Access to Appointments Based on Insurance Status in Washington, D.C.
George Washington University Medical School, USA.Journal of Health Care for the Poor and Underserved (Impact Factor: 1.1). 08/2008; 19(3):687-96. DOI: 10.1353/hpu.0.0036
In the U.S., emergency departments see millions of patients requiring timely and adequate outpatient follow-up. Using a hypothetical patient presenting with a scripted presentation of hypertension evaluated in the emergency department and requiring close outpatient follow-up, randomly selected providers in the District of Columbia were queried by phone to evaluate their accessibility based on insurance status. Seventy one percent of calls for privately insured hypothetical patients resulted in a successful appointment. Medicaid fee-for-service was associated with a significantly lower rate of successful appointments (36.6%) than private insurance (p=.002.) Uninsured "patients" had only a 13% success rate when considering out-of-pocket payment limitations of less than $50 (p<.001 compared with private). Access to primary care follow-up is poor in the District of Columbia for all types of insurance; however people with Medicaid fee-for-service and the uninsured face especially strong barriers.
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ABSTRACT: Adherence to emergency department (ED) discharge instructions among immigrant Spanish-speaking populations in the United States is suboptimal. Our objectives were to: (1) investigate associations between functional health literacy (FHL) and ED discharge instruction adherence in Spanish-speaking populations, and (2) compare the ED adherence rates of Spanish speakersto English speakers. Using a matched cohort design, the FHL of adult native Spanish speakers in a tertiary care ED was assessed using the Test of Functional Health Literacy of Adults in Spanish (TOHFLA-S). Gender-matched and age-matched native English speakers were assessed using TOHFLA. TOFHLA scores range from 1 to 100 with adequate FHL cutoff at 74. Excluded patients were those aged less than 19 years, unwilling, prisoners, institutionalized, extremely ill, with a psychiatric complaint, in receipt of nonspecific instructions for follow-up, or with poor vision. A second interview assessed adherence with follow-up appointments and filling prescriptions. Fifty matched pairs were enrolled. Spanish speakers were less likely to understand discharge instructions (Spanish speakers, 78%; English speakers, 94%; p < .0001) or to keep follow-up appointments (Spanish speakers, 46%; English speakers, 83%; p <.0001). TOFHLA for Spanish speakers averaged 62 vs 93 for English speakers (p < .0001). FHL was associated with understanding of and adherence to discharge instructions for Spanish speakers. Further, Spanish speakers reported lack of understanding as a primary reason for nonadherence. Spanish-speaking patients were less likely to comply with discharge instructions and scored lower on a test of FHL than English-speaking patients. Poor adherence to ED discharge instructions was associated with lower FHL scores for our Spanish-speaking population. Alternative methods of providing discharge instructions to this population of patients should be explored.Journal of the National Medical Association 09/2007; 104(11-12):521-7. DOI:10.1016/j.annemergmed.2007.06.326 · 0.96 Impact Factor
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ABSTRACT: For the first time since 1994, there appears to be a real window of opportunity to enact universal health care coverage. President Obama and leading members of Congress have made health care reform a top priority. With 45 million individuals uninsured,1 and millions more finding their health care insurance inadequate,2 the United States may finally join the ranks of other industrialized countries and guarantee coverage for all of its citizens.JAMA The Journal of the American Medical Association 06/2009; 301(17):1816-8. DOI:10.1001/jama.2009.613 · 35.29 Impact Factor
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