{"title":"Catastrophic Spending On Insulin In The United States, 2017-18.","authors":"Baylee F Bakkila, Sanjay Basu, Kasia J Lipska","doi":"10.1377/hlthaff.2021.01788","DOIUrl":"https://doi.org/10.1377/hlthaff.2021.01788","url":null,"abstract":"<p><p>Insulin is considered an essential medicine for people with diabetes, but its price has doubled during the past decade, posing substantial financial barriers to patients in the US. In this article we describe out-of-pocket spending on insulin and consider risk factors that could contribute to the likelihood of a person experiencing catastrophic spending, defined as spending more than 40 percent of their postsubsistence family income on insulin alone. Using nationally representative data from the 2017 and 2018 Medical Expenditure Panel Surveys, we examined out-of-pocket spending on insulin among people who filled at least one insulin prescription. Among Americans who use insulin, 14.1 percent reached catastrophic spending over the course of one year, representing almost 1.2 million people. Nearly two-thirds of patients who experienced catastrophic spending on insulin were Medicare beneficiaries. Catastrophic spending was 61 percent less likely among Medicaid beneficiaries than among Medicare beneficiaries, suggesting that factors other than income, such as different types of insurance coverage, may influence catastrophic insulin spending. Policy reform is needed to curb out-of-pocket spending, especially for Medicare beneficiaries and people with low incomes, who appear to be particularly vulnerable to catastrophic spending.</p>","PeriodicalId":300542,"journal":{"name":"Health affairs (Project Hope)","volume":" ","pages":"1053-1060"},"PeriodicalIF":9.7,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40571152","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Phantom Networks Prevent Children And Adolescents From Obtaining The Mental Health Care They Need.","authors":"Brett Dolotina, Jack Turban","doi":"10.1377/hlthaff.2022.00588","DOIUrl":"https://doi.org/10.1377/hlthaff.2022.00588","url":null,"abstract":"<p><p>In October 2021, the American Academy of Pediatrics and other groups declared a national emergency in child and adolescent mental health. Despite this, pediatric mental health services remain largely inaccessible for many families. A major factor contributing to the lack of access is phantom networks, which are insurance company rosters of in-network mental health providers who, in reality, don't see patients in the network. Phantom networks compound barriers to mental health care for children and adolescents. This is particularly problematic for youth, many of whom use Medicaid, who seek time-sensitive care for severe psychiatric conditions such as psychosis or suicidality. We call on US policy makers to support nationwide legislation that establishes high-quality oversight processes for in-network provider lists.</p>","PeriodicalId":300542,"journal":{"name":"Health affairs (Project Hope)","volume":" ","pages":"1026-1028"},"PeriodicalIF":9.7,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40480011","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Louise B Russell, Lara Livia Santos da Silva, Rodrigo Fracalossi de Moraes, Risha Gidwani, Paula M Luz, Cristiana M Toscano
{"title":"Effect Of Nonpharmaceutical Interventions On COVID-19 Cases And Deaths In Brazil.","authors":"Louise B Russell, Lara Livia Santos da Silva, Rodrigo Fracalossi de Moraes, Risha Gidwani, Paula M Luz, Cristiana M Toscano","doi":"10.1377/hlthaff.2021.01613","DOIUrl":"https://doi.org/10.1377/hlthaff.2021.01613","url":null,"abstract":"<p><p>Lacking national direction, in 2020 Brazilian states adopted a variety of nonpharmaceutical interventions to combat COVID-19, adjusting their stringency over time. We took advantage of this variation across states and over time to estimate the independent effect of seven interventions on the growth rate ratios of COVID-19 cases and deaths. Panel regressions using daily data from March to December 2020 for twelve states show that two interventions, suspension of public events and masking mandates, significantly reduced the spread of the disease. Partial and full suspension of public events were equally effective. Full masking mandates were more effective than partial ones. Together, suspension of public events and full masking mandates reduced the growth rate ratios of both cases and deaths almost to 1, the point at which cases and deaths are no longer increasing. Policy makers may find this analysis useful as they aim to choose the most effective nonpharmaceutical interventions to reduce COVID-19's social and economic burdens.</p>","PeriodicalId":300542,"journal":{"name":"Health affairs (Project Hope)","volume":" ","pages":"1005-1012"},"PeriodicalIF":9.7,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40571151","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Record ACA Enrollment; 2023 Payment Rule.","authors":"Katie Keith","doi":"10.1377/hlthaff.2022.00137","DOIUrl":"https://doi.org/10.1377/hlthaff.2022.00137","url":null,"abstract":"<p><p>Marketplace enrollment rose significantly, and the Biden administration proposed sweeping new standards for 2023.</p>","PeriodicalId":300542,"journal":{"name":"Health affairs (Project Hope)","volume":" ","pages":"322-323"},"PeriodicalIF":9.7,"publicationDate":"2022-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39917053","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Jing Huang, Brian T Fisher, Vicky Tam, Zi Wang, Lihai Song, Jiasheng Shi, Caroline La Rochelle, Xi Wang, Jeffrey S Morris, Susan E Coffin, David M Rubin
{"title":"The Effectiveness Of Government Masking Mandates On COVID-19 County-Level Case Incidence Across The United States, 2020.","authors":"Jing Huang, Brian T Fisher, Vicky Tam, Zi Wang, Lihai Song, Jiasheng Shi, Caroline La Rochelle, Xi Wang, Jeffrey S Morris, Susan E Coffin, David M Rubin","doi":"10.1377/hlthaff.2021.01072","DOIUrl":"https://doi.org/10.1377/hlthaff.2021.01072","url":null,"abstract":"<p><p>Evidence for the effectiveness of masking on SARS-CoV-2 transmission at the individual level has accumulated, but the additional benefit of community-level mandates is less certain. In this observational study of matched cohorts from 394 US counties between March 21 and October 20, 2020, we estimated the association between county-level public masking mandates and daily COVID-19 case incidence. On average, the daily case incidence per 100,000 people in masked counties compared with unmasked counties declined by 23 percent at four weeks, 33 percent at six weeks, and 16 percent across six weeks postintervention. The beneficial effect varied across regions of different population densities and political leanings. The most concentrated effects of masking mandates were seen in urban counties; the benefit of the mandates was potentially stronger within Republican-leaning counties. Although benefits were not equally distributed in all regions, masking mandates conferred benefit in reducing community case incidence during an early period of the COVID-19 pandemic.</p>","PeriodicalId":300542,"journal":{"name":"Health affairs (Project Hope)","volume":" ","pages":"445-453"},"PeriodicalIF":9.7,"publicationDate":"2022-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39928769","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Beyond Research, Taking Action Against Racism.","authors":"Heather Tirado Gilligan","doi":"10.1377/hlthaff.2021.02040","DOIUrl":"https://doi.org/10.1377/hlthaff.2021.02040","url":null,"abstract":"<p><p>One large Massachusetts health system has ambitious plans for how it can become an antiracist institution.</p>","PeriodicalId":300542,"journal":{"name":"Health affairs (Project Hope)","volume":" ","pages":"158-162"},"PeriodicalIF":9.7,"publicationDate":"2022-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39896767","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Structural Racism In Historical And Modern US Health Care Policy.","authors":"Ruqaiijah Yearby, Brietta Clark, José F Figueroa","doi":"10.1377/hlthaff.2021.01466","DOIUrl":"https://doi.org/10.1377/hlthaff.2021.01466","url":null,"abstract":"<p><p>The COVID-19 pandemic has illuminated and amplified the harsh reality of health inequities experienced by racial and ethnic minority groups in the United States. Members of these groups have disproportionately been infected and died from COVID-19, yet they still lack equitable access to treatment and vaccines. Lack of equitable access to high-quality health care is in large part a result of structural racism in US health care policy, which structures the health care system to advantage the White population and disadvantage racial and ethnic minority populations. This article provides historical context and a detailed account of modern structural racism in health care policy, highlighting its role in health care coverage, financing, and quality.</p>","PeriodicalId":300542,"journal":{"name":"Health affairs (Project Hope)","volume":" ","pages":"187-194"},"PeriodicalIF":9.7,"publicationDate":"2022-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39896768","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Honoring Dr. Shalon Irving, A Champion for Health Equity.","authors":"Tanjala S Purnell, Wanda Irving, Soleil Irving, Lauren Underwood, Raegan McDonald-Mosley, Chidinma Ibe, Debra Hickman, Janice Bowie","doi":"10.1377/hlthaff.2021.01447","DOIUrl":"https://doi.org/10.1377/hlthaff.2021.01447","url":null,"abstract":"<p><p>Shalon Irving's 2017 death brought national attention to maternal mortality among Black women in the US. This essay remembers her life and legacy.</p>","PeriodicalId":300542,"journal":{"name":"Health affairs (Project Hope)","volume":" ","pages":"304-308"},"PeriodicalIF":9.7,"publicationDate":"2022-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39594099","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}