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Will you be covered during the next recession? Unequal safety-nets for private health insurance in the United States.

ABSTRACT: Health insurance coverage for working-age adults in the United States is still predominantly determined by their jobs or their spouse's jobs. This article revealed that SES disparities in access to a spouse's coverage as a safety-net significantly contributed to the inequities in coverage loss during economic instability. Using the longitudinal Survey of Income and Program Participation (1996-2012), this article examines insurance transitions between socioeconomic groups during the two most recent recessions in the United States. The SES disparity in private coverage spiked during periods of high job-loss. Higher SES men's and women's coverages were barely affected as they became insured by their spouses even as they lost their own. Wives' insurance plans played a large role in mitigating declines in higher SES men's coverages during the 2008 recession.

SUBMITTER: Sohn H

PROVIDER: S-EPMC7243774 | biostudies-literature | 2020 Dec

REPOSITORIES: biostudies-literature

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Will you be covered during the next recession? Unequal safety-nets for private health insurance in the United States.

Sohn Heeju H

Health policy OPEN 20200522

Health insurance coverage for working-age adults in the United States is still predominantly determined by their jobs or their spouse's jobs. This article revealed that SES disparities in access to a spouse's coverage as a safety-net significantly contributed to the inequities in coverage loss during economic instability. Using the longitudinal Survey of Income and Program Participation (1996-2012), this article examines insurance transitions between socioeconomic groups during the two most rece ...[more]

PMID: 32835216

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Project description:Background and aimsThe United States of America and Sweden both contain a public and private component to their healthcare systems. While both countries spend a similar amount per capita on public healthcare expenditures, the United States spends significantly more in the private healthcare sector. Sweden has a social democratic model of health care, and given its identity as a welfare state, private health insurance providers have a small and nuanced role.MethodsThis paper was completed after searches were queried for "Sweden," "United States," and variants of the words "insurance," "public," "private," "Medicare," "Medicaid," "public," and "costs." A preliminary search in May 2022, yielded 78 articles, of which 45 were ultimately considered relevant for this review. Inclusion criteria consisted of English language articles, topic relevance, and verification of MEDLINE-indexed journals. These searches were performed in PubMed, Google Scholar, Embase, and Cochrane. Summary findings of these searches are compiled in this review.ResultsSweden guarantees low-cost appropriate care to all citizens with equitable access; however, drawbacks of its system include high financial burden, lack of primary care infrastructure, as well as geographical and socioeconomic inequities. On the other hand, the United States' healthcare system is built around the private sector with public health insurance reserved only for the most vulnerable patient populations.ConclusionOur goal is to provide an overview, compare the role of private health insurance in both countries, and highlight policies that have had beneficial effects in each nation. Possible solutions to the drawbacks of each nation's health insurance policies could be addressed by additional support to Sweden's vulnerable population by developing a program similar to the US' Medicare Advantage program. Conversely, the United States may benefit from increasing access to public health insurance, especially in instances where families face unemployment.

Project description:BackgroundPsychiatric disorders are equally common during pregnancy as among non-pregnant women, and many of these conditions are treated with psychotropic medicines. Relatively little is known about patterns of use of many these agents during pregnancy, and specifically of how rates may have shifted during the last decade. We aimed to quantify the rate of pregnancy related exposures to categories of psychotropic medicines stratified according to the primary indication for use (antidepressants, antipsychotics, anxiolytics, and psychostimulants), trimester of pregnancy, trends over time and region, and indication for use.MethodsWe conducted a retrospective cohort study of pregnancies among women in the Truven Health MarketScan database (source population 70 million Americans), which captures person-specific clinical use and includes detailed information on filled prescriptions, hospitalizations and outpatient visits for all privately insured employees and their dependents. We classified psychotropic medicines of interest using ATC level 3 accordingly: antipsychotics (N05A); anxiolytics (N05B); antidepressants (N06A); psychostimulants, agents used for ADHD and cognitive enhancement (N06B). We also examined temporal and regional trends in use.ResultsWe included 343,299 women who had a live birth between Jan 1, 2006 and Dec 31, 2011, of whom 10.3% were dispensed one or more psychotropic medicines during pregnancy. This rate varied from 6% to 15% between states. The rate of use of psychotropic medicines was relatively stable between 2006 and 2011. The most commonly used psychotropic medicines were selective serotonin reuptake inhibitors (5.1%) and benzodiazepine or benzodiazepine-like medicines (3.9%). Among psychotropic users, the most commonly associated psychiatric diagnosis was depression (25.0%), followed by anxiety disorders (24.4%). Approximately 1.6% of women used more than one category of psychotropic medicine in pregnancy, most commonly an antidepressant and an anxiolytic medicine (1.2%).ConclusionsGiven this relatively high rate of use, the lack of evidence that the most frequently used medications improve birth outcomes and the safety concerns associated with both early and late pregnancy use for many frequently-used medications, there is a need for further study of factors driving psychotropic medication use during pregnancy.

Dataset Information

Will you be covered during the next recession? Unequal safety-nets for private health insurance in the United States.

Publications

Will you be covered during the next recession? Unequal safety-nets for private health insurance in the United States.

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