Wages, Health Benefits, and Workers' Health

Examines the divide in the U.S. labor market between higher wage earners with health insurance, and lower wage earners who often lack coverage and access to essential health care

Health care and hospitalisation costs of cardiovascular disease (CVD) in Thailand

Background: Cardiovascular disease (CVD) has become a leading cause of death and disability in Thailand due to the unhealthy lifestyle of the populace; triggering high risk of exposure to CVD, increase in the number of hospital admissions year on year. Objectives: The concerns generated by the inflation in the health care expenditure among service providers motivated this study to examine the costs of hospitalisation of inpatients with (CVD) conditions in Thailand, 2009. Methods: Anonymised secondary data of 327,435 CVD inpatients under “Universal Coverage” (UC) health care scheme were obtained from the National Health Security Office (NHSO), Thailand. The data(51.69%- women and 48.31% - men) were classified using International Classification of Diseases, Tenth Revision (ICD-10) code, of which I20-I25 are Ischemic heart disease (IHD), I60-I69 are stroke and I00- I99areallCVD conditions. Results: Average costs of treatments for all CVD conditions, IHD and stroke were ฿21,921 (£1 = ฿50), ฿32,884 (highest) and ฿25,617.67per patient respectively. Absolute total cost increased with age and the cost of admission of male patients is higher than female. The average (three months) length of stay for stroke patients was found to be the highest. Conclusion: Providers generally spent a total of ฿7,177 million on the treatment of CVD with IHD and stroke taking ฿2,544 million and ฿1,920 million respectivel

Health Coverage for Aging Baby Boomers: Findings From The Commonwealth Fund Survey of Older Adults

Examines healthcare quality and access by baby boomers in working families. Offers recommendations for expanding coverage, including options for savings accounts and early participation in Medicare

Squeezed: Why Rising Exposure to Health Care Costs Threatens the Health and Financial Well-Being of American Families

Examines U.S. healthcare costs compared with other industrialized countries, individual health insurance coverage, individual market regulations, and the impact of high deductible plans on the health of individuals with chronic disease

Gaps in Health Insurance: An All-American Problem

Presents findings from a survey that examines health insurance coverage, rising healthcare costs, and the health and financial consequences to families that experience breaks in insurance

Front and Center: Ensuring That Health Reform Puts People First

Outlines the failures of the healthcare system and the benefits of the Commonwealth Fund's comprehensive reform plan for the uninsured, the underinsured, those who cannot afford out-of-pocket costs or premiums, and others without adequate access to care

A Pilot Randomized Controlled Trial of a Holistic Needs Assessment Questionnaire in a Supportive and Palliative Care Service

Context. At present, there is no widely used systematic, evidence-based holistic approach to assessment of patients’ supportive and palliative care needs. Objectives To determine whether the use of a holistic needs assessment questionnaire, SPARC, will lead to improved health care outcomes for patients referred to a palliative care service. Methods This was an open, pragmatic, randomized controlled trial. Patients (N=182) referred to the palliative care service were randomized to receive SPARC at baseline (n=87) or after a period of two weeks (waiting list control n=95). Primary outcome measure: difference in score between MYCAW patient-nominated concern 1 on the patient self-scoring visual analogue scale at baseline and the two-week follow-up. Secondary outcomes: difference in scores in the MYCAW, EQ-5D, and PEI scores at weeks 2, 4 and 6. Results There was a significant association between change in MYCAW score and whether the patients were in the intervention or control group (χ2trend = 5.51; df = 1; P = 0.019). A higher proportion of patients in the control group had an improvement in MYCAW score from baseline to week 2: Control: 34 of 70 (48.6%) vs. Intervention: 19 of 66 (28.8%). There were no significant differences (no detectable effect) between the control and intervention groups in the scores for EQ5D and PEI at 2-, 4-, or 6-week follow-up. Conclusion This trial result identifies a potential negative effect of SPARC in specialist palliative care services, raising questions that standardized holistic needs assessment questionnaires may be counterproductive if not integrated with a clinical assessment that informs the care plan

Improving Communication between Doctors and Parents after Newborn Screening

Background: Newborn screening (NBS) enables early treatment, and some consider it a natural vehicle for genetic screening. Bioethicists argue for caution since families of infants with carrier status can develop psychosocial complications. This paper describes the methods and feasibility of Wisconsin’s statewide project for quality improvement of communication and psychosocial outcomes after NBS. Methods: When NBS identifies carrier status for cystic fibrosis or sickle cell, we contact primary care providers (PCPs), answer questions, and invite them to rehearse informing the parents. Three months later, we telephone the parents, assess knowledge and psychosocial outcomes, provide counseling, and assist with self-referral to further resources. Afterward, evaluation surveys are provided to the parents, to be returned anonymously. Results: Birthing facilities provided accurate PCP names for 73% of 817 infants meeting inclusion criteria; we identified PCPs for 21% more. We reached 47.3% of PCPs in time to invite a rehearsal; 60% of these accepted. We successfully called 50.2% of eligible parents; 61% recalled a PCP explanation, and 48.5% evaluated the explanation favorably. Evaluations by parents with limited health literacy were less favorable. Conclusion: It is feasible to follow parents for psychosocial outcomes after NBS. Preliminary data about communication is mixed, but further data will describe psychosocial outcomes and investigate outcomes’ associations with communication