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Open Access Publications from the University of California

Scholarly Works (27 results)

  • Article
Policy Alerts and Briefs (2000)
    Cover page: INCREASING ACCESS TO PRIVATE AND PUBLIC HEALTH INSURANCE, Policy Alert
    • Thesis
    • Peer Reviewed
    UC San Diego Electronic Theses and Dissertations (2024)

    Background: Cardiovascular disease is a large contributor to premature death and disability in the U.S. Effective treatments such as cardiac rehabilitation (CR) programs exist, yet participation remains notably low, especially among certain demographic and socioeconomic groups. Despite the introduction of automated referral systems, barriers to participation persist. This study seeks to examine the impact of social vulnerability on CR participation and pinpoint specific barriers to participation encountered post-automatic referral.

    Methods: Employing a mixed-methods approach, the study examined data from individuals referred to UC San Diego Health's CR program between July and December 2023. Sociodemographic characteristics were meticulously assessed, and logistic regression was utilized to explore the intricate relationship between social vulnerability and enrollment. Qualitative analysis of survey responses from non-enrollees was conducted to identify additional barriers, and the regional distribution of enrollees versus non-enrollees was scrutinized.

    Results: Out of the 302 referred participants, 54.3% enrolled, with younger individuals exhibiting a greater likelihood of participation. Logistic regression unveiled that higher overall SVI scores were intimately associated with diminished enrollment rates. Specific themes revolving around socioeconomic status and housing/transportation barriers significantly curtailed the likelihood of participation by 68%, respectively.

    Conclusions: This study serves as an indicator of the multifaceted challenges encountered by patients post-CR referral, underscoring the profound impact of social vulnerability on healthcare utilization. The findings underscore the exigency for targeted interventions and programmatic enhancements to effectively address disparities and fervently advocate for health equity in CR participation.

      • Thesis
      • Peer Reviewed
      UC San Diego Electronic Theses and Dissertations (2023)

      The objective of this paper was to analyze trends in state mandated benefit laws after the ACA intended to reduce the growing rate. One provision of the ACA was intended to discourage states from enacting new mandated benefit laws by establishing a list of Essential Health Benefits (EHBs). A comparative analysis of state mandated benefit laws from years 1949-2022 was conducted. Data was collected through 1. BlueCross BlueShield (BCBS) 2. CMS database of state mandates, 3. Searches of legiscan and google, and 4. California Health Benefit Review Program (CHBRP). Dates were collected and compared for each individual mandated law. Additionally, categories of state mandated laws specific to fertility preservation were examined. Data from 2011-2019 indicated that there was a decrease in enacted/revised mandated benefit laws after the ACA. State legislative bill text for mandates specific to fertility preservation was analyzed to determine what type of language is being used to ensure states are not responsible for defraying the cost of mandated benefit laws. The main findings from this study highlights that there are still benefit mandate laws that are being enacted post the ACA that could fall outside of EHBs. This study highlights that there are gaps with what constitutes benefit mandate laws falling under EHBs or needing state defrayal. Additionally, more clarification is needed on what the current process is of determining which benefit mandate laws requires state defrayal.

        Cover page: Analysis of Health Insurance Benefit Mandates Prior and Post Affordable Care Act in the United States
        • Thesis
        • Peer Reviewed
        UC San Diego Electronic Theses and Dissertations (2023)

        Several US states have recently introduced and/or passed laws mandating health insurance coverage of non-pharmacological pain management treatment therapies (NPMT) as a non-opioid alternative for the treatment of pain. This thesis explores the heterogeneity of the existing legislation regarding benefit mandates of NPMTs and the potential implications of variation. A systemic characterization was conducted with the seven US states that mandate NPMT therapies for the management and treatment of pain. Features of the legislation were summarized by theme (e.g., eligible treatment/providers). Analysis documented substantial differences across all seven states that may influence patient access to these treatments. As future policymakers consider enacting NPMT benefit mandates, there are key considerations to be made including how specific the policy language should be in regard to eligible treatments and providers, benefit design, inclusion of publicly insured populations in required coverage, and interaction with other state and federal policies.

          • Article
          Policy Alerts and Briefs (2006)
            Cover page: Financing and Delivery of Health Care: California Trends
            • Article
            Policy Alerts and Briefs (2006)
              Cover page: Public Health in California: Trends and Challenges in 2006
              • Article
              • Peer Reviewed
              UC San Diego Previously Published Works (2020)
              Purpose: Previous research has shown that Asian Americans are less likely to receive recommended clinical preventive services especially for cancer compared with non-Hispanic whites. Health insurance expansion has been recommended as a way to increase use of these preventive services. This study examines the extent to which utilization of preventive services by Asians overall and by ethnicity compared with non-Hispanic whites is moderated by health insurance. Methods: Data from the California Health Interview Survey (CHIS) was used to examine preventive service utilization among non-Hispanic whites, Asians, and Asian subgroups 50-64 years of age by insurance status. Six waves of CHIS data from 2001 to 2011 were combined to allow analysis of Asian subgroups. Logistic regression models were run to predict the effect of insurance on receipt of mammography, colorectal cancer (CRC) screening, and flu shots among Asians overall and by ethnicity compared with whites. Results: Privately insured Asians reported significantly lower adjusted rates of mammography (83.1% vs. 87.6%) and CRC screening (54.7% vs. 59.4%), and higher rates of influenza vaccination (48.7% vs. 38.5%) than privately insured non-Hispanic whites. Adjusted rates of cancer screening were lower among Koreans and Chinese for mammography, and lower among Filipinos for CRC screening. Conclusion: This study highlights the limitations of providing insurance coverage as a strategy to eliminate disparities for cancer screening among Asians without addressing cultural factors.
                Cover page: The Importance of Health Insurance in Addressing Asian American Disparities in Utilization of Clinical Preventive Services: 12-Year Pooled Data from California.
                • Article
                • Peer Reviewed
                UC San Diego Previously Published Works (2020)

                Introduction

                In 2016, the California Department of Health Care Services issued All Plan Letter 16-014 to the Medi-Cal Managed Care plans to provide information on requirements for comprehensive tobacco-cessation services. Researchers at the University of California, San Diego set out to (1) examine Medi-Cal's Managed Care plans' progress in implementing each section of All Plan Letter 16-014, (2) understand various factors related to implementation of the All Plan Letter, and (3) make recommendations to improve implementation.

                Methods

                Researchers surveyed health educators within California's 25 Medi-Cal Managed Care plans to document each one's smoking-cessation services and policies in 2018. Data were collected for 24 of the 25 Medi-Cal Managed Care plans (96%) through 3 methods, including: (1) a web-based survey, (2) an in-depth phone interview, and (3) collection of smoking cessation-relevant documents.

                Results

                Managed Care plans demonstrate low levels of full implementation, with only 1 fully implementing all 20 provisions of the All Plan Letter. On average, Managed Care plans implemented 13 of the 20 provisions. Managed Care plans had the highest implementation rates for provisions related to requirements for coverage of the 7 U.S. Food and Drug Administration-approved medications for tobacco cessation, in which 12 (55%) fully implemented all related required provisions. Managed Care plans had lowest implementation rates for provisions related to data collection, with only 4 (18%) fully implementing all 3 requirements.

                Conclusions

                Although All Plan Letter 16-014 was successful in creating more comprehensive and consistent benefits across Managed Care plans, 95% of Managed Care plans have not fully implemented it. Further guidance from the Department of Health Care Services and integration with the California Smokers' Helpline may be needed to achieve full implementation.
                  Cover page: Implementation of a Comprehensive Tobacco-Cessation Policy in Medicaid Managed Care Plans in California
                  • Article
                  • Peer Reviewed
                  UC San Diego Previously Published Works (2023)

                  Objectives

                  To make projections of cigarette consumption that incorporate state-specific trends in smoking behaviors, assess the potential for states to reach an ideal target, and identify State-specific targets for cigarette consumption.

                  Methods

                  We used 70 years (1950-2020) of annual state-specific estimates of per capita cigarette consumption (expressed as packs per capita or "ppc") from the Tax Burden on Tobacco reports (N = 3550). We summarized trends within each state by linear regression models and the variation in rates across states by the Gini coefficient. Autoregressive Integrated Moving Average (ARIMA) models were used to make state-specific forecasts of ppc from 2021 through 2035.

                  Results

                  Since 1980, the average rate of decline in US per capita cigarette consumption was 3.3% per year, but rates of decline varied considerably across US states (SD = 1.1% per year). The Gini coefficient showed growing inequity in cigarette consumption across US states. After reaching its lowest level in 1984 (Gini = 0.09), the Gini coefficient began increasing by 2.8% (95% CI: 2.5%, 3.1%) per year from 1985 to 2020 and is projected to continue to increase by 48.1% (95% PI = 35.3%, 64.2%) from 2020 to 2035 (Gini = 0.35; 95% PI: 0.32, 0.39). Forecasts from ARIMA models suggested that only 12 states have a realistic chance (≥50%) of reaching very low levels of per capita cigarette consumption (≤13 ppc) by 2035, but that all US states have opportunity to make some progress.

                  Conclusion

                  While ideal targets may be out of reach for most US states within the next decade, every US state has the potential to lower its per capita cigarette consumption, and our identification of more realistic targets may provide a helpful incentive.
                    Cover page: Trends in cigarette consumption across the United States, with projections to 2035
                    • Article
                    • Peer Reviewed
                    UC San Diego Previously Published Works (2018)
                    OBJECTIVE:Cigarette smoking and smoking-related diseases disproportionately affect low-income populations. Health insurance coverage of smoking cessation treatments is increasingly used to encourage quitting. We assess the relationship between state Medicaid coverage of smoking cessation treatments and past-year quitting in adult Medicaid beneficiaries. DATA SOURCES:2009-2014 National Health Interview Survey (NHIS); 2008-2013 indicators of state Medicaid coverage of smoking cessation treatments. STUDY DESIGN:A triple-differencing specification based on differences in Medicaid cessation coverage policies across states as well as within-state differences between Medicaid beneficiaries and a counterfactual group of low-income adults not covered by Medicaid. DATA COLLECTION/EXTRACTION METHODS:Individual-level NHIS data with restricted geographical identifiers were merged with state-year Medicaid coverage indicators. PRINCIPAL FINDINGS:Combined coverage of both cessation counseling and medications in state Medicaid programs was associated with increased quitting, with an estimated mean increase in past-year quitting of 3.0 percentage points in covered Medicaid beneficiaries relative to persons without coverage. CONCLUSIONS:Combined coverage of both smoking cessation counseling and medication by state Medicaid programs could help reduce cigarette smoking among Medicaid beneficiaries.
                      Cover page: Does State Medicaid Coverage of Smoking Cessation Treatments Affect Quitting?
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