Does government provision of healthcare explain the relationship between income inequality and low birthweight?

This paper estimates the relationship between state and county income inequality and low birthweight (LBW) in the U.S. It examines whether more unequal societies are also less healthy because such societies have lower investment in population health. The model includes an extensive list of community and individual controls and community fixed-effects. Results show that unequal states in fact have greater social investments, and absent these investments children born in such states would be more likely to be LBW. Using alternate measures of inequality reveals that income inequality in the upper tail of the income distribution is not related to LBW; but inequality in the lower tail of the income distribution is associated with increased LBW where the supply of healthcare mitigates the effect of income inequality. Consistent with prior findings, county income inequality is not significantly related to LBW.     

Socioeconomic predictors of weight loss after laparoscopic Roux-Y gastric bypass

Introduction  Successful weight loss after laparoscopic Roux-Y gastric bypass (LRYGB) hinges on many elements including neurohormonal, anatomical, and postoperative behavioral changes. To date, the effects of socioeconomic factors have been inadequately studied. We examine several components of socioeconomic status and its relationship to weight loss after LRYGB. Methods  Between August 2002 and July 2006, 405 LRYGB were performed by a single surgeon. Patient demographics were entered into a longitudinal, prospective database. At 1-year follow-up, 309 patients were available for analysis. Regional median household income (RMAHI) and primary insurance carrier were used as surrogates for preoperative socioeconomic status. Analysis of covariance (ANCOVA) test was used for statistical analysis. According to RMAHI, we divided the patients into three groups: US $20,001–40,000 (group A, n = 67), US $40,001–60,000 (group B, n = 153), and more than US $60,000 (group C, n = 89). Initial body mass index (BMI) was 52.76 ± 1.01, 51.28 ± 0.67, and 48.87 ± 0.94 kg/m², respectively. Additionally, patients were divided according to private insurance or state-based insurance. A total of 274 patients had private insurance, with an initial mean BMI of 50.6 kg/m², and 35 patients had state-based insurance, with an initial BMI of 53.0 kg/m². Results  After 1 year, weight loss in groups A, B and C was 110.6 ± 4.3, 110.0 ± 2.5, and 103.9 ± 3.6 lb with BMI decrease of 17.7 ± 0.6, 17.7 ± 0.4, and 16.9 ± 0.6 kg/m², respectively. Weight loss in the private insurance group was 49.2 ± 0.9 kg compared with 50.2 ± 2.3 kg in the state-based group with BMI decrease of 17.4 ± 0.3 and 18.4 ± 0.8 kg/m², respectively. There were no statistical significances in the effect of socioeconomic status, median household income, and insurance carrier on postoperative weight loss. Conclusion  With appropriate patient selection, the socioeconomic status of patients undergoing LRYGB does not affect postoperative weight loss.     

健康对个人家庭收入的影响

健康是人力资本的一个重要组成部分,是一种非常重要的人力资本,它是其他形式的人力资本得以存在的前提和基础。通过从健康状况对几个方面的影响进行分析,简单阐述了健康对个人家庭收入的影响。     

指数法分析在海南省某医院业务收入中的应用

目的：分析医院收入的构成和影响因素,掌握医院业务发展和收入变化趋势,为医院制定发展战略提供政策建议。方法：应用指数法分析海南省某医院业务量和业务收入构成及其影响因素;用直线回归法预测2009年的业务量和业务收入。结果：2005年比2006年病人数增长了11．21％,医院业务收入增加了5859．51万元。人均费用降低9．44％,业务收入减少5120．74万元,两项因素综合作用使得医院收入增长1．52％,绝对额增长738．77万元。用直线回归预测2009年医院门诊量达到1316．66千人次,住院人数达到40．85千人次,业务收入将达到76007．87万元。结论：医院应通过努力提高门诊量,带动住院量增加,同时通过提高医疗服务质量,积极拓展新农合农民医疗需求市场。应用直线回归法预测的结果比较可靠。     

Impact of regional differences in stroke symptom awareness and low-income status on seeking emergency medical service in China

Background:Unawareness of stroke symptoms and low income are two barriers that affect the seeking of emergency medical service (EMS). This study aimed to assess the effect of unawareness and low income on seeking EMS and to investigate the regional distribution of the unawareness and low-income status and their associations with failing to call EMS in China.Methods:A total of 187,723 samples from the China National Stroke Screening Survey was interviewed cross-sectionally. Four status of awareness and annual income were identified: unaware and low-income, unaware-only, low-income-only, and aware and regular income. The outcomes were whether they intended to call EMS or not. The regional distribution of each status and their associations with not calling EMS were presented.Results:The status of unaware and low-income, unaware-only, and low-income-only accounted for 6.3% (11,806/187,673), 11.9% (22,241/187,673), and 21.5% (40,289/187,673) of the total sample, respectively. Not calling EMS was significantly associated with the status of unaware and low-income (odds ratio [OR]: 3.21, 95% confidence interval [CI]: 3.07–3.35), unaware-only (OR: 2.38, 95% CI: 2.31–2.46), and low-income-only (OR: 1.67, 95% CI: 1.63–1.71), compared with the aware and regular income status. The Midwest regions had higher percentages of people in the unaware and low-income status; the East, South, and Central had higher percentages of unaware-only status; the North and Northeast regions had a higher percentage of low-income-only status, compared with other regions.Conclusion:The existence of the regional difference in unawareness and low income justifies the specific stroke education strategies for the targeted regions and population.     

Testing dental quality measures: Emergency department visits for nontraumatic dental conditions and subsequent follow-up dental visits

BackgroundThe goal of this study was to test the feasibility, reliability, and validity of the Dental Quality Alliance’s adult dental quality measures for system-level implementation for ambulatory care sensitive (ACS) emergency department (ED) visits for nontraumatic dental conditions (NTDCs) in adults and follow-up after ED visits for NTDCs in adults.MethodsMedicaid enrollment and claims data from Oregon and Iowa were used for measure testing. Testing included validation of diagnosis codes in claims data through patient record reviews of ED visits and calculations of κ statistic, sensitivity, and specificity.ResultsAdult Medicaid enrollees’ ACS NTDC ED visits ranged from 209 through 310 per 100,000 member-months. In both states, patients in the age category 25 through 34 years and non-Hispanic Black patients had the highest rates of ACS ED visits for NTDCs. Only one-third of all ED visits were associated with a follow-up dental visit within 30 days, decreasing to approximately one-fifth with a 7-day follow-up. The agreement between the claims data and patient records for identification of ACS ED visits for NTDCs was 93%, κ statistic was 0.85, sensitivity was 92%, and specificity was 94%.ConclusionsTesting revealed the feasibility, reliability, and validity of 2 DQA quality measures. Most beneficiaries did not have a follow-up with a dentist within 30 days of an ED visit.Practical ImplicationsAdoption of quality measures by state Medicaid programs and other integrated care systems will enable active tracking of beneficiaries with ED visits for NTDCs and develop strategies to connect them to dental homes.