Pub Date : 2021-07-13DOI: 10.1108/IJHG-05-2021-0046
Sutti Sooampon, P. Pisarnturakit, S. Sooampon
PurposeThis study investigated the conditions required to foster healthcare innovation. Due to the limited research and development (R&D) capability of the Thai private sector, universities are increasingly expected to be emerging sources of healthcare products. However, the lack of experience in research commercialization requires that whether and how Thai university researchers can serve this mission be explored.Design/methodology/approachA promising dental implant product development project was investigated using the single-case research methodology. In-depth interviews were conducted with three key members involved in this innovative project. Questions concerning how a team of university researchers could embark on and overcome the obstacles encountered during their entrepreneurial project were asked. Based on the conceptual foundation of academic entrepreneurship, primary and additional secondary data were analyzed to acquire knowledge of academic entrepreneurship in healthcare in an emerging economy.FindingsHealthcare inequality has generated entrepreneurial initiatives by healthcare researchers to develop low-cost dental implants. However, their efforts have been insufficient to progress to the commercialization stage. An informal relationship among socially oriented partners, including interdisciplinary experts, not-for-profit-oriented manufacturers and early adopters contributed to this project's success.Originality/valueTo foster healthcare innovation, the authors’ micro-level evidence of a socially oriented partnership on an informal basis indicates the need for inter-professional governance that maintains a cross-organizational environment between healthcare researchers and external parties. The future contributions to innovation management by healthcare professionals should be enhanced. A socially entrepreneurial model of healthcare innovation is suggested for further consideration as an enabling policy option for inter-professional partnership in emerging economies.
{"title":"Fostering healthcare innovation: a qualitative study of dental implant product development by Thai university researchers","authors":"Sutti Sooampon, P. Pisarnturakit, S. Sooampon","doi":"10.1108/IJHG-05-2021-0046","DOIUrl":"https://doi.org/10.1108/IJHG-05-2021-0046","url":null,"abstract":"PurposeThis study investigated the conditions required to foster healthcare innovation. Due to the limited research and development (R&D) capability of the Thai private sector, universities are increasingly expected to be emerging sources of healthcare products. However, the lack of experience in research commercialization requires that whether and how Thai university researchers can serve this mission be explored.Design/methodology/approachA promising dental implant product development project was investigated using the single-case research methodology. In-depth interviews were conducted with three key members involved in this innovative project. Questions concerning how a team of university researchers could embark on and overcome the obstacles encountered during their entrepreneurial project were asked. Based on the conceptual foundation of academic entrepreneurship, primary and additional secondary data were analyzed to acquire knowledge of academic entrepreneurship in healthcare in an emerging economy.FindingsHealthcare inequality has generated entrepreneurial initiatives by healthcare researchers to develop low-cost dental implants. However, their efforts have been insufficient to progress to the commercialization stage. An informal relationship among socially oriented partners, including interdisciplinary experts, not-for-profit-oriented manufacturers and early adopters contributed to this project's success.Originality/valueTo foster healthcare innovation, the authors’ micro-level evidence of a socially oriented partnership on an informal basis indicates the need for inter-professional governance that maintains a cross-organizational environment between healthcare researchers and external parties. The future contributions to innovation management by healthcare professionals should be enhanced. A socially entrepreneurial model of healthcare innovation is suggested for further consideration as an enabling policy option for inter-professional partnership in emerging economies.","PeriodicalId":42859,"journal":{"name":"International Journal of Health Governance","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2021-07-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47035150","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-07-12DOI: 10.1108/IJHG-01-2021-0006
M. Avery, A. Cripps, G. Rogers
PurposeThis study explores key governance, leadership and management activities that have impact on quality, risk and safety within Australian healthcare organisations.Design/methodology/approachCurrent non-executive directors (n = 12) of public and private health boards were interviewed about contemporary approaches to fiduciary and corporate responsibilities for quality assurance and improvement outcomes in the context of risk and safety management for patient care. Verbatim transcripts were subjected to thematic analysis triangulated with Leximancer-based text mining.FindingsBoards operate in a strong legislative, healthcare standards and normative environment of quality and risk management. Support and influence that create a positive quality and risk management culture within the organisation, actions that disseminate quality and risk broadly and at depth for all levels, and implementation and sustained development of quality and risk systems that report on and contain risk were critical tasks for boards and their directors.Practical implicationsFindings from this study may provide health directors with key quality and risk management agenda points to expand or deepen the impact of governance around health facilities' quality and risk management.Originality/valueThis study has identified key governance activities and responsibilities where boards demonstrate that they add value in terms of potential improvement to hospital and health service quality care outcomes. The demonstrable influence identified makes an important contribution to our understanding of healthcare governance.
{"title":"Health boards' governance of quality and risk: quality improvement agenda for the board","authors":"M. Avery, A. Cripps, G. Rogers","doi":"10.1108/IJHG-01-2021-0006","DOIUrl":"https://doi.org/10.1108/IJHG-01-2021-0006","url":null,"abstract":"PurposeThis study explores key governance, leadership and management activities that have impact on quality, risk and safety within Australian healthcare organisations.Design/methodology/approachCurrent non-executive directors (n = 12) of public and private health boards were interviewed about contemporary approaches to fiduciary and corporate responsibilities for quality assurance and improvement outcomes in the context of risk and safety management for patient care. Verbatim transcripts were subjected to thematic analysis triangulated with Leximancer-based text mining.FindingsBoards operate in a strong legislative, healthcare standards and normative environment of quality and risk management. Support and influence that create a positive quality and risk management culture within the organisation, actions that disseminate quality and risk broadly and at depth for all levels, and implementation and sustained development of quality and risk systems that report on and contain risk were critical tasks for boards and their directors.Practical implicationsFindings from this study may provide health directors with key quality and risk management agenda points to expand or deepen the impact of governance around health facilities' quality and risk management.Originality/valueThis study has identified key governance activities and responsibilities where boards demonstrate that they add value in terms of potential improvement to hospital and health service quality care outcomes. The demonstrable influence identified makes an important contribution to our understanding of healthcare governance.","PeriodicalId":42859,"journal":{"name":"International Journal of Health Governance","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2021-07-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45667258","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-06-30DOI: 10.1108/ijhg-03-2021-0026
Philippa Simmonds, S. Vallgårda
PurposeThis paper qualitatively explores arguments in the UK meat tax debate, including how they align with values from specific political ideologies and perspectives on sustainable food security.Design/methodology/approachThe authors conducted a scoping media analysis of articles published over 1 year in six leading UK newspapers, followed by semi-structured interviews with ten key stakeholders in late 2019. The authors identified categories of arguments, distilled the core conflicts and analysed how arguments reflected different ideas about human nature, the role of the state and solutions to food system challenges.FindingsArguments were categorised into five major topics: climate change and environment; human health; effects on animals; fairness; and acceptability of government intervention. Pro-meat tax arguments often aligned with modern liberal ideology, and sometimes echoed demand restraint or food system transformation perspectives on sustainable food security. Arguments against meat taxes were more likely to align with the efficiency perspective or classical liberal ideology.Originality/valueTo the authors’ knowledge, this is one of the first interpretive analyses of this controversial suggested policy. Despite having similarities with other debates around taxation – particularly taxes on sugar sweetened beverages – the meat tax debate contains unique complexities due to the prominence of environmental arguments, and differing values pertaining to animal welfare and rights. This study highlights the need for policy research exploring values, in addition to quantitative evidence.
{"title":"“It's not as simple as something like sugar”: values and conflict in the UK meat tax debate","authors":"Philippa Simmonds, S. Vallgårda","doi":"10.1108/ijhg-03-2021-0026","DOIUrl":"https://doi.org/10.1108/ijhg-03-2021-0026","url":null,"abstract":"PurposeThis paper qualitatively explores arguments in the UK meat tax debate, including how they align with values from specific political ideologies and perspectives on sustainable food security.Design/methodology/approachThe authors conducted a scoping media analysis of articles published over 1 year in six leading UK newspapers, followed by semi-structured interviews with ten key stakeholders in late 2019. The authors identified categories of arguments, distilled the core conflicts and analysed how arguments reflected different ideas about human nature, the role of the state and solutions to food system challenges.FindingsArguments were categorised into five major topics: climate change and environment; human health; effects on animals; fairness; and acceptability of government intervention. Pro-meat tax arguments often aligned with modern liberal ideology, and sometimes echoed demand restraint or food system transformation perspectives on sustainable food security. Arguments against meat taxes were more likely to align with the efficiency perspective or classical liberal ideology.Originality/valueTo the authors’ knowledge, this is one of the first interpretive analyses of this controversial suggested policy. Despite having similarities with other debates around taxation – particularly taxes on sugar sweetened beverages – the meat tax debate contains unique complexities due to the prominence of environmental arguments, and differing values pertaining to animal welfare and rights. This study highlights the need for policy research exploring values, in addition to quantitative evidence.","PeriodicalId":42859,"journal":{"name":"International Journal of Health Governance","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2021-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49534319","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-06-03DOI: 10.1108/ijhg-06-2021-137
I. Ibragimova, H. Phagava
{"title":"Editorial","authors":"I. Ibragimova, H. Phagava","doi":"10.1108/ijhg-06-2021-137","DOIUrl":"https://doi.org/10.1108/ijhg-06-2021-137","url":null,"abstract":"","PeriodicalId":42859,"journal":{"name":"International Journal of Health Governance","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2021-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42270906","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-06-01DOI: 10.1108/IJHG-11-2020-0129
E. Ree, L. Ellis, S. Wiig
PurposeTo discuss how managers contribute in promoting resilience in healthcare, and to suggest a model of managers' role in supporting resilience and elaborate on how future research and implementation studies can use this to further operationalize the concept and promote healthcare resilience.Design/methodology/approachThe authors first provide an overview of and discuss the main approaches to healthcare resilience and research on management and resilience. Second, the authors provide examples on how managers work to promote healthcare resilience during a one-year Norwegian longitudinal intervention study following managers in nursing homes and homecare services in their daily quality and safety work. They use this material to propose a model of management and resilience.FindingsThe authors consider managerial strategies to support healthcare resilience as the strategies managers use to engage people in collaborative and coordinated processes that adapt, enhance or reorganize system functioning, promoting possibilities of learning, growth, development and recovery of the healthcare system to maintain high quality care. The authors’ model illustrates how managers influence the healthcare systems ability to adapt, enhance and reorganize, with high quality care as the key outcome.Originality/valueIn this study, the authors argue that managerial strategies should be considered and operationalized as part of a healthcare system's overall resilience. They propose a new model of managers' role in supporting resilience to be used in practice, interventions and future research projects.
{"title":"Managers' role in supporting resilience in healthcare: a proposed model of how managers contribute to a healthcare system's overall resilience","authors":"E. Ree, L. Ellis, S. Wiig","doi":"10.1108/IJHG-11-2020-0129","DOIUrl":"https://doi.org/10.1108/IJHG-11-2020-0129","url":null,"abstract":"PurposeTo discuss how managers contribute in promoting resilience in healthcare, and to suggest a model of managers' role in supporting resilience and elaborate on how future research and implementation studies can use this to further operationalize the concept and promote healthcare resilience.Design/methodology/approachThe authors first provide an overview of and discuss the main approaches to healthcare resilience and research on management and resilience. Second, the authors provide examples on how managers work to promote healthcare resilience during a one-year Norwegian longitudinal intervention study following managers in nursing homes and homecare services in their daily quality and safety work. They use this material to propose a model of management and resilience.FindingsThe authors consider managerial strategies to support healthcare resilience as the strategies managers use to engage people in collaborative and coordinated processes that adapt, enhance or reorganize system functioning, promoting possibilities of learning, growth, development and recovery of the healthcare system to maintain high quality care. The authors’ model illustrates how managers influence the healthcare systems ability to adapt, enhance and reorganize, with high quality care as the key outcome.Originality/valueIn this study, the authors argue that managerial strategies should be considered and operationalized as part of a healthcare system's overall resilience. They propose a new model of managers' role in supporting resilience to be used in practice, interventions and future research projects.","PeriodicalId":42859,"journal":{"name":"International Journal of Health Governance","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2021-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42762527","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-05-07DOI: 10.1108/IJHG-12-2020-0134
M. Glette, S. Wiig
PurposeThe purpose of this paper is to increase knowledge of the role organizational factors have in how health personnel make efficiency-thoroughness trade-offs, and how these trade-offs potentially affect clinical quality dimensions.Design/methodology/approachThe paper is a thematic synthesis of the literature concerning health personnel working in clinical, somatic healthcare services, organizational factors and clinical quality.FindingsIdentified organizational factors imposing trade-offs were high workload, time limits, inappropriate staffing and limited resources. The trade-offs done by health personnel were often trade-offs weighing thoroughness (e.g. providing extra handovers or working additional hours) in an environment weighing efficiency (e.g. ward routines of having one single handover and work-hour regulations limiting physicians' work hours). In this context, the health personnel functioned as regulators, balancing efficiency and thoroughness and ensuring patient safety and patient centeredness. However, sometimes organizational factors limited health personnel's flexibility in weighing these aspects, leading to breached medication rules, skipped opportunities for safety debriefings and patients being excluded from medication reviews.Originality/valueBalancing resources and healthcare demands while maintaining healthcare quality is a large part of health personnel's daily work, and organizational factors are suspected to affect this balancing act. Yet, there is limited research on this subject. With the expected aging of the population and the subsequent pressure on healthcare services' resources, the balancing between efficiency and thoroughness will become crucial in handling increased healthcare demands, while maintaining high-quality care.
{"title":"The role of organizational factors in how efficiency-thoroughness trade-offs potentially affect clinical quality dimensions – a review of the literature","authors":"M. Glette, S. Wiig","doi":"10.1108/IJHG-12-2020-0134","DOIUrl":"https://doi.org/10.1108/IJHG-12-2020-0134","url":null,"abstract":"PurposeThe purpose of this paper is to increase knowledge of the role organizational factors have in how health personnel make efficiency-thoroughness trade-offs, and how these trade-offs potentially affect clinical quality dimensions.Design/methodology/approachThe paper is a thematic synthesis of the literature concerning health personnel working in clinical, somatic healthcare services, organizational factors and clinical quality.FindingsIdentified organizational factors imposing trade-offs were high workload, time limits, inappropriate staffing and limited resources. The trade-offs done by health personnel were often trade-offs weighing thoroughness (e.g. providing extra handovers or working additional hours) in an environment weighing efficiency (e.g. ward routines of having one single handover and work-hour regulations limiting physicians' work hours). In this context, the health personnel functioned as regulators, balancing efficiency and thoroughness and ensuring patient safety and patient centeredness. However, sometimes organizational factors limited health personnel's flexibility in weighing these aspects, leading to breached medication rules, skipped opportunities for safety debriefings and patients being excluded from medication reviews.Originality/valueBalancing resources and healthcare demands while maintaining healthcare quality is a large part of health personnel's daily work, and organizational factors are suspected to affect this balancing act. Yet, there is limited research on this subject. With the expected aging of the population and the subsequent pressure on healthcare services' resources, the balancing between efficiency and thoroughness will become crucial in handling increased healthcare demands, while maintaining high-quality care.","PeriodicalId":42859,"journal":{"name":"International Journal of Health Governance","volume":"ahead-of-print 1","pages":""},"PeriodicalIF":1.3,"publicationDate":"2021-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43049592","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-04-30DOI: 10.1108/IJHG-03-2021-0033
F. M. MacVane Phipps
Using historic institutionalism to evaluate healthcare governance in Vietnam and the Philippines during COVID-19
利用历史制度主义评估越南和菲律宾在COVID-19期间的医疗治理
{"title":"International Journal of Health Governance review: 26.2","authors":"F. M. MacVane Phipps","doi":"10.1108/IJHG-03-2021-0033","DOIUrl":"https://doi.org/10.1108/IJHG-03-2021-0033","url":null,"abstract":"Using historic institutionalism to evaluate healthcare governance in Vietnam and the Philippines during COVID-19","PeriodicalId":42859,"journal":{"name":"International Journal of Health Governance","volume":"26 1","pages":"213-219"},"PeriodicalIF":1.3,"publicationDate":"2021-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46914179","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-02-18DOI: 10.1108/ijhg-03-2021-134
I. Ali, Priya Balasubramaniam, A. Berland, F. M. MacVane Phipps
{"title":"Editorial","authors":"I. Ali, Priya Balasubramaniam, A. Berland, F. M. MacVane Phipps","doi":"10.1108/ijhg-03-2021-134","DOIUrl":"https://doi.org/10.1108/ijhg-03-2021-134","url":null,"abstract":"","PeriodicalId":42859,"journal":{"name":"International Journal of Health Governance","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2021-02-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44622715","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-02-18DOI: 10.1108/ijhg-03-2021-136
I. Ibragimova, H. Phagava
{"title":"Editorial","authors":"I. Ibragimova, H. Phagava","doi":"10.1108/ijhg-03-2021-136","DOIUrl":"https://doi.org/10.1108/ijhg-03-2021-136","url":null,"abstract":"","PeriodicalId":42859,"journal":{"name":"International Journal of Health Governance","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2021-02-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47565767","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-12-16DOI: 10.1108/ijhg-02-2020-0014
Arjun Varadarajan, R. Walker, Joni S. Williams, Kinfe G. Bishu, S. Nagavally, L. Egede
PurposeThe purpose of this paper is to examine the influence of insurance coverage changes over time for patients with diabetes on expenditures and access to care before and after the Affordable Care Act (ACA).Design/methodology/approachThe Medical Expenditure Panel Survey (MEPS) from 2002–2017 was used. Access included having a usual source of care, having delay in care or having delay in obtaining prescription medicine. Expenditures included inpatient, outpatient, office-based, prescription and emergency costs. Panels were broken into four time categories: 2002–2005 (pre-ACA), 2006–2009 (pre-ACA), 2010–2013 (post-ACA) and 2014–2017 (post-ACA). Logistic models for access and two-part regression models for cost were used to understand differences by insurance type over time.FindingsType of insurance changed significantly over time, with an increase for public insurance from 30.7% in 2002–2005 to 36.5% in 2014–2017 and a decrease in private insurance from 62.4% in 2002–2005 to 58.2% in 2014–2017. Compared to those with private insurance, those who were uninsured had lower inpatient ($2,147 less), outpatient ($431 less), office-based ($1,555 less), prescription ($1,869 less) and emergency cost ($92 less). Uninsured were also more likely to have delay in getting medical care (OR = 2.22; 95% CI 1.86, 3.06) and prescription medicine (OR = 1.85; 95% CI 1.53, 2.24) compared with privately insured groups.Originality/valueThough insurance coverage among patients with diabetes did not increase significantly, the type of insurance changed overtime and fewer individuals reported having a usual source of care. Uninsured individuals spent less across all cost types and were more likely to report delay in care despite the passage of the ACA.
{"title":"Relationship between insurance and access and cost of care in patients with diabetes before and after the affordable care act","authors":"Arjun Varadarajan, R. Walker, Joni S. Williams, Kinfe G. Bishu, S. Nagavally, L. Egede","doi":"10.1108/ijhg-02-2020-0014","DOIUrl":"https://doi.org/10.1108/ijhg-02-2020-0014","url":null,"abstract":"PurposeThe purpose of this paper is to examine the influence of insurance coverage changes over time for patients with diabetes on expenditures and access to care before and after the Affordable Care Act (ACA).Design/methodology/approachThe Medical Expenditure Panel Survey (MEPS) from 2002–2017 was used. Access included having a usual source of care, having delay in care or having delay in obtaining prescription medicine. Expenditures included inpatient, outpatient, office-based, prescription and emergency costs. Panels were broken into four time categories: 2002–2005 (pre-ACA), 2006–2009 (pre-ACA), 2010–2013 (post-ACA) and 2014–2017 (post-ACA). Logistic models for access and two-part regression models for cost were used to understand differences by insurance type over time.FindingsType of insurance changed significantly over time, with an increase for public insurance from 30.7% in 2002–2005 to 36.5% in 2014–2017 and a decrease in private insurance from 62.4% in 2002–2005 to 58.2% in 2014–2017. Compared to those with private insurance, those who were uninsured had lower inpatient ($2,147 less), outpatient ($431 less), office-based ($1,555 less), prescription ($1,869 less) and emergency cost ($92 less). Uninsured were also more likely to have delay in getting medical care (OR = 2.22; 95% CI 1.86, 3.06) and prescription medicine (OR = 1.85; 95% CI 1.53, 2.24) compared with privately insured groups.Originality/valueThough insurance coverage among patients with diabetes did not increase significantly, the type of insurance changed overtime and fewer individuals reported having a usual source of care. Uninsured individuals spent less across all cost types and were more likely to report delay in care despite the passage of the ACA.","PeriodicalId":42859,"journal":{"name":"International Journal of Health Governance","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2020-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45253745","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
京公网安备 11010802042870号
京ICP备2023020795号-1
扫码关注我们
求助内容：
应助结果提醒方式：