Assuntos
Cuidadores/economia , Cuidadores/legislação & jurisprudência , Financiamento Pessoal/economia , Financiamento Pessoal/legislação & jurisprudência , Instituição de Longa Permanência para Idosos/economia , Instituição de Longa Permanência para Idosos/legislação & jurisprudência , Responsabilidade Legal , Indigência Médica/economia , Indigência Médica/legislação & jurisprudência , Programas Nacionais de Saúde/economia , Programas Nacionais de Saúde/legislação & jurisprudência , Casas de Saúde/economia , Casas de Saúde/legislação & jurisprudência , Idoso , Alemanha , HumanosRESUMO
Tampa General Hospital has created a fund that case managers can use to pay for post-discharge services for unfunded patients when there is no other option. Case managers can use the fund to pay for home health services, a short stay in a skilled nursing facility, or other post-discharge services to free beds for other patients. Case managers and social workers huddle with the treatment team every day and identify challenging patients early in the stay. The case management and social work team tries to identify family or other community support that can help care for undocumented patients after discharge.
Assuntos
Administração de Caso , Apoio Financeiro , Indigência Médica/economia , Florida , Hospitais Gerais , Estudos de Casos OrganizacionaisAssuntos
Custos de Medicamentos/legislação & jurisprudência , Indústria Farmacêutica/legislação & jurisprudência , Farmacoeconomia/legislação & jurisprudência , Produção de Droga sem Interesse Comercial/legislação & jurisprudência , Honorários por Prescrição de Medicamentos/legislação & jurisprudência , Indústria Farmacêutica/economia , Definição da Elegibilidade/legislação & jurisprudência , Financiamento Governamental/legislação & jurisprudência , Humanos , Indigência Médica/economia , Indigência Médica/legislação & jurisprudência , Uso Off-Label/economia , Uso Off-Label/legislação & jurisprudência , Produção de Droga sem Interesse Comercial/economia , Patient Protection and Affordable Care Act , Estados UnidosRESUMO
OBJECTIVES/HYPOTHESIS: This study was designed to describe the implementation, utilization, and outcomes of an otolaryngology clinic for indigent patients employing a novel design. STUDY DESIGN: Pilot study. METHODS: A tertiary-care academic otolaryngology department partnered with a nonprofit outpatient clinic for indigent patients in order to provide free subspecialty consultation services. A novel format was utilized in which the department provided on-site, scheduled outpatient multidisciplinary consultation on weekends, staffed by volunteer health care providers and ancillary staff. A review of the program was conducted using prospectively collected data. Clinic design, staffing, utilization, and feasibility were described, along with demographic and clinical data for all patients participating in the clinic from October 2010 through January 2012. RESULTS: Five clinics were held over 15 months, totaling 74 patient visits, with positive feedback regarding accessibility and quality of services provided. A total of 60 procedures were performed, including audiograms, endoscopies, otologic procedures, biopsies and/or excisions. The estimated value of medical services that were provided was $37,302. Four potentially life-threatening conditions were newly diagnosed. Twenty patients received conclusive evaluation and treatment at the time of their first visit. Eighteen patients required further subspecialty treatment and/or surgery that could not be provided in the outpatient setting, and were referred appropriately. CONCLUSIONS: The partnership between an academic otolaryngology department and a nonprofit clinic provided free on-site consultation for indigent patients. Such an arrangement is feasible, well utilized, and successful in delivering comprehensive specialized services to indigent patients who lack traditional access to medical care.
Assuntos
Instituições de Assistência Ambulatorial/organização & administração , Implementação de Plano de Saúde/organização & administração , Acessibilidade aos Serviços de Saúde/organização & administração , Indigência Médica/estatística & dados numéricos , Otorrinolaringopatias/terapia , Centros Médicos Acadêmicos , Adolescente , Adulto , Idoso , Estudos de Viabilidade , Feminino , Humanos , Masculino , Indigência Médica/economia , Michigan , Pessoa de Meia-Idade , Organizações sem Fins Lucrativos/organização & administração , Otolaringologia/organização & administração , Otorrinolaringopatias/diagnóstico , Projetos Piloto , Pobreza , Desenvolvimento de Programas , Avaliação de Programas e Projetos de Saúde , Medição de Risco , Resultado do Tratamento , Adulto JovemRESUMO
BACKGROUND: An equitable health care system that responds to the needs of its people is important to break the cycle of poverty and ill-health. However, rising health care cost, and the preponderance of user fees to finance health care have often limited access to needed health services. STUDY DESIGN: A cross-sectional descriptive study design was employed, using a pretested, semi-structured, interviewer-administered questionnaire. RESULTS: The study was carried out among 188 respondents. Majority (88.2%) of the respondents were within the age-group 20-49 years, about two-thirds 63.8% were married and about half (42.8%) had family size between 5 and 9. The study revealed that about a quarter (26.1%) experienced hardship in settling their medical bills. While one-third (31.1%) had to sell their assets, about half (45.2%) had to secure loan while 16.6% had to resort to begging because of hardship encountered in settling the medical bills. Furthermore, of those who sold theirs asset; 46.2% sold their farmlands, 38.5% sold a piece of land, while 16.3% sold their vehicles. CONCLUSION: This study has revealed that inhabitants of Samaru community experience hardship in settling their medical bills. Consequently, innovative strategies like deferment of payment and fee exemption, enrolling into community-based health insurance schemes as well as voluntary contributory health insurance schemes etc need to be considered, in order to alleviate the hardship in settling the medical bills.
Assuntos
Financiamento Pessoal/economia , Gastos em Saúde , Indigência Médica/economia , Adulto , Estudos Transversais , Pesquisas sobre Atenção à Saúde , Humanos , Pessoa de Meia-Idade , Nigéria , Pobreza , Fatores Socioeconômicos , População Urbana , Adulto JovemRESUMO
BACKGROUND: This study examines health-related "hardship financing" in order to get better insights on how poor households finance their out-of-pocket healthcare costs. We define hardship financing as having to borrow money with interest or to sell assets to pay out-of-pocket healthcare costs. METHODS: Using survey data of 5,383 low-income households in Orissa, one of the poorest states of India, we investigate factors influencing the risk of hardship financing with the use of a logistic regression. RESULTS: Overall, about 25% of the households (that had any healthcare cost) reported hardship financing during the year preceding the survey. Among households that experienced a hospitalization, this percentage was nearly 40%, but even among households with outpatient or maternity-related care around 25% experienced hardship financing.Hardship financing is explained not merely by the wealth of the household (measured by assets) or how much is spent out-of-pocket on healthcare costs, but also by when the payment occurs, its frequency and its duration (e.g. more severe in cases of chronic illnesses). The location where a household resides remains a major predictor of the likelihood to have hardship financing despite all other household features included in the model. CONCLUSIONS: Rural poor households are subjected to considerable and protracted financial hardship due to the indirect and longer-term deleterious effects of how they cope with out-of-pocket healthcare costs. The social network that households can access influences exposure to hardship financing. Our findings point to the need to develop a policy solution that would limit that exposure both in quantum and in time. We therefore conclude that policy interventions aiming to ensure health-related financial protection would have to demonstrate that they have reduced the frequency and the volume of hardship financing.
Assuntos
Gastos em Saúde , Acessibilidade aos Serviços de Saúde/economia , Indigência Médica/economia , Saúde da População Rural/economia , Análise de Variância , Características da Família , Financiamento Pessoal/economia , Financiamento Pessoal/métodos , Pesquisas sobre Atenção à Saúde , Acessibilidade aos Serviços de Saúde/estatística & dados numéricos , Humanos , Índia , Modelos Logísticos , Indigência Médica/estatística & dados numéricos , Áreas de Pobreza , Características de Residência , Saúde da População Rural/estatística & dados numéricosAssuntos
Hospitais Filantrópicos/economia , Indigência Médica/legislação & jurisprudência , Isenção Fiscal/legislação & jurisprudência , Fiscalização e Controle de Instalações , Administração Financeira de Hospitais/economia , Hospitais Filantrópicos/legislação & jurisprudência , Humanos , Notificação de Abuso , Indigência Médica/economia , Patient Protection and Affordable Care Act , Estados UnidosRESUMO
Annual costs paid by families for intravenous infusion of home parenteral nutrition (HPN) health insurance premiums, deductibles, co-payments for health services, and the wide range of out-of-pocket home health care expenses are significant. The costs of managing complex chronic care at home cannot be completely understood until all out-of-pocket costs have been defined, described, and tabulated. Non-reimbursed and out-of-pocket costs paid by families over years for complex chronic care negatively impact the financial stability of families. National health care reform must take into account the long-term financial burdens of families caring for those with complex home care. Any changes that may increase the out-of-pocket costs or health insurance costs to these families can also have a negative long-term impact on society when greater numbers of patients declare bankruptcy or qualify for medical disability.
Assuntos
Dedutíveis e Cosseguros/economia , Financiamento Pessoal/economia , Renda/estatística & dados numéricos , Nutrição Parenteral no Domicílio/economia , Falência da Empresa/economia , Doença Crônica , Efeitos Psicossociais da Doença , Doença de Crohn/economia , Doença de Crohn/psicologia , Doença de Crohn/terapia , Família/psicologia , Feminino , Reforma dos Serviços de Saúde/economia , Pesquisas sobre Atenção à Saúde , Humanos , Assistência de Longa Duração/economia , Masculino , Indigência Médica/economia , Pessoa de Meia-Idade , Pesquisa em Administração de Enfermagem , Nutrição Parenteral no Domicílio/psicologia , Qualidade de Vida/psicologia , Fatores SocioeconômicosRESUMO
OBJECTIVE: To gather pilot data on the economic impact of terminal illness on families and on the feasibility of training caregivers as a method of stemming illness-related poverty. DESIGN: Exploratory, descriptive study involving semistructured interviews with patient and caregiver dyads. SETTING: Pallium India Palliative Care Clinic in Trivandrum, Kerala, India. PARTICIPANTS: Eleven patient-caregiver dyads (22 individual participants) visiting Pallium India in 2008. METHODS: Trained interviewers conducted face-to-face interviews consisting of 114 questions with the patient and caregiver separately. Questions covered topics of economic impact of illness on household, family, and individual. Questions included if the illness had so impacted families that they needed to sell assets or significantly reduce work and/or schooling. RESULTS: All families reported that patients were obliged to give up work as a result of illness. In seven families, the caregiver also had to change work habits. All respondents stated illness had forced them to sell assets. Ten households reported that their children were obliged to miss school due to the illness. All respondents indicated they would use trained caregivers to help with the care burden if available. Nine respondents thought that use of trained caregivers would have reduced or prevented some of the household's illness-related change. Nine caregivers said they would be interested in becoming a trained caregiver. CONCLUSION: These data indicate that a definitive study would be feasible and would reveal how much assistance caregiver training could lend to household socio-economic resilience.
Assuntos
Atitude Frente a Saúde , Cuidadores , Efeitos Psicossociais da Doença , Família , Pobreza , Assistência Terminal , Absenteísmo , Adulto , Cuidadores/educação , Cuidadores/psicologia , Emprego/economia , Emprego/psicologia , Família/psicologia , Características da Família , Estudos de Viabilidade , Feminino , Humanos , Renda/estatística & dados numéricos , Índia , Masculino , Indigência Médica/economia , Indigência Médica/psicologia , Pessoa de Meia-Idade , Projetos Piloto , Pobreza/economia , Pobreza/prevenção & controle , Inquéritos e Questionários , Assistência Terminal/economia , Assistência Terminal/psicologiaAssuntos
Assistência Médica/organização & administração , Pessoas sem Cobertura de Seguro de Saúde , Reforma dos Serviços de Saúde/economia , Acessibilidade aos Serviços de Saúde/economia , Humanos , Indigência Médica/economia , Medicamentos sob Prescrição/economia , Medicamentos sob Prescrição/provisão & distribuição , Estados UnidosRESUMO
Steps that Grady Health System in Atlanta undertook in transforming its revenue cycle include: Conducting a complete revenue cycle assessment. Enhancing staff skill levels and customer service techniques--and holding staff. accountable for errors. Automating processes that previously were performed manually. Validating applications for financial assistance electronically. Screening for Medicare/Medicaid eligibility among self-pays.
Assuntos
Economia Hospitalar/organização & administração , Eficiência Organizacional/economia , Indigência Médica/economia , Automação , Georgia , Estudos de Casos OrganizacionaisRESUMO
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.
Assuntos
Doença Crônica/economia , Efeitos Psicossociais da Doença , Acessibilidade aos Serviços de Saúde/economia , Indigência Médica/estatística & dados numéricos , Pessoas sem Cobertura de Seguro de Saúde/estatística & dados numéricos , Obesidade/economia , Adulto , Feminino , Planos de Assistência de Saúde para Empregados , Acessibilidade aos Serviços de Saúde/tendências , Humanos , Cobertura do Seguro , Masculino , Programas de Assistência Gerenciada , Indigência Médica/economia , Indigência Médica/tendências , Pessoa de Meia-Idade , Estados Unidos , Adulto JovemRESUMO
Antidepressant uses have been rising rapidly over the past decades. Two main theories have been advanced to explain this. One claims that socio-economic change causes a global rise of depressive illness. The other holds that European and North American corporations are aggressively marketing antidepressants to expand their global reach. Both theories assume that multinational capitalism drives rising depression rates. Based on ethnographic data from India, this article shows that antidepressants are increasingly used in this country as well, but for reasons than have been little explored yet. Taking fluoxetine (Prozac) as the main example, it is argued that the spread of antidepressants in India is ;unlicensed' by Euro-American corporations in at least three ways: (i) drug marketing is driven by Indian generic producers; (ii) fluoxetine is given by practitioners who have no license to do so; and (iii) knowledge of fluoxetine is spread through unlicensed ;floating' prescriptions that patients take from one prescriber to another.
Assuntos
Antidepressivos/uso terapêutico , Capitalismo , Competência Clínica , Transtorno Depressivo/tratamento farmacológico , Países em Desenvolvimento , Aprovação de Drogas , Indústria Farmacêutica , Medicamentos Genéricos/uso terapêutico , Licenciamento , Medicamentos sob Prescrição/uso terapêutico , Marketing Social , Antidepressivos/economia , Antidepressivos/provisão & distribuição , Encéfalo/efeitos dos fármacos , Estudos Transversais , Transtorno Depressivo/economia , Transtorno Depressivo/epidemiologia , Transtorno Depressivo/etnologia , Medicamentos Genéricos/economia , Medicamentos Genéricos/provisão & distribuição , Ética Médica , Fluoxetina/economia , Fluoxetina/provisão & distribuição , Fluoxetina/uso terapêutico , Humanos , Índia , Indigência Médica/economia , Indigência Médica/etnologia , Medicamentos sob Prescrição/economia , Medicamentos sob Prescrição/provisão & distribuição , Mudança Social , Justiça Social , Marketing Social/éticaRESUMO
BACKGROUND CONTEXT: Access to care for poor/near poor patients is a concerning and growing problem within the American system of medical care. PURPOSE: The objective of this study was to examine the relationship between health insurance status and access to spine care among patients below 65 years of age eventually receiving treatment at our tertiary academic medical center. STUDY DESIGN: Descriptive study based on chart review and telephone interviews. PATIENT SAMPLE: Two groups of 64 patients each with surgical pathology of limited complexity and limited comorbidities, one with Medicaid insurance and one with private, commercial insurance. OUTCOME MEASURES: Reasons for referral, travel distance, travel time, frequency of visits, and proximity of fellowship-trained spinal surgeons. METHODS: Two groups, each with 64 consecutive spine surgical patients, were studied and compared. Group One had "Medicaid" coverage and Group Two was privately insured. All patients (both groups) were treated surgically for similar pathology of limited complexity and had limited comorbidities. They were assessed to determine the difficulties they encountered in receiving care before referral to our medical center including factors such as referral by a local provider based on insurance status alone and travel time/distance/frequency to eventually receive care at our center. The availability of local care for these patients (fellowship-trained spine surgeons in their local area) was also assessed. RESULTS: The great majority (78%) of poor/near poor patients with Medicaid coverage from counties at some distance from (and local to) our center were referred/deferred on the basis of insurance status alone given surgical problems which could have comfortably been addressed by orthopedic surgeons, neurosurgeons, or fellowship-trained spine surgeons local to the patient. This difficulty in access to care results in a significant burden (measured in time/travel/costs) for these patients. CONCLUSIONS: The poor/near poor with Medicaid insurance have less access to local spine care than those with private, commercial health insurance. The implications (from both surgeon and patient perspectives) of this dilemma are discussed.
Assuntos
Acessibilidade aos Serviços de Saúde/economia , Indigência Médica/economia , Pessoas sem Cobertura de Seguro de Saúde , Encaminhamento e Consulta/economia , Doenças da Coluna Vertebral/cirurgia , Humanos , Seguro Saúde , Medicaid , Pobreza , Padrões de Prática Médica/economia , Estados UnidosRESUMO
We conduct an evaluation of MedShare, a program designed to enhance access to prescription drugs for indigent patients in the Greater Cincinnati area. The program expands access to drugs by providing subsidies to reduce the costs paid by patients for their prescriptions. The assumption is that by expanding access to prescription drugs, participant health outcomes as measured by quality of life improve. Although the program appears outwardly successful, we found little difference between program participants and comparison groups. We feel that these findings point to a major flaw with existing health policy: access alone is not sufficient to improve health outcomes. Too often programs are created and, provided they show outwards signs of success (e.g., enrollment and utilization), are assumed to be improving the health of the community. Our findings indicate that one must look beyond just expanding access to ensure that programs are indeed achieving their overall objectives.
Assuntos
Política de Saúde , Acessibilidade aos Serviços de Saúde , Necessidades e Demandas de Serviços de Saúde/economia , Seguro de Serviços Farmacêuticos/economia , Indigência Médica/economia , Medicamentos sob Prescrição/economia , Desenvolvimento de Programas , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Ohio , Cooperação do Paciente , Projetos Piloto , Testes Psicológicos , Psicometria , Qualidade de Vida/psicologia , Apoio Social , Estados Unidos , Adulto JovemRESUMO
The Deficit Reduction Act of 2005 makes changes in the Medicaid program that may have a significant effect on children's health. Nurses and other health care professionals should be aware of these changes in order to monitor the impact of the legislation, guide families in the process of accessing needed services, and advocating on behalf of children and families.