Examining Time to Treatment and the Role of School‐Based Health Centers in a School‐Based Sexually Transmitted Infection Program

BACKGROUND

Barriers to health care service utilization contribute to the spread of sexually transmitted infections (STIs) among teens. School‐based STI screening programs reach adolescents outside of the clinic‐based health care model and schools with school‐based health centers (SBHCs) may expedite treatment because of their proximity to the population. This study examined whether students who tested positive for STIs in a school‐based screening program had differing times to treatment based on treatment location.

METHODS

All positive cases of chlamydia and gonorrhea from the 2012‐2013 school year in a Chicago Department of Public Health (CDPH) and Chicago Public Schools school‐based STI screening program were reviewed. Median time to treatment was compared for those treated at an SBHC versus those treated elsewhere (CDPH STI clinic, community health center, private physician).

RESULTS

Overall, 540 students had positive results. The median age was 17 years, 427 had chlamydia (79.1%), 59 had gonorrhea (10.9%), and 54 had dual infections (10.0%); 144 were tested in a school with a SBHC on site (26.7%). Of the 483 students who received treatment (89.4%), those treated at a SBHC had a faster time to treatment compared to CDPH STI clinics (median 17 days versus 28 days, respectively, p < .001).

CONCLUSIONS

For students testing positive in the Chicago school‐based STI program, time to treatment is accelerated in locations with SBHCs.

     

Quality Health Care and Willingness to Pay for Health Insurance Retention: A Randomized Experiment in Kolkata Slums

The low quality of health care in developing countries reduces the poor's incentives to use quality health services and their demand for health insurance. Using data from a field experiment in India, I show that randomly offering insurance policyholders a free preventive checkup with a qualified doctor has a twofold effect: receiving this additional benefit raises willingness to pay to renew health insurance by 53%, doubling the likelihood of hypothetical renewal; exposed individuals are 10 percentage points more likely to consult a qualified practitioner when ill after the checkup. Both effects are concentrated on poorer households. There is no effect on health knowledge and healthcare spending. This suggests that exposing insured households to quality preventive care can be a cost‐effective way of raising the demand for quality health care and retaining policyholders in the insurance scheme. Copyright © 2016 John Wiley & Sons, Ltd.     

The Impact of the Eligibility Threshold of a French Means‐Tested Health Insurance Programme on Doctor Visits: A Regression Discontinuity Analysis

This paper assesses the impact of eligibility for a free means‐tested complementary health insurance plan, called Couverture Maladie Universelle Complémentaire (CMUC), on doctor visits. We use information on the selection rule to qualify for the plan to identify the effect of eligibility and adopt a regression discontinuity approach. Our sample consists of low‐income individuals enrolled in the Health Insurance Fund and recipients of social benefits from the Family Allowance Fund of an urban area in Northern France. Our findings do not show significant impacts of the CMUC threshold on the number of doctor visits within the full sample. Among the subsample of adults under 30 years old, however, eligible individuals are more likely to see a specialist and have, on average, significantly more specialist visits than non‐eligible individuals. This specific impact of the CMUC cut‐off point among young adults may be explained by the fact that young adults are less likely to be covered by a complementary health insurance plan when they are not recipients of the CMUC plan. © 2017 The Authors. Health Economics Published by John Wiley & Sons, Ltd.     

Health Insurance and Health Care among the Mid‐Aged and Older Chinese: Evidence from the National Baseline Survey of CHARLS

We document the recent profile of health insurance and health care among mid‐aged and older Chinese using data from the China Health and Retirement Longitudinal Study conducted in 2011. Overall health insurance coverage is about 93%. Multivariate regressions show that respondents with lower income as measured by per capita expenditure have a lower chance of being insured, as do the less‐educated, older, and divorced/widowed women and rural‐registered people. Premiums and reimbursement rates of health insurance vary significantly by schemes. Inpatient reimbursement rates for urban people increase with total cost to a plateau of 60%; rural people receive much less. Demographic characteristics such as age, education, marriage status, per capita expenditure, and self‐reported health status are not significantly associated with share of out‐of‐pocket cost after controlling community effects. For health service use, we find large gaps that vary across health insurance plans, especially for inpatient service. People with access to urban health insurance plans are more likely to use health services. In general, Chinese people have easy access to median low‐level medical facilities. It is also not difficult to access general hospitals or specialized hospitals, but there exists better access to healthcare facilities in urban areas. Copyright © 2016 John Wiley & Sons, Ltd.     

Effects of the State Children's Health Insurance Program on access to dental care and use of dental services

OBJECTIVE: To provide national estimates of implementation effects of the State Children's Health Insurance Program (SCHIP) on dental care access and use for low-income children. DATA SOURCE: The 1997-2002 National Health Interview Survey. STUDY DESIGN: The study design is based on variation in the timing of SCHIP implementation across states and among children observed before and after implementation. Two analyses were conducted. The first estimated the total effect of SCHIP implementation on unmet need for dental care due to cost in the past year and dental services use for low-income children (family income below state SCHIP eligibility thresholds) using county and time fixed effects models. The second analysis estimated differences in dental care access and use among low-income children with SCHIP or Medicaid coverage and their uninsured counterparts, using instrumental variables methods to control for selection bias. Both analyses controlled for child and family characteristics. PRINCIPAL FINDINGS: When SCHIP had been implemented for more than 1 year, the probability of unmet dental care needs for low-income children was lowered by 4 percentage points. Compared with their uninsured counterparts, those who had SCHIP or Medicaid coverage were less likely to report unmet dental need by 8 percentage points (standard error: 2.3), and more likely to have visited a dentist within 6 or 12 months by 17 (standard error: 3.7) and 23 (standard error: 3.6) percentage points, respectively. SCHIP program type had no differential effects. CONCLUSIONS: Consistent results from two analytical approaches provide evidence that SCHIP implementation significantly reduced financial barriers for dental care for low-income children in the U.S. Low-income children enrolled in SCHIP or Medicaid had substantially increased use of dental care than the uninsured.     

Language Proficiency and the Enrollment of Medicaid-Eligible Children in Publicly Funded Health Insurance Programs

Objectives: The purpose of the study was to examine the effect of language proficiency on enrollment in a state-sponsored child health insurance program. Methods: 1055 parents of Medicaid-eligible children, who were enrolled in a state-sponsored child health insurance program, were surveyed about how they learned about the state program, how they enrolled their children in the program, and perceived barriers to Medicaid enrollment. We performed weighted ² tests to identify statistically significant differences in outcomes based on language. We conducted multivariate analyses to evaluate the independent effect of language controlling for demographic characteristics. Results: Almost a third of families did not speak English in the home. These families, referred to as limited English proficiency families, were significantly more likely than English-proficient families to learn of the program from medical providers, to receive assistance with enrollment, and to receive this assistance from staff at medical sites as compared to the toll-free telephone information line. They were also more likely to identify barriers to Medicaid enrollment related to know-how—that is, knowing about the Medicaid program, if their child was eligible, and how to enroll. Differences based on language proficiency persisted after controlling for marital status, family composition, place of residence, length of enrollment, and employment status for almost all study outcomes. Conclusions: This study demonstrates the significant impact of English language proficiency on enrollment of Medicaid-eligible children in publicly funded health insurance programs. Strong state-level leadership is needed to develop an approach to outreach and enrollment that specifically addresses the needs of those with less English proficiency.