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The South African government has been focused on repealing unconstitutional laws, passing transformative policies, and building democratic and transparent policies responsive to the demands of the current generation and the public. This erected a need to have policy systems that largely resonate and address the problems upstretched in societies, intending to improve the quality of lives and advance communities. The National Framework for Municipal Indigent Policies issued a guiding document as a source of reference for the formulation and implementation of municipal indigent policies, with the intent of reducing poverty and eliminating service delivery backlogs in municipalities. The study seeks to examine and explore how indigent policies are implemented in rural municipalities to propose strategies to enhance the framework for sustainable service delivery. The objective of the study is to determine whether municipal indigent policies fulfil their dual purpose, which is to improve the lives of indigents and improve access to basic services. The study has established that indigent policies are deemed not sufficient to address the needs of indigents living in poverty and are reinforcing poverty rather than alleviating it. This has resulted in the dysfunction of municipal administration in terms of their indigent policies' implementation, failing the policies to yield their intended objectives, and as a result, most rural municipalities ended up being characterised as poor in their service delivery. The study argues that indigent policies can be consistent and serve as appropriate tools to fulfil the needs of indigent households, given that they are effectively formulated and their implementation yields desired outcomes. The study employed a qualitative research methodology supplemented by scholarly review of existing literature and document analysis. The study significantly contributes to theory and practice, concludes by proposing possible ways in which the challenges confronting municipal indigent policies can be effectively dealt with, and recommends that further empirical research be conducted to draw conclusions from both primary and secondary data.

Evictions are increasingly recognized as a serious concern facing low-income households. This study evaluated whether expansions of Medicaid can prevent evictions from occurring. We examined data from a privately licensed database of eviction records in fourteen states (286 counties) and used a difference-in-differences research design to compare rates of eviction before and after California's early Medicaid expansion (51 counties). Early Medicaid expansion in California was associated with a reduction in the number of evictions, with 24.5 fewer evictions per month in each county from a pre-expansion average of 224.7. These results imply that for every thousand new Medicaid enrollees in California, Medicaid expansion was associated with roughly twenty-two fewer evictions per year. Additionally, we found a 2.9-percentage-point reduction in evictions per capita associated with early expansion. The effects were concentrated among counties with the highest pre-expansion rates of uninsurance. We conclude that health insurance coverage is associated with improved housing stability.

abstract People with low incomes have poorer health outcomes, including greater risk for disease and shorter lifespans. This pattern has the least favorable outcomes for those living in poverty but is present at every level of the income ladder. Income support programs that provide a social safety net for families-including the Earned Income Tax Credit and Temporary Assistance for Needy Families-can influence health by meeting families' basic needs and supporting participation in economic development. However, families face inequitable access to income support programs. States vary in whether they offer the Earned Income Tax Credit, and this can lead to unequal access and participation across groups. Critical challenges for policy makers are identifying barriers to access to and participation in income supports as well as developing strategies to increase equitable access to income supports. This article synthesizes evidence on income and health and its relevance to income supports.

The United States has the largest socioeconomic disparities in health care access of any wealthy country. We assessed changes in these disparities in the United States under the Affordable Care Act (ACA). We used survey data for the period 2011-15 from the Behavioral Risk Factor Surveillance System to assess trends in insurance coverage, having a personal doctor, and avoiding medical care due to cost. All analyses were stratified by household income, education level, employment status, and home ownership status. Health care access for people in lower socioeconomic strata improved in both states that did expand eligibility for Medicaid under the ACA and states that did not. However, gains were larger in expansion states. The absolute gap in insurance coverage between people in households with annual incomes below $25,000 and those in households with incomes above $75,000 fell from 31 percent to 17 percent (a relative reduction of 46 percent) in expansion states and from 36 percent to 28 percent in nonexpansion states (a 23 percent reduction). This serves as evidence that socioeconomic disparities in health care access narrowed significantly under the ACA.

Discusses risk to Māori and the need to consider Māori health equity in all levels of decision-making and in all strategies aimed at mitigating the impact of an overwhelming COVID-19 outbreak. Source: National Library of New Zealand Te Puna Matauranga o Aotearoa, licensed by the Department of Internal Affairs for re-use under the Creative Commons Attribution 3.0 New Zealand Licence.

AbstractObjectiveTo understand how health insurance coverage and employment changed among working age adults with low incomes in Georgia, the first state to implement Medicaid expansion with work requirements under the Pathways to Coverage program.DesignQuasi-experimental difference-in-differences study.SettingGeorgia, which expanded Medicaid with work requirements on 1 July 2023; Alabama, Florida, Mississippi, South Carolina, and Tennessee, which neighbor Georgia and did not expand Medicaid; and South Dakota, which simultaneously expanded Medicaid without work requirements.ParticipantsAdults aged 19-64 years with low incomes defined as ≤100% of the federal poverty level who completed the US Census Bureau’s household pulse survey between 2021 and 2024.Main outcome measuresMedicaid coverage, uninsured rate, and employment.ResultsThe study population consisted of 3303 adults in Georgia (intervention state) and 14 148 in neighboring states that did not expand Medicaid (controls). After the implementation of Pathways to Coverage, Medicaid coverage did not change in Georgia (35.5% to 32.4%) or in neighboring control states (39.6% to 39.3%), resulting in no differential change in Medicaid coverage between these states (adjusted difference-in-differences −3.0 percentage points, 95% confidence interval −7.6 to 1.6). These patterns were similar for the uninsured rate (−2.3 percentage points, −6.9 to 2.3). Additionally, employment did not increase in Georgia compared with control states (−1.6 percentage points, −8.7 to 5.4). In a secondary analysis that aimed to isolate the effects of work requirements, Medicaid coverage did not change in Georgia (35.5% to 32.4%) but increased in South Dakota (36.6% to 44.6%)—a state that expanded Medicaid without work requirements—resulting in a differential decrease in coverage in Georgia relative to South Dakota (−11.7 percentage points, −19.5 to −3.9). There was no differential change in employment (−0.1 percentage points, −9.8 to 9.6) between these states.ConclusionsThe implementation of work requirements with Medicaid expansion in Georgia did not increase health insurance coverage or employment during the first 15 months of the program. These findings have important implications as US policy makers recently enacted legislation that will mandate work requirements in Medicaid programs across all US states beginning in 2026.

Objective The study examined the relationship between health insurance coverage and access to needed healthcare including preventive, primary, and tertiary care among Chinese adult population. Data and methods Data for this study came from the 2018 China Health and Retirement Longitudinal Study (CHARLS), a population-based probability sample survey. Key measures included insurance coverage (high-, moderate-, low- and no-insurance), access to care (physical examination, physician visit, office visit, inpatient care, and satisfaction with care), and personal sociodemographics. Multiple-factor generalized linear mixed model was applied to estimate the odds ratio (OR) and the 95% confidence interval (CI) of HI coverage for the four indicators of access to care, after controlling for individual characteristics and aggregation among different villages. Results The majority of Chinese adults had some health insurance with only 3.15% uninsured. However, most had low-coverage insurance (64.82%), followed by moderate-coverage insurance (16.70%), and high-coverage insurance (15.33%). Health insurance was significantly and positively associated with access to needed healthcare (preventive, primary, and tertiary). There was also a significant gradient association between extent of insurance coverage and access to care. Conclusion Not only health insurance mattered in enhancing access to care but that there was a significant gradient association between extent of insurance coverage and access to care with higher coverage relating to better access.

Parkinson's disease (PD) is associated with non-motor symptoms (NMS) that can cause progressive disability and impact quality of life of people with PD (PwP) and increase burden on care partners. This survey was designed to evaluate the prevalence, impact, and educational preferences regarding NMS on PwP and their care partners. A 17-question survey was sent to the total membership of PMDAlliance, a nonprofit organization reaching 3,685 households of PwP. Care partners and other interested individuals could also respond. The survey was conducted using Survey Monkey, an online survey platform, and included distinct questions for respondents with and without NMS. A total of 700 individuals responded to the survey. Of the respondents, 378 (54%) were care partners and 287 (41%) were PwP. About 90% of the respondents reported having experience with NMS in PwP, including sleep problems (84%), cognitive symptoms (76%), anxiety (65%), depression (56%), hallucinations (40%), and delusions (23%). NMS in PwP were reported by more care partners (97%) than PwP (80%). NMS had at least some impact on quality of life for 84% of the respondents; 48% indicated that NMS represented a greater challenge than motor symptoms. Care partners were more likely than PwP to report that NMS were more challenging than motor symptoms (58% vs 32%). Respondents with and without NMS indicated a desire for NMS education. This survey underscores the significant impact of NMS on the quality of life of PwP and highlights the need for improved recognition and education about its effects.

Background To achieve equitable access to cancer clinical trials (CCTs), patients must overcome structural, clinical, and attitudinal barriers to trial enrollment. The goal of this systematic review was to study the relationship between socioeconomic status (SES), assessed either by direct or proxy measures, and CCT enrollment. Methods The review team and medical librarian developed search strategies for each database to identify studies for this systematic review, which was conducted according to PRISMA guidelines. Inclusion criteria were as follows: studies published in relevant scientific journals between January 2000 and July 2022, primary sources, English literature, and studies conducted in the US. Sixteen studies fulfilled the inclusion criteria and were reviewed. The risk of bias assessment was conducted independently by two reviewers using the Newcastle Ottawa scale. Results The initial search yielded 4070 citations, and 16 studies were included in our review. Four of the studies included used patient reported annual income as a measure of SES, while the remaining 12 studies used patient zip code as a proxy measurement of SES. Consistent with our hypothesis, 13 studies showed a positive association between high SES (patient‐reported or proxy measurement) and CCT enrollment. Two studies showed a negative association, and one study showed no relationship. Conclusions The existing literature suggests that low SES is associated with lower participation in CCT. The small number of studies identified on this topic highlights the need for additional research on SES and other barriers to CCT participation. A systematic review of the literature showed that socioeconomic status (SES) is a barrier to participation in clinical trials for cancer. However, proxy measures of SES were often used, such as median income in a given zip code, and further research is needed.

Previous research suggests that enrolling in Medicaid reduces evictions by improving health and providing financial protection. However, previous studies have not examined whether the loss of Medicaid affects eviction outcomes. We analyzed eviction filings and completed evictions after a large, mandatory Medicaid disenrollment in Tennessee in 2005. We conducted a difference-in-differences analysis using data from the Eviction Lab at Princeton University and found that relative to other southern states, the TennCare disenrollment led to a 27.6 percent greater increase in the average annual number of eviction filings at the county level during the period 2005-09 and a 24.5 percent greater increase in the average annual number of completed evictions at the county level during that same period. Our findings have implications for the housing stability of Medicaid recipients today, many of whom are being disenrolled because of the unwinding of the Medicaid continuous enrollment provision that is occurring across the country. To protect housing stability for people disenrolled from Medicaid, policy makers may wish to consider new initiatives aimed at preventing an increase in eviction.