Newswise — The articles below will be published online December 16, 2010, at 4 p.m. (ET) by the American Journal of Public Health under “First Look” at http://www.ajph.org/first_look.shmtl, and they are currently scheduled to appear in the February 2011 print issue of the Journal. “First Look” articles have undergone peer review, copyediting and approval by authors but have not yet been printed to paper or posted online by issue. The American Journal of Public Health is published by the American Public Health Association, www.apha.org, and is available at www.ajph.org.
(1) Gaps in the system: Addressing the need for ongoing coverage among uninsured working-aged adults with chronic health care needs
A new study from the American Journal of Public Health found that there are high numbers of insurance coverage gaps among working-aged adults with chronic conditions and disabilities.
Researchers sought to determine how part-year and full-year gaps in health insurance coverage affected working-aged persons with chronic health care needs. They used data from the 2002-2004 Medical Expenditure Panel Survey to compare access, utilization and out-of-pocket spending burden among key groups of persons with chronic conditions and disabilities. Among 92 million adults with chronic conditions, 21 percent experienced at least one month uninsured during the average year (2002-2004). Among the 25 million persons reporting both chronic conditions and disabilities, 23 percent were uninsured for one or more months during the average year. Furthermore, researchers reported that these gaps in coverage were associated with significantly higher levels of access problems, lower rates of ambulatory visits and prescription drug use and higher levels of out-of-pocket spending.
The study’s authors suggested, “The passage of health care reform in the form of the Patient Protection and Affordable Care Act (PPACA) reflects a growing consensus that health care in the United States must be re-orientated toward prevention, better management of chronic conditions, and greater attention to the health and community-based support of persons with disabilities.” They continued, “The success of this agenda will depend on reform of both public programs and private insurance practices to ensure that coverage remains steadfast during periods of unemployment, loss of income, or ill health.”
[From: “Ongoing Coverage for Ongoing Care: Access, Utilization, and Out-of-Pocket Spending Among Uninsured Working-Aged Adults with Chronic Health Care Needs” ]. (2) Higher minimum wages do not hinder access to health care for low-skilled U.S. workers
In a new study from the American Journal of Public Health, researchers found evidence that higher minimum wages do not negatively harm health care access for low-skilled workers in the United States, as critics claimed it would. Conversely, researchers discovered evidence that higher minimum wages are significantly associated with reduced odds of workers reporting cost-related barriers to needed medical care.
Researchers examined whether minimum wage policy is associated with access to medical care among low-skilled workers in the United States. They analyzed a data set consisting of measures of health care access from the Behavioral Risk Factor Surveillance System and state-level ecological controls from the U.S. Census Bureau of Labor Statistics covering the period from 1996-2007. The data set was limited to individuals who were economically active between the ages of 18 and 64, because they were most interested in the potential effects of the minimum wage on health care access for covered workers. The researchers found higher minimum wages to be associated with a reduced likelihood of experiencing unmet medical need among low-skilled workers, and do not appear to be associated with uninsurance.
The researchers stated, “With these findings, this study makes an important contribution to the policy debate over minimum wage law; the lack of evidence for the detrimental effects of higher minimum wages on health insurance and access suggests that the fears evinced by opponents of minimum wage increases are misplaced….These findings appear to refute the suggestion that minimum wage laws have detrimental effects on access to health care, as opponents of the policies have previously suggested.”
[From: “Associations between Minimum Wage Policy and Access to Health Care: Evidence from the Behavioral Risk Factor Surveillance System, 1996-2007.” ].
(3) Drug arrests not found to deter hard drug users over time
Drug arrests do not deter injection drug users over time and may have some unintended negative impacts on public health, reports a new study from the American Journal of Public Health.
The researchers analyzed drug-related data from the Federal Bureau of Investigation’s Uniform Crime Reporting Program for 93 large U.S. metropolitan statistical areas from 1992 to 2002 to predict (previously published) annual estimates of the number of injection drug users per 10,000 population. They found that neither drug-related arrest rates nor changes in drug-related arrests were associated with the change of the rate of injection drug users over time. The researchers stated that a recent estimate of the average annual expense of incarcerating a single prisoner was $23,876, implying that the United States spends $12 billion annually to incarcerate 500,000 inmates for drug-related offences. Evidence suggests that high rates of arrest and incarceration may even increase the spread of some infectious diseases, including HIV, sexually transmitted infections and tuberculosis.
The study’s author said, “Deterrence-based approaches to reducing drug use do not appear to reduce injection drug users’ prevalence. Alternative approaches such as harm reduction, which prevents HIV transmission and increases referrals to treatment, may be a better foundation for policy.”
[From: “Drug Arrests and Injection Drug Deterrence.” Contact: Samuel R. Friedman, National Development and Research Institutes Inc., New York, NY, [email protected]].
The American Journal of Public Health is the monthly Journal of the American Public Health Association (APHA), the oldest and most diverse organization of public health professionals in the world. APHA is a leading publisher of books and periodicals promoting sound scientific standards, action programs and public policy to enhance health. More information is available at www.apha.org.
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