Barriers to healthcare for American Indians experiencing homelessness

Members of American Indian (AI) communities face many barriers to receiving both mental and physical healthcare. These barriers can have a negative effect on overall health. Barriers are compounded for AIs who are also experiencing homelessness, and AI make up a disproportionate percentage of the homeless population nationwide. In-depth semi-structured interviews were conducted with 12 service providers and 16 homeless participants in a mid-size Midwestern city to identify barriers to care for homeless participants. Key barriers identified in this study for homeless participants were: transportation, phone accessibility, discrimination, and cold and bureaucratic cultures of healthcare systems. Major barriers identified by service providers were: access to care, discrimination and mistrust, and restrictive policies. Given generally higher disease prevalence within the homeless population and health disparities within the AI community, steps should be taken to reduce barriers to healthcare.     

Macroeconomic and financing determinants of out of pocket payments in health care: Evidence from selected OECD countries

In this paper, we examine the impact of macroeconomic, as well public and private health insurance financing (PHI) factors on out of pocket (OOP) healthcare expenditures, by using fixed/random effects and dynamic panel data methodology to a dataset of 26 EU and OECD countries for a period lasting from 1995 to 2013. The existing empirical literature has focused on testing the hypothesis that several macroeconomic and health financing determinants have an effect on OOP healthcare expenditures. Nevertheless, the related articles have not well tested the hypothesis concerning the potential impact of PHI financing on OOP spending. We find that public and PHI financing have a significant countervailing effect on OOP spending. Moreover, we show that unemployment rate has a significant positive impact on OOP expenditures. Sensitivity tests with variation of specifications and samples show that our findings are robust. We argue that policy-makers should give serious consideration to PHI institution; our results indicate that there is an inverse effect on OOP spending. We suggest that our examined countries have to provide financial risk protection to their citizens against OOP payments, rather than only attending health budgetary retrenchments in order to adjust public finances.     

Contractual Integration of Physician and Hospital Services in the U.S.

Using a binary-choice, probabilistic model, this study analyzes data covering the institutional and market characteristics of 759 hospitals in 81 metropolitan statistical are as in the United States to understand why many of them have chosen to contractually integrate with physician and physician group practices. The results support the theory that the contractual integration of physician and hospital services in the U.S. during the 1990s occurred in response to market pressures to circumvent the transaction costs of monitoring physician utilization of hospital resources. They also support the views of Robinson (1997) and Shortell (1997) that the nature of the coordination, the governance structure, and the part to which market mechanisms play are largely determined by the demands for coordination from the market served by the hospital, the capabilities of the hospital to pull physicians into integration arrangements, and the historical context and constraints binding the hospital's decision making. This revised version was published online in July 2006 with corrections to the Cover Date.     

Health literacy and uptake of annual physical checkups among emerging adults in the United States: Findings from the Behavioral Risk Factor Surveillance System

Public health literature is replete with evidence on the determinants of preventive healthcare utilization. However, gap exists in the relationship between health literacy, a key social determinant of health, and annual physical checkups, especially among younger adults in the United States. This age group is one of the least likely to utilize such services for screening and prevention of diseases, which can have a significant impact on their long-term health as they progress through the life course. Using the Andersen Healthcare Utilization framework, this study investigated the association between health literacy, an enabling factor, and uptake of annual physical checkups among emerging adults aged 18–29. A binary logistic regression model was employed to achieve the study objective using data from the 2016 Behavioral Risk Factor Surveillance System data (N = 9515). Findings showed that 61% of young adults had physical checkups in the past year. After adjusting for predisposing, need, and other enabling factors, experiencing difficulties with oral and written health literacy and having difficulties obtaining medical information and advice were significantly associated with lower odds of physical checkups in the past year. These findings provide evidence for strategies like Healthy People 2030 that aim to increase preventive healthcare service utilization among emerging adults.     

Chronic care,integrated care,and mental health: Moving the needle now

Healthcare reform is currently a hot topic in the United States, and the Chronic Care Model has frequently been cited as the foundation of recent attempts to integrate mental health and physical health care. However, challenges exist to fully integrated care that have delayed adequately meeting the multiple needs of mental health service recipients. This article highlights multiple changes that can be incorporated into mental health care now, derived from the Chronic Care Model, to better meet clients’ physical and mental health needs. These changes include focusing on population-level data and incorporating technology and multidisciplinary teams in treatment and prevention efforts.     

Unmet physical and mental healthcare needs of children with a history of familial homelessness and unstable housing

The objective of this paper is to examine whether children with a history of unstable housing, and more specifically homelessness, have unmet physical and mental healthcare needs. Further, this paper describes primary caregivers’ barriers to children’s healthcare. Data were collected from 6492 primary caregivers of children ages 0–17 years residing in five Dallas, Texas counties. Primary caregivers reported whether they previously experienced homelessness with their children, their children’s unmet mental and physical healthcare needs, and primary reasons for the unmet healthcare needs. Results suggest that children with a history of homelessness or unstable housing had increased odds of both mental and physical unmet healthcare needs. Prevention efforts should attempt to bridge resources for families who obtain housing but are still at increased risk for the long-term effects of homelessness exposure.     

Gestational weight gain counselling gaps as perceived by pregnant women and new mothers: Findings from the electronic maternal health survey

ProblemToo much or too little gestational weight gain (GWG) can negatively impact maternal and fetal health, according to Institute of Medicine Guidelines.BackgroundHealth care providers are key players in providing reliable evidence-informed prenatal advice related to appropriate GWG. However, there appears to be inconsistent GWG communication among healthcare providers during prenatal care.AimTo determine pregnant women and new mothers’ perceptions of healthcare provider GWG and dietary counselling during the pregnancy period.MethodsA reliable and validated cross-sectional electronic survey was administered to currently pregnant women and women who had recently given birth. The web-based questionnaire was self-administered and took 10–25 min.FindingsA total of 1507 eligible women participated in the survey. More than half (57%) reported that their healthcare provider talked to them about personal weight gain limits. Of these participants, about a third (34%) of participants were counselled regularly at each or most visits. Among the women that were not counselled on personal GWG limits, over half (56%) reported that healthcare provider guidance would have been helpful to achieve their target weight. Less than half (45%) of participants reported that their healthcare providers discussed dietary requirements or changes in pregnancy.DiscussionThese findings highlight areas for improvement in prenatal dialogue, which can support better outcomes for both mother and baby.ConclusionA better understanding of pregnant and mothers’ perceptions about weight and diet counselling is needed to understand what may need greater attention and clarification and to improve such dialogue.     

Availability without access? Globalization and socio-political cleavages in emerging economies

Scholars argue that globalization is reconfiguring socio-political cleavages. No longer do class divisions dominate. Rather, the argument goes, societies are increasingly divided between ‘cosmopolitans’ (who welcome globalization) and ‘communitarians’ (who do not). While that may be the case, studies generally consider the impact of globalization on cleavages in advanced, rather than emerging, economies. Here, we address the latter context. By exploring the impact of liberalized healthcare and education on societal structures, we argue that globalization is encouraging social stratification that could underwrite the development of a cosmopolitan/communitarian cleavage in emerging economies. Specifically, we argue that an expansion of trade into new markets is increasing the availability of goods, services, and ideas, but the high cost of new products means that access is often restricted to local elites. Thus, while elites are connecting to global networks, non-elites are increasingly disconnected – which is an arrangement that could foster a cosmopolitan/communitarian cleavage.     

The governance of primary mental health planning by Primary Health Networks

The establishment of Primary Health Networks (PHNs) was accompanied by assignment of responsibility for funding for primary mental healthcare. To ensure this funding is spent in line with government priorities, the Federal government developed a planning document with established priorities and guidance documents for how the planning document should be completed. This paper examines how these documents shape service delivery through enabling some activities and excluding others and identifies the assumptions that underpin these documents. Data were drawn from discourse and content analysis of completed planning documents from the PHNs and of the guidance documents and from reflection upon mental health planning from 55 interviews with key personnel from six PHNs. Service delivery is shaped by outcome measures that promote service access, cost‐effectiveness and clinical effectiveness, contributing to service options that favour self‐management for mild mental illness and clinical (but not social) services for people with severe mental illness. There is also limited scope for mental health promotion with prevention activities focused upon populations identified by the government as being at‐risk. This occurs to the detriment of other at‐risk populations.     

The institution of medicine and transgender identity construction: Between a doc and a hard place

Research shows that when transgender young people are well-supported throughout their gender transition they have similar levels of depression to their cisgender counterparts. For transgender young people who wish to transition medically, these support systems may include parents as advocates and healthcare professionals who specialize in transgender services. Decisions about steps throughout transition are made by transgender children, their parents, and their physicians. An examination of gender structure theory and medicalization literature helps to assess how medicine-on institutional, interactional, and individual levels-contributes to cisnormativity and enables us to reflect on the relationships among sex, gender, and science. This literature review aims to analyze how cultural ideologies influence medical processes that shape the identity construction of transgender children and it sheds light on parental involvement throughout transitions.