DiversityNursing Blog

Insuring Undocumented Residents Could Help Solve Multiple US Health Care Challenges

Posted by Erica Bettencourt

Mon, Mar 30, 2015 @ 10:36 AM

Source: University of California - Los Angeles

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Latinos are the largest ethnic minority group in the United States, and it's expected that by 2050 they will comprise almost 30 percent of the U.S. population. Yet they are also the most underserved by health care and health insurance providers. Latinos' low rates of insurance coverage and poor access to health care strongly suggest a need for better outreach by health care providers and an improvement in insurance coverage. Although the implementation of the Affordable Care Act of 2010 seems to have helped (approximately 25 percent of those eligible for coverage under the ACA are Latino), public health experts expect that, even with the ACA, Latinos will continue to have problems accessing high-quality health care.

Alex Ortega, a professor of public health at the UCLA Fielding School of Public Health, and colleagues conducted an extensive review of published scientific research on Latino health care. Their analysis, published in the March issue of the Annual Review of Public Health, identifies four problem areas related to health care delivery to Latinos under ACA: The consequences of not covering undocumented residents. The growth of the Latino population in states that are not participating in the ACA's Medicaid expansion program. The heavier demand on public and private health care systems serving newly insured Latinos. The need to increase the number of Latino physicians and non-physician health care providers to address language and cultural barriers.

"As the Latino population continues to grow, it should be a national health policy priority to improve their access to care and determine the best way to deliver high-quality care to this population at the local, state and national levels," Ortega said. "Resolving these four key issues would be an important first step."

Insurance for the undocumented

Whether and how to provide insurance for undocumented residents is, at best, a complicated decision, said Ortega, who is also the director of the UCLA Center for Population Health and Health Disparities.

For one thing, the ACA explicitly excludes the estimated 12 million undocumented people in the U.S. from benefiting from either the state insurance exchanges established by the ACA or the ACA's expansion of Medicaid. That rule could create a number of problems for local health care and public health systems.

For example, federal law dictates that anyone can receive treatment at emergency rooms regardless of their citizenship status, so the ACA's exclusion of undocumented immigrants has discouraged them from using primary care providers and instead driven them to visit emergency departments. This is more costly for users and taxpayers, and it results in higher premiums for those who are insured.

In addition, previous research has shown that undocumented people often delay seeking care for medical problems.

"That likely results in more visits to emergency departments when they are sicker, more complications and more deaths, and more costly care relative to insured patients," Ortega said.

Insuring the undocumented would help to minimize these problems and would also have a significant economic benefit.

"Given the relatively young age and healthy profiles of undocumented individuals, insuring them through the ACA and expanding Medicaid could help offset the anticipated high costs of managing other patients, especially those who have insurance but also have chronic health problems," Ortega said.

The growing Latino population in non-ACA Medicaid expansion states

A number of states opted out of ACA Medicaid expansion after the 2012 Supreme Court ruling that made it voluntary for state governments. That trend has had a negative effect on Latinos in these states who would otherwise be eligible for Medicaid benefits, Ortega said.

As of March, 28 states including Washington, D.C., are expanding eligibility for Medicaid under the ACA, and six more are considering expansions. That leaves 16 states who are not participating, many of which have rapidly increasing Latino populations.

"It's estimated that if every state participated in the Medicaid expansion, nearly all uninsured Latinos would be covered except those barred by current law -- the undocumented and those who have been in the U.S. less than five years," Ortega said. "Without full expansion, existing health disparities among Latinos in these areas may worsen over time, and their health will deteriorate."

New demands on community clinics and health centers

Nationally, Latinos account for more than 35 percent of patients at community clinics and federally approved health centers. Many community clinics provide culturally sensitive care and play an important role in eliminating racial and ethnic health care disparities.

But Ortega said there is concern about their financial viability. As the ACA is implemented and more people become insured for the first time, local community clinics will be critical for delivering primary care to those who remain uninsured.

"These services may become increasingly politically tenuous as undocumented populations account for higher proportions of clinic users over time," he said. "So it remains unclear how these clinics will continue to provide care for them."

Need for diversity in health care workforce

Language barriers also can affect the quality of care for people with limited English proficiency, creating a need for more Latino health care workers -- Ortega said the proportion of physicians who are Latino has not significantly changed since the 1980s.

The gap could make Latinos more vulnerable and potentially more expensive to treat than other racial and ethnic groups with better English language skills.

The UCLA study also found recent analyses of states that were among the first to implement their own insurance marketplaces suggesting that reducing the number of people who were uninsured reduced mortality and improved health status among the previously uninsured.

"That, of course, is the goal -- to see improvements in the overall health for everyone," Ortega said.

Topics: US, study, UCLA, clinic, diversity, health, healthcare, hospital, care, residents, undocumented, language barrier, health centers, Insuring

'Easy-to-walk Communities' Linked To Better Cognition In Older Adults

Posted by Erica Bettencourt

Mon, Nov 10, 2014 @ 01:42 PM

By Marie Ellis

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It is well known that exercise is good for the mind and body, but to what extent does the neighborhood or community in which we live affect our physical and mental health? New research from the University of Kansas suggests the walkability of a community has a great impact on cognition in older adults.

Previous studies have detailed the importance physical exercise has for executive function in older adults.

But how can the layout of a neighborhood encourage its residents to get out and walk? This is precisely what Amber Watts, assistant professor of clinical psychology at the University of Kansas, wanted to find out.

"Depending on which type of walking [leisure vs. walking to get somewhere] you're interested in, a neighborhood might have different characteristics," she says. "Features of a neighborhood that encourage walking for transportation require having someplace worth walking to, like neighbors' houses, stores and parks."

She adds that neighborhoods that encourage leisure walking have "pleasant things to look at," including walking trails and trees, and they should feel safe.

Her research, which she presented yesterday at the Gerontological Society of America's annual meeting in Washington, DC, suggests that neighborhoods that encourage walking can protect against cognitive decline in older adults.

To conduct her research, Watts used geographic information systems (GIS) to judge walkability. This involved maps that measure and analyze spatial data.

Better physical and mental health

Detailing how she collected her data, Watts explains:

"GIS data can tell us about roads, sidewalks, elevation, terrain, distances between locations and a variety of other pieces of information. We then use a process called space syntax to measure these features, including the number of intersections, distances between places or connections between a person's home and other possible destinations they might walk to."

She also looked at how complicated a route is from one location to another: "For example, is it a straight line from point A to point B, or does it require a lot of turns to get there?"

To conduct the study, Watts and colleagues tracked 25 people with mild Alzheimer's disease and 39 older adults without any cognitive impairment. Using the space syntax data, they created a "walkability score" for the participants' home addresses.

Then, they estimated the relationship between a person's neighborhood scores and how well they performed on cognitive tests over 2 years. The cognitive tests included three categories: attention, verbal memory and mental status. The team also factored in issues that might influence cognitive scores, including age, gender, education and wealth.

Results from the study suggest that communities that are easier to walk in are linked to better physical health outcomes - such as lower body mass and blood pressure - and cognition - including better memory.

Watts and her colleagues believe their findings could benefit older adults, health care professionals, caregivers and even architects and urban planners.

Do mentally complex neighborhoods act like a brain-training game?

Though elaborate community layouts may be expected to confuse older residents, Watts and her team found that they actually serve to keep cognition sharp.

"There seems to be a component of a person's mental representation of the spatial environment, for example, the ability to picture the streets like a mental map," Watts says.

She adds that complicated environments may demand more intricate mental processes in order to navigate them, which could keep the mind sharp. This is in line with previous studies, which have demonstrated how staying mentally active helps to preserve memory.

"Our findings suggest that people with neighborhoods that require more mental complexity actually experience less decline in their mental functioning over time," Watts adds.

She explains that a challenging environment keeps an individual's body and mind healthy:


"With regard to the complexity of neighborhood street layouts - for example, the number of turns required getting from point A to point B - our results demonstrate that more complex neighborhoods are associated with preserved cognitive performance over time.


We think this may be because mental challenges are good for us. They keep us active and working at that optimal level instead of choosing the path of least resistance."

A National Institute on Aging grant, KU Strategic Initiative Grant and Frontiers Clinical Translational Science award helped fund the study.

Source: www.medicalnewstoday.com

Topics: health, brain, health care, medicine, community, elderly, lifestyle, seniors, walking, neighborhoods, cognition, residents

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