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Access to emergency operative care: a comparative study between the Canadian and American health care systems.

https://arctichealth.org/en/permalink/ahliterature149522
Source
Surgery. 2009 Aug;146(2):300-7
Publication Type
Article
Date
Aug-2009
Author
Susan A Krajewski
S Morad Hameed
Douglas S Smink
Selwyn O Rogers
Author Affiliation
Department of Surgery, University of British Columbia, Vancouver, British Columbia, Canada. susankrajewski@post.harvard.edu
Source
Surgery. 2009 Aug;146(2):300-7
Date
Aug-2009
Language
English
Publication Type
Article
Keywords
Adult
Appendicitis - pathology - surgery
Canada
Emergency medical services
Ethnic Groups
Female
Health Services Accessibility
Healthcare Disparities
Humans
Income
Insurance, Health
Male
Medicaid
Medicare
Middle Aged
National Health Programs
Socioeconomic Factors
United States
Universal Coverage
Young Adult
Abstract
Canada provides universal health insurance to all citizens, whereas 47 million Americans are uninsured. There has not been a study comparing access to emergency operative care between the 2 countries. As both countries contemplate changes in health care delivery, such comparisons are needed to guide health policy decisions. The purpose of this study is to determine whether or not there is a difference in access to emergency operative care between Canada and the United States.
All patients diagnosed with acute appendicitis from 2001 to 2005 were identified in the Canadian Institute for Health Information database and the US Nationwide Inpatient Sample. Severity of appendicitis was determined by ICD-9 codes. Patients were further characterized by age, gender, insurance status, race, and socioeconomic status (SES; income). Univariate and multivariate analyses were performed to determine the odds of appendiceal perforation at different levels of SES in each country.
There were 102,692 Canadian patients and 276,890 American patients with acute appendicitis. In Canada, there was no difference in the odds of perforation between income levels. In the United States, there was a significant, inverse relationship between income level and the odds of perforation. The odds of perforation in the lowest income quartile were significantly higher than the odds of perforation in the highest income bracket (odds ratio, 1.20; 95% confidence interval, 1.16-1.24).
The results suggest that access to emergency operative care is related to SES in the United States, but not in Canada. This difference could result from the concern over the ability to pay medical bills or the lack of a stable relationship with a primary care provider that can occur outside of a universal health care system.
PubMed ID
19628089 View in PubMed
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Access to the Indian health service care system is not associated with early enrollment in medicaid for American Indian and Alaska Natives with cancer.

https://arctichealth.org/en/permalink/ahliterature259101
Source
Cancer Epidemiol Biomarkers Prev. 2014 Feb;23(2):362-4
Publication Type
Article
Date
Feb-2014
Author
Andrea N Burnett-Hartman
Mark E Bensink
Kristin Berry
David G Mummy
Victoria Warren-Mears
Carol Korenbrot
Scott D Ramsey
Source
Cancer Epidemiol Biomarkers Prev. 2014 Feb;23(2):362-4
Date
Feb-2014
Language
English
Publication Type
Article
Keywords
Adult
Aged
Aged, 80 and over
Alaska
Female
Health Services Accessibility - statistics & numerical data
Health services needs and demand
Humans
Indians, North American - statistics & numerical data
Male
Medicaid - statistics & numerical data
Middle Aged
United States
United States Indian Health Service - statistics & numerical data
Young Adult
Abstract
For uninsured American Indians and Alaskan Natives (AIAN) diagnosed with cancer, prompt enrollment in Medicaid may speed access to treatment and improve survival. We hypothesized that AIANs who were eligible for the Indian Health Service Care System (IHSCS) at cancer diagnosis may be enrolled in Medicaid sooner than other AIANs.
Using Washington, Oregon, and California State Cancer Registries, we identified AIANs with a primary diagnosis of lung, breast, colorectal, cervical, ovarian, stomach, or prostate cancer between 2001 and 2007. Among AIANs enrolled in Medicaid within 365 days of a cancer diagnosis, we linked cancer registry records with Medicaid enrollment data and used a multivariate logistic regression model to compare the odds of delayed Medicaid enrollment between those with (n = 223) and without (n = 177) IHSCS eligibility.
Among AIANs who enrolled in Medicaid during the year following their cancer diagnosis, approximately 32% enrolled >1 month following diagnosis. Comparing those without IHSCS eligibility to those with IHSCS eligibility, the adjusted odds ratio (OR) for moderately late Medicaid enrollment (between 1 and 6 months after diagnosis) relative to early Medicaid enrollment (=1 month after diagnosis) was 1.10 [95% confidence interval (CI), 0.62-1.95] and for very late Medicaid enrollment (>6 months to 12 months after diagnosis), OR was 1.14 (CI, 0.54-2.43).
IHSCS eligibility at the time of diagnosis does not seem to facilitate early Medicaid enrollment.
Because cancer survival rates in AIANs are among the lowest of any racial group, additional research is needed to identify factors that improve access to care in AIANs.
PubMed ID
24296857 View in PubMed
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The accumulated challenges of long-term care.

https://arctichealth.org/en/permalink/ahliterature146298
Source
Health Aff (Millwood). 2010 Jan-Feb;29(1):29-34
Publication Type
Article
Author
David Barton Smith
Zhanlian Feng
Author Affiliation
Center for Health Equality, School of Public Health, at Drexel University, in Philadelphia, Pennsylvania, USA. david.b.smith@drexel.edu
Source
Health Aff (Millwood). 2010 Jan-Feb;29(1):29-34
Language
English
Publication Type
Article
Keywords
Chronic Disease
Cost Control - methods
Health Policy - trends
Health Services Accessibility - statistics & numerical data - trends
Health Services for the Aged
Health Services, Indigenous - economics - supply & distribution
Healthcare Disparities
Humans
Long-Term Care - methods - organization & administration - standards - trends
Medicaid
Organizational Objectives
Quality of Health Care - standards
United States
Abstract
During the past century, long-term care in the United States has evolved through five cycles of development, each lasting approximately twenty years. Each, focusing on distinct concerns, produced unintended consequences. Each also added a layer to an accumulation of contradictory approaches--a patchwork system now pushed to the breaking point by increasing needs and financial pressures. Future policies must achieve a better synthesis of approaches inherited from the past, while addressing their unintended consequences. Foremost must be assuring access to essential care, delivery of high-quality services in an increasingly deinstitutionalized system, and a reduction in social and economic disparities.
PubMed ID
20048357 View in PubMed
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The adequacy of prenatal care and incidence of low birthweight among the poor in Washington State and British Columbia.

https://arctichealth.org/en/permalink/ahliterature218009
Source
Am J Public Health. 1994 Jun;84(6):986-91
Publication Type
Article
Date
Jun-1994
Author
S J Katz
R W Armstrong
J P LoGerfo
Author Affiliation
Department of Medicine, University of Michigan, Ann Arbor.
Source
Am J Public Health. 1994 Jun;84(6):986-91
Date
Jun-1994
Language
English
Publication Type
Article
Keywords
Adult
British Columbia - epidemiology
Cross-Sectional Studies
Female
Humans
Infant, Low Birth Weight
Infant, Newborn
Maternal Age
Medicaid
National Health Programs
Odds Ratio
Parity
Poverty
Prenatal Care
Quality of Health Care
Risk factors
United States
Washington - epidemiology
Abstract
The purpose of this study was to examine differences in adequacy of prenatal care and incidence of low birthweight between low-income women with Medicaid in Washington State and low-income women with Canadian provincial health insurance in British Columbia.
A population-based cross-sectional study was done by using linked birth certificates and claims data.
Overall, the adjusted odds ratio for inadequate prenatal care in Washington (comparing women with Medicaid with those with private insurance) was 3.2. However, the risk varied by time of Medicaid enrollment relative to pregnancy (2.0, 1.0, 2.7, 6.3; for women who enrolled prior to pregnancy, during the first trimester, during the second trimester, or during the third trimester, respectively). In British Columbia, the adjusted odds ratio for inadequate care (comparing women receiving a health premium subsidy with those receiving no subsidy) was 1.5 for women receiving a 100% subsidy and 1.2 for women receiving a 95% subsidy. The risk for low birthweight followed a similar trend in both regions, but there was no association with enrollment period in Washington.
Overall, the risk for inadequate prenatal care among poor women was much greater in Washington than in British Columbia. Most of the difference was due to Washington women's delayed enrollment in Medicaid. In both regions, the poor were at similar risk for low birthweight relative to their more affluent counterparts.
Notes
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PubMed ID
8203697 View in PubMed
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Airborne particulate matter from primarily geologic, non-industrial sources at levels below National Ambient Air Quality Standards is associated with outpatient visits for asthma and quick-relief medication prescriptions among children less than 20 years old enrolled in Medicaid in Anchorage, Alaska.

https://arctichealth.org/en/permalink/ahliterature80178
Source
Environ Res. 2007 Mar;103(3):397-404
Publication Type
Article
Date
Mar-2007
Author
Chimonas Marc-Andre R
Gessner Bradford D
Author Affiliation
Division of Occupational and Environmental Medicine, Duke University Medical Center, Durham, NC 27710, USA. mchimonas@msn.com
Source
Environ Res. 2007 Mar;103(3):397-404
Date
Mar-2007
Language
English
Publication Type
Article
Keywords
Adolescent
Alaska - epidemiology
Ambulatory Care - statistics & numerical data
Anti-Asthmatic Agents - therapeutic use
Asthma - drug therapy - epidemiology - etiology
Child
Child, Preschool
Cohort Studies
Female
Humans
Infant
Infant, Newborn
Male
Medicaid
Models, Statistical
Particle Size
Particulate Matter - adverse effects - analysis - standards
Abstract
In Anchorage, Alaska, particulates with aerodynamic diameter or = 34 micro g/m(3). A significant 18.1% increase (RR: 1.181, 95% CI: 1.010-1.381) in the rate of quick-relief medication prescriptions occurred during days with PM(10) of 34-60 micro g/m(3), and a 28.8% increase (RR: 1.288, 95% CI: 1.026-1.619) occurred during days with PM(10) > or = 61 micro g/m(3). Similar results for outpatient asthma visits and quick-relief medication occurred in weekly models. There were no significant associations with PM(2.5) in either daily or weekly models. These subtle but statistically significant associations suggest that non-industrial, geologic sources of PM(10) may have measurable health effects at levels below current national standards.
PubMed ID
17049511 View in PubMed
Less detail
Source
Anchorage : State of Alaska, Department of Health & Social Services, Division of Health Care Services. 24 pages.
Publication Type
Report
Date
2004
Source
Anchorage : State of Alaska, Department of Health & Social Services, Division of Health Care Services. 24 pages.
Date
2004
Language
English
Geographic Location
U.S.
Publication Type
Report
Physical Holding
University of Alaska Anchorage
Keywords
Alaska
Medicaid
Notes
ALASKA RA412.45.A4A472 2004
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Alaska's medical assistance programs: Medicaid, Denali KidCare, CAMA.

https://arctichealth.org/en/permalink/ahliterature288908
Source
Juneau: State of Alaska, Dept. of Health and Social Services, Division of Medical Assistance. 27 pages.
Publication Type
Book/Book Chapter
Author
Alaska. Division of Medical Assistance.
Source
Juneau: State of Alaska, Dept. of Health and Social Services, Division of Medical Assistance. 27 pages.
Language
English
Geographic Location
U.S.
Publication Type
Book/Book Chapter
Physical Holding
University of Alaska Anchorage
Keywords
Alaska
Denali KidCare Program
Chronic and Acute Medical Assistance (CAMA) Program
Medicaid
Medical care
Notes
ALASKA RA412.45.A4A47 (2000, 2003)
Providing health coverage for Alaskans in need.
Less detail

Alcohol-related hospitalizations of elderly people. Prevalence and geographic variation in the United States.

https://arctichealth.org/en/permalink/ahliterature6168
Source
JAMA. 1993 Sep 8;270(10):1222-5
Publication Type
Article
Date
Sep-8-1993
Author
W L Adams
Z. Yuan
J J Barboriak
A A Rimm
Author Affiliation
Department of Medicine, Medical College of Wisconsin, Milwaukee.
Source
JAMA. 1993 Sep 8;270(10):1222-5
Date
Sep-8-1993
Language
English
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Alcoholism - economics - epidemiology
Cross-Sectional Studies
Female
Hospitals - utilization
Humans
Male
Medicare Part A - statistics & numerical data
Morbidity
Patient Admission - economics - statistics & numerical data
Prevalence
United States - epidemiology
United States Centers for Medicare and Medicaid Services
Abstract
OBJECTIVE--To determine the prevalence, geographic variation, and charges to Medicare of alcohol-related hospitalizations among elderly people in the United States. DESIGN--A cross-sectional prevalence study using 1989 hospital claims data from the Health Care Financing Administration (HCFA). Rates were determined using (1) hospital claims records from the HCFA's Medicare Provider Analysis and Review Record (MEDPAR) database for all Medicare Part A beneficiaries aged 65 years and older; (2) county population estimates for 1985 from the Bureau of the Census; and (3) per capita consumption of alcohol by state in 1989 as estimated by the US Department of Health and Human Services. SETTING--Data include all hospital inpatient Medicare Part A beneficiaries aged 65 years and older in the United States in 1989. RESULTS--The prevalence of alcohol-related hospitalizations among people aged 65 years and older nationally in 1989 was 54.7 per 10,000 population for men and 14.8 per 10,000 for women. Comparison with hospital records showed that MEDPAR data had a sensitivity of 77% to detect alcohol-related hospitalizations. There was considerable geographic variation; prevalence ranged from 18.9 per 10,000 in Arkansas to 77.0 per 10,000 in Alaska. A strong correlation existed between alcohol-related hospitalizations and per capita consumption of alcohol by state (Spearman correlation coefficient, .64; P
Notes
Erratum In: JAMA 1993 Nov 3;270(17):2055
PubMed ID
8355385 View in PubMed
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An innovative blood lead screening program for Indian children.

https://arctichealth.org/en/permalink/ahliterature179708
Source
Public Health Rep. 2004 Mar-Apr;119(2):141-3
Publication Type
Article
Author
Embry M Howell
Loretta Russette
Author Affiliation
Urban Institute, Health Policy Center, 2100 M St., NW, Washington, DC 20037, USA. ehowell@ui.urban.org
Source
Public Health Rep. 2004 Mar-Apr;119(2):141-3
Language
English
Publication Type
Article
Keywords
Age Factors
Child, Preschool
Health education
Humans
Indians, North American
Infant
Lead - blood
Lead Poisoning - prevention & control
Mass Screening
Medicaid
Montana
United States
United States Environmental Protection Agency
Abstract
There is little information on the lead levels of Indian children nationally. In the late 1990s, members of the Chippewa and Cree tribes living on the Rocky Boy Reservation near Box Elder, Montana, were concerned about environmental pollution and how it might be affecting the health of their children. With financial assistance from the Environmental Protection Agency, the tribes designed and implemented an innovative lead screening program for young children. Because most children on the reservation participated in WIC and Head Start, those programs were used to identify and screen close to 100% of young children on the reservation. The average blood lead level for children ages 1-5 on the Rocky Boy reservation was 2.4 micrograms/dL, which is not significantly different from that of children of the same age nationally. The project showed that Indian families will participate readily in screening programs that may improve their children's health.
Notes
Cites: N Engl J Med. 2003 Apr 17;348(16):1515-612700370
PubMed ID
15192900 View in PubMed
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86 records – page 1 of 9.