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Biomedical subjects

E M Howell

Publications and source records attributed to E M Howell.

25 records · Page 2Linked to original sources
PubMedDate not supplied

Perinatal substance abuse treatment. Findings from focus groups with clients and providers.

Thirty-three focus groups were conducted with pregnant women in substance abuse treatment and their providers in order to identify factors in women's lives that facilitate and hamper their treatment process and successful program components to address the needs of this high-risk population. The focus groups were conducted as part of a larger evaluation of demonstrations funded by the Health Care Financing Administration. From the 88 women in the focus groups we received a picture of their troubled lives and the events that led to their participation in the programs. The women had difficult childhoods, and currently had weak support networks and difficult relationships with male partners, many of whom were substance abusers. Most had children, which complicated getting into and staying in treatment. However, fear of losing custody of children was a major motivator for treatment. Important components of successful programs included: (a) the development of interorganizational linkages between various governmental agencies, especially child protection systems, prenatal care providers, and substance abuse treatment agencies and providers; (b) outreach and systems for identifying pregnant substance abusers through provider education and routine screening; and (c) intensive case management, necessary to link women to the many services they needed in order to obtain treatment, such as child care, transportation, and housing.

Adult↗
PubMedDate not supplied

Medicaid and pregnancy: issues in expanding eligibility.

Recent federal and state policy has expanded Medicaid eligibility to provide health insurance coverage for pregnant women with family incomes below 133 percent of the federal poverty level. It has yet to be determined how such expanded coverage will affect enrollment in Medicaid or use of prenatal care. Using 1983 data from three states with widely divergent Medicaid programs--including one that already had most of the expanded eligibility options available today--this study found that about 40-60 percent of women who were covered by Medicaid at the time of their deliveries had not been enrolled in the program when they became pregnant. In addition, a large number of women did not receive Medicaid-covered prenatal care early in pregnancy, even though they were enrolled at that time. Almost all women in the study group visited more than one ambulatory care provider at some time during the nine months before birth and one year following birth; 29-51 percent visited more than one hospital outpatient department.

Adolescent↗
PubMedDate not supplied

Low-income persons' access to health care: NMCUES Medicaid data.

Data from the National Medical Care Utilization and Expenditure Survey (NMCUES) are presented on access to medical care for low-income people in 1980. NMCUES was a national probability household survey jointly sponsored by the National Center for Health Statistics and the Health Care Financing Administration. NMCUES also included four State Medicaid Household Surveys. Data from both the national sample, for all low-income people, and from the four State surveys, for Medicaid people, were included in this analysis. The NMCUES data provided several measures which were previously unavailable on Medicaid experience, in particular, detailed Medicaid eligibility information in combination with income, health status, and health care use. This information can provide a comparison between access to care for those covered by Medicaid, and other low-income persons. In 1980 Medicaid covered a minority of poor and low-income people, only 44 percent of the poor younger than 65 years of age and 38 percent of poor people 65 years of age and older. While almost all elderly had Medicare coverage, about 25 percent of younger low-income people had no form of health insurance, compared with only 9 percent of non poor persons who were uninsured. Another measure of access is a regular source of care, the "place where a person goes for health care when sick." In 1980, 15 percent of people younger than 65 who were covered by Medicaid had no regular source of care. This is similar to the rate for the privately insured. However, the types of providers that were cited as the regular source of care differed. Medicaid recipients were more likely to have hospital outpatient departments and emergency rooms as a regular source.About one-fourth of the uninsured had no regular source of care.The third measure of access presented is physician-visit rates adjusted for health status.Again, Medicaid-covered persons resembled the privately insured, while the uninsured had much lower visit rates, after adjusting for their relatively good health status.Within the Medicaid Program, there are differences between States and eligibility groups in rates of physician visits after adjusting for health status.For example, Texas, the most restrictive of the State Medicaid Programs among the four States surveyed, had substantially lower rates, and those differences were most marked for those covered under the Aid for Dependent Children program population.An examination of trends in measures of access to care during the 1970s suggests that there was little change in access to care for the low-income population during the decade. It is not possible to examine the specific experience of the Medicaid population during the decade owing to a lack of data on that population for the earlier period.

Activities of Daily Living↗