Health Seeking Behavior in Karnataka: Does Micro-Health Insurance Matter?

Background:

Health seeking behaviour in the event of illness is influenced by the availability of good health care facilities and health care financing mechanisms. Micro health insurance not only promotes formal health care utilization at private providers but also reduces the cost of care by providing the insurance coverage.

Objectives:

This paper explores the impact of Sampoorna Suraksha Programme, a micro health insurance scheme on the health seeking behaviour of households during illness in Karnataka, India.

Materials and Methods:

The study was conducted in three randomly selected districts in Karnataka, India in the first half of the year 2011. The hypothesis was tested using binary logistic regression analysis on the data collected from randomly selected 1146 households consisting of 4961 individuals.

Results:

Insured individuals were seeking care at private hospitals than public hospitals due to the reduction in financial barrier. Moreover, equity in health seeking behaviour among insured individuals was observed.

Conclusion:

Our finding does represent a desirable result for health policy makers and micro finance institutions to advocate for the inclusion of health insurance in their portfolio, at least from the HSB perspective.     

Associations Between Online Pornography and Sexual Behavior Among Adolescents: Myth or Reality?

This study aimed to compare the sexual behavior of adolescents who were or were not exposed to online pornography, to assess to what extent the willingness of exposure changed these possible associations, and to determine the profiles of youths who were exposed to online pornography. Data were drawn from the 2002 Swiss Multicenter Adolescent Survey on Health, a self-administered cross-sectional, paper and pencil questionnaire. From the 7529 adolescents aged 16–20 years, 6054 (3283 males) used the Internet during the previous month and were eligible for our study. Males were divided into three groups (wanted exposure, 29.2%; unwanted exposure, 46.7%; no exposure, 24.1%) whereas females were divided into two groups (exposure, 35.9%; no exposure, 64.1%). The principal outcome measures were demographic characteristics, Internet use parameters and risky sexual behaviors. Risky sexual behaviors were not associated with online pornography exposure in any of the groups, except that males who were exposed (deliberately or not) had higher odds of not having used a condom at last intercourse. Bi/homosexual orientation and Internet use parameters were not associated either. Additionally, males in the wanted exposure group were more likely to be sensation-seekers. On the other hand, exposed girls were more likely to be students, higher sensation-seekers, early maturers, and to have a highly educated father. We conclude that pornography exposure is not associated with risky sexual behaviors and that the willingness of exposure does not seem to have an impact on risky sexual behaviors among adolescents.     

The Rural–Urban Divide: Health Services Utilization Among Older Mexicans in Mexico

Context: Mexico. Purpose: Using the health care service utilization model as a framework, this paper will analyze the differences in health care service use among older Mexicans living in urban and rural areas in Mexico. Methods: The Mexican Health and Aging Survey (MHAS) data were used to test the applicability of Andersen's “model of health services” of predisposing (ie, age, sex, etc.), enabling (education, insurance coverage, etc.) and need factors (diabetes, hypertension, etc.) to predict ever being in the hospital and physician visits in the past year by place of residence (urban, rural, semi-rural). Findings: Results showed that older Mexicans living in the most rural areas (populations of 2,500 or fewer) were significantly less likely to have been hospitalized in the previous year and visited the physician less often (P < .0001) than their urban counterparts. The significant difference in hospitalization between rural and urban residing older Mexicans was largely accounted for by having health care coverage. Certain need factors such as diabetes, previous heart attack, hypertension, depression, and functional limitations predicted frequency of physician visits and hospitalization, but they did not explain variations between rural and urban older Mexicans. Conclusions: Not having insurance coverage was associated with a lower likelihood of spending an overnight visit in the hospital and visiting a physician for older Mexicans. This lower utilization may be due to barriers to access rather than better health.     

Impact of Alabama’s Immigration Law on Access to Health Care Among Latina Immigrants and Children: Implications for National Reform

We conducted in-depth interviews in May to July 2012 to evaluate the effect of Alabama’s 2011 omnibus immigration law on Latina immigrants and their US- and foreign-born children’s access to and use of health services.The predominant effect of the law on access was a reduction in service availability. Affordability and acceptability of care were adversely affected because of economic insecurity and women’s increased sense of discrimination. Nonpregnant women and foreign-born children experienced the greatest barriers, but pregnant women and mothers of US-born children also had concerns about accessing care.The implications of restricting access to health services and the potential impact this has on public health should be considered in local and national immigration reform discussions.IN THE ABSENCE OF RECENT national immigration reform, state legislatures have increasingly proposed measures to address local immigration issues. Since 2007, legislators have put forth more than 1300 immigration-related bills and resolutions annually.1 Most of these failed to become law; however, in the past 4 years, Alabama, Arizona, Georgia, Indiana, South Carolina, and Utah have passed omnibus legislation to enforce immigration policy and discourage settlement of unauthorized immigrants.1 These laws contain numerous provisions that authorize local law enforcement personnel, employers, and others to verify an individual’s immigration status. All of these states also require verification of lawful presence in the United States for individuals seeking public benefits, such as health care, from state and local agencies; exceptions are made for prenatal and emergency care, child and adult protective services, and other services exempt under federal law (e.g., immunizations; the Special Supplemental Nutrition Program for Women, Infants, and Children; and short-term in-kind disaster relief).2Previous research has found that laws aimed exclusively at restricting immigrants’ access to public benefits reduce immigrants’ use of health services. Following the 1994 passage of California’s Proposition 187, immigrants failed to receive or delayed medical care out of fear of deportation.3,4 As reported in one study, fear of deportation that results in delayed treatment of communicable diseases, such as tuberculosis, can pose significant health risks to the individual and the general public.3 Requirements to present proof of lawful residence to receive publicly funded health services, such as those established in the 2005 Deficit Reduction Act, can also affect eligible legal residents and US citizens,5–7 and groups that are less able to provide appropriate documentation, such as adolescents and the elderly, may be deemed ineligible for services.6,8The broader scope of recent state-level initiatives means that immigrants’ use of health care may be adversely affected not only because unauthorized immigrants are explicitly prohibited from receiving services, but also because the laws may exacerbate transportation and financial barriers, which affect other aspects of health care access. Anecdotal evidence suggests that recent state legislation has indeed hindered immigrants’ access to routine health care.9,10 However, few studies have assessed how these laws have affected immigrants’ use of health services.11,12 With growing calls for comprehensive national immigration reform, it is important to evaluate the impact of state-level laws on immigrants’ access to care to inform discussions that will shape future policies.We examined Latina immigrants’ experiences accessing health care following the June 2011 passage of the Alabama Taxpayer and Citizen Protection Act, House Bill 56 (HB 56), which was considered the toughest state immigration law in the United States.13 Specifically, we assessed the range of ways the law has affected several dimensions of access to care for Latina immigrants and their US- and foreign-born children. Latino immigrants constitute the largest immigrant group in Alabama and in the United States overall14,15; in fact, Alabama reported the second-largest percentage increase in its Latino population between 2000 and 2010, after South Carolina.16 We focused on Latinas because they have a primary role in their children’s health and health care and typically have more health needs and greater use of health services than men.17,18     

Disparities in Adolescent Health and Health Care: Does Socioeconomic Status Matter?

DATA COLLECTION/EXTRACTION METHODS: National household survey. DATA SOURCES/STUDY SETTING: We analyzed data on 12,434 adolescents (10 through 18 years old) included in the 1999 and 2000 editions of the National Health Interview Survey. STUDY DESIGN: We assessed the presence of income gradients using four income groups. Outcome variables included health status, health insurance coverage, access to and satisfaction with care, utilization, and unmet health needs. PRINCIPAL FINDINGS: After adjustment for confounding variables using multivariate analysis, statistically significant disparities were found between poor adolescents and their counterparts in middle- and higher-income families for three of four health status measures, six of eight measures of access to and satisfaction with care, and for six of nine indicators of access to and use of medical care, dental care, and mental health care. CONCLUSION: Our analyses indicate adolescents in low-income families remain at a disadvantage despite expansions of the Medicaid program and the comparatively new State Children's Health Insurance Program (SCHIP). Additional efforts are needed to ensure eligible adolescents are enrolled in these programs. Nonfinancial barriers to care must also be addressed to reduce inequities.     

Patients’ Online Information-Seeking Behavior Throughout Treatment: The Impact on Medication Beliefs and Medication Adherence

ABSTRACT

Research on the longitudinal impact of using the internet as an information source on patients’ beliefs and medication adherence is scarce. Chronic patients (N = 107) from six hospitals were surveyed to longitudinally explore their online information seeking behavior throughout treatment (i.e., before the consultation about their newly prescribed medication in the initiation phase and after six months in the implementation phase) and how this affects their medication beliefs (concerns and necessity) and medication adherence after three weeks (T1) and six months (T2). Most patients (79%) used the internet. Patients who used the internet before the consultation reported to have more concerns about their medication at T1 and T2 compared to those who did not. Moreover, patients who used the internet throughout treatment valued their concerns higher than the necessity after six months (T2). Patients who used the internet after the consultation reported to be more non-adherent after three weeks (T1) compared to those who did not. Because of the longitudinal nature of this study, we were able to pinpoint in which treatment phase patients’ online information seeking behavior is particular relevant in affecting patients’ beliefs and medication adherence.     

The Burden of Culture? Health Outcomes Among Immigrants from the Former Soviet Union in the United States

Immigrants in the U.S. often experience better health than the native-born, and many explanations for this phenomenon center around the positive health behaviors that immigrants bring from their home cultures. Immigrants from the former Soviet Union may be an exception; because they come from societies where unhealthy lifestyles and high mortality are common, they are often expected to experience worse health than the native population. Using data from the Integrated Health Interview Series, I compare FSU immigrants with U.S.-born, non-Hispanic whites on several health measures. FSU immigrants are twice as likely as native whites to report fair or poor health, but they are less likely to smoke or drink, and are less likely to report a functional limitation. FSU immigrants’ advantage in functional limitation is largely explained by their very high levels of education and marriage, indicating that selectivity is important to understanding the health of this population.     

Community Violence and Health Risk Factors Among Adolescents on Chicago's Southside: Does Gender Matter?

We assessed community violence, school engagement, negative peer influences, mental health problems, and human immunodeficiency virus risk among 563 black adolescents. Boys reported higher rates of community violence exposures and gang involvement, while girls reported higher mental health distress. In the presence of multiple risk factors, negative peer norms were the strongest correlate of human immunodeficiency virus risk behaviors.     

You Should Know Better: Can Self-Affirmation Facilitate Information-Seeking Behavior and Interpersonal Discussion?

This study explores whether self-affirmation has the capacity not merely to reduce the perceived threat associated with health-related information but also to facilitate interpersonal discussion and affect health information–seeking behavior. The context for the study is the ongoing California drought, which serves as suitable context to examine the intersection of self-affirmation and information-seeking behavior because it involves a threatening message (the destructive consequences of the drought) and highlights discrepancies between actual (water waste) and prosocial (water conservation) behavior. Results of a month-long longitudinal panel study demonstrate significant effects of self-affirmation on interpersonal discussion, information seeking, knowledge, and water-conserving behavior across time. Implications for theorizing longer term effects of self-affirmation and practical implications for promoting behavioral change through the enhancement of knowledge and self-esteem are considered.     

Childhood Nutrition in Rural China: What Impact Does Public Health Insurance Have?

ObjectivesTo investigate the impact of public health insurance coverage, specifically the New Cooperative Medical Scheme (NCMS), on childhood nutrition in poor rural households in China, and to identify the mechanisms through which health insurance coverage affects nutritional intake.MethodsLongitudinal data on 3291 children were taken from four time periods (2004, 2006, 2009, and 2011) from the China Health and Nutrition Survey (CHNS). Panel data analysis was performed with the fixed-effect model and the propensity score matching with difference-in-differences (PSM-DID) approach.ResultsThe introduction of the NCMS was associated with a decline in calories, fat, and protein intake, and an increase in the intake of carbohydrates. The NCMS had the greatest negative effect on children aged 0 to 5 years, particularly girls. Out-of-pocket medical expenses were identified as the main channel through which the NCMS affected the nutritional intake of children.ConclusionsThe study showed that the NCMS neither significantly improved the nutritional status of children nor enhanced intake of high-quality nutrients among rural poor households. These findings were attributed to the way in which health-seeking behavior was modified in the light of NCMS coverage. Specifically, NCMS coverage tended to increase healthcare utilization, which in turn increased out-of-pocket medical expenditures. This encouraged savings to aid financial risk protection and resulted in less disposable income for food consumption.     

Do Positive Parenting Practices Moderate Parental Mental Health and Child Behavior Among Homeless Families?

The social interaction learning framework was used to explore whether positive parenting practices (noncoercive discipline, clear expectations, and praise and incentives) mitigated any effects of parent mental health (psychological distress and parenting stress) on child externalizing behaviors in a predominantly African American sample of homeless parents residing in transitional housing (N = 52, 79.6% female). The results showed that the positive relationship between psychological distress and child behavior was attenuated when parents provided high levels of praise and incentives. In addition, a positive relationship between parenting stress and child behavior existed only when parents transmitted low levels of praise and incentives. No significant findings existed for noncoercive discipline and clear expectations. The results suggest the need to further understand the positive aspects of parenting in the context of homelessness that can promote child adjustment even if parental mental health is compromised.     

Does the Universal Health Insurance Program Affect Urban‐Rural Differences in Health Service Utilization Among the Elderly? Evidence From a Longitudinal Study in Taiwan

Purpose: To assess the impact of the introduction of Taiwan's National Health Insurance (NHI) on urban‐rural inequality in health service utilization among the elderly. Methods: A longitudinal data set of 1,504 individuals aged 65 and older was constructed from the Survey of Health and Living Status of the Elderly. A difference‐in‐differences model was employed and estimated by the random‐effect probit method. Finding: The introduction of universal NHI in Taiwan heterogeneously affected outpatient and inpatient health service utilization among the elderly in urban and rural areas. The introduction of NHI reduced the disparity of outpatient (inpatient) utilization between the previously uninsured and insured older urban residents by 12.9 (22.0) percentage points. However, there was no significant reduction in the utilization disparity between the previously uninsured and insured elderly among rural residents. Conclusions: Our study on Taiwan's experience should provide a valuable lesson to countries that are in an initial stage of proposing a universal health insurance system. Although NHI is designed to ensure the equitable right to access health care, it may result in differential impacts on health service utilization among the elderly across areas. The rural elderly tend to confront more challenges in accessing health care associated with spatial distance, transportation, social isolation, poverty, and a lack of health care providers, especially medical specialists.     

Older Korean American Men’s Prostate Cancer Screening Behavior: The Prime Role of Culture

East and South Asian male immigrants show markedly low odds of prostate cancer screening as compared to U.S.-born men. However, knowledge about these immigrants’ culture-based screening behavior and barriers to screening is extremely limited. This study investigates factors influencing receipt of prostate cancer screening among Korean American immigrant men, particularly investigating culture’s impact on screening behaviors. Data were collected through a convenience and purposive sampling technique from 134 Korean American males aged 50 and older recruited in New York City. A structured questionnaire was used and cultural variables were measured by adopting items from Tang and colleagues’ work. Approximately 60 % of the sample had received a prostate-specific antigen (PSA) test in their lifetime, and of these, about 66 % reported having done so in the previous 12 months. Logistic regression analysis revealed that a crisis-oriented intervention approach was associated with a substantially reduced likelihood of screening. A positive correlation was noted between the use of Eastern medicine and PSA test receipt. Further analysis revealed a significant interaction effect between use of Eastern medicine and age in predicting PSA test uptake. Culture-specific intervention strategies for increasing prostate cancer screening in this group are discussed, with particular attention to increasing pertinent health literacy. Health professionals should consider the cultural domain when working with Korean immigrant men in order to provide culturally competent care.     

Health Behavior Change: Can Genomics Improve Behavioral Adherence?

The National Human Genome Research Institute recommends pursuing “genomic information to improve behavior change interventions” as part of its strategic vision for genomics. The limited effectiveness of current behavior change strategies may be explained, in part, by their insensitivity to individual variation in adherence responses.The first step in evaluating whether genomics can inform customization of behavioral recommendations is evidence reviews to identify adherence macrophenotypes common across behaviors and individuals that have genetic underpinnings. Conceptual models of how biological, psychological, and environmental factors influence adherence also are needed.Researchers could routinely collect biospecimens and standardized adherence measurements of intervention participants to enable understanding of genetic and environmental influences on adherence, to guide intervention customization and prospective comparative effectiveness studies.IN ITS RECENTLY PUBLISHED Nature article, “Charting a Course for Genomic Medicine: From Base Pairs to Bedside,” the National Human Genome Research Institute describes research priorities for the coming decade, with the overarching aim of using a genomic understanding of disease to inform improvements in medical care.1 The breadth of territory covered is impressive, but it precludes precise delineation of the many and diverse directions that could be taken to achieve this vision.Noteworthy for the field of public health is the recommendation for research to pursue applications of “genomic information to improve behavior change interventions.”1^(p210) Indeed, the fundamental importance of behavior change in any efforts to improve health outcomes is indisputable. Behavioral risk factors (e.g., tobacco use, poor diet, and physical inactivity) are major contributors to the incidence of chronic diseases worldwide.2 Recognition is increasing that reducing the burden of chronic disease will require researchers to acknowledge the complex interrelationships among behavior, environment (both social and physical), and genetics3: the genomic perspective.Nascent research suggests elemental questions and initial hypotheses about how genomic discovery may lead to more effective behavior change interventions. Certain crucial tenets should guide this exploration: (1) current intervention strategies have had limited effect on long-term behavior change and need innovation, (2) standard behavior change recommendations are insensitive to individual variation in intervention response, and (3) understanding the genomics that underlie individual variation could suggest methods for customizing behavior change recommendations to be evaluated in comparative effectiveness trials.     

Perceptions of Adolescents’ Sexual Behavior Among Mothers Living With and Without HIV: Does Dyadic Sex Communication Matter?

Previous studies suggest that mothers can help adolescents make responsible sexual decisions by talking with them about sexual health. Yet, it is not clear how and when mothers make decisions about talking with their adolescents about sex. We sought to determine: (1) the accuracy of mothers’ and adolescents’ predictions of adolescents’ age of sexual debut; and (2) if mothers’ beliefs about their adolescents’ sexual behavior affected the frequency of mother–adolescent communication about sexual topics and, in turn, if mother–adolescent communication about sexual topics affected mothers’ accuracy in predicting adolescents’ current and future sexual behavior. Participants were 129 urban, ethnic minority HIV-negative youth (52% male and 48% female; ages 10–14 years at baseline; ages 13–19 years at follow-up) and their mothers; 47% of mothers were HIV-positive. Most mothers and adolescents predicted poorly when adolescents would sexually debut. At baseline, mothers’ communication with their early adolescents about sexual topics was not significantly associated with mothers’ assessments of their early adolescents’ future sexual behavior. At follow-up, mothers were more likely to talk with their adolescents about HIV prevention and birth control if they believed that their adolescents had sexually debuted, though these effects were attenuated by baseline levels of communication. Only one effect was found for adolescents’ gender: mothers reported greater communication about sex with daughters. Studies are needed to determine how mothers make decisions about talking with their adolescents about sex, as well as to examine to what extent and in what instances mothers can reduce their adolescents’ sexual risk behavior by providing comprehensive, developmentally appropriate sex education well before adolescents are likely to debut.     

The Veterans Health Administration: An American Success Story?

The Veterans Health Administration (VHA) provides health care for U.S. military veterans. By the early 1990s, the VHA had a reputation for delivering limited, poor-quality care, which led to health care reforms. By 2000, the VHA had substantially improved in terms of numerous indicators of process quality, and some evidence shows that its overall performance now exceeds that of the rest of U.S. health care. Recently, however, the VHA has started to become a victim of its own success, with increased demands on the system raising concerns from some that access is becoming overly restricted and from others that its annual budget appropriations are becoming excessive. Nonetheless, the apparent turnaround in the VHA's performance offers encouragement that health care that is both financed and provided by the public sector can be an effective organizational form.     

Hospital Readmissions Among Post-acute Nursing Home Residents: Does Obesity Matter?

ObjectivesTo explore profiles of obese residents who receive post-acute care in nursing homes (NHs) and to assess the relationship between obesity and hospital readmissions and how it is modified by individual comorbidities, age, and type of index hospitalizations.DesignRetrospective cohort study.Setting and participantsMedicare fee-for-service beneficiaries who were newly admitted to free-standing US NHs after an acute inpatient episode between 2011 and 2014 (N = 2,323,019).MeasuresThe Minimum Data Set 3.0 were linked with Medicare data. The outcome variable was 30-day hospital readmission from an NH. Residents were categorized into 3 groups based on their body mass index (BMI): nonobese, mildly obese, moderate-to-severely obese. We tested the relationship between obesity and 30-day readmissions by fixed-effects logit models and stratified analyses by the type of index hospitalization and residents' age.ResultsForty percent of the identified residents were admitted after a surgical episode, and the rest were admitted after a medical episode. The overall relationship between obesity and readmissions suggested that obesity was associated with higher risks of readmission among the oldest old (≥85 years) residents but with lower risks of readmission among the youngest group (65-74 years). After accounting for individual co-covariates, the association between obesity and readmissions among the oldest old residents became weaker; the adjusted odds ratio was 1.061 (P = .049) and 1.004 (P = .829) for moderate-to-severely obese patients with surgical and medical index hospitalizations, respectively. The protective effect of obesity among younger residents reduced after adjusting for covariates.Conclusions/RelevanceThe relationship between obesity and hospital readmission among post-acute residents could be affected by comorbidities, age, and the type of index hospitalization. Further studies are also warranted to understand how to effectively measure NH quality outcomes, including hospital readmissions, so that policies targeting at quality improvement can successfully achieve their goals without unintended consequences.