Subject(s)
Medically Uninsured/statistics & numerical data , Patient Protection and Affordable Care Act/legislation & jurisprudence , Deductibles and Coinsurance , Forecasting , Health Services Accessibility/statistics & numerical data , Health Services Accessibility/trends , Humans , Insurance Coverage/statistics & numerical data , Insurance Coverage/trends , Medicaid/legislation & jurisprudence , Medicaid/statistics & numerical data , Medical Indigency/statistics & numerical data , Medical Indigency/trends , Poverty/statistics & numerical data , Preexisting Condition Coverage/statistics & numerical data , Risk , United StatesABSTRACT
When all of the insurance and health care reforms of the ACA are fully implemented, some public financing needs for behavioral health services will remain. This commentary outlines a number of the residual functions of the public mental health system in an ACA world, and it identifies opportunities for expansions of service areas not covered by traditional insurance or the health delivery reforms for behavioral health services within the scope of the ACA.
Subject(s)
Emigrants and Immigrants/legislation & jurisprudence , Health Services Accessibility/legislation & jurisprudence , Medicaid/legislation & jurisprudence , Medical Indigency/legislation & jurisprudence , Mental Health Services/legislation & jurisprudence , Mentally Ill Persons/legislation & jurisprudence , Patient Protection and Affordable Care Act/economics , Emigrants and Immigrants/classification , Financing, Government , Forensic Psychiatry/economics , Forensic Psychiatry/legislation & jurisprudence , Health Plan Implementation , Health Services Accessibility/economics , Humans , Insurance Coverage/economics , Insurance Coverage/legislation & jurisprudence , Medicaid/economics , Medical Indigency/trends , Medically Uninsured , Mental Disorders/economics , Mental Disorders/prevention & control , Mental Disorders/therapy , Mental Health Services/economics , Needs Assessment , Patient Protection and Affordable Care Act/standards , Prisoners/legislation & jurisprudence , United StatesSubject(s)
Community Networks/economics , Medicaid/economics , Medically Uninsured/statistics & numerical data , Patient Advocacy , Safety-net Providers/economics , Students, Medical/psychology , Community Networks/organization & administration , Financing, Government/trends , Georgia , Humans , Medicaid/legislation & jurisprudence , Medicaid/trends , Medical Indigency/trends , Patient Protection and Affordable Care Act , Politics , Reimbursement Mechanisms , Safety-net Providers/trends , United StatesSubject(s)
Health Care Reform/statistics & numerical data , Health Care Reform/trends , Healthcare Disparities/statistics & numerical data , Healthcare Disparities/trends , Medical Indigency/statistics & numerical data , Medical Indigency/trends , Medically Uninsured/statistics & numerical data , Minority Groups/statistics & numerical data , State Health Plans/statistics & numerical data , State Health Plans/trends , Cross-Sectional Studies , Financing, Government/statistics & numerical data , Financing, Government/trends , Health Services Needs and Demand/statistics & numerical data , Health Services Needs and Demand/trends , Humans , MinnesotaABSTRACT
The University of Iowa Hospitals and Clinics in Iowa City, has developed strategies to identify uninsured patients early in the stay, and help them access ongoing care in the community. Twelve healthcare benefit assistance program social workers educate patients and families about financial options and help them apply for government-sponsored programs. Through a Revolving Fund agreement, the hospital pays the Medicaid rate to post-acute facilities while patients' Social Security Disability is pending and is paid back when the disability coverage is approved. Dedicated social workers help patients who need brand name medications and can't afford them sign up for national pharmaceutical assistance programs.
Subject(s)
Community Health Services/economics , Health Services Accessibility/economics , Hospitals, University/economics , Medical Assistance/economics , Medically Uninsured/statistics & numerical data , Social Work/economics , Community Health Services/standards , Eligibility Determination/economics , Eligibility Determination/standards , Health Services Accessibility/standards , Hospitals, University/trends , Humans , Iowa , Medical Assistance/standards , Medical Indigency/trends , Social Work/methods , Social Work/standards , WorkforceABSTRACT
Almost 72 million working-age Americans--18-64 years old--live with chronic conditions, such as diabetes, asthma or depression. In 2007, almost three in 10, or more than 20 million people with chronic conditions, lived in families with problems paying medical bills--a significant increase from 21 percent in 2003, according to a new national study by the Center for Studying Health System Change (HSC). While problems paying medical bills are especially acute and still rising for uninsured people with chronic conditions (62%), medical-bill problems also are significant and growing among people with private insurance and higher incomes. For the more than 20 million chronically ill adults with medical bill problems in 2007, one in four went without needed medical care, half put off care and more than half went without a prescription medication because of cost concerns.
Subject(s)
Chronic Disease/economics , Cost of Illness , Health Services Accessibility/economics , Medical Indigency/statistics & numerical data , Medically Uninsured/statistics & numerical data , Obesity/economics , Adult , Female , Health Benefit Plans, Employee , Health Services Accessibility/trends , Humans , Insurance Coverage , Male , Managed Care Programs , Medical Indigency/economics , Medical Indigency/trends , Middle Aged , United States , Young AdultABSTRACT
The committee that wrote the 2000 Institute of Medicine report on the health care safety net reconvened in 2006 to reflect on the safety net from the perspective of rising numbers of uninsured and underinsured people, the aftermath of Hurricane Katrina, high immigration levels, and new fiscal and policy pressures on care for vulnerable populations. Safety-net providers now participate in Medicaid managed care but find it difficult to meet growing needs for specialty services, particularly mental health care and affordable prescription drugs. How current state reforms and coverage expansions will affect care for the poor and uninsured is a critical issue.
Subject(s)
Health Policy/trends , Health Services Accessibility/trends , Medical Indigency/statistics & numerical data , Medically Uninsured/statistics & numerical data , State Health Plans/economics , Disasters , Drug Prescriptions/economics , Economics, Medical , Emergency Medical Services/economics , Emergency Medical Services/statistics & numerical data , Emigration and Immigration/trends , Health Services Accessibility/economics , Health Services Needs and Demand/economics , Health Services Needs and Demand/trends , Humans , Managed Care Programs , Medicaid , Medical Indigency/trends , Medically Uninsured/legislation & jurisprudence , Mental Health Services/economics , National Academies of Science, Engineering, and Medicine, U.S., Health and Medicine Division , Specialization , State Health Plans/trends , United States , Vulnerable Populations/statistics & numerical dataSubject(s)
Arabs , Delivery of Health Care , Ethics , Refugees , Concentration Camps , Delivery of Health Care/economics , Delivery of Health Care/ethics , Delivery of Health Care/history , Delivery of Health Care/legislation & jurisprudence , Delivery of Health Care/methods , Delivery of Health Care/trends , History, 20th Century , History, 21st Century , Israel , Medical Indigency/ethnology , Medical Indigency/trends , Middle East , Politics , Refugees/history , Societies, Medical/ethics , Societies, Medical/historySubject(s)
Case Management/organization & administration , Medical Indigency , Medically Uninsured/statistics & numerical data , Counseling , Eligibility Determination , Health Resources , Health Services Accessibility , Humans , Insurance Coverage/statistics & numerical data , Job Description , Medical Indigency/statistics & numerical data , Medical Indigency/trends , Patient Advocacy , Social Support , United StatesABSTRACT
OBJECTIVE: The Colorado Child Health Plan Plus is a non-Medicaid state Child Health Insurance Plan. The objective of this study was to compare early enrolling (EE) children with uninsured children in low-income families (ULI) with respect to 1) sociodemographic factors and previous insurance, 2) health status, and 3) previous health care access and utilization. METHODS: Cross-sectional telephone surveys were conducted during 1999 of 1) randomly selected EE children (n = 711) and 2) ULI children identified by random-dial survey (n = 105). RESULTS: Enrolling children were less likely to be Hispanic (32.7% vs 55.2%); 5.5% of EE versus 27.6% of ULI children had never been insured. Prevalence of chronic conditions was similar (16.2% of EE vs 13.5% of ULI children), but learning/behavioral difficulties (9.7% of EE vs 18.6% of ULI) and fair/poor health (5.4% of EE vs 17.2% of ULI) were higher for uninsured children. In the previous year, 88.2% of EE versus 66.1% of ULI children had a usual source of care. The mean number of preventive visits was similar (1.4 vs 1.2), but the EE group reported a higher mean number of sick visits (2.0 vs 1.1), emergency visits (0.48 vs 0.15), and hospitalizations (0.09 vs 0.02). CONCLUSIONS: In the first 2 years of the program, Child Health Plan Plus is not yet reaching the "hard-to-reach" but, rather, disproportionately high numbers of non-Hispanic children who already have a usual source of care and recent insurance. EE children did not have higher rates of chronic conditions but did demonstrate higher utilization before enrollment, possibly reflecting patterns of enrollment into the program.