Title X-Funded Health Center Staff Members' Perspectives on Barriers to Insurance Use For Confidential Family Planning Services.

CONTEXT: Under the Affordable Care Act (ACA), the number of patients who have health insurance among those receiving family planning and reproductive health services at Title X-funded health centers has grown. However, billing some patients' insurance for services may be difficult because of Title X's extensive confidentiality protections. Little is known about health centers' experiences in addressing these difficulties. METHODS: Eight focus group discussions were conducted with a convenience sample of 54 Title X-funded health center staff members and state program administrators in January and April 2015. Transcripts were examined through thematic analysis. RESULTS: Participants identified five key barriers to centers' ability to bill patients' health insurance. Insurance providers' policyholder communications (e.g., explanations of benefits or patient portal postings) can threaten confidentiality for patients insured as dependents. Patients and providers are sometimes confused about insurance providers' confidentiality protections; centers are hesitant to bill insurance when protections are unclear. Changes in Medicaid family planning waiver coverage in some states have added to this uncertainty. Health centers can encounter significant administrative burdens when billing insurance while trying to protect patients' confidentiality. Finally, patients sometimes hesitate to use their insurance because of financial or other concerns. CONCLUSIONS: Title X-funded health centers face several barriers to their ability to bill patients' health insurance while maintaining confidentiality protections. As a result, they are likely to continue relying on Title X funds to cover services for some insured patients despite the expansion of health insurance under the ACA.

A closed-claim analysis of complaints after paediatric antebrachial fractures.

INTRODUCTION: Antebrachial fractures in children (AFC) are common and account for one third of all paediatric fractures. The Danish Patient Compensation Association (PCA) receives complaints from patients who believe that they have sustained injuries due to potential malpractice or unfortunate circumstances. Case files on AFC from the PCA were assessed to identify causality and factors contributing to complaints and potential malpractice. METHODS: A closed-claim analysis was performed in 138 cases with the diagnosis codes DS52.2 through DS52.6. RESULTS: The most frequent complaints were fracture re-displacement (n = 49) and dissatisfaction with an otherwise correctly treated injury (n = 30). Doctor's delay due to missed primary diagnosis was found to be a median of 63 days. Complaints about surgery were almost equally distributed between K-wire and intramedullary nails, and unequally distributed for conservative treatment between splinting (n = 29) and casting (n = 10). Two thirds of the in-juries were unacknowledged and evaluated as light injuries or no injury. One third of the complaints were acknowledged; the majority of which were both-bone fractures. CONCLUSIONS: Two thirds of all complaints were due to normal fracture sequelae; thus, patient anticipation should be accommodated by thorough patient information. Mid-diaphyseal fractures of the forearm are overrepresented among the acknowledged complaints. Casting seems to be preferred to splinting. However, more awareness of these fractures using routinely performed radiographs at the first visit to the emergency room and at follow-up could avoid complaints as well as doctor's delay. FUNDING: none. 
TRIAL REGISTRATION: not relevant.