Recently, Medicaid has changed in terms of both perception and reality. After a period of decline in entitlement, that trend has been reversed through both Federal mandates and an increasing role for Medicaid in dealing with the uninsured. As States and the Federal Government seek structural solutions, further eligibility expansions may be necessary, such as public subsidies of private insurance or using Medicaid as a reinsurance mechanism. Currently, there is considerable State activity in identifying such solutions. These activities have given us some ideas about what is necessary to expand coverage to more of the population. Continued demonstrations and better definitions of the respective roles of the private and public sectors are needed.
<p>The Church Health Center (CHC) in Memphis was founded in 1987 to provide quality, affordable health care for working, uninsured people and their families. With numerous, dedicated financial supporters and health care volunteers, CHC has become the largest faith-based health care organization of its type nationally, serving >61,000 patients. CHC embraces a holistic approach to health by promoting wellness in every dimension of life. It offers on-site services including medical care, dentistry, optometry, counseling, social work, and nutrition and fitness education, to promote wellness in every dimension of life. A 2012 economic analysis estimated that a $1 contribution to the CHC provided roughly $8 in health services. The CHC has trained >1200 Congregational Health Promoters to be health leaders and is conducting research on the effectiveness of faith community nurses partnering with congregations to assist in home care for patients recently discharged from Memphis hospitals. The MEMPHIS Plan, CHC's employer-sponsored health care plan for small business and the self-employed, offers uninsured people in lower-wage jobs access to quality, affordable health care. The CHC also conducts replications workshops several times a year to share their model with leaders in other communities. The Institute for Healthcare Improvement (IHI) recently completed a case study that concluded: "The CHC is one of a very few organizations successfully embodying all three components of the IHI Triple Aim by improving population health outcomes, enhancing the individual's health care experience, and controlling costs. All three have been part of the Center's DNA since its inception, and as a transforming force in the community, the model is well worth national attention." <em>Ethn Dis.</em>2015;25(4):507-510; doi:10.18865/ ed.25.4.507</p>
Often, policy analysts are asked to produce data for which there are no universally accepted methods. Policymakers and legislators are continually searching for accurate estimates of the magnitude of the problem with which to inform their debate, but often need the estimates within a short period of time—too short to allow large, population‐based sample surveys. This means that such estimates must be produced from data that may lack the specificity sought by policymakers and legislators, using techniques not perfectly suited for the analysis. The recent focus on health care financing policies has created a situation where estimates of the number of medically uninsured persons are key to decision‐making about coverage policies. This article describes the use of the 1992 Current Population Survey and logistic regression analysis to explain the determinants of women of childbearing age in North Carolina without medical insurance, and to develop county‐level estimates of their population. This is an example of using logistic regression as a fool for prediction and projection of data crucial to the policymaking process as well as adapting a method normally used in the academic environment to the policy world.
Describes the use of the 1992 current population survey and logistic regression analysis to explain the determinants of women of childbearing age in North Carolina without medical insurance, and to develop county-level estimates of their population. (Original abstract-amended)
African, Caribbean and Black immigrants face persistent legislative barriers to accessing healthcare services in Canada. This Institutional Ethnography examines how structural violence and exclusionary legislative frameworks restrict the right to HIV healthcare access for many Black immigrants. We conducted semi-structured interviews with Black immigrants living with HIV (n = 20) and healthcare workers in Toronto, Canada (n = 15), and analyzed relevant policy texts. Findings revealed that exclusionary immigration and healthcare legislation shaping and regulating immigrants' right to health restricted access to public resources, including health insurance and HIV healthcare and related services, subjecting Black immigrants with precarious status to structural violence. Healthcare providers and administrative staff worked as healthcare gatekeepers. These barriers undermine public health efforts of advancing health equity and ending HIV "while leaving no one behind." We urge continued policy reforms in Canada's immigration and healthcare systems regarding HIV care access for Canada's precarious status immigrants.
Intro -- Reviewers -- Foreword -- Preface -- Acknowledgments -- Contents -- List of Boxes, Figures, and Tables -- Summary -- 1 Introduction -- 2 Caught in a Downward Spiral -- 3 Coverage Matters -- 4 Communities at Risk -- 5 Summary of Findings and Recommendation -- Appendix A: Executive Summary of the 2004 IOM Report "Insuring America's Health: Principles and Recommendations -- Appendix B: Statistics on the Nonelderly U.S. Population Without Health Insurance, 2007 -- Appendix C: State Regulations Promoting Access to Individual Health Insurance Policies, 2007 -- Appendix D: Recent Studies of the Impacts of Health Insurance for Children: Summary Tables -- Appendix E: Recent Studies of the Impacts of Health Insurance for Adults: Summary Table -- Appendix F: Committee Biographies.
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