Medical Care最新文献

{"title":"Adding Self-Care Complementary and Integrative Health Therapies to Care for Chronic Pain: The Assessing Pain, Patient Reported Outcomes and Complementary Health (APPROACH) Study.","authors":"Steven B Zeliadt, Scott S Coggeshall, Barbara Bokhour, A Rani Elwy, Benjamin Kligler, Claudia Der-Martirosian, Ethan W Rosser, Marlena Shin, Joy Toyama, Michelle L Upham, Xiaoyi Zhang, Stephanie L Taylor","doi":"10.1097/MLR.0000000000002295","DOIUrl":"10.1097/MLR.0000000000002295","url":null,"abstract":"<p><strong>Background: </strong>Health care systems and insurers are expanding coverage for practitioner-delivered and self-care complementary and integrative health (CIH) therapies for chronic pain.</p><p><strong>Objectives: </strong>To determine if combining practitioner-delivered and self-care CIH therapies (PD/SC-CIH) improves pain outcomes more than practitioner-delivered CIH (PD-CIH) therapies alone.</p><p><strong>Research design: </strong>Pragmatic nonrandomized trial. Structural nudges and the availability of CIH therapies were used as a surrogate to randomization.</p><p><strong>Subjects: </strong>Of 3306 veterans with chronic musculoskeletal pain at 18 medical centers in the Veterans Health Administration between March 2021 and March 2023.</p><p><strong>Measures: </strong>PD-CIH therapies included acupuncture, chiropractic care, or massage therapy. Participants in the PD/SC-CIH arm also received yoga, mindfulness/meditation, and/or Tai Chi/Qigong. The primary outcome was the change in pain-related functional interference at 6 months.</p><p><strong>Results: </strong>Pain interference improved in both arms (-0.62 and -0.70), with 39.5% and 41.1%, respectively, achieving clinically meaningful improvement with no difference between arms in improvement in pain interference: -0.12 (-0.28 to 0.05). At 6 months, more participants in the PD/SC-CIH arm reported their use of CIH therapies specifically led to perceived improvements across 4 global patient-centered measures: pain (11%; 5%-18%); fatigue (28%; 17%-40%); mental health (24%; 14%-35%); and overall well-being (27%; 18%-35%).</p><p><strong>Conclusions: </strong>Both approaches to offering CIH therapies were equally associated with improvements in pain interference among this large cohort with real-world CIH therapy engagement. More patients in the PD/SC-CIH arm perceived that their use of CIH therapies improved multiple health dimensions. Patients with chronic musculoskeletal pain should be encouraged to add self-care CIH therapies and health care systems should expand their availability.</p><p><strong>Study registration: </strong>ClinicalTrials.gov Identifier: NCT05097521.</p>","PeriodicalId":18364,"journal":{"name":"Medical Care","volume":" ","pages":"283-292"},"PeriodicalIF":2.8,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147344648","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Measuring Income Inequality Within 8 Health Care Professions in the United States.","authors":"Ioana Popovici, Manuel J Carvajal","doi":"10.1097/MLR.0000000000002301","DOIUrl":"10.1097/MLR.0000000000002301","url":null,"abstract":"<p><strong>Objectives: </strong>This study investigated intraoccupational income and wage-rate distributions across 8 health care professions: physicians and surgeons, dentists, physician assistants, optometrists, pharmacists, nurse practitioners and nurse midwives, physical therapists, and registered nurses.</p><p><strong>Methods: </strong>The research was based on a sample of 142,527 U.S. practitioners from the 2019 to 2022 American Community Survey (ACS) and focused on 4 inequality indicators: the coefficient of variation, lower median share, 90-10 decile ratio, and Gini coefficient.</p><p><strong>Results: </strong>Findings revealed substantial income dispersion, with dentists and physicians/surgeons displaying the highest levels of inequality, while pharmacists, registered nurses, physical therapists, and nurse practitioners and nurse midwives exhibited more even distributions. The occupations' degree of inequality was correlated with average annual income and wage-rate levels. Gender disparities were significant across all professions, with male practitioners consistently earning more than their female counterparts. The degree of inequality was greater for professions in which there were more male than female practitioners. Annual income and wage-rate inequality also was identified within genders.</p><p><strong>Conclusions: </strong>This research contributes to understanding income disparities within health care professions and suggests that further exploration is needed to identify the determinants of these inequalities and their long-term evolution.</p>","PeriodicalId":18364,"journal":{"name":"Medical Care","volume":" ","pages":"318-325"},"PeriodicalIF":2.8,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147355612","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Telehealth Uptake and Rural-Urban and Racial/Ethnic Disparities in Postpartum Care Access Among Medicaid Beneficiaries in South Carolina, 2018-2022.","authors":"Anirban Chatterjee, Xuzhuo Zhao, Jihong Liu, Berry A Campbell, Jiani Yu, Nansi S Boghossian, Bo Cai, Xiaoming Li, Peiyin Hung","doi":"10.1097/MLR.0000000000002298","DOIUrl":"10.1097/MLR.0000000000002298","url":null,"abstract":"<p><strong>Background: </strong>Although telehealth is increasingly being used for providing postpartum care, its role in ensuring timely postpartum care initiation in racial/ethnic minorities and rural residents is unknown.</p><p><strong>Objectives: </strong>To compare attendance and timeliness of postpartum care initiation by pandemic exposure and telehealth uptake across race/ethnicity and rural-urban residences.</p><p><strong>Research design: </strong>Retrospective cohort study.</p><p><strong>Subjects: </strong>Medicaid-insured individuals who gave birth in South Carolina between January 1, 2018, and September 30, 2022, were aged 15-49 years, and were followed up until December 31, 2022.</p><p><strong>Measures: </strong>Cox proportional hazards models examined associations between pandemic exposures, telehealth uptake, and racial/ethnic and rural/urban disparities in postpartum care initiation timeliness.</p><p><strong>Results: </strong>Median time to postpartum care initiation was 25 days [interquartile range (IQR): 14-41 d] with variations across race/ethnicity and residence. Fully-exposed nontelehealth users had slower initiation [adjusted hazard ratio (aHR): 0.95; 95% CI: 0.91-1.00], while telehealth users had quicker initiation (aHR: 2.19; 95% CI: 1.93-2.48) compared with non- or partially-exposed individuals. Among minimal- or no-telehealth users, postpartum care initiation was slower for Hispanic and non-Hispanic Black individuals compared with their non-Hispanic White peers. There were no differences in timely care initiation by race or residence among fully-exposed telehealth users.</p><p><strong>Conclusions: </strong>Telehealth may improve racial/ethnic disparities in timely postpartum care initiation. Rural-urban disparities in initiating timely postpartum care still warrant further investigation.</p>","PeriodicalId":18364,"journal":{"name":"Medical Care","volume":" ","pages":"298-309"},"PeriodicalIF":2.8,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13056415/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147355687","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hospital Nursing Has Not Returned to Pre-COVID Conditions: Time for a Different Approach.","authors":"Karen B Lasater, Matthew D McHugh, Linda H Aiken","doi":"10.1097/MLR.0000000000002296","DOIUrl":"10.1097/MLR.0000000000002296","url":null,"abstract":"<p><strong>Background: </strong>Hospital nurse burnout, job dissatisfaction, and intent to leave were high before the COVID-19 pandemic and reached alarmingly new heights during the pandemic.</p><p><strong>Objective: </strong>Evaluate whether hospital nurses' job outcomes and evaluations of patient safety, quality of care, and hospital management responsiveness have returned at least to prepandemic levels.</p><p><strong>Design: </strong>Cross-sectional study of survey data from 50,044 nurses in New York and Illinois hospitals: prepandemic (December 2019-February 2020), during (April 2021-June 2021), and postpandemic (December 2023-March 2024).</p><p><strong>Measures: </strong>Nurse outcomes (ie, high burnout, job dissatisfaction, intention to leave employer). Hospital nursing resources (eg, unfavorable work environment, nurse staffing ratio). Hospital management responsiveness (eg, nurses' confidence in management to resolve clinical care problems).</p><p><strong>Results: </strong>Nurses' job dissatisfaction and intentions to leave their hospital employer rose significantly over time, with the highest percentages postpandemic-32.2% of nurses reporting job dissatisfaction and 27.4% intending to leave. Percentages of nurses with high burnout have remained high before (48.0%), during (51.0%), and after (48.5%) the pandemic. Nurses' evaluations of their working conditions are at their worst postpandemic: 49.2% reported unfavorable work environments, 61.5% reported not enough staff, and objective measures of staffing ratios on medical-surgical units were 6.0 patients-to-nurse, up from 5.7 prepandemic. Evaluations of patient safety, quality of care, and management responsiveness were significantly worse postpandemic.</p><p><strong>Conclusions: </strong>Job dissatisfaction and intentions to leave employment continue to rise even after the pandemic has receded, and more nurses lack confidence in their management to act in the best interest of patients. New policy approaches seem warranted, including setting minimum safe hospital nurse staffing requirements.</p>","PeriodicalId":18364,"journal":{"name":"Medical Care","volume":" ","pages":"293-297"},"PeriodicalIF":2.8,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147284374","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Safe Minimum Nurse Staffing Requirements for Hospitals: Evidence From Pennsylvania.","authors":"K Jane Muir, Linda H Aiken, Heather Brom, Vaneh Hovsepian, Karen B Lasater, Matthew D McHugh","doi":"10.1097/MLR.0000000000002332","DOIUrl":"https://doi.org/10.1097/MLR.0000000000002332","url":null,"abstract":"<p><strong>Background: </strong>The Pennsylvania legislature is considering limiting the number of patients nurses care for to promote safe care.</p><p><strong>Objective: </strong>To determine whether variation in nurse workloads is associated with adverse consequences for patients, nurses, and hospital costs in Pennsylvania.</p><p><strong>Methods: </strong>Observational study of 547,689 medical and surgical patients and 2782 direct care nurses in 132 Pennsylvania hospitals. The independent variable was medical-surgical nurse staffing ratios. Patient outcomes included 30-day mortality, 30-day readmissions, and length of stay. Nurse outcomes included burnout, job dissatisfaction, intent to leave, and evaluations of hospital management and patient care. Hospital outcomes were HCAHPS Star Ratings and cost offsets associated with better staffing.</p><p><strong>Results: </strong>Hospital nurse staffing ranged from 3 to 9 patients per nurse (average 5.9). Each additional patient per nurse was associated with higher odds of 30-day mortality (AOR: 1.08, 95% CI: 1.03, 1.13, P<0.001), longer length of stay (IRR: 1.02, 95% CI: 1.00, 1.04, P<0.05) and higher odds of readmission (AOR: 1.04, 95% CI: 1.01, 1.07, P<0.05). Worse staffing was associated with higher odds of nurse burnout, job dissatisfaction, and intent to leave, and lower patient satisfaction. Cost savings from patient outcomes and nurse retention were projected to offset costs of additional nurses needed for hospitals to meet a minimum safe nurse staffing level proposed in legislation.</p><p><strong>Conclusions: </strong>Large differences across Pennsylvania hospitals in the amount of nursing care patients receive are associated with negative consequences. A state policy establishing minimum safe nurse staffing requirements in hospitals is in the public's interest.</p>","PeriodicalId":18364,"journal":{"name":"Medical Care","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147816890","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association Between Team-Based Continuity of Care Measures and End-of-Life Health Care Outcomes: A Retrospective Cohort Study in Ontario, Canada.","authors":"Shuaib Hafid, Sarina Isenberg, Aaron Jones, Aria Wills, Taylor Shorting, Ana Gayowsky, Aleisha Fernandes, Kieran L Quinn, Colleen Webber, Erin Gallagher, Peter Tanuseputro, Michelle Howard","doi":"10.1097/MLR.0000000000002334","DOIUrl":"https://doi.org/10.1097/MLR.0000000000002334","url":null,"abstract":"<p><strong>Background: </strong>Continuity of care (COC) measurements that reflect relational continuity have been used as quality indicators, yet their applicability near the end of life may be limited. Modified continuity indices-UPC-Team (Usual Provider of Care) and BB-Team (Bice-Boxerman)-were developed to reflect escalating care needs and capture associations with patient-centered outcomes.</p><p><strong>Objectives: </strong>To measure associations between the modified COC indices, UPC-Team, and BB-Team during the last year of life and end-of-life (EOL) health care outcomes.</p><p><strong>Methods: </strong>Retrospective cohort study of adults who died between January 1, 2018, and December 31, 2022, with advanced chronic obstructive pulmonary disease and/or heart failure prevalent ≥2 years before death, using health administrative data from Ontario, Canada. Multivariate regressions measured associations between the indices and days spent in community during the last 30 and 14 days of life, and place of death.</p><p><strong>Results: </strong>Among 175,323 included individuals (median age at death=80; 55.4% male), the median number of community days was 23 and 10 in the last 30 and 14 days of life; 56.5% died in a health care institution. Higher UPC-Team and BB-Team scores were associated with increased odds of institutional deaths and fewer community days.</p><p><strong>Conclusions: </strong>Higher continuity scores were associated with increased odds of institutional death and fewer days spent in the community, suggesting limited utility of these modified indices in predicting favorable EOL health care outcomes. Findings highlight the need for future research to incorporate all aspects of continuity (ie, relational, informational, and management) to better capture care coordination in this context.</p>","PeriodicalId":18364,"journal":{"name":"Medical Care","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147775725","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Success Rates of Venture Capital Investment in Biopharmaceutical Development.","authors":"So-Yeon Kang, Mingqian Liu, Sean S Huang","doi":"10.1097/MLR.0000000000002325","DOIUrl":"https://doi.org/10.1097/MLR.0000000000002325","url":null,"abstract":"<p><strong>Background: </strong>Large biopharmaceutical companies increasingly outsource early research and development (R&D) to startups funded by venture capital (VC). Yet little is known about how effective VC funding is at advancing new drugs to market.</p><p><strong>Objectives: </strong>To examine the outcomes of clinical trials conducted by VC-backed startups and identify factors associated with their progression.</p><p><strong>Research design: </strong>Retrospective cohort study of VC-backed biopharmaceutical clinical trials.</p><p><strong>Subjects: </strong>Index phase 1 trials initiated between January 2006 and December 2015, tracked through April 2024.</p><p><strong>Measures: </strong>Progression to phase 2, phase 3, and US Food and Drug Administration (FDA) approval. Associations between trial characteristics and progression were estimated using multinomial logistic regression.</p><p><strong>Results: </strong>Among 1357 VC-backed phase 1 trials, 10.9% failed to complete phase 1, 13.3% completed phase 1 and stopped, 42.5% progressed only to phase 2, 19.2% only to phase 3, and 14.1% ultimately received FDA approval. Cancer-related trials achieved FDA approval in 8.7% of cases. Compared with small-molecule trials, biological trials were less likely to progress to phase 3 [-11.3 percentage points (pp), P<0.001] or receive FDA approval (-14.1 pp, P<0.001). Greater initial investment in phase 1 was associated with higher progression, including a 6.2 pp higher probability of FDA approval (P<0.001).</p><p><strong>Conclusions: </strong>Clinical trial success rates among VC-backed startups were within the range of approval rates previously reported for large manufacturers. Progression varied substantially by drug modality, therapeutic focus, and initial investment size, underscoring how capital allocation and development strategy shape R&D outcomes.</p>","PeriodicalId":18364,"journal":{"name":"Medical Care","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-04-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147775712","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Paradoxical Association of Disaggregated Data Collection With Diabetes Control Among Latino Patients.","authors":"John D Heintzman, Dang Dinh, Jorge Kaufmann, JenniferA Lucas, Wyatt P Bensken, Danielle M Crookes, Karen Florez, Sandra Echeverria, Miguel Marino","doi":"10.1097/MLR.0000000000002331","DOIUrl":"https://doi.org/10.1097/MLR.0000000000002331","url":null,"abstract":"<p><strong>Background: </strong>Data disaggregation in Latino patients has been called for by national organizations. However, analyses of the association between the collection of this data point, especially the place of birth, and common disease-specific factors, including disease severity, are lacking.</p><p><strong>Objective: </strong>To examine the relationship between the collection of place of birth data and diabetes control in a national network of community health centers (CHCs).</p><p><strong>Participants: </strong>Hispanic/Latino adult patients, aged 18 to 79 years, with diabetes.</p><p><strong>Measures: </strong>We described the following groups by demographic, clinical, and neighborhood factors, and compared odds of hemoglobin a1c (HbA1c) always <7% or ever >9%, stratified by preferred language: (1) patients whose clinics never collected place of birth; (2) those whose clinics did collect this information, but they personally did not have a country of birth in their record; and (3) those with country of birth documented.</p><p><strong>Results: </strong>In our study population (n=81,107), Spanish-preferring Latinos with their place of birth recorded (HbA1c always <7: OR=0.75, 95% CI: 0.65-0.87; HbA1c ever >9: OR=1.68, 95% CI: 1.44-1.95) had worse HbA1c measures than Spanish-preferring Latino patients in clinics that did not collect country of birth.</p><p><strong>Conclusions: </strong>In a national CHC network, Spanish-preferring Latino patients with country of birth information in their records had less well-controlled HbA1cs than those who were served by clinics that did not collect these data. These surprising findings underscore the need to assess disaggregated data collection in Latino patients to better understand the data necessary for high-quality primary care in Latino communities.</p>","PeriodicalId":18364,"journal":{"name":"Medical Care","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-04-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147775714","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diabetes Diagnosis Patterns in Medicaid: How State Policy, Managed Care, and Social Vulnerability Shape Detection in Medicaid.","authors":"Maria L Alva, Slun Booppasiri, Alexander Crowell, Michelle F Magee, Boon Peng Ng","doi":"10.1097/MLR.0000000000002328","DOIUrl":"10.1097/MLR.0000000000002328","url":null,"abstract":"<p><strong>Objective: </strong>To describe patterns of type 2 diabetes diagnosis prevalence in Medicaid administrative data by individual and contextual factors.</p><p><strong>Methods: </strong>Diagnosed prevalence was estimated using the 2016-2021 Transformed Medicaid Statistical Information System (T-MSIS) and a Bayesian multilevel regression framework. The first level included patient characteristics (age, sex, and race/ethnicity), the Social Vulnerability Index (SVI), plan-level characteristics, payment models, and federal level of poverty (FLP) eligibility thresholds. The second level incorporates partial pooling over the state to model state fixed effects. Adults ages 21-64 years with 24+ months consecutive enrollment were included. States with a high degree of missing data were excluded.</p><p><strong>Results: </strong>Among 4.41 million eligible Medicaid beneficiaries in N=11 states with high-quality T-MSIS data, 10.3% had a type 2 diabetes diagnosis record. State-level diagnosed prevalence based on administrative data ranged from 6.5%-13.0%, and increased with age (4.1% for 21-35 vs. 23.9% for 55-64 y), was higher among \"Other\" race (14.3%), Hispanic (12.0%), and Black (10.9%) enrollees versus White (9.1%). Higher county-level obesity was associated with increased odds (third vs. first tertile OR 1.26, 95% CI: 1.25-1.27), while living in urban areas (OR 0.91, 95% CI: 0.90-0.91) and in the highest SVI quartile (OR 0.74, 95% CI: 0.73-0.75) with lower odds. Race interactions were most pronounced for contextual socioeconomic modifiers (SVI, FPL, and plan type).</p><p><strong>Conclusions: </strong>Evidence generated confirms that odds of having a recorded type 2 diabetes diagnosis are shaped by age, comorbidities, race/ethnicity, and social vulnerability. Notable variations by state and care plans were identified. Documentation and data improvements are needed.</p>","PeriodicalId":18364,"journal":{"name":"Medical Care","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147775653","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"US Medicaid Spending and Health Insurance Coverage for People Involved in the Criminal Legal System as Children.","authors":"Ian A Silver, Jenna L Dole, Daniel C Semenza","doi":"10.1097/MLR.0000000000002330","DOIUrl":"https://doi.org/10.1097/MLR.0000000000002330","url":null,"abstract":"<p><strong>Introduction: </strong>Early involvement in the US criminal legal system (CLS) is linked to persistent health disadvantages, including reduced health insurance coverage in adulthood.</p><p><strong>Objectives: </strong>The current study examined the influence of increases and cuts to federal and state Medicaid expenditures on health insurance enrollment among individuals with varying levels of CLS involvement before age 18.</p><p><strong>Research design: </strong>The current study is a cohort study of individuals who participated in the National Longitudinal Survey of Youth 1997 (2003-2021).</p><p><strong>Patients and methods: </strong>The total sample included 8240 participants. This study applied Bayesian lagged random-intercept logistic regression to assess associations between Medicaid spending and uninsurance among individuals with and without CLS contact before age 18.</p><p><strong>Measures: </strong>Federal and State Medicaid expenditures were measured in total dollars spent by the federal government and state governments, respectively. Contact with the CLS before 18 was measured as arrested before 18, incarcerated in a juvenile facility before 18, or incarcerated in an adult facility before 18. Uninsurance was measured as the absence of insurance on the date of the interview.</p><p><strong>Results: </strong>Greater CLS severity was associated with higher odds of being uninsured, while higher federal Medicaid expenditures were associated with a lower uninsurance rate. Simulations indicated that a 50% federal Medicaid spending cut could increase uninsurance for those with CLS involvement before 18, whereas a 20% spending increase would increase the probability of insurance.</p><p><strong>Conclusions: </strong>Findings highlight the federal Medicaid's role in mitigating coverage inequities and suggest that reducing expenditures could exacerbate ongoing health disparities rooted in early CLS involvement.</p>","PeriodicalId":18364,"journal":{"name":"Medical Care","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147690954","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}