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ObjectiveTo examine whether hospitals are more likely to temporarily close their emergency departments (EDs) to ambulances (through ambulance diversions) if neighboring diverting hospitals are public vs private.Data sources/study settingAmbulance diversion logs for California hospitals, discharge data, and hospital characteristics data from California's Office of Statewide Health Planning and Development and the American Hospital Association (2007).Study designWe match public and private (nonprofit or for-profit) hospitals by distance and size. We use random-effects models examining diversion probability and timing of private hospitals following diversions by neighboring public vs matched private hospitals.Data collection/extraction methodsN/A.Principal findingsHospitals are 3.6 percent more likely to declare diversions if neighboring diverting hospitals are public vs private (P&nbsp

The Emergency Medical Treatment and Labor Act (EMTALA), which requires Medicare-participating hospitals to provide emergency care to patients regardless of their ability to pay, plays an important role in protecting the uninsured. Yet many hospitals do not comply. This study examines the reasons for noncompliance and proposes solutions. We conducted eleven semi-structured key informant interviews with hospitals, hospital associations, and patient safety organizations in the Centers for Medicare & Medicaid Services region with the highest number of EMTALA complaints filed. Respondents identified five main causes of noncompliance: financial incentives to avoid unprofitable patients, ignorance of EMTALA’s requirements, high referral burden at hospitals receiving EMTALA transfer patients, reluctance to jeopardize relationships with transfer partners by reporting borderline EMTALA violations, and opposing priorities of hospitals and physicians. Respondents suggested five methods to improve compliance, including educating subspecialists about EMTALA, informally educating hospitals about borderline violations, and incorporating EMTALA-compliant processes into hospital operations such as by routing transfer requests through the emergency department. To improve compliance we suggest: 1) more closely aligning Medicaid/Medicare payment policies with EMTALA, 2) amending the Act to permit informal mediation between hospitals about borderline violations, 3) increasing the hospital’s role in ensuring EMTALA compliance, and 4) expanding the role of hospital associations.

The Personal Responsibility Work Opportunity and Reconciliation Act (PRWORA) of 1996 imposed time limits on the receipt of welfare cash benefits and mandated cash benefit sanctions for failure to meet work requirements. Many studies examining the health implications of PRWORA have found associated declines in health insurance coverage and healthcare utilization among single mothers but no impact of PRWORA on health outcomes. A limitation of this literature is that most studies cover a time period before time limits were implemented in all states and also before individuals began actually timing out. This work builds on previous studies by exploring this research question using data from the Survey of Income and Program Participation that covers a time period after all states have implemented time limits (1991-2009). We use a difference-in-differences study design that exploits variability in eligibility for cash welfare benefits by marital status and state-level variation in timing of PRWORA implementation to identify the effect of PRWORA. Using ordinary least square regression models, controlling for state-level and federal policies, individual-level demographics and state and year fixed-effects, we find that PRWORA leads to 7 and 5 percentage point increases in self-reported poor health and self-reported disability among white single mothers without a diploma, respectively.

Background: Neighborhood socioeconomic status (nSES) has been found to be associated with breast cancer risk. It remains unclear whether this association applies across racial/ethnic groups independent of individual-level factors and is attributable to other neighborhood characteristics. Methods: We examined the independent and joint associations of education and nSES with odds of breast cancer. Residential addresses were geocoded for 2,838 cases and 3,117 controls and linked to nSES and social and built environment characteristics. We estimated ORs and 95% confidence intervals (CI) using multilevel logistic regression controlling for individual-level breast cancer risk factors and assessed the extent to which nSES associations were due to neighborhood characteristics. Results: Women living in the highest versus lowest nSES quintile had a nearly 2-fold greater odds of breast cancer, with elevated odds (adjusted ORs, 95% CI) for non-Hispanic whites (NHWs; 2.27; 1.45–3.56), African Americans (1.74; 1.07–2.83), U.S.-born Hispanics (1.82; 1.19–2.79), and foreign-born Hispanics (1.83; 1.06–3.17). Considering education and nSES jointly, ORs were increased for low education/high nSES NHWs (1.83; 1.14–2.95), high education/high nSES NHWs (1.64; 1.06–2.54), and high education/high nSES foreign-born Hispanics (2.17; 1.52–3.09) relative to their race/ethnicity/nativity-specific low education/low nSES counterparts. Adjustment for urban and mixed-land use characteristics attenuated the nSES associations for most racial/ethnic/nativity groups except NHWs. Conclusions: Our study provides empirical evidence for a role of neighborhood environments in breast cancer risk, specifically social and built environment attributes. Impact: Considering the role of neighborhood characteristics among diverse populations may offer insights to understand racial/ethnic disparities in breast cancer risk. Cancer Epidemiol Biomarkers Prev; 26(4); 541–52. ©2017 AACR.

© 2015, Springer Science+Business Media New York. We examine the association of patient activation and physical activity and fruit and vegetable consumption among obese safety net patients. Adult obese patients (n = 198) of three safety net clinics completed a survey assessing patient activation, physical activity, fruit and vegetable consumption, care experiences, and health status. Multivariate logistic regression models incrementally assessed the adjusted relation of patient activation and physical activity and fruit and vegetable consumption. In adjusted analyses, higher activated patients had higher odds [Odds ratio (OR) 1.58, p

THE CALIFORNIA Journal of Politics & Policy Volume 3, Issue 4 Access to Job-Based Insurance for California Workers and Families: The Effect of the Great Recession and Doublle-Digit Unemployment in California Shana Alex Lavarreda, Ninez A. Ponce, Livier Cabezas, and E. Richard Brown University of California, Los Angeles Abstract Lack of health insurance affects workers and families who depend on job-based coverage for health care. In 2007, the unemployment rate in California was 5.5%. By the end of 2009, it had more than doubled to 12.3%. This study uses data from the 2007 and 2009 California Health Interview Survey to assess changes in ac- cess to job-based health insurance among California workers and their dependents. We find that although increased unemployment dramatically reduced the number of employees, the proportion of employees with no access to job-based coverage through either their own or a spouse’s work remained constant. Among adults with no family access to job-based insurance, the most significant determinants of being uninsured were income and citizenship. Due to more generous public health insur- ance options, children with the lowest household incomes were not significantly more likely to be uninsured than children with higher household incomes. The re- sults highlight the importance of public health insurance for children and confirm the need for the Affordable Care Act’s insurance expansion provisions. Keywords: employment-based insurance, workers, children, recession Copyright © 2011 The Berkeley Electronic Press. All rights reserved. www.bepress.com/cjpp