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Family separation policies' impacts on children's education and well-being are critical issues of our time. This paper argues through ethnographic study that although im/migrant parents believed in the promise of a better life for their children as they migrated, COVID-19 and remote schooling contributed to a breakdown in structures of care once they were in the United States. Thus, the experience of remote schooling during 2020 was a difficult task for parents and children who were already dealing with the trauma of detention or separation at the border. Ultimately, we argue that to understand the educational experiences of im/migrant parents and children in the United States, we must consider a multiple disruptions framework. The findings in this article reveal the layered consequences that broader immigration policy has on the everyday educational lives of im/migrant children and their parents.

Health care reform tops the list of issues that voters consider important going into the 2020 elections. As health professionals, it is imperative that we not only become informed about this issue but also help shape our healthcare future. Based on a review of the health service and health policy literature, we address several myths that add to the confusion regarding the public debate on health care reform. This Commentary does not advocate for any specific reform proposal but identifies and debunks several commonly mentioned myths. Public understanding of these myths is essential as the health care reform debate continues to evolve. We also suggest several ways for health educators and professionals to engage actively in this dialogue as part of our professional responsibility. Translating health care reform into health education practice is consistent with the Code of Ethics for the Health Education profession that provides a framework of shared values within which Health Education is practiced. Including health care reform into health education practice also is consistent with several areas included in the Responsibilities and Competencies for Certified Health Education Specialists. A AJHE Self-Study quiz is online for this article via the SHAPE America Online Institute (SAOI) http://portal.shapeamerica.org/trn-Webinars

This policy commentary addresses a significant access to care issue that faces methadone maintenance patients seeking residential treatment in the United States. Methadone maintenance therapy (MMT) has demonstrated strong efficacy in the outpatient treatment of opiate dependence. However, many opiate dependent patients are also in need of more intensive interventions, such as residential care. Many publically-funded residential treatment programs explicitly decline to admit MMT patients, contending that methadone raises both clinical and administrative problems in treatment. Although advocates within the field believe that this issue is a violation of the American's with Disabilities Act (ADA) in the United States, no lawsuits have been brought forth, and there is no legal precedent or public policy to inform the debate. The present paper provides an overview of this problem and discusses factors that may contribute to the problem, including an abstinence-oriented philosophy and treatment program operational concerns. The paper also draws parallels between methadone and other medical conditions and analyzes the problem in the context of disabilities encompassed in the ADA. Finally, recommendations on strategies for increasing access to residential care for MMT patients are provided.

Critical to resolving the problem of health disparities among Latinos is examining the needs within ethnic subpopulations. This paper focused on the unique challenges encountered by one ethnic subpopulation -- Latinos of Mexican descent living in colonias. Findings reaffirm the importance of looking within ethnic subpopulations to understand the complexities of health disparities. This paper reports on data collected measuring access to health care among Latinos of Mexican descent living in several colonias in two southern Texas counties. Observations are based on data gathered from a nonprobability sample obtained through a face to face questionnaire focusing on health care access. Persons living in two Texas counties near the US border were included in this sample, and demographic data were compared to county, state and national statistics to examine the comparability of the sample to similar populations. Findings from this snowball sample, N=271, suggested lower rates of health insurance coverage compared to the Latino population nationwide, decreased patterns of preventive screenings for blood pressure, diabetes, cholesterol, cancers (ie, breast, cervical, and prostate), and regular access to health care in Mexico by slightly more than half the sample. Seeking care in Mexico may be a viable solution for many indigent people of Mexican descent living in close geographic proximity to the border because it surmounts the political, cultural, linguistic, or economic barriers to health care services in the United States. Nonetheless, there are longer term questions regarding quality of care and health and wellness for this group of people.

This reaction to the Major Contribution presents a conceptualization of health disparities as another form of oppression of marginalized populations in our society. Consistent with this view, health disparities are then situated within a larger, national context, showing that counseling psychologists' involvement is an integral part of a multidisciplinary national effort. Examples of roles that counseling psychologists can take, beyond those related to patient-provider interactions, are presented in the context of cancer health disparities in Latina women. These roles include acting as staff trainer and consultant, patient and community health empowerment coach, patient advocate, and public policy analyst, as well as the traditional roles of health counselor, psychotherapist, and researcher. Finally, the author issues a call for action for counseling psychologists, for whom the amelioration of disparities is a perfect fit.

Of all of the medical specialties, child and adolescent psychiatry has the most severe shortage of practitioners. This shortage is even more pronounced in economically disadvantaged and rural areas. The American Indian population is younger, more economically disadvantaged, and more rural than the general U.S. population (United States Census Bureau, 2000). Researchers and many American Indians believe that their traumatic history and current marginalization has made them more likely to experience mental health problems such as alcoholism and posttraumatic stress disorder. Telepsychiatry, the use of real-time, interactive videoconferencing to deliver psychiatric services, is an exciting opportunity to ensure that American Indians are not left out of the improvement of mental health services. The use of telepsychiatry can assist in providing child and adolescent psychiatric services to patients in remote and underserved areas while sparing patients and providers long, expensive, and life-disrupting journeys. Furthermore, this paper presents an example of telepsychiatry being used to treat American Indian children.

This paper extends and further validates the quality-of-life/community-healthcare model and measures developed by Rahtz and Sirgy (2000). The quality of life (QOL) model is based on the theoretical notion that community residents' satisfaction with healthcare services available within their community affects community quality of life and life satisfaction. This study extends the model and, in keeping with past research, posits that the bottom-up spillover from community QOL to life satisfaction is greater for those individuals with low personal health satisfaction, lower income, and old age. Data were collected from 1094 community residents in the East-Coast area of the United States. The results provide good support of the new model. Managerial implications and applications for the new model are discussed.

Comments on three articles (see records EJ733583, EJ733584, and EJ733585) on the status of children's mental health services in the United States, which appeared in the September 2005 issue of the "American Psychologist." The current authors suggest that, although this series of articles provides important information, the articles fall short in meeting the mark of comprehensively describing the solutions necessary to effectively address the crisis facing children's mental health in this country.

This paper examines the extent to which US citizenship status affects the probability of a person's having a usual source of care and the predictors associated with access to health care among non-citizens. The research is founded on the analysis of data from the 2005 California Health Interview Survey (CHIS) (n = 33,187 adults, ages 18–64). Guided by a modified Andersen model of access to health care, the researchers conducted a series of logistic regression analyses using the survey data to compare native-born citizens with non-citizens who were 1.6 times less likely to access a usual source of care. Among non-citizens, insurance status, shorter duration of residence in the United States, and lower levels of English proficiency were related to a lower probability of having a usual source of care. Based on this research it is argued that affordable health care and health insurance options and access to culturally and linguistically sensitive services are needed to increase access to health care among these identified subgroups of non-citizens. [ABSTRACT FROM AUTHOR]

This paper will explore the application of an account of justice in health and health care to the special case of children. It is tempting to hold that children require no special treatment in an account of just health care; justice requires guaranteeing access to at least basic health care services to all persons, whatever their age group, within the constraints of a society's resources. However, I will argue that for a number of reasons we need to address what justice requires specifically for children from the health care system, even if the answer must be embedded within a general account of justice in health and health care. [ABSTRACT FROM AUTHOR]

Although Indigenous groups continue to experience extensive health disparities, little research explores the role of structural barriers in contributing to health disparities for state‐recognised tribes, who do not receive healthcare services from the Indian Health Service. In addition, much research focuses on discrete physical health outcomes, without utilising community‐based approaches to allow participants to identify healthcare priorities and needs in their own voices. In partnership with a community advisory board, a qualitative descriptive methodology was used to conduct 31 life‐course interviews with participants of a state‐recognised tribe in the Gulf South region of the United States to explore healthcare experiences. Participants identified unmet healthcare needs and healthcare infrastructure barriers. Some of the most common barriers and unmet healthcare needs included: Long Distance to Healthcare Services and Difficulty in Accessing Specialists, Need for Increased Communication, Long Hospital or Appointment Wait Times, Unmet Mental Health Needs, Need for Substance Use or Abuse Prevention Programs and Need for Health Education. These findings highlight some of the structural barriers that exacerbate existing health disparities and suggest important areas of intervention, such as including a focus on mental health needs. Increased healthcare resources and recognition of sovereignty for this state‐recognised tribe are also needed to begin to address these barriers. In addition, because of the long history of exploitation of Indigenous communities, healthcare interventions should meaningfully include Indigenous tribes in the development and implementation of any healthcare programs. [ABSTRACT FROM AUTHOR]

Background: This article examines how immigration policy uncertainty during the Trump presidency shaped how immigrant serving organizations (ISOs) responded to the needs of immigrant community members in the first six months of the COVID-19 pandemic. Methods: We draw on semi-structured interviews conducted over the summer of 2020 with 31 directors and program coordinators of ISOs and health clinics in three southern states (KY, NC, SC). Results: Responding to anti-immigrant policies laid the groundwork for organizations to respond quickly and nimbly to COVID-19 related upheavals. However, organizational flexibility may signal organizational precarity, especially given the long-term impacts of both Trump administration immigration policies and the COVID-19 pandemic. Discussion: Our findings underline how ISOs facilitate access to health and social services for immigrant families. Our findings suggest that this organizational adaptability may signal a relationship between organizational precarity and immigration policy uncertainty that could have an impact well beyond the pandemic. [ABSTRACT FROM AUTHOR]

Limited information is available on the barriers to practice for advanced practice registered nurses (APRNs) among states with full, restricted, and reduced practice. The purpose of this study is to identify practice barriers in relationship to United States (U.S.) state practice authority, APRN type, area of practice (rural, suburban, urban), and nature of practice (outpatient, inpatient, and both). An electronic survey of a convenience sample of APRNs was conducted to assess barriers to practice. Identified barriers were examined based on state practice environment, APRN role, practice setting, and location. Data were analyzed using thematic analysis for qualitative data and descriptive analysis for quantitative data. Over 7,000 APRNs representing all 50 states participated. Themes that were identified and reported by respondents, included licensure and administrative barriers, therapy restrictions, physician signature requirements, a lack of collegiality, prescribing barriers, uneven reimbursement, physician only procedures, and telehealth issues. Barriers were identified in all states, regardless of the type of practice authority. All four APRN role types identified practice barriers, some of which were more frequent for some roles than others. Restrictions for home health approval and the requirement for a physician signature for durable medical supply orders were identified by over 40% of respondents practicing in rural areas. Barriers to APRN practice continue to restrict aspects of patient care and patient access to care, even in states with full practice authority. Continued efforts to reduce barriers to APRN practice are needed to ensure patient access to care, especially in rural areas. [ABSTRACT FROM AUTHOR]

Although a history of incarceration is associated with poor long-term health status, the experience of seeking health care access during reentry is complex. Semistructured open-ended interviews were conducted among individuals with a recent history of incarceration (N= 20). The majority of participants weremale (90%) and African American (80%). The majority (55%) had one or more chronic medical conditions, 40% reported active substance addiction, and 75% reported having a chronic psychiatric condition. In qualitative analysis, participants described the three biggest facilitators to accessing health care as eligibility for Medicaid, support through reentry organizations, and online resources. Participants said the major barriers to accessing health care were multiple and competing priorities, limitations of Medicaid, and lack of access to health records. Ensuring individuals with a history of incarceration are connected to the public assistance programs for which they are eligible is an important public health initiative and may facilitate successful reintegration. [ABSTRACT FROM AUTHOR]

This study examined factors influencing health information and mental health support seeking among individuals in U.S. prisons using the 2014 data from the Programme for the International Assessment of Adult Competencies. Results showed that not only are age, race, health status, receiving health information (e.g., from health experts, friends, and other incarcerated individuals), and readiness to learn associated with health information seeking from the media, but so too are competencies such as literacy, numeracy, and problem-solving skills. Years of education moderated the association between social trust and seeking mental health support. In addition, gender, work duration, and attending substance abuse support groups, life skills groups, and religious groups are associated with seeking mental health support in prisons. Findings from this study may provide insight for correctional health stakeholders working in partnership to deliver more tailored health and mental health interventions in U.S. prison settings. [ABSTRACT FROM AUTHOR]

Background: Disparities in access to care persist for Latino youth born in the United States (US). The association of maternal characteristics, such as maternal citizenship status and insurance coverage, on youth health insurance coverage is unclear and is important to examine given the recent sociopolitical shifts occurring in the US.Methods: We analyzed pooled cross-sectional data from the 2010-2018 National Health Interview Survey to examine the association of Latina maternal citizenship status on maternal insurance coverage status and youth uninsurance among US-born Latino youth. Our study sample consisted of 15,912 US-born Latino youth (ages < 18) with linked mothers. Our outcome measures were maternal insurance coverage type and youth uninsurance and primary predictor was maternal citizenship status. Generalized structural equation modeling was used to examine the relationships between maternal characteristics (maternal citizenship, maternal insurance coverage status) and youth uninsurance.Results: Overall, 7% of US-born Latino youth were uninsured. Just 6% of youth with US-born mothers were uninsured compared to almost 10% of those with noncitizen mothers. Over 18% of youth with uninsured mothers were uninsured compared to 2.2% among youth with mothers who had private insurance coverage. Compared to both US-born and naturalized citizen Latina mothers, noncitizen Latina mothers had 4.75 times the odds of reporting being uninsured. Once adjusted for predisposing, enabling, and need factors, maternal uninsurance was strongly associated with youth uninsurance and maternal citizenship was weakly associated with youth uninsurance among US-born Latino youth.Conclusion: Maternal citizenship was associated with both maternal uninsurance and youth uninsurance among US-born Latino youth. Federal- and state-level health policymaking should apply a two-generational approach to ensure that mothers of children are offered affordable health insurance coverage, regardless of their citizenship status, thus reducing uninsurance among US-born Latino youth. [ABSTRACT FROM AUTHOR]

The Emergency Medical Treatment and Active Labor Act in 1986 was intended to bring an end to incidents of "patient dumping." However, due to the conflation of various federal legislative provisions, hospitals faced with the prospect of long‐term unreimbursed care of an immigrant patient, whether legally present in the United States or not, are in some cases having such patients transported to another country. These transfers are often being effectuated without patient consent. After an overview of the flaws in the legal system that have effectively encouraged such patient transfers, this essay uses a clinical case to demonstrate how physicians can collaborate with an interdisciplinary team and with family members to ensure that the best interests of immigrant patients are met. Finally, the essay calls on physicians to advocate for the development of hospital policies and practices that will protect patients from international patient dumping. [ABSTRACT FROM AUTHOR]

A meta-study of 83 articles published from 1981 to 2016 was conducted on Hispanics access to health care in the US. Few of these studies have included acculturation and even fewer the role of social capital as important factors that impact healthcare access for this population. Among those that do include these two factors, there is confusion as to how they are defined and operationalized. Acculturation and social capital could serve to overcome some of the structural barriers in place that manifest stronger among Hispanics who are relatively newcomers to a healthcare system that is highly complex to navigate. The majority of studies included in this systematic review of the literature are in public health journals, which do not focus on sociological aspects as much. This study exposes the need to expand the worldviews used in the literature in order to enrich our understanding of access to health care for Hispanics. [ABSTRACT FROM AUTHOR]

The enactment of the Affordable Care Act increased the emphasis on health promotion and disease prevention by making preventive care accessible for many Americans, especially young adults, who could remain on their parents or legal guardians' health insurance until the age of 26. Yet, many Americans receive only half of the recommended preventive care services, which highlight the need for the improvement of health promotion and prevention services. The aim of this study was to assess the relationship among access to health care insurance, perceptions about health insurance, and use of preventive care services among young adults. Nine hundred and forty-six participants ages 19-34 completed a 40 question web-based survey. Data analysis suggested that while the majority of participants had health insurance, there were significant differences in opinions about the ACA, health insurance, and use of preventive services by gender, education level, and health insurance status. Overall, participants with health insurance were more likely to have received at least three of the basic preventive care services; however, most of them were not getting the preventive care as recommended. Results reaffirm the need for further studies on the impact of health insurance among young adults and the need for the emphasis on health promotion to educate young adults about the importance of disease prevention and preventive services. [ABSTRACT FROM AUTHOR]

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Background: We examine the association between family structure and children's health care utilization, barriers to health care access, health, and schooling and cognitive outcomes and assess whether socioeconomic status (SES) accounts for those family structure differences. We advance prior research by focusing on understudied but increasingly common family structures including single father families and five different family structures that include grandparents. Methods: Our data on United States children aged birth through 17 (unweighted N = 198,864) come from the 1997-2013 waves of the National Health Interview Survey, a nationally representative, publicly available, household-based sample. We examine 17 outcomes across nine family structures, including married couple, cohabiting couple, single mother, and single father families, with and without grandparents, and skipped-generation families that include children and grandparents but not parents. The SES measures include family income, home ownership, and parents' or grandparents' (depending on who is in the household) employment and education. Results: Compared to children living with married couples, children in single mother, extended single mother, and cohabiting couple families average poorer outcomes, but children in single father families sometimes average better health outcomes. The presence of grandparents in single parent, cohabiting, or married couple families does not buffer children from adverse outcomes. SES only partially explains family structure disparities in children's well-being. Conclusions: All non-married couple family structures are associated with some adverse outcomes among children, but the degree of disadvantage varies across family structures. Efforts to understand and improve child well-being might be most effective if they recognize the increasing diversity in children's living arrangements. [ABSTRACT FROM AUTHOR]

Persons who inject drugs (PWID) shoulder the greater part of the hepatitis C virus (HCV) epidemic in the USA. PWID are also disproportionately affected by limited access to health care and preventative services. We sought to compare current health care coverage, HCV, and HIV testing history, hepatitis A and B vaccination coverage, and co-occurring substance use among PWID in two US cities with similar estimated numbers of PWID. Using data from the 2009 National HIV Behavioral Surveillance system in Denver ( n = 428) and Seattle ( n = 507), we compared HCV seroprevalence and health care needs among PWID. Overall, 73 % of participants who tested for HCV antibody were positive. Among those who were HCV antibody-positive, vaccination coverage for hepatitis A and B was low (43 % in Denver and 34 % in Seattle) and did not differ significantly from those who were antibody-negative. Similarly, participation in alcohol or drug treatment programs during the preceding 12 months was not significantly higher among those who were HCV antibody-positive in either city. Significantly fewer participants in Denver had health care coverage compared to Seattle participants (45 vs. 67 %, p < 0.001). However, more participants in Seattle reported being disabled for work and, thus, more likely to be receiving health care coverage through the federal Medicaid program. In both cities, the vast majority of those who were aware of their HCV infection reported not receiving treatment (90 % in Denver and 86 % in Seattle). Our findings underscore the need to expand health care coverage and preventative medical services for PWID. Furthermore, our findings point to the need to develop comprehensive and coordinated care programs for infected individuals. [ABSTRACT FROM AUTHOR]

Objectives The atraumatic restorative treatment ( ART) was developed as an affordable, patient-friendly dental caries management procedure that does not need extensive operator training or special skills. The aim of this study was to determine factors that influence the decision to use ART using an innovative marketing research technique known as conjoint analysis. Methods A conjoint survey was completed by 723 members of the American Academy of Pediatric Dentistry. Three factors (age of the child, level of cooperation, type of insurance) were varied across three levels to create nine patient scenarios. The weights that practitioners placed on these factors in decisions to use ART in treating carious lesions were determined by conjoint analysis. Factors such as lesion location, depth, and extension were fixed in the nine clinical scenarios. Results Seven-hundred twenty-three pediatric dentists completed the survey (32 percent). Age of the child was the most important factor in pediatric dentists' decisions to use ART (46 percent) compared with level of cooperation (41 percent) and type of insurance coverage (11 percent). For the age factor, the age of 2 years had the greatest utility (0.55) compared with age 4 (−0.09) and age 6 (−0.46). For types of insurance coverage, having no insurance (0.124) had the greatest utility compared with having public insurance (−0.119). Conclusions Although insurance coverage was the least important among the factors, being without insurance, being very young, and being uncooperative was the scenario where pediatric dentists most favored ART when making trade offs between different factors using the conjoint design. [ABSTRACT FROM AUTHOR]

Annual chlamydia screening is recommended for sexually active women aged 25 years and younger, though less than half of eligible women are screened each year. If acceptable to young women, nontraditional testing venues and new communication technologies could promote efficiencies in sexually transmitted disease (STD) screening and facilitate screening by overcoming barriers at systems and patient levels. Objective. This study sought to explore young women’s technology use, preferences for STD-testing venues, attitudes toward nontraditional venues, and acceptability of test results delivery options. Method. A total of 80 ethnographic one-on-one telephone interviews were conducted with African American, Caucasian, and Latina women, aged 15 to 25 years, in 10 metropolitan areas of the United States. Interviews were recorded, transcribed, and analyzed using NVivo2. Results. Alternative STD-testing venues and results delivery channels are valued by young women for their convenience and accessibility, but they must also offer privacy, confidentiality, and emotional/informational support to be acceptable. Assuring provider (or self) competence and valid/accurate test results is also important. Conclusions. Although new technologies have been embraced by young women for personal and social uses, they may not be as readily embraced for the provision of STD-related services. Additional social marketing efforts may be needed to promote acceptance of nontraditional STD-testing settings and results delivery methods. [ABSTRACT FROM PUBLISHER]

Background. The contribution of race differences in access to health care to disparities in chronic kidney disease (CKD) incidence in the United States is unknown.Methods. We examined race differences in usual source of health care, health insurance and CKD incidence among 3883 Whites and 1607 Blacks with hypertension or diabetes enrolled in the Atherosclerosis Risk in Communities Study. In multivariable analyses, we explored the incremental contribution of access to health care in explaining Blacks’ excess CKD incidence above and beyond other socioeconomic, lifestyle and clinical factors.Results. Compared with Whites, Blacks had poorer access to health care (3 vs 0.3% with no usual source of health care or health insurance, P < 0.001) and experienced greater CKD incidence (14.7 vs 12.0 cases per 1000 person-years, P < 0.001). Blacks’ excess risk of CKD persisted after adjusting for demographic, socioeconomic, lifestyle and clinical factors [hazard ratio (HR) (95% confidence interval (95% CI)) = 1.21 (1.01–1.47)]. Adjustment for these factors explained 64% of the excess risk among Blacks. The increased risk for CKD among Blacks was attenuated after additional adjustment for race differences in access to health care [HR (95% CI) = 1.19 (0.99–1.45)], which explained an additional 10% of the disparity.Conclusions. In this population at risk for developing CKD, we found that poorer access to health care among Blacks explained some of Blacks’ excess risk of CKD, beyond the excess risk explained by demographic, socioeconomic, lifestyle and clinical factors. Improved access to health care for high-risk individuals could narrow disparities in CKD incidence. [ABSTRACT FROM AUTHOR]

Objective: We sought to determine the differences in observed and unobserved factors affecting rates of health insurance coverage between US Latino adults and US Latino adults of Mexican ancestry. Our hypothesis was that Latinos of Mexican ancestry have worse health insurance coverage than their non-Mexican Latino counterparts.Methods: The National Health Interview Survey (NHIS) database from 1999-2007 consists of 33,847 Latinos. We compared Latinos of Mexican ancestry to non-Mexican Latinos in the initial descriptive analysis of health insurance coverage. Disparities in health insurance coverage across Latino categories were later analyzed in a multivariable logistic regression framework, which adjusts for confounding variables. The Blinder-Oaxaca technique was applied to parse out differences in health insurance coverage into observed and unobserved components.Results: US Latinos of Mexican ancestry consistently had lower rates of health insurance coverage than did US non-Mexican Latinos. Approximately 65% of these disparities can be attributed to differences in observed characteristics of the Mexican ancestry population in the US (e.g., age, sex, income, employment status, education, citizenship, language and health condition). The remaining disparities may be attributed to unobserved heterogeneity that may include unobserved employment-related information (e.g., type of employment and firm size) and behavioral and idiosyncratic factors (e.g., risk aversion and cultural differences).Conclusions: This study confirmed that Latinos of Mexican ancestry were less likely to have health insurance than were non-Mexican Latinos. Moreover, while differences in observed socioeconomic and demographic factors accounted for most of these disparities, the share of unobserved heterogeneity accounted for 35% of these differences. [ABSTRACT FROM AUTHOR]

The article focuses on the barriers of public health insurance and health care access to low-income families in the U.S. Public health insurance programs expanded coverage for the poor. Family physicians provide significant services to the poor. Study shows that lack of insurance coverage, poor access to services and unaffordable costs are among the major barriers in accessing health care for children. Results indicate that these barriers can be insurmountable for low-income families.

The Sonya Slifka Longitudinal Multiple Sclerosis (MS) Study follows a population-based cohort of approximately 2000 people with MS to study demographic and clinical characteristics, use and cost of health services, provider and treatment characteristics, neurological, economic, and psychosocial outcomes. We examined key indicators of access to health care and found that the majority of participants had health insurance, a usual source of care, and access to specialty care. Nevertheless, 3.8% did not have health insurance which, with application of sampling weights, corresponds to approximately 7000 people with MS in the US population. Even with insurance, population-based estimates indicated that substantial numbers of people with MS have plans that pay nothing toward prescription medication, limit their access to specialists, and restrict their choice of hospitals and providers. Some 9% of the sample, corresponding to 15 800 people with MS, did not have a usual source of MS care; 11.8% or 17 300 people did not have a usual source of general health care; and 31% or 57 400 people did not see the specialists that they or their physicians wanted them to see. Further, 10.5% or 19 400 people reported difficulty obtaining prescription medication, 4.1% or 7600 people encountered obstacles accessing medical care, and 2.4% or 4500 people could not obtain the mental health services they needed. Finally, out-of-pocket health care expenditures were twice those found for the general population. Two-thirds of study participants (representing almost 70 000 people) chose their MS care providers because they were neurologists or MS specialists, creating a demand that almost certainly exceeds current supply. [ABSTRACT FROM AUTHOR]

TOPIC. A Universal Health Care System: Is it Right for the United States? The over 45 million Americans who are uninsured speak volumes about the problems with our present healthcare system. Many Americans do not have access to basic health care and it is time to revisit the importance of universal health care for all Americans. PURPOSE. To gain a greater understanding of the facts, figures, and support for universal health care in America. SOURCE OF INFORMATION. A literature review of five research studies. CONCLUSION. The implementation of universal health care in America is a plausible feat, but the support of several facets of society is necessary for this to become a reality. [ABSTRACT FROM AUTHOR]

Objectives. Hospitalization for ambulatory care sensitive conditions, also called preventable hospitalization, has been widely accepted as an indicator of access to primary health care, and of the overall success of the primary health care system. Our objective is to examine associations between preventable hospitalization and race and ethnicity in the USA, separately for six major chronic diseases: angina, asthma, chronic obstructive pulmonary disease, congestive heart failure, diabetes and hypertension. Design. We used the 1997 Nationwide Inpatient Sample, 1997 Current Population Survey and 1997 National Health Interview Survey, to calculate rates of preventable hospitalization, and the prevalence of ambulatory care sensitive conditions, for African Americans, Hispanics and non-Hispanic whites. Rates were calculated for ages 19–64, and 65 and over. Preventable hospitalization rates that accounted for underlying hospitalization patterns were also estimated. A final set of estimations adjusted the preventable hospitalization rates for disease prevalence. Results. Preventable hospitalization rates were notably higher for African Americans and Hispanics than for non-Hispanic whites for almost all of the conditions, both for women and men and for both age groups. Rates adjusted for underlying hospitalization patterns showed a similar pattern. Adjusted for disease prevalence, rate differences remained notably large for both women and men, and for both age groups. Particularly great, for both African Americans and Hispanics of both sexes, are the risks of preventable hospitalization for asthma, diabetes and hypertension. Conclusion. African Americans and Hispanics have high preventable hospitalization rates for major chronic conditions, even after disease prevalence and underlying hospital utilization patterns are considered. These rates are particularly high for asthma, diabetes and hypertension, which are amenable to prevention and management interventions. Our results suggest a need to improve access to quality primary health care for African Americans and Hispanics in the USA, and for enhanced support of targeted prevention efforts. [ABSTRACT FROM AUTHOR]

Keywords: Race, minority health, access to health care, socioeconomics, ethnicity. [ABSTRACT FROM AUTHOR]