Does Chronic Illness Affect the Adequacy of Health Insurance Coverage?

Although chronically ill individuals need protection against high medical expenses, they often have difficulty obtaining adequate insurance coverage due to medical underwriting practices used to classify and price risks and to define and limit coverage for individuals and groups. Using data from healthy and chronically ill individuals in Indiana, we found that illness decreased the probability of having adequate insurance, particularly among single individuals. Chronic illness decreased the probability of having adequate coverage by about 10 percentage points among all individuals and by about 25 percentage points among single individuals. Preexisting condition exclusions were a major source of inadequate insurance. Our results emphasize the impact of enforcing the Health Insurance Portability and Accountability Act (HIPAA) of 1997, which limits preexisting condition exclusions

Chronic Illness and Health Insurance-Related Job Lock

We examine job duration patterns for evidence of health insurance-related job lock among chronically ill workers or workers with a chronically ill family member. Using Cox proportional hazard models, we allow for more general insurance effects than in the existing literature to indicate the impact of health insurance and health status on workers\u27 job durations. We use data for workers in Indiana predating the Health Insurance Portability and Accountability Act (HIPAA) to examine the potential impact of HIPAA on job mobility. Chronic illness reduced job mobility by about 40 percent among the workers in our sample who relied on their employers for coverage as compared to otherwise similar workers who did not rely on their employers for coverage. Our results identify previously underappreciated job lock among chronically ill workers and workers with a chronically ill family member, clarify how one best researches job lock, and indicate the potential impact of policies aimed at alleviating job lock and promoting inter-employer worker mobility. This paper was revised August 2000

Does Chronic Illness Affect the Adequacy of Health Insurance Coverage?

Although chronically ill individuals need protection against high medical expenses, they often have difficulty obtaining adequate insurance coverage due to medical underwriting practices used to classify and price risks and to define and limit coverage for individuals and groups. Using data from healthy and chronically ill individuals in Indiana, we found that illness decreased the probability of having adequate insurance, particularly among single individuals. Chronic illness decreased the probability of having adequate coverage by about 10 percentage points among all individuals and by about 25 percentage points among single individuals. Pre-existing condition exclusions were a major source of inadequate insurance. Our results emphasize the impact of enforcing the Health Insurance Portability and Accountability Act (HIPAA) of 1997, which limits pre-existing condition exclusions

Does Chronic Illness Affect the Adequacy of Health Insurance Coverage?

Up-to-date information about CPR’s research projects and other activities is available from our World Wide Web site at www-cpr.maxwell.syr.edu. All recent working papers and Policy Briefs can be read and/or printed from there as well. Although chronically ill individuals need protection against high medical expenses, they often have difficulty obtaining adequate insurance coverage due to medical underwriting practices used to classify and price risks and to define and limit coverage for individuals and groups. Using data from healthy and chronically ill individuals in Indiana, we found that illness decreased the probability of having adequate insurance, particularly among single individuals. Chronic illness decreased the probability of having adequate coverage by about 10 percentage points among all individuals and by about 25 percentage points among single individuals. Preexisting condition exclusions were a major source of inadequate insurance. Our results emphasize the impact of enforcing the Health Insurance Portability and Accountability Act (HIPAA) of 1997, which limits preexisting condition exclusions

Patient prioritization of comorbid chronic conditions in the Veteran population: Implications for patient-centered care

OBJECTIVE: Patients with comorbid chronic conditions may prioritize some conditions over others; however, our understanding of factors influencing those prioritizations is limited. In this study, we sought to identify and elaborate a range of factors that influence how and why patients with comorbid chronic conditions prioritize their conditions. METHODS: We conducted semi-structured, one-on-one interviews with 33 patients with comorbidities recruited from a single Veterans Health Administration Medical Center. FINDINGS: The diverse factors influencing condition prioritization reflected three overarching themes: (1) the perceived role of a condition in the body, (2) self-management tasks, and (3) pain. In addition to these themes, participants described the rankings that they believed their healthcare providers would assign to their conditions as an influencing factor, although few reported having shared their priorities or explicitly talking with providers about the importance of their conditions. CONCLUSION: Studies that advance understanding of how and why patients prioritize their various conditions are essential to providing care that is patient-centered, reflecting what matters most to the individual while improving their health. This analysis informs guideline development efforts for the care of patients with comorbid chronic conditions as well as the creation of tools to promote patient-provider communication regarding the importance placed on different conditions

Rab3D is critical for secretory granule maturation in PC12 cells.

Neuropeptide- and hormone-containing secretory granules (SGs) are synthesized at the trans-Golgi network (TGN) as immature secretory granules (ISGs) and complete their maturation in the F-actin-rich cell cortex. This maturation process is characterized by acidification-dependent processing of cargo proteins, condensation of the SG matrix and removal of membrane and proteins not destined to mature secretory granules (MSGs). Here we addressed a potential role of Rab3 isoforms in these maturation steps by expressing their nucleotide-binding deficient mutants in PC12 cells. Our data show that the presence of Rab3D(N135I) decreases the restriction of maturing SGs to the F-actin-rich cell cortex, blocks the removal of the endoprotease furin from SGs and impedes the processing of the luminal SG protein secretogranin II. This strongly suggests that Rab3D is implicated in the subcellular localization and maturation of ISGs

Dual Use of Veterans Health Administration and Indian Health Service: Healthcare Provider and Patient Perspectives

Many American Indian and Alaska Native veterans are eligible for healthcare from Veterans Health Administration (VHA) and from Indian Health Service (IHS). These organizations executed a Memorandum of Understanding in 2003 to share resources, but little was known about how they collaborated to deliver healthcare. To describe dual use from the stakeholders’ perspectives, including incentives that encourage cross-use, which organization’s primary care is “primary,” and the potential problems and opportunities for care coordination across VHA and IHS. VHA healthcare staff, IHS healthcare staff and American Indian and Alaska Native veterans. Focus groups were conducted using a semi-structured guide. A software-assisted text analysis was performed using grounded theory to develop analytic categories. Dual use was driven by variation in institutional resources, leading patients to actively manage health-seeking behaviors and IHS providers to make ad hoc recommendations for veterans to seek care at VHA. IHS was the “primary” primary care for dual users. There was little coordination between VHA and IHS resulting in delays and treatment conflicts, but all stakeholder groups welcomed future collaboration. Fostering closer alignment between VHA and IHS would reduce care fragmentation and improve accountability for patient care

Sequential Analysis of Trans-SNARE Formation in Intracellular Membrane Fusion

SM proteins stabilize cis-SNARE complexes leading to a specific preferred topology for trans-SNARE formation

Nucleotide Binding Switches the Information Flow in Ras GTPases

The Ras superfamily comprises many guanine nucleotide-binding proteins (G proteins) that are essential to intracellular signal transduction. The guanine nucleotide-dependent intrinsic flexibility patterns of five G proteins were investigated in atomic detail through Molecular Dynamics simulations of the GDP- and GTP-bound states (SGDP and SGTP, respectively). For all the considered systems, the intrinsic flexibility of SGDP was higher than that of SGTP, suggesting that Guanine Exchange Factor (GEF) recognition and nucleotide switch require higher amplitude motions than effector recognition or GTP hydrolysis. Functional mode, dynamic domain, and interaction energy correlation analyses highlighted significant differences in the dynamics of small G proteins and Gα proteins, especially in the inactive state. Indeed, SGDP of Gαt, is characterized by a more extensive energy coupling between nucleotide binding site and distal regions involved in GEF recognition compared to small G proteins, which attenuates in the active state. Moreover, mechanically distinct domains implicated in nucleotide switch could be detected in the presence of GDP but not in the presence of GTP. Finally, in small G proteins, functional modes are more detectable in the inactive state than in the active one and involve changes in solvent exposure of two highly conserved amino acids in switches I and II involved in GEF recognition. The average solvent exposure of these amino acids correlates in turn with the rate of GDP release, suggesting for them either direct or indirect roles in the process of nucleotide switch. Collectively, nucleotide binding changes the information flow through the conserved Ras-like domain, where GDP enhances the flexibility of mechanically distinct portions involved in nucleotide switch, and favors long distance allosteric communication (in Gα proteins), compared to GTP