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Disparities in access to health services continue to exist among adults age 65 and older in the United States despite near-universal insurance coverage provided through Medicare. One potential barrier to health service utilization is knowledge of health insurance coverage. Medicare has been drastically restructured in the recent past, and as the program becomes increasingly privatized, Medicare enrollees are left with more choices, but also a more complicated system through which to navigate. This study examines the relationship between Medicare enrollee knowledge of their Medicare health insurance and sociodemographic factors, health status, and the use of health services. Data was analyzed from the National Health Interview Survey (NHIS), a nationally representative study of the U.S. civilian, non-institutionalized, household population. Included in this study were Black, Hispanic, and White respondents aged 65 and older who participated in the NHIS from 2004 to 2009 (N=30,002). The prevalence of a lack of Medicare knowledge appears to be low among Medicare enrollees, with 13% reporting they did not know the answer to one or more questions about their coverage. Age and chronic illness status were found to be related to Medicare plan knowledge, with older adults and those who were not chronically ill more likely to report they did not know some aspect about their Medicare plan. Respondents who reported not knowing at least one question about their Medicare plan reported significantly fewer medical office visits and more time since they last interacted with a doctor, were less likely to have talked with a medical specialist, and have had surgery over the past year. The findings from this study suggest that knowledge of health insurance coverage is an important correlate of health service utilization, which may be shaped by disparities in access to health insurance across the life course.

Under the Patient Protection and Affordable Care Act (ACA), many low-income consumers have become eligible for government support to buy health insurance. Whether these consumers are able to take advantage of the support and to make sound decisions about purchasing health insurance likely depends on their knowledge and skills in navigating complex financial products. This ability is frequently referred to as “financial literacy.” We examined the level and distribution of consumers' financial literacy across income groups, using 2012 data collected in the RAND American Life Panel, an internet panel representative of the US population. Low financial literacy was particularly prevalent among individuals with incomes between 100% and 400% of the federal poverty level, many of whom will be eligible for health insurance subsidies. In this group, people who are young, less educated, female, and have less income were more likely to have low financial literacy. Our findings suggest the need for targeted policies to support vulnerable consumers in making good choices for themselves, possibly above and beyond the support measures already part of the ACA.

This paper aims to evaluate Ghana's National Health Insurance Scheme (NHIS) on healthcare utilisation by exploring its heterogeneous effects based on residential status and wealth.

The study used the Ghana Socioeconomic Panel Survey (GSPS) datasets. An instrumental variable strategy, specifically the two-stage residual inclusion (2SRI), was employed to control endogenous NHIS membership.

Generally, the results show that NHIS improves healthcare utilisation (i.e. visits to a health facility and formal care). Concerning the heterogeneous effects of health insurance on healthcare utilisation, the results revealed that NHIS members are more likely to seek care, irrespective of their residence status. The results further indicate that the probability of visiting a health facility and utilising formal care increases for the poorest NHIS participants. Based on these, the authors conclude that NHIS provides equitable healthcare access and utilisation for its vulnerable populations, who are beneficiaries.

To the best of the authors' knowledge, this paper is the first to explore the heterogeneous effects of NHIS on healthcare utilisation across residential and income subpopulations. Splitting the dataset by residential status to examine healthcare utilisation inequality is worthwhile. In addition, analysing utilisation in terms of health care type would show whether Ghana's NHIS may be viewed as welfare-enhancing through increased formal health care utilisation.

The peer review history for this article is available at: https://publons.com/publon/10.1108/IJSE-05-2023-0330

This chapter describes the results of an exploratory study that examined parents’ experiences with the law as they obtained funding for speech generating devices for their children with communication disabilities, either through public health insurance, private health insurance, or a public school. Exploring legal consciousness: Experiences of families seeking funding for assistive technologies for children with disabilities. Law, Policy, and Society Dissertations. Paper 17. Retrieved from http://hdl.handle.net/2047/d20000265). The study explored how parents engaged with the law and how their experiences and perceptions about the law compared to the formal law. This research was based on sociolegal theory, particularly the concept of legal consciousness, which examines how people think and act in relation to the law as a consequence of social interactions, and analyzes how law in action compares with the formal law. Sociolegal theory broadens the definition of law to include “the meanings, sources of authority, and cultural practices” (Ewick & Silbey, 1998, p. 22) as well as the formal law.

Similar to other sociolegal research, this study collected personal narratives of law using grounded theory methods to identify themes within those narratives. The narratives revealed that while parents expressed varieties of legal consciousness, there was one overarching theme: the law provided a framework for parents to envision rights, discuss rights, and claim rights. While few parents invoked formal legal mechanisms to solve grievances, the law created a rights consciousness among parents which empowered them to acknowledge and validate the notion of rights and entitlements.

This qualitative study explores how individuals understand health insurance concepts and make health insurance purchase decisions. The study sought to develop a model of the health insurance decision-making process.

This study used semi-structured interview questions and the micro-moment time-line interview technique with newly hired employees to discuss the steps that individuals follow when making health insurance decisions. The researcher used an open coding approach to analyze the steps listed by each participant, and emergent themes were used to code all interview transcripts in Atlas.ti.

This study identified information tactics used by individuals when evaluating health insurance documentation. The findings also shed light on the personal reflection individuals undertake when making their health insurance choices.

The information needs and preferred information sources identified in this study will be of interest to information professionals and human resources officers providing assistance with health insurance enrolment.

The findings demonstrating that participants characterized their health insurance choice as a shared decision is a novel contribution of this study.

The purpose of this paper is to establish the main factors influencing willingness to pay for health insurance and pension schemes among informal workers in low- and middle-income countries (LMICs). Historically, informal economy workers have been excluded from social protection coverage. There is a growing need, interest and policy discourse in LMICs to extend social security to informal economy workers. However, little is known about informal workers' willingness to pay (WTP) for social security services in different LMIC settings.

The authors conducted a systematic review and searched five databases from 1987 to 2017. Included papers focused on “social security”, “social insurance”, “pension”, “informal economy”, “informal sector” and “informal workers” in LMICs. Authors conducted independent data appraisal and data extraction. A total of 1790 papers were identified. After exclusion, 34 papers were included in the analysis. Given the heterogeneous results, the authors performed a narrative synthesis to consolidate the findings of the different studies.

In total, 34 studies from 17 countries were included in the review, out of which 23 studies focused on health insurance, 7 studies on pension schemes and 4 studies on social security in general. The study showed that income and trust were associated with WTP for both health insurance and pension schemes. In addition, family size, age, education and residential area were common factors for both forms of social security. For health insurance, experience of sickness, attitude and presence of medical doctors as well as distance from the healthcare facility all played a role in determining WTP. For pension schemes, low and flexible contribution rates, benefit package, government subsidies and quality of administration of the schemes influenced enrolment and contributions.

More evidence is needed for WTP for pensions among informal workers.

The findings show that socio-economic differences, scheme-type (health or pension) and level of trust influence WTP for health insurance or pension among informal sector workers. The review results suggest that the factors influencing WTP for health insurance and pensions interplay in a complex web of relations. More evidence is needed on WTP for pensions among informal workers.

Further studies are particularly needed on the interrelationship of the influences to WTP, including gender issues, access barriers and socioeconomic factors, among program design issues for social security.

This paper is based on a systematic review methodology and contributes to the discourse on extending social security to informal economy workers based on evidence from various countries.

Objective – To understand the role and influence of villagers’ trust for the health insurer on enrollment in a community-based health insurance (CBHI) scheme in Cambodia.

Methodology/approach – This study was conducted in northwest Cambodia where a CBHI scheme operates with the highest enrollment rates in the country. A mixed method approach was employed to gauge how individuals in the community trust the health insurer, and whether this plays a role in their decisions to enroll in CBHI schemes. Focus groups and household surveys were carried out to identify and measure trust levels, and to explore the association between insurer trust and enrollment in CBHI schemes.

Findings – Although villagers generally trusted the health insurance organization, villagers with poor experiences with other organizations in the past were less willing to trust the insurer. Insurer trust represented a combination of interpersonal and impersonal trust. After controlling for demographic factors, health care utilization, and household socio-economic status, insurer trust levels for villagers who newly enrolled (RRR=1.07, p<0.001) and renewed insurance (RRR=1.15, p<0.001) were significantly higher than those who never enrolled in CBHI schemes.

Implications for policy – This study illustrates the relationship between CBHI enrollment and villagers’ trust for the health insurer in a low-income, post-conflict country. It highlights the need for staff of health insurance organizations to place greater emphasis on building trusting interpersonal relationships with villagers. Understanding the nature of trust for the health insurer is essential to improve health insurance enrollment and protect people in poor rural communities against the impact of health-related shocks.

The health-care industry has multiple stakeholders, with knowledge dispersed among clinicians, experts and patients and their families. As the adoption of health-care information technologies (HITs) depends on multiple factors, this study aims to uncover the motivators for adopting them.

The study considers 391 respondents, representing the health-care sector, to evaluate the motivators for adopting HITs for better-dispersed knowledge management. The authors analyze the responses using exploratory factor analysis (EFA) to identify the actual structure of the factors, followed by confirmatory factor analysis (CFA).

EFA categorized the factors into four classes: quality management; information sharing; strategic governance; and available technological infrastructure. CFA revealed that the strategic governance factor is most predictive of successfully adopting HITs that model the normative pressure of Institutional theory in health-care organizations. These results indicate that, along with considerations of finances, care quality and infrastructure, effective government involvement and policy-making are important for successful HIT adoption.

Results reveal that stakeholders’ motivating factors for HIT adoption in a developed economy like the United Arab Emirates are based on considering HITs as a knowledge management mechanism. These factors may help other nations in HIT implementation and drive valuable innovations in the health-care sector. This research presents the implications for health-care professionals and stakeholders in relation to adopting HITs and their role in knowledge flow for efficient care.

HITs offer an affordable and convenient platform for collaboration among diverse teams in the health-care sector. Apart from this, it helps in facilitating an interactive platform for knowledge creation and transfer for the benefit of users and providers.

Securing a job in an industry is a boon for most of the slum dwellers. When the primary earner of a slum household suffers from occupational illness and injuries, without insurance coverage or partial coverage of insurance, this boon may become a curse in the long run. The occupational security and safety along with the fact that whether such workers are insured is an important aspect and has a close link with the expenditure on illness. Thus, the accessibility to employees’ insurance in the risky industrial occupation, particularly for slum dwellers, is crucial to protect them from falling into poverty. Studies on occupational health of the poor workers are either limited to informal sectors or remain industry specific and the analysis of their accessibility to job insurance is rarely done. The paper aims to discuss these issues.

The research questions are framed to analyze the types of insurance accessible to workers across various industries; the accessibility to insurance, however, varying across risk intensities of various industries; and the determinants of insurance accessibility of the industrial workers living in slums. The determinants of accessibility of job insurance are analyzed with a binary Logit model. A multi-stage random sampling technique is used to collect the primary data from 320 industrial workers living in the slums of the Indian state of West Bengal.

The industrial workers, irrespective of the types of industries, are exposed to a high-risk category without proper job insurance. The higher industrial income is not adequate to prevent financial hardships. Access to insurance is more likely for the respondents with job tenure of more than two years and less likely for the workers who are working for more than eight hours per day.

This study provides a significant insight to the policymakers concerning health dynamics of the slum dwellers, which can improve their livelihood.

The analysis of the industry-specific risk intensities with accessibility to insurance contributes to understanding the coverage of the insurance scheme for the workers in slums.

Consumer health literacy is a necessary skill in all facets of library work, from reference desk to programming to website development. In this chapter, the authors present key terms in the domain of health literacy; challenges and controversies in research and public library practice; and findings from a recent study of public library workers meeting consumer health information needs. Finally, the authors present examples of National Library of Medicine (NLM) initiatives for public libraries and public librarians focusing on bridging health literacy gaps. Socially disadvantaged groups who are the most affected by health disparities tend to be those who are lower-income, have less education, and are not White. The combined effects of environment and socioeconomic status mean that these communities have particular, highly local challenges in addressing their health issues, as individuals and as a population. Health literacy can serve as the enabling factor in obtaining quality health information, navigating healthcare, and seeking better health. To support the public, NLM and its National Network of Libraries of Medicine have placed a strategic emphasis on public libraries in order to develop long-term partnerships. The goals of these partnerships are to support staff development and programming, and to promote resource-sharing about programs and activities focusing on health information. Public libraries are everywhere and open to all. This makes them the ideal community agency to reach out to the public and implement national information initiatives.