Triple jeopardy: Adolescent experiences of sex work and migration in Zimbabwe

Adolescence, migration and sex work are independent risk factors for HIV and other poor health outcomes. They are usually targeted separately with little consideration on how their intersection can enhance vulnerability. We interviewed ten women in Zimbabwe who experienced sex work and migration during adolescence, exploring implications for their health and for services to meet their needs. For most, mobility was routine throughout childhood due to family instability and political upheaval. The determinants of mobility, e.g. inability to pay school fees or desire for independence from difficult circumstances, also catalysed entry into sex work, which then led to further migration to maximise income. Respondents described their adolescence as a time of both vulnerability and opportunity, during which they developed survival skills. While these women did not fit neatly into separate risk profiles of “sex worker” “migrant” or “adolescent”, the overlap of these experiences shaped their health and access to services. To address the needs of marginalised populations we must understand the intersection of multiple risks, avoiding simplified assumptions about each category.     

Why millions of children eligible for Medicaid and SCHIP are uninsured: poor retention versus poor take-up

More than two-thirds of uninsured U.S. children are eligible for public coverage, and most current policy debate assumes that this is largely attributable to poor take-up. This paper explores the contribution of poor retention in Medicaid and the State Children's Health Insurance Program (SCHIP) to this phenomenon. The results indicate that one-third of all uninsured children in 2006 had been enrolled in Medicaid or SCHIP the previous year. Among those uninsured but eligible for public coverage in 2006, at least 42 percent had been enrolled in Medicaid or SCHIP the previous year. Both of these measures of disenrollment have increased since 2000.     

Response to health insurance by previously uninsured rural children.

OBJECTIVE: To examine the healthcare utilization and costs of previously uninsured rural children. DATA SOURCES/STUDY SETTING: Four years of claims data from a school-based health insurance program located in the Mississippi Delta. All children who were not Medicaid-eligible or were uninsured, were eligible for limited benefits under the program. The 1987 National Medical Expenditure Survey (NMES) was used to compare utilization of services. STUDY DESIGN: The study represents a natural experiment in the provision of insurance benefits to a previously uninsured population. Premiums for the claims cost were set with little or no information on expected use of services. Claims from the insurer were used to form a panel data set. Mixed model logistic and linear regressions were estimated to determine the response to insurance for several categories of health services. PRINCIPAL FINDINGS: The use of services increased over time and approached the level of utilization in the NMES. Conditional medical expenditures also increased over time. Actuarial estimates of claims cost greatly exceeded actual claims cost. The provision of a limited medical, dental, and optical benefit package cost approximately $20-$24 per member per month in claims paid. CONCLUSIONS: An important uncertainty in providing health insurance to previously uninsured populations is whether a pent-up demand exists for health services. Evidence of a pent-up demand for medical services was not supported in this study of rural school-age children. States considering partnerships with private insurers to implement the State Children's Health Insurance Program could lower premium costs by assembling basic data on previously uninsured children.     

The uninsured, the working uninsured, and the public

Recent opinion surveys show a high level of public support for the current employer-based health insurance system. Many Americans are not aware that this system is endangered or that the number of uninsured persons is growing. The public appears to favor a two-track system for the working uninsured--strengthening the existing employer-based system and developing a parallel system for those without employer coverage.     

Identifying the insured and uninsured in rural America: an empirical discriminant analysis

PurposeThis present study sought to investigate whether there were factors that could discriminate insured from uninsured rural Americans.MethodsData for four groups were used: 34 uninsured, 102 government-insured (GP), 324 private- or employer-insured (PEP), and 96 both government- and private- or employer-insured (GPEP). A discriminant analysis was conducted on the four groups, using group membership as the dependent variable; age, education, income, attitude to insurance, emergency room visit, chronic disease prevalence were the independent variables.FindingsThe analysis yielded three discriminant functions, however the only significant function was the one that discriminated the PEP-insured individuals from the other groups. About 48% of the cases were classified correctly with the significant discriminant function.ConclusionThe findings of this study can serve as a baseline for future research seeking to eradicate barriers to getting health insurance among the uninsured in rural America.     

Avoiding the cost burden of newborn screening for the poor and uninsured: Mississippi's model

The Mississippi State Department of Health Genetic Screening Program began in 1982 with hospitals joining the program on a volunteer basis. In 1985 legislation which mandated Newborn Screening provided the Mississippi Department of Health with the responsibility to promulgate rules and regulations establishing laboratory standards, to assure that each newborn was screened and to bill the hospital for each test. The Mississippi State Department of Health charges $12.75 per each newborn tested. This cost includes PKU, T4 (TSH if T4 is abnormal), and Hemoglobinopathy screening, as well as an administrative and follow-up charge. In order to compare the costs of existing systems which coordinate services related to newborn screening, a survey has been done. The confirmatory test for hemoglobinopathy screening will be performed in the Mississippi State Department of Health Laboratory beginning July 1, 1990. This will enable the Mississippi Genetic Screening Program to charge for patients who qualify for Medicaid.     

Health insurance, the uninsured, and hospitals: collision course

The number of uninsured Americans is approaching 50 million, with little evidence that the situation will improve any time soon. Although the consequences of this are serious in many ways, the implications for hospitals are especially severe, as they are the providers of care of last resort. Among the most serious problems for hospitals that treat uninsured patients are financial losses; difficulties in planning and in allocating resources; the need to make painful choices; litigation, both public and private; loss of community faith; the possible closing of needed institutions; and a perception of moral failure. The question is whether American hospitals have the will and the ability to stave off an impending disaster.     

Health care access in three nations: Canada, insured America, and uninsured America.

This analysis provides new statistics for one of the oldest and fiercest debates in American health policy: whose residents have better access to health care, the United States' or Canada's? Data from the 2002-2003 Joint Canada U.S. Survey of Health show that, despite major differences in their health systems, most Canadians and Americans get the care they need. However, one group of Americans is much more likely to report serious access barriers--the uninsured. About one-third of currently or recently uninsured Americans, aged 18 to 64, said they could not get needed health care (over three times the rate of insured Americans or Canadians). Compared with Canadians and insured Americans, the uninsured are less likely to use hospital or physician services, and those who do are less satisfied with the care they receive. They are also less likely to purchase prescribed medications, due to cost. From a consumer perspective, the most salient feature of the Canadian system is its universality. In contrast, insured Americans under age 65 are at risk of losing their insurance and facing substantial access barriers.