome financial barriers, they described substantial frustration at the limitations and complexities of United States health and social care systems, resulting in a reliance on a fragmented, uncertain resource landscape. The administrative burden resulting from bureaucratic systems and the advocacy responsibilities required to navigate them ultimately fell on interviewees and their caregivers. Thus, participants described their ability to overcome financial barriers as being influenced by individual and interpersonal factors, such as social support, comfort asking for help, time, prior experience navigating resources, and physical and mental health. However, participants noted health system organizational factors, such as whether all new patients proactively met with a social worker or financial navigator, as having the potential to lessen the administrative and financial burden experienced. Conclusion: We present an adapted conceptual framework outlining multi-level factors influencing patient experiences coping with financial barriers to medical care. In addition to influencing whether a patient ultimately delays or forgoes care due to cost, financial barriers also have the potential to independently affect patient mental, physical, and financial health.

How do conversations on social media help to explain financial barriers to family planning services for Rwandan adolescent girls within the prevailing cultural and legal context?

Purpose: Financial barriers to health services have been identified in African countries. Rwanda has a pro-poor, countrywide insurance scheme that includes a package of family planning services. However, there is lower utilisation by adolescents. This qualitative study explored conversations on social media platforms around financial barriers to family planning in Rwanda, particularly for adolescents. The study's objective was to provide direction to policy revisions to improve access to contraceptives for adolescents. Methods: A search string was used to capture conversations on social media around financing barriers to family planning services for adolescents. Key themes were identified through analysis of the content of these messages. The themes were compared with existing literature on this topic. Results: There is a paucity of direct postings on public sites by adolescents, reflecting social stigma related to teenage sexual activity and lack of inter-generational dialogue on this subject. Key themes identified from the conversations were: prohibitive prices for socially acceptable contraceptives in the private sector, social stigma affecting access to affordable publicly available services and backfiring of well-intentioned laws and policies. Conclusion: The financial barriers to contraceptives by adolescents are compounded by legal frameworks, social and cultural factors and the intersection between them. The 'relationship' between the conversations captured on social media and socio-cultural and legal context is recursive. Careful consideration to both policies and interventions is required to increase access to contraceptives for adolescents.

Evaluation of Access to Care Barriers and Their Effect on General Health Status Among Native Hawaiian and Pacific Islander Adults.

There is a paucity of information on access to care barriers faced by Native Hawaiian and Pacific Islander (NHPI) community. This study utilized the 2014 Native Hawaiian and Pacific Islander National Health Interview Survey (NHPI NHIS) data to evaluate access to care barriers among NHPI population and their effect on general health status. Access to care barriers were categorized as financial barrier (affordability) and non-financial barriers (availability, accommodation, acceptability, and accessibility). Overall, 13.7% reported of the fair/poor general health and over 30% reported at least one access to care barrier. Logistic regression model was used to evaluate how financial and non-financial barriers affect general health status, adjusting for socio-demographic variables such as age, poverty threshold, and marital status and health-related variables such as smoking status and chronic health conditions. Those who reported financial barrier (21.2%) were more likely to be in fair/poor general health (odds ratio 2.25, 95% confidence interval 1.43-3.56). Non-financial barrier, reported by 20.0% of the study population, was found to be not associated with general health status after adjusting for socio-demographic and health-related variables. Improving access to care among NHPI community could be achieved by identifying and addressing the barriers, which in turn could lead to improvement in the general health status among NHPI community.

Addressing Financial Barriers to Health Care Among People Who are Low-Income and Insured in New York City, 2014-2017.

While health care-associated financial burdens among uninsured individuals are well described, few studies have systematically characterized the array of financial and logistical complications faced by insured individuals with low household incomes. In this mixed methods paper, we conducted 6 focus groups with a total of 55 residents and analyzed programmatic administrative records to characterize the specific financial and logistic barriers faced by residents living in public housing in East and Central Harlem, New York City (NYC). Participants included individuals who enrolled in a municipal community health worker (CHW) program designed to close equity gaps in health and social outcomes. Dedicated health advocates (HAs) were explicitly paired with CHWs to provide health insurance and health care navigational assistance. We describe the needs of 150 residents with reported financial barriers to care, as well as the navigational and advocacy strategies taken by HAs to address them. Finally, we outline state-level policy recommendations to help ameliorate the problems experienced by participants. The model of paired CHW-HAs may be helpful in addressing financial barriers for insured populations with low household income and reducing health disparities in other communities.

Changes in Barriers That Cause Unmet Healthcare Needs in the Life Cycle of Adulthood and Their Policy Implications: A Need-Selection Model Analysis of the Korea Health Panel Survey Data.

Using 68,930 observations selected from 16,535 adults in the Korea Health Panel Survey (2014-2018), this study explored healthcare barriers that prevent people from meeting their healthcare needs most severely during adulthood, and the characteristics that are highly associated with the barrier. This study derived two outcome variables: a dichotomous outcome variable on whether an individual has experienced healthcare needs, and a quadchotomous outcome variable on how an individual's healthcare needs ended. An analysis was conducted using a multivariable panel multinomial probit model with sample selection. The results showed that the main cause of unmet healthcare needs was not financial difficulties but non-financial barriers, which were time constraints up to a certain age and the lack of caring and support after that age. People with functional limitations were at a high risk of experiencing unmet healthcare needs due to a lack of caring and support. To reduce unmet healthcare needs in South Korea, the government should focus on lowering non-financial barriers to healthcare, including time constraints and lack of caring and support. It seems urgent to strengthen the foundation of "primary care", which is exceptionally scarce now, and to expand it to "community-based integrated care" and "people-centered care".

Identifying health care access barriers in southern rural Ecuador.

BACKGROUND: Access to professional health care providers in Loja Province, Ecuador can be difficult for many citizens. The Health Care Access Barrier Model (HCAB) was established to provide a framework for classification, analysis, and reporting of modifiable health care access barriers. This study uses the HCAB Model to identify barriers and themes impacting access to health care access in southern rural Ecuador. METHODS: The research team interviewed 22 participants and completed 15 participant observation studies in the study area. Interviews and a single focus group session of artisans were recorded and transcribed from Spanish to English, and thematic analysis was performed. RESULTS: The thematic analysis found financial, structural, and cognitive health care access barriers. Cost of medications, transportation, missed responsibilities at work and home, difficulty scheduling appointments, and misconceptions in health literacy were the predominant themes contributing to health care access. These pressure points provide insight on where actions may be taken to alleviate access barriers. CONCLUSION: Modifiable health care access barriers outlined in the HCAB are evident in the study area. Further research and implementation of programs to resolve these barriers, such as the creation of health care subcenters and/or mobile clinic, insurance coverage of specialized care, increasing availability and accessibility to affordable transportation, improving roadways, introduction of a 24/7 call center to schedule medical visits, monetary incentive for primary care physicians to practice in rural and underserved areas, provision of affordable work equipment, and emphasizing the improvement of health care literacy through education, may diminish current barriers, identify additional barriers, and improve overall health in the rural area of Loja, Ecuador and similar rural regions around the world.