Milbank Quarterly最新文献

{"title":"The Long Arc of Substance Use Policy Innovation in Medicaid: Looking Back, Looking Forward.","authors":"Brendan Saloner","doi":"10.1111/1468-0009.70007","DOIUrl":"10.1111/1468-0009.70007","url":null,"abstract":"<p><p>Policy Points The role of Medicaid in financing, organizing, and delivering substance use disorder (SUD) treatment has grown tremendously over time owing to expansions of eligibility and a push toward more uniformity in benefits. Current innovations in SUD treatment focus on expanding the delivery system to create a comprehensive continuum of care, using more value-based payment to reward quality care, and integrating SUD treatment with other systems (e.g., housing, employment, and the criminal legal system). Many of the promising innovations in delivery have not yet been rigorously studied, and implementation of effective models is often stymied because of the lack of flexibility in program requirements and variation in needs and resources across communities. Although policymakers can justifiably laud the great strides Medicaid has made in raising the standards for SUD treatment, there is a huge remaining gap in access to services amidst an unprecedented overdose crisis and looming turmoil in the program.</p>","PeriodicalId":49810,"journal":{"name":"Milbank Quarterly","volume":" ","pages":""},"PeriodicalIF":4.8,"publicationDate":"2025-03-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143677332","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":"Medicaid Expansion Among Nonelderly Adults and Cardiovascular Disease: Efficiency Vs. Equity.","authors":"Luke E Barry, Sanjay Basu, May Wang, Roch A Nianogo","doi":"10.1111/1468-0009.70004","DOIUrl":"10.1111/1468-0009.70004","url":null,"abstract":"<p><p>Policy Points Evidence suggests Medicaid expansion has improved cardiovascular disease (CVD) outcomes, especially among those of lower socioeconomic status. However, less is known about the cost-effectiveness of Medicaid in achieving these outcomes and reducing CVD disparities. We found that Medicaid expansion resulted in a reduction in CVD incidence, suggesting that it was cost-effective in reducing CVD outcomes and equity enhancing but with a high degree of uncertainty. Policymakers will need to trade-off among a number of different factors in consideration of the value of Medicaid including health (especially in treating the chronically ill), financial protection, reduced uncompensated care, and health disparities.</p><p><strong>Context: </strong>Evidence suggests Medicaid expansion has improved cardiovascular disease (CVD) outcomes, especially among those of lower socioeconomic status. However, less is known about the cost-effectiveness of Medicaid in achieving these outcomes and reducing CVD disparities. We use distributional cost-effectiveness analysis methods to examine the efficiency and equitability of Medicaid expansion in reducing CVD outcomes.</p><p><strong>Methods: </strong>A Monte Carlo Markov-chain microsimulation model was developed to examine lifetime changes in CVD outcomes and disparities as a result of expansion and the associated cost and quality-of-life impacts.</p><p><strong>Findings: </strong>Medicaid expansion was associated with a reduction of 11 myocardial infarctions, eight strokes, and four CVD deaths per 100,000 person-years compared with no expansion. The largest reductions occurred for those with lower income and education, and those of Black and Hispanic race/ethnicity. We found that the benefits of expansion generally balanced out the costs while redistributing health from higher to lower income groups. In probabilistic sensitivity analysis, we found-using a health opportunity cost threshold of $150,000-that Medicaid expansion was cost-effective in reducing CVD outcomes 53% of the time and both cost-effective (efficient) and equity enhancing 26% to 29% of the time.</p><p><strong>Conclusions: </strong>Medicaid expansion resulted in a reduction in CVD incidence, suggesting that it was both cost-effective and equity enhancing in reducing CVD outcomes but with a high degree of uncertainty.</p>","PeriodicalId":49810,"journal":{"name":"Milbank Quarterly","volume":" ","pages":""},"PeriodicalIF":4.8,"publicationDate":"2025-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143671652","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":"How Are You Doing… Really? A Review of Whole Person Health Assessments.","authors":"Stephanie B Gold, Allison Costello, Maura Gissen, Selin Odman, Larry A Green, Kurt C Stange, Réna Swann, Rebecca S Etz","doi":"10.1111/1468-0009.12727","DOIUrl":"10.1111/1468-0009.12727","url":null,"abstract":"&lt;p&gt;&lt;p&gt;Policy Points A redirection of measurement in health care from a narrow focus on diseases and care processes towards assessing whole person health, as perceived by the person themself, may provide a galvanizing view of how health care can best meet the needs of people and help patients feel heard, seen, and understood by their care team. This review identifies key tensions to navigate as well as four overarching categories of whole person health for consideration in developing an instrument optimized for clinical practice. The categories (body and mind, relationships, living environment and finances, and engagement in daily life) include nine constituent domains. To maximize value and avoid unintended consequences of implementing a new measure, it is essential to ensure adequate time with the person providing the responses. Use of the instrument should be framed around the goal of better understanding a person's whole health and strengthening their relationship with the care team and not for comparisons across physicians or meeting a target score.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Context: &lt;/strong&gt;Frustration with the burden of proliferating measures in health care focused on diseases and care processes has added to the growing desire to measure what matters to people, including understanding how people are doing in terms of their whole health. There is no consensus in the literature on an ideal whole person health instrument for use in practice. To provide a foundation for assessing whole person health and support further instrument development, this review summarizes past work on assessing person-reported whole health, articulates conceptual domains encompassing whole health, and identifies lessons from existing instruments, including considerations for administration.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A scoping literature review and instrument review were conducted. Concepts from the literature and instruments were thematically coded using a grounded theory approach.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Findings: &lt;/strong&gt;We identified four overarching categories of whole person health, consisting of nine domains: body and mind (physical well-being, mental/emotional well-being, meaning and purpose [spiritual well-being], sexual well-being), relationships (social well-being), living environment and finances (financial well-being, environmental well-being), and engagement in daily life (autonomy and functioning, activities). A tenth domain of global well-being was used for instruments that assessed well-being as a whole. In total, 281 instruments were examined; most were specific to a single domain or subdomain. Fifty instruments assessed at least three domains; only five assessed all domains identified. Two key tensions must be navigated in the development of a whole person health instrument: comprehensiveness versus brevity, and standardization versus flexibility.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;The array of whole person health domains identified in this review and lack of con","PeriodicalId":49810,"journal":{"name":"Milbank Quarterly","volume":" ","pages":"205-241"},"PeriodicalIF":4.8,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11923716/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142957847","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":"Centering Equity in Evidence-Informed Decision Making: Theoretical and Practical Considerations.","authors":"Bomi Kim Hirsch, Kiersten Frobom, Gillian Giglierano, Michael C Stevenson, Marjory L Givens","doi":"10.1111/1468-0009.70002","DOIUrl":"10.1111/1468-0009.70002","url":null,"abstract":"<p><p>Policy Points The population health research field should develop a synthesized approach to evaluate evidence for an intervention's potential impact on equity. When empirical evidence is lacking, theory and frameworks should guide the equity assessments in four areas: 1) understanding historical context, meaning root causes of disparities and inequity; 2) understanding intervention design and intended beneficiaries; 3) understanding differential impact and intersectionality; and 4) understanding community context before implementing or scaling interventions. The synthesized approach of equity assessment better informs practitioners and policymakers in evidence-based decision making to advance equity.</p>","PeriodicalId":49810,"journal":{"name":"Milbank Quarterly","volume":" ","pages":"11-31"},"PeriodicalIF":4.8,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11923710/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143525109","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":"Mental Health Treatment Access: Experience, Hypotheticals, and Public Opinion.","authors":"Jake Haselswerdt","doi":"10.1111/1468-0009.12726","DOIUrl":"10.1111/1468-0009.12726","url":null,"abstract":"<p><p>Policy Points Policymakers should consider both material (e.g., cost) and attitudinal (e.g., skepticism) barriers to mental health treatment access. Public support for government action on mental health is high but varies based on experience-based and hypothetical beliefs about barriers to treatment. Appeals to personal experience and perspective-taking may be successful in building support for government action on mental health.</p><p><strong>Context: </strong>Mental health problems represent a major public health issue for the United States, and access to mental health treatment is both inadequate and unevenly distributed. There is a strong justification for government action on mental health treatment, but it is unclear whether there is a political constituency for such action. Existing work suggests that stigma and othering of people with mental illnesses contributes to reduced support for intervention. I expand on the existing literature by focusing on mental health as an issue that may apply to Americans' own lives rather than only to a stigmatized outgroup.</p><p><strong>Methods: </strong>Using original questions on a nationally representative 2023 survey of 1,000 American adults, I measured agreement with statements about barriers to mental health treatment access that respondents have experienced or, if they have not sought treatment, their hypothetical assessment of these barriers. I also measured their support for statements in favor of change to address mental health. I analyzed the demographic and political correlates of agreement with the barrier statements and used regressions to examine their possible causal effect on support for change.</p><p><strong>Findings: </strong>Agreement with statements about access barriers follows expected patterns in some cases (e.g., socioeconomic status) but not in others (e.g., race/ethnicity). I also documented a notable partisan and ideological divide in these experiences and beliefs. I found that Americans who agreed that material factors are a barrier to access were more supportive of action on mental health, whereas those who agreed with statements suggesting discomfort or skepticism were less supportive.</p><p><strong>Conclusions: </strong>These findings suggest that personal experience and perspective-taking should be integrated into the study of public opinion on mental health, complementing existing work on stigma and othering. Appeals to experience and perspective-taking may be a successful strategy for building public support for action on mental health.</p>","PeriodicalId":49810,"journal":{"name":"Milbank Quarterly","volume":" ","pages":"100-129"},"PeriodicalIF":4.8,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11923704/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142883615","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":"Comprehensiveness in Primary Care: A Scoping Review.","authors":"Agnes Grudniewicz, Ellen Randall, Lori Jones, Aidan Bodner, M Ruth Lavergne","doi":"10.1111/1468-0009.12723","DOIUrl":"10.1111/1468-0009.12723","url":null,"abstract":"<p><p>Policy Points Efforts to address a perceived decline of comprehensiveness in primary care are hampered by the absence of a clear and common understanding of what comprehensiveness means. This scoping review mapped two domains of comprehensiveness (breadth of care and approach to care) as well as a set of factors that enable comprehensive practice. The resulting conceptual map supports greater clarity for future use of the term comprehensiveness, facilitating more precisely targeted research, practice, and policy efforts to improve primary care systems.</p><p><strong>Context: </strong>Associated with system efficiency and patient-perceived quality, comprehensiveness is widely recognized as foundational to high-quality primary care. However, there is concern that comprehensiveness is declining and that primary care physicians are providing a narrower range of services. Efforts to address this perceived decline are hampered by the many different and sometimes vague definitions of comprehensiveness in current use. This scoping review explored how comprehensiveness in primary care is conceptualized and defined in order to map its attributes in support of being able to more clearly and precisely define this key concept in research, practice, and policy.</p><p><strong>Methods: </strong>We conducted a scoping review, following the methods of Arksey and O'Malley and Levac and colleagues. The search included terms for two key concepts: primary care and comprehensiveness. Developed in Ovid Medical Literature Analysis and Retrieval System Online (MEDLINE), the search was adapted for Cumulated Index in Nursing and Allied Health Literature (CINAHL) and Embase, as well as for gray literature. After a multistep review, included sources underwent detailed data extraction.</p><p><strong>Findings: </strong>A total of 360 sources were extracted; 57% were empirical studies and 65% were published between 2010 and 2022. Across these sources, we identified nine attributes of comprehensiveness in primary care. We mapped these attributes into two conceptual domains: breadth of care (services, settings, health needs and conditions, patients served, and availability) and approach to care (one-stop shop, whole-person care, referrals and coordination, and longitudinal care). Additionally, we identified three enablers of comprehensiveness, namely structures and resources, teams, and competency.</p><p><strong>Conclusions: </strong>The conceptual map of comprehensiveness in primary care offers a valuable tool that supports clarity for future use of the term comprehensiveness. The domains and attributes we identified can be used to develop definitions and measures that are appropriate to research, practice, and policy contexts, enabling more precise efforts to improve primary care systems.</p>","PeriodicalId":49810,"journal":{"name":"Milbank Quarterly","volume":" ","pages":"153-204"},"PeriodicalIF":4.8,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11923724/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142822893","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":"Naming and Framing: Six Principles for Embedding Health Equity Language in Policy Research, Writing, and Practice.","authors":"Kamaria Kaalund, Jay A Pearson, Andrea Thoumi","doi":"10.1111/1468-0009.70000","DOIUrl":"10.1111/1468-0009.70000","url":null,"abstract":"<p><p>Policy Points Science communication and health policy language often fail to adequately define and contextualize systemic barriers-like structural racism and wealth inequity-that contribute to disparities in health outcomes. Health policy practitioners should understand best practices for communicating research and policy findings to various audiences and understand how to disseminate messages that are culturally and linguistically responsive to different community needs. As no perfect term exists, adopting health equity language principles can help health policy practitioners avoid dehumanizing and exclusionary language as well as ill-suited terminology that perpetuates racist systems and leads to inequities in population health.</p><p><strong>Context: </strong>Language specificity in research, advocacy, and writing is an important tool to ensure more equitable health policies. All health policy practitioners working at the intersection of health care, health policy, and health equity have a role in upholding ethical standards that promote the use of humanizing, inclusive, and antisupremacist language.</p><p><strong>Methods: </strong>We conducted an environmental scan and synthesized themes across commonly used and publicly available health equity language guides to provide specific guidance to health policy practitioners to inform their policy research, analysis, writing, and dissemination.</p><p><strong>Findings: </strong>We identify and describe six guiding principles to dismantle systems that work against the goals of health equity through policy-focused research, writing, and communications. These principles include avoiding blaming language, contextualizing health inequities, acknowledging that systems are not passive, understanding that one-size-fits-all terminology does not exist, seeking input from community members, and paying attention to omissions.</p><p><strong>Conclusions: </strong>Applying these principles will better equip health policy practitioners to develop or inform equitable policies and meaningfully engage in dialogue with community members to advance equitable health policy.</p>","PeriodicalId":49810,"journal":{"name":"Milbank Quarterly","volume":" ","pages":"130-152"},"PeriodicalIF":4.8,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11923698/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143400609","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":"The Political Economy of the World Health Organization Model Lists of Essential Medicines.","authors":"Kristina Jenei","doi":"10.1111/1468-0009.70001","DOIUrl":"10.1111/1468-0009.70001","url":null,"abstract":"&lt;p&gt;&lt;p&gt;Policy Points The World Health Organization (WHO) Model Lists of Essential Medicines (EML) aims to select clinically beneficial and cost-effective medicines that ought to be prioritized by health systems based on the priority needs of their populations. However, the rapid evolution within the pharmaceutical sector toward complex, high-priced medicines has challenged WHO decision making in recent years, as evidenced by earlier literature demonstrating inconsistencies in the application of decision criteria and recommendations. Proposed solutions to these challenges focus on technical aspects of the program, such as refining the quality of evidence in applications, improving the connection with guidelines, and using evidence assessment frameworks. Yet, earlier literature has not examined the political challenges that the WHO-as a global health organization-has encountered during the past 20 years. This article examines these challenges by reviewing documents and interviewing stakeholders involved with the WHO EML decision making. A diverse range of stakeholders shape the process to select medicines, each with different interests (e.g., protecting commercial interests versus advocating for access) and ideas (the role of the WHO EML in indirectly resulting in lower prices versus safeguarding low- and middle-income countries from catastrophic expenditure). A lack of data and financial and human resources inhibits evaluation of the impact of the EML and exacerbates the influence of external actors, including which products are reviewed and how they are recommended. As a result, a degree of inconsistency has emerged, both in recommendations and in the concept of essential medicines.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Context: &lt;/strong&gt;The World Health Organization (WHO) Model Lists of Essential Medicines (EML) aims to help countries select medicines based on the priority needs of their populations. However, rapid evolution within the pharmaceutical sector toward complex, high-priced medicines has challenged WHO decision making, leading to inconsistent decisions. The purpose of this paper is to investigate how political factors impact the WHO EML.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Document review and semistructured interviews of diverse stakeholder groups with direct experience with the WHO EML, either as stakeholders involved with WHO EML processes (e.g., selection of medicines, observers) or external applications (n = 29). Donabedian's structure-process-outcome framework was combined with the Three I's framework (ideas, interests, and institutions) to understand how political factors shape the WHO EML.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Findings: &lt;/strong&gt;The concept of essential medicines evolved from an original focus on generic medicines in resource-constrained countries to include complex, high-priced therapeutics also relevant to high-income nations. The WHO has never explicitly addressed whom its decisions are for. Some believe the Model Lists have a \"symbolic\" price-lowering mechani","PeriodicalId":49810,"journal":{"name":"Milbank Quarterly","volume":" ","pages":"52-99"},"PeriodicalIF":4.8,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11923723/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143525113","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":"Population Health Imperiled.","authors":"Alan B Cohen","doi":"10.1111/1468-0009.70003","DOIUrl":"10.1111/1468-0009.70003","url":null,"abstract":"","PeriodicalId":49810,"journal":{"name":"Milbank Quarterly","volume":"103 1","pages":"5-10"},"PeriodicalIF":4.8,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11923713/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143665035","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":"Innovative Insurance to Improve US Patient Access to Cell and Gene Therapy.","authors":"Rena M Conti, Patrick Demartino, Jonathan Gruber, Andrew W Lo, Yutong Sun, Jackie Wu","doi":"10.1111/1468-0009.12728","DOIUrl":"10.1111/1468-0009.12728","url":null,"abstract":"<p><p>Policy Points Cell and gene therapies (CGTs) offer treatment for rare and oftentimes deadly disease, but their prices are high, and payers may seek to limit spending. Total annual costs of covering all existing and expected CGTs for the entire US population 2023-2035 to amount to less than $20 per person and concentrate in commercial and state Medicaid plans. Reinsurance fees add to expected costs. Policies that improve coverage and affordability are needed to assure patient access to CGTs.</p><p><strong>Context: </strong>Cell and gene therapies (CGTs) offer treatment to rare and oftentimes deadly diseases. Because of their high price and uncertain clinical outcomes, US insurers commonly restrain patient access to CGTs, and these barriers may create or perpetuate existing disparities. A reconsideration of existing insurance policies to improve access and reduce disparities is currently underway. One method insurers use to support access and protect them from large, unexpected claims is the purchase of reinsurance. In exchange for an upfront per-member-per-month (PMPM) premium, the reinsurer pays the claim and rebates the insurer at the end of the contract period if there are funds leftover. However, existing reinsurance plans may not cover CGTs or charge exorbitant fees for coverage.</p><p><strong>Methods: </strong>We simulate the incremental annual per-person reinsurer costs to cover CGTs existing or expected between 2023 and 2035 for the US population and by payer type based on previously published estimates of expected US spending on CGTs, assumed US population of 330 persons, and current CGT reinsurance fees. We illustrate our methods by estimating the incremental annual per-person costs overall payers and to state Medicaid plans of sickle cell disease-targeted CGTs.</p><p><strong>Findings: </strong>We estimate annual incremental spending on CGTs 2023-2035 to amount to $20.4 billion, or $15.69 per person. Total annual estimated spending is expected to concentrate among commercial plans. Sickle cell-targeted CGTs add a maximum of $0.78 PMPM in costs to all payers and will concentrate within state Medicaid programs. Reinsurance fees add to expected costs.</p><p><strong>Conclusions: </strong>Annual per-person costs to provide access to CGTs are expected to concentrate in commercial and state Medicaid plans. Policies that improve CGT coverage and affordability are needed.</p>","PeriodicalId":49810,"journal":{"name":"Milbank Quarterly","volume":" ","pages":"32-51"},"PeriodicalIF":4.8,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11923689/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143014860","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}