Browsing by Subject "Health Economics"
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Item Access to Health and Social Services for Poverty Level Adults with Chronic Disease or Disability(2006-12-01) Reese, Sharon E.; Kristine Lykens; Sue Lurie; Richard ScotchReese, Sharon E., Access to Health and Social Services for Poverty Level Adults with Chronic Disease or Disability. Doctor of Public Health (Health Management and Policy), December, 2006, 79 pp., 7 tables, 51 references. This dissertation reports the results of research into the difficulties poverty level adults with disabilities have in accessing vital health and social services. Chapter one gives a background of the problem, a purpose of the research, the research question, limitations and constraints, and the importance of the study. Chapter two is a review of the literature concerning this population and access. Chapter three reviews the methodology used in the study, with chapters four and five presenting results, conclusions and recommendations. Qualitative methods using a focus group and individual interviews five major themes emerged: health issues, access or obtaining care, interactions with providers, obtaining medication, and transportation (table 6). A review of these themes and the particular responses of participants in these areas highlighted the need for policy change in the area of access to services for this special group. This dissertation also makes recommendations for policy changes and potential barriers to those changes.Item An Analysis of Texas Hospitals: Assessing the Association between Charity Care, Uncompensated Care, & Community Benefits(2007-05-01) Mitias, Marcus J.; Nuha Lackan; Jeff Talbert; Douglas MainsMitias, Marcus J. An Analysis of Texas Hospitals: Assessing the Association between Charity Care, Uncompensated Care, & Community Benefits. Master of Public Health (Health Management & Policy), May 2007, 47 pp., 5 tables, 11 illustrations, references, 45 titles. The question of whether not-for-profit hospitals are meeting their charitable obligations is once again starting to intensify. Congress is calling for increased scrutiny of not-for-profit hospitals. Similarly, pressure is mounting in Texas where the not-for-profit hospital sector struggles to justify the contributions they make to the community. This cross-sectional study examines the county level association between charity care, uncompensated care expenditures, and community benefits, and hospital structure, and the number of uninsured. Descriptive and multi-linear regression analyses are used to compare hospital charity care and uncompensated care expenditures in Texas. Results indicate the number of uninsured is significantly associated with charity care expenditures and uncompensated care expenditures.Item An Evaluation of the Impact of Continuity of Care on Cost of Services in New and Renewing CHIP Enrollees(2001-01-01) Montague, Brian; Kristine Lykens; Muriel Marshall; Karan SinghObjective. To assess the impact of continuity of care as measured by enrollment history on the cost of services in Colorado’s state insurance program for children in low-income families, the Child Health Plan Plus. Design. A retrospective cohort study using data extracted from the eligibility/enrollment system and the claims payment system for inpatient and specialty services. All children enrolled in the program for at least 90 days and managed under the state managed-care network from its inception to April 1st of 2000 were included in the analysis (n-11841). Enrollees were separated into three enrollment groups: new members, renewing members, and members transition from a prior outpatient services group. The odds by enrollment groups: new members, renewing members, and members transition from a prior outpatient services program. The odds by enrollment group an average monthly claims greater than the 75th percentile amongst those with claims (n-2661) and the odds of presence of any claim in the full data set were compared means of a logistic regression model. In order to permit inferences regarding the total cost of care, all models included age group as a cofactor. Presence of chronic or congenital disease, ethnicity, primary language, urban residence, and the presence of multiple parents or caretakers were tested using univariate chi-square analysis and significant factors (p [less than] 0.1) were included as effects in the models. Results. All cofactors with the exception of ethnicity were significant in both models. Chronic disease status was associated with an increased risk of all claims. (OR=4.961, p [less than] 0.0001) and high claims (OR=9.639, p [less than] 0.0001). Renewal status was associated with a decreased risk of any claim (OR=0.921, p [less than] 0.0936) while rollover status was associated with both an increased risk of any claim (OR=1.157, p=0.0034) and a decreased risk of high claims (OR=0.731, p=0.0033). Residence in rural counties increased the risk of any claim (OR=0.0428, p [less than] 0.0001) and an increased risk of high claims (OR=1.472, p=0.0376). Conclusions. Enrollment history had a modest, though significant, effect on the presence of any claim and the specific presence of high claims. Rollover status was protective increasing utilization of the system overall but reducing the risk of high claims whereas renewal status only reduced the risk of utilization overall. The absence of multiple adults in the household showed a pattern consistent with episodic use of the system. Relative to urban residents, residents of rural counties were more likely to have used any service and less likely to have incurred high claims. This effect may be attributable to the transition of patients to HMO networks in urban counties. Linguistic or cultural barriers as reflected in primary language strongly decreased utilization, suggesting that these may be important barriers to address in outreach and member education.Item Examining the Relationship Between Relative Wellbeing & Health Disparities in the City of Dallas(2006-08-01) Byerly, Jerah J.; Urrutia-Rojas, XimenaByerly, Jerah J., Examining the Relationship between Relative Wellbeing & Health Disparities in the City of Dallas. Master of Public Health (Community Health), August 2006,43 pp., 8 tables, 6 illustration (figures), bibliography , 29 titles. Health disparities are studies across many diseases and demographic characteristics. This study examined health disparities in relation to geographic assets … a social determinant of health. The purpose of this project was to replicate the Relative Wellbeing Index model in Albrecht & Ramasubramanian’s 2004 study, “The Moving Target: A Geographic Index of Relative Wellbeing”. This study sought to measure well-being at the neighborhood level in Dallas. Data was collected from 2000 U.S. Census. Results indicated the presences of pockets of extreme concentration and social isolation. South Dallas and Fair Park, two of the lowest socioeconomic neighborhoods, had the lowest level of wellbeing. In conclusion, the study indicated Well being scores were not equally distributed across neighborhoods in the City of Dallas.Item Latino Immigrants in Fort Worth: Contributing Factors to Lack of Health Insurance and Their Impacton Utilization of Health Services(2004-04-14) Moreno, Jose J.; Lykens, Kristine; Urrutia-Rojas, Ximena; Mains, Doug A.This quantitative research study consists of a secondary data analysis examining the factors contributing to the lack of health insurance in a group of Latino immigrants in Fort Worth, and the impact it has on their utilization for health care services. The data analyzed was previously collected to assess the needs for health insurance of Latino immigrants in Fort Worth. Bivariate analysis and multivariate logistic regression analysis methods of the sampled population were determine some of the main factors for lack of health insurance resulting in underutilization of health care service. Results of the study lacked the strong statistical association expected from the predictor variables, however, results of the study reveal areas where health care policies affect and may improve conditions of the immigrant population in Fort Worth, Texas.Item The Impact of Race, Ethnicity, and Income on Dental Utilization(2004-05-01) Maresh, Kyeung Oak; Sejong Bae; Shande Chen; Karan SinghKyeung, Oak Maresh. The Impact of Race, Ethnicity, and Income on Dental Utilization Master of Public Health (Biostatics), May 2004, 29 pp., 5 tables, 43 references. Objective To determine if there is a difference in access to dental care services among the difference race/ethnic groups, to ascertain if dental care access differs according to income levels, and to look at the utilization patterns of dental care services. Methods The study data is public use data provided by the Medical Expenditure Panel Survey. The data for this study consisted of the 1999 Full Year Consolidated (Medical Expenditure Panel Survey) household component and the 1999 dental visits (HC-033B). Chi-square tests were performed to determine if there was a significant association (p [less than] 0.05) between each variable and the probability of dental care visits. Multiple logistic stepwise regression was performed to identify each predictor associated with dental care service. Results This study confirmed that minority ethnic groups access fewer dental care services than do non-Hispanic Whites. It also confirmed the second hypothesis that there is a positive relationship between income levels and access to dental care services. Conclusion The result of this study furthers our understanding of race/ethnicity and socioeconomic status in relation to dental care access. They may also help to raise consciousness of dental care utilization and provide basic information to set up efficient prevention strategies increasing dental care utilization among minority racial/ethnic groups and those of low socioeconomic status.