Christopher Keane

The impact of a children's health insurance program by age

Objectives. 1) To examine age variation in unmet need/delayed care, access, utilization, and restricted activities attributable to lack of health insurance in children before they receive health insurance; and 2) to examine the effect of health insurance on these indicators within each age group of children (in years). Methods. We use cohort data on children before and after receiving health insurance. The study population consists of 750 children, 0 through 19 years of age, newly enrolling in two childrens health programs. The families of the newly enrolled children were interviewed at the time of their enrollment (baseline), and again at 6 months and 1 year after enrollment. The dependent variables measured included access to regular provider, utilization, unmet need or delayed health care, and restrictions on activities attributable to health insurance status. All these indicator variables were examined by age groups (0–5, 6–10, 11–14, and 15–19 years of age). χ2tests were performed to determine whether these dependent variables varied by age at baseline. Using logistic regression, odds ratios were calculated for baseline indicators by age group of child, adjusting for variables commonly found to be associated with health insurance status and utilization. Changes in indicator variables from before to after receiving health insurance within each age group were documented and tested using the McNemar test. A comparison group of families of children enrolling newly 12 months later were interviewed to identify any potential effects of trend. Results. All ages of children saw statistically significant improvements in access, reduced unmet/delayed care, dental utilization, and childhood activities. Before obtaining health insurance, older children, compared with younger children, were more likely to have had unmet/delayed care, to have not received health care, to have low access, and to have had activities limited by their parents. This pattern held for all types of care except dental care. Age effects were strong and independent of covariates. After being covered by health insurance, the majority of the delayed care, low utilization, low access, and limited activities in the older age groups (11–14 and 15–19 years) was eliminated. Thus, as levels of unmet need, delayed care, and limitations in activities approached zero in all age groups by 1 year after receipt of health insurance, age variation in these variables was eliminated. By contrast, age variation in utilization remained detectable yet greatly reduced. Conclusion. Health insurance will reduce unmet need, delayed care, and restricted childhood activities in all age groups. Health care professionals and policy makers also should be aware of the especially high health care delay, unmet need, and restricted activities experienced by uninsured older children. The new state childrens health insurance programs offer the potential to eliminate these problems. Realization of this potential requires that enrollment criteria, outreach strategies, and delivery systems be effectively fashioned so that all ages of children are enrolled in health insurance.

Maintenance of Mobility in Residents of an Alzheimer Special Care Facility

The cognitive and functional decline of demented residents in a specialized Alzheimers facility was compared to that of demented residents living in a traditional nursing home. All residents met DSM-III-R criteria for dementia. The evaluation consisted of a clinical interview with patients and collateral assessments of cognition, general health, problem behaviors, depression, and a broad range of activities of daily living (ADLs) including mobility. Residents were evaluated at baseline and 6-month intervals over 18 months. Similar rates of decline were found in cognition and overall ADLs in both groups. However, the most striking finding was preserved mobility in residents of the Alzheimers facility. This finding suggests that specialized facilities do not halt or slow the overall progression of cognitive and functional decline seen in Alzheimers disease; however, residents of such facilities may show slower decline in mobility.

Local Health Departments' Mission to the Uninsured

It is often maintained that local health departments (LHDs) should not directly provide personal health services. However, our nationally representative sample revealed that most LHD directors (87%) believed LHDs must directly provide these services, primarily because they perceived a high level of unmet need among the uninsured. While only a minority believed LHDs should focus exclusively on the core functions, this proportion rose dramatically when we asked directors to assume that there were no uninsured people. Directors who perceived a high level of unmet need among the uninsured in their jurisdictions were much less likely to believe that LHDs should exclusively focus on the core functions. In theory, LHDs have a unique responsibility for assuring that the uninsured and vulnerable have access to personal health services. However, a majority of directors (67%) acknowledged that they have no enforceable means of assuring access to services the health department did not directly provide.

Factors Influencing Food Buying Practices in Residents of a Low-Income Food Desert and a Low-Income Food Oasis:

Studies suggest that proximity to a supermarket influences access to healthy foods. However, little is known about factors that influence food buying practices within areas with limited supermarket access. This study identified these factors and explored how they are related and influence healthy eating. Twenty-five men and women engaged in the concept mapping process, a mixed methods approach allowing participants to identify, sort, and rate ideas. Participants generated 121 unique (nonduplicate) statements of factors that influence food buying practices and sorted them into 12 clusters that represented their perceptions. Average cluster ratings for residents with poor supermarket access were higher than residents with supermarket access. Awareness of these factors is important for increasing access to and consumption of healthy foods.

Perceived Outcomes of Public Health Privatization: A National Survey of Local Health Department Directors

Almost three quarters of the nations local health departments (LHDs) have privatized some services. About half of LHD directors who privatized services reported cost savings and half reported that privatization had facilitated their performance of the core public health functions. Expanded access to services was the most commonly reported positive outcome. Of those privatizing, over two-fifths of LHDs reported a resulting increase in time devoted to management. Yet, one-third of directors reported difficulty monitoring and controlling services that have been contracted out. Communicable disease services was cited most often as a service that should not be privatized. There is a pervasive concern that by contracting out services, health departments can lose the capacity to respond to disease outbreaks and other crises.

Identification and Intervention for Urinary Incontinence by Community Physicians and Geriatric Assessment Teams

Objective: To determine the difference in the recognition and intervention/referral rates for urinary incontinence (UI) by out‐patient Geriatric Assessment Units (GAUs) and private physicians in community‐based practices (CMDs).

How does food security impact residents of a food desert and a food oasis

This study explored how factors that influence food buying practices make it harder for food secure and food insecure households to eat healthy. Twenty-five men and women participated in the concept mapping process, a mixed methods approach that allows participants to identify, sort, and rate ideas according to their perceptions. Participants identified 121 unique statements and sorted them into 12 clusters that represented their perceptions. Cluster ratings were higher among food-insecure participants compared to food-secure participants. A secondary aim was to explore how food security and food desert statuses are perceived to hinder healthy eating. Food secure participants in a food desert perceived clusters as more important to hindering healthy eating than food-secure participants in a food oasis. Similar perceptions were noted among food-insecure residents in either a food desert or a food oasis. Findings contribute to our understanding of how perceptions differ by food desert and food security statuses.

Services Privatized in Local Health Departments: A National Survey of Practices and Perspectives

Privatization of public health is seemingly an oxymoron. Functions such as environmental regulation and communicable disease control would seem to be the unique purview of governmental public health departments. These services constitute public goods in that they affect entire communities, whereas personal health services are private goods, privately consumed by individuals.1 Recent pressures such as the penetration of managed care has led to shifts in personal health service provision from the public to the private sector and to various forms of public–private collaboration.2,3 However, some privatization theorists contend that public goods cannot be as effectively provided by the private sector. Others contend that even certain private goods, such as personal health services, should not be contracted out to the private sector.1 These opinions suggest that research on privatization in local health departments should examine the specific services, both public and private, that have been contracted out, a task previous studies of such health departments have not systematically addressed (L. Whitehand, M. Bechamps, and R. Bialek, unpublished data, 1997).4–15 Other articles based on the national survey of local health department directors described here have not outlined in detail the specific services privatized.16 In the present study, we examined the specific services privatized, the profit vs nonprofit status of contractors, and directors’ views about what services should not be privatized.

Financial distress and depressive symptoms among African American women: identifying financial priorities and needs and why it matters for mental health.

Prior research found that financial hardship or distress is one of the most important underlying factors for depression/depressive symptoms, yet factors that contribute to financial distress remain unexplored or unaddressed. Given this, the goals of the present study were (1) to examine the relationship between perceived financial distress and depressive symptoms, and (2) to identify financial priorities and needs that may contribute to financial distress. Surveys from 111 African American women, ages 18–44, who reside in Allegheny County, PA, were used to gather demographic information and measures of depressive symptoms and financial distress/financial well-being. Correlation and regression analyses revealed that perceived financial distress was significantly associated with levels of depressive symptoms. To assess financial priorities and needs, responses to two open-ended questions were analyzed and coded for common themes: “Imagine you won a

School closure as an influenza mitigation strategy: how variations in legal authority and plan criteria can alter the impact

10,000 prize in a local lottery. What would you do with this money?” and “What kinds of programs or other help would be beneficial to you during times of financial difficulties?” The highest five priorities identified by the participants were paying bills and debt, saving, purchasing a home or making home repairs, and/or helping others. The participant’s perceived needs during times of financial difficulty included tangible assistance and/or financial education. The findings from this study can be used to create new and/or enhance existing programs, services, and/or interventions that focus on the identified financial priorities and needs. Collaborative efforts among professionals in different disciplines are also needed, as ways to manage and alleviate financial distress should be considered and discussed when addressing the mental health of African American women.