Prevalence and Risk Factors for Medical Debt and Subsequent Changes in Social Determinants of Health in the US.

Importance: Cost barriers discourage many US residents from seeking medical care and many who obtain it experience financial hardship. However, little is known about the association between medical debt and social determinants of health (SDOH).

Objective: To determine the prevalence of and risk factors associated with medical debt and the association of medical debt with subsequent changes in the key SDOH of food and housing security.

Trends in Health Care Use Among Black and White Persons in the US, 1963-2019.

Importance: In the US, Black people receive less health care than White people. Data on long-term trends in these disparities, which provide historical context for interpreting contemporary inequalities, are lacking.

Objective: To assess trends in Black-White disparities in health care use since 1963.

Specialty Care Utilization Among Adults with Limited English Proficiency.

Background: People with limited English proficiency (LEP) face greater barriers to accessing medical care than those who are English proficient (EP). Language-related differences in the use of outpatient care across the full spectrum of physician specialties have not been studied.

Objective: To compare outpatient visit rates to physicians in 28 specialties by people with LEP vs EP.

Health Care Spending And Use Among Hispanic Adults With And Without Limited English Proficiency, 1999-2018.

One in seven people in the US speak Spanish at home, and twenty-five million people in the US have limited English proficiency. Using nationally representative data from the Medical Expenditure Panel Survey, we compare health care spending for and health care use by Hispanics adults with limited English proficiency with spending for and use by English-proficient Hispanic and non-Hispanic adults. During 2014-18 mean annual per capita expenditures were $1,463 (35 percent) lower for Hispanic adults with limited English proficiency than for Hispanic adults who were English proficient, after adjustment for respondents' characteristics.

Trends in Unmet Need for Physician and Preventive Services in the United States, 1998-2017.

Importance: Improvements in insurance coverage and access to care have resulted from the Affordable Care Act (ACA). However, a focus on short-term pre- to post-ACA changes may distract attention from longer-term trends in unmet health needs, and the problems that persist.

Objective: To identify changes from 1998 to 2017 in unmet need for physician services among insured and uninsured adults aged 18 to 64 years in the United States.

The Effect Of Veterans Health Administration Coverage On Cost-Related Medication Nonadherence.

High out-of-pocket drug spending worsens adherence and outcomes, especially for patients who are poor, chronically ill, or members of minority groups. The Veterans Health Administration (VHA) system provides drugs at minimal cost, which could reduce cost-related medication nonadherence. Using data for 2013-17 from the National Health Interview Survey, we evaluated the association of VHA coverage with such nonadherence.

Association Between Forced Sexual Initiation and Health Outcomes Among US Women.

Importance: The #MeToo movement has highlighted how frequently women experience sexual violence. However, to date, no recent studies have assessed the prevalence of forced sex during girls' and women's first sexual encounter or its health consequences.

Objective: To estimate the prevalence of forced sexual initiation among US women and its association with subsequent reproductive, gynecologic, and general health outcomes.

The Effects on Hospital Utilization of the 1966 and 2014 Health Insurance Coverage Expansions in the United States.

Background: Persons with comprehensive health insurance use more hospital care than those who are uninsured or have high-deductible plans. Consequently, analysts generally assume that expanding coverage will increase society-wide use of inpatient services. However, a limited supply of beds might constrain this growth.

Analysis of Work Requirement Exemptions and Medicaid Spending.

This study estimates the number of Medicaid enrollees at risk of losing coverage if work requirements are implemented and calculates current Medicaid spending for those enrollees at the national level and among states with approved or pending waivers.

Out-of-Pocket Spending and Premium Contributions After Implementation of the Affordable Care Act.

Importance: The Affordable Care Act (ACA) was associated with a reduced number of Americans who reported being unable to afford medical care, but changes in actual health spending by households are not known.

Objectives: To estimate changes in household spending on health care nationwide after implementation of the ACA.

Design, Setting, And Participants: Population-based data from the Medical Expenditure Panel Survey from January 1, 2012, through December 31, 2015, and multivariable regression were used to examine changes in out-of-pocket spending, premium contributions, and total health spending (out-of-pocket plus premiums) after the ACA's coverage expansions on January 1, 2014.

Training Internal Medicine Residents in Social Medicine and Research-Based Health Advocacy: A Novel, In-Depth Curriculum.

Problem: Health disparities are pervasive worldwide. Physicians have a unique vantage point from which they can observe the ways social, economic, and political factors impact health outcomes and can be effective advocates for enhanced health outcomes and health equity. However, social medicine and health advocacy curricula are uncommon in postgraduate medical education.

Health Spending For Low-, Middle-, And High-Income Americans, 1963-2012.

US medical spending growth slowed between 2004 and 2013. At the same time, many Americans faced rising copayments and deductibles, which may have particularly affected lower-income people. To explore whether the health spending slowdown affected all income groups equally, we divided the population into income quintiles.

Access to Care and Chronic Disease Outcomes Among Medicaid-Insured Persons Versus the Uninsured.

Objectives: We sought to determine the association between Medicaid coverage and the receipt of appropriate clinical care.

Methods: Using the 1999 to 2012 National Health and Nutritional Examination Surveys, we identified adults aged 18 to 64 years with incomes below the federal poverty level, and compared outpatient visit frequency, awareness, and control of chronic diseases between the uninsured (n = 2975) and those who had Medicaid (n = 1485).

Results: Respondents with Medicaid were more likely than the uninsured to have at least 1 outpatient physician visit annually, after we controlled for patient characteristics (odds ratio [OR] = 5.

Era of faster FDA drug approval has also seen increased black-box warnings and market withdrawals.

After approval, many prescription medications that patients rely on subsequently receive new black-box warnings or are withdrawn from the market because of safety concerns. We examined whether the frequency of these safety problems has increased since 1992, when the Prescription Drug User Fee Act, legislation designed to accelerate the drug approval process at the Food and Drug Administration, was passed. We found that drugs approved after the act's passage were more likely to receive a new black-box warning or be withdrawn than drugs approved before its passage (26.

Infective endocarditis in the U.S., 1998-2009: a nationwide study.

Background: Previous studies based on local case series estimated the annual incidence of endocarditis in the U.S. at about 4 per 100,000 population.

Computed tomography associated cancers and cancer deaths following visits to U.S. emergency departments.

We estimated the number of future cancers and cancer deaths following computed tomography scans (CTs) performed in U.S. emergency departments annually and determined whether increases in the proportion of visits resulting in CTs over the past decade were accompanied by changes in markers of severity of illness or primary reason for visit.

Undiagnosed and uncontrolled hypertension and hyperlipidemia among immigrants in the US.

Cardiovascular disease is a major cause of mortality and disability. We analyzed the National Health and Nutrition Examination Survey (1998-2008). We used logistic regression analysis to compare the odds of having undiagnosed and uncontrolled hypertension and hyperlipidemia among FB and US born adults sequentially adjusting for (1) age and gender, (2) income and education, and (3) insurance status.

Giving office-based physicians electronic access to patients' prior imaging and lab results did not deter ordering of tests.

Policy-based incentives for health care providers to adopt health information technology are predicated on the assumption that, among other things, electronic access to patient test results and medical records will reduce diagnostic testing and save money. To test the generalizability of findings that support this assumption, we analyzed the records of 28,741 patient visits to a nationally representative sample of 1,187 office-based physicians in 2008. Physicians' access to computerized imaging results (sometimes, but not necessarily, through an electronic health record) was associated with a 40-70 percent greater likelihood of an imaging test being ordered.

Hypertension, diabetes, and elevated cholesterol among insured and uninsured U.S. adults.

In this paper we explore whether uninsured Americans with three chronic conditions were less likely than the insured to be aware of their illness or to have it controlled. Among those with diabetes and elevated cholesterol, the uninsured were more often undiagnosed. Among hypertensives and people with elevated cholesterol, the uninsured more often had uncontrolled conditions.

Health insurance and mortality in US adults.

Objectives: A 1993 study found a 25% higher risk of death among uninsured compared with privately insured adults. We analyzed the relationship between uninsurance and death with more recent data.

Methods: We conducted a survival analysis with data from the Third National Health and Nutrition Examination Survey.

U.S. physicians' views on financing options to expand health insurance coverage: a national survey.

Background: Physician opinion can influence the prospects for health care reform, yet there are few recent data on physician views on reform proposals or access to medical care in the United States.

Objective: To assess physician views on financing options for expanding health care coverage and on access to health care.

Design And Participants: Nationally representative mail survey conducted between March 2007 and October 2007 of U.

The health and health care of US prisoners: results of a nationwide survey.

Objectives: We analyzed the prevalence of chronic illnesses, including mental illness, and access to health care among US inmates.

Methods: We used the 2002 Survey of Inmates in Local Jails and the 2004 Survey of Inmates in State and Federal Correctional Facilities to analyze disease prevalence and clinical measures of access to health care for inmates.

Results: Among inmates in federal prisons, state prisons, and local jails, 38.