Publications - Health Policy and Administration

Predictors of Payment Behavior among the Medically Uninsured: A Prospective Cohort Study of Patients Seeking Ambulatory Services

Mon, 01 Nov 2010 05:00:00 GMT

Predictors of Payment Behavior among the Medically Uninsured: A Prospective Cohort Study of Patients Seeking Ambulatory Services Weiner, Saul J.; Andes, Steven Background. Little is known about the characteristics of uninsured patients who attempt to pay for their care. Purpose. This study sought to identify predictors of payment after receiving care at three urban hospitals. Methodology. One hundred and seventy uninsured ambulatory patients were interviewed about their health status, income, and credit and payment histories at the point of care. Eighteen months later, data on payment outcomes were extracted from the medical financial records for each subject. Findings. Patients were more likely to make a payment if they reported higher income, health insurance for other services, or worrying about their credit. They were less likely to pay anything if they owed a large sum, were seeking care at the public site, or had received care in an emergency room. Conclusions. Specific characteristics of uninsured patients, the site of care, and the size of the bill are all associated with payment outcome. This is a copy of an article published in the Journal of Health Care for the Poor and Underserved © 2010 Johns Hopkins University Press. DOI:10.1353/hpu.2010.0917

Validation of the Crime and Violence Scale (CVS) Against the Rasch Measurement Model Including Differences by Gender, Race and Age

Thu, 01 Apr 2010 05:00:00 GMT

Validation of the Crime and Violence Scale (CVS) Against the Rasch Measurement Model Including Differences by Gender, Race and Age Conrad, Kendon J.; Conrad, Karen M.; Chan, Ya-Fen; Riley, Barth B.; Dennis, Michael L. In assessing criminality, researchers have used counts of crimes, arrests etc. because interval measures were not available. Additionally, crime seriousness varies depending on demographic factors. This study examined the Crime and Violence Scale (CVS) regarding: psychometric quality using item response theory (IRT); and invariance of the crime seriousness hierarchy for gender, age, and racial/ethnic groups on 7435 respondents. The CVS is a useful measure of criminality, though some items could be improved or dropped. Differential item functioning analysis revealed that crime seriousness varies by age and gender. IRT shows promise in assessing and adjusting for demographic variations in crime seriousness. Post print version of article may differ from published version. The definitive version is available through SAGE Publications at DOI: 10.1177/0193841X10362162.

Misconceptions about breast lumps and delayed medical presentation in urban breast cancer patients.

Mon, 01 Mar 2010 06:00:00 GMT

Misconceptions about breast lumps and delayed medical presentation in urban breast cancer patients. Rauscher, Garth H.; Ferrans, Carol Estwing; Kaiser, Karen; Campbell, Richard T.; Calhoun, Elizabeth E.; Warnecke, Richard B. BACKGROUND: Despite current recommendations for women to be screened for breast cancer with mammography every one to two years, less than half of all newly diagnosed breast cancers are initially detected through screening mammography. Prompt medical attention to a new breast symptom can result in earlier stage at diagnosis, yet many patients delay seeking medical care after becoming aware of a breast symptom. METHODS: In a population-based study of breast cancer we examined factors potentially associated with patient delay in seeking health care for a breast symptom among 436 symptomatic urban breast cancer patients (146 White, 197 Black and 95 Hispanic). Race/ethnicity, socioeconomic status, health care access and utilization, and misconceptions about the meaning of breast lumps were the key independent variables. RESULTS: Sixteen percent of patients reported delaying more than 3 months before seeking medical advice about breast symptoms. Misconceptions about breast lumps, and lacking a regular provider, health insurance and recent preventive care were all associated with prolonged patient delay (p<0.005 for all). Misconceptions were much more common among ethnic minorities and women of lower socioeconomic status. CONCLUSION: Reducing patient delay and disparities in delay will require both educating women about the importance of getting breast lumps evaluated in a timely manner, and providing greater access to regular health care. Postprint version of article may differ from published version. The definitive version is available at DOI: 10.1158/1055-9965.EPI-09-0997

The role of health care systems in increased tobacco cessation.

Tue, 01 Jan 2008 06:00:00 GMT

The role of health care systems in increased tobacco cessation. Curry, Susan J.; Keller, Paula; Orleans, C. Tracy; Fiore, Michael Health care delivery systems are critical components of tobacco cessation efforts. This review summarizes recent evidence in support of the health care system recommendations in the 2000 U.S. Public Health Service Clinical Practice Guideline, Treating Tobacco Use and Dependence. Measurable progress in addressing tobacco use through the health care system is summarized, including accountabilities for addressing tobacco in national health care reporting systems, increases in reported advice to quit smoking from health care providers, and wider availability of insurance coverage for tobacco cessation treatments. Despite progress, significant gaps remain between what is possible and what is done by health care systems to impact tobacco cessation. A four-point public policy agenda is outlined to help close these gaps. Copyright Policy: http://www.annualreviews.org/authors/preprints.aspx