Health Affairs Scholar最新文献

Geographic Variation in Shortfalls of Dementia Specialists in the U.S. 美国痴呆症专科医生短缺的地域差异

Health Affairs Scholar Pub Date : 2024-07-18 DOI: 10.1093/haschl/qxae088

Jodi L Liu, Lawrence Baker, Annie Yu-An Chen, Jue (Jessie) Wang

{"title":"Geographic Variation in Shortfalls of Dementia Specialists in the U.S.","authors":"Jodi L Liu, Lawrence Baker, Annie Yu-An Chen, Jue (Jessie) Wang","doi":"10.1093/haschl/qxae088","DOIUrl":"https://doi.org/10.1093/haschl/qxae088","url":null,"abstract":"\u0000 Dementia specialists – neurologists, geriatricians, and geriatric psychiatrists – serve a critical clinical function in diagnosing early-stage Alzheimer’s disease and determining eligibility for treatment with disease-modifying therapies. However, the availability of dementia specialists is limited and varies across the U.S. Using data from the Area Health Resources Files, we found that the median density of dementia specialists across hospital referral regions in U.S. is 29.7 per 100,000 population aged 65 and older (interquartile range 20.7 to 44.0). We derived thresholds of 33 to 45 dementia specialists per 100,000 population aged 65 and older as the provider density necessary to care for older adults with mild cognitive impairment and dementia. Based on these thresholds, we estimated that 34% to 60% of the population aged 65 and older resided in areas with potential dementia specialist shortfalls. The extent of potential shortfalls varied by state and rurality. A better understanding of potential gaps in the availability of dementia specialists will inform policies and practices to ensure access to services for people with cognitive impairment and dementia.","PeriodicalId":502462,"journal":{"name":"Health Affairs Scholar","volume":"38 10","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141639864","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}

引用次数: 0

Health Affairs Scholar Pub Date : 2024-07-17 DOI: 10.1093/haschl/qxae090

F. LaMountain, Molly T Beinfeld, William Wong, Eunice Kim, James D Chambers

{"title":"Biosimilar underutilization alone does not foretell a broken biologics market","authors":"F. LaMountain, Molly T Beinfeld, William Wong, Eunice Kim, James D Chambers","doi":"10.1093/haschl/qxae090","DOIUrl":"https://doi.org/10.1093/haschl/qxae090","url":null,"abstract":"\u0000 Biosimilars offer the potential for cost savings and expanded access to biologic products, however, there are concerns regarding the rate of biosimilar uptake. We assessed the relationship between biosimilar and originator pricing, coverage, and market share by describing four case studies that fall into two categories: (1) sole preferred coverage strategy (i.e., aim is to have originator product preferred; biosimilar(s) non-preferred), defined as steep ASP reductions for originator products (decline in net prices by at least 50% following the introduction of biosimilar competition by 2022) and (2) non-sole preferred coverage strategy (i.e., aim is to have originator product preferred alongside biosimilar products), defined as moderate ASP reductions for originator products with (net prices did not decline by at least 50% of its pre-biosimilar competition value). We found that originators with sole preferred coverage strategies maintained formulary preference and market share relative to originators with non-sole preferred coverage strategies. Regardless of strategy, the market-weighted ASP for all four product families (originator and biosimilars) declined significantly in the years following the introduction of biosimilars, suggesting that biosimilar uptake alone may not be a complete measure of whether the biosimilar market is facilitating competition and lowering prices.","PeriodicalId":502462,"journal":{"name":"Health Affairs Scholar","volume":"28 10","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141640144","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}

引用次数: 0

Regional Variation in Length of Stay for Stroke Inpatient Rehabilitation in Traditional Medicare and Medicare Advantage 传统医疗保险和医疗保险优势计划中脑卒中住院康复的住院时间的地区差异

Health Affairs Scholar Pub Date : 2024-07-16 DOI: 10.1093/haschl/qxae089

D. Luo, M. Ouayogodé, John Mullahy, Ying (Jessica) Cao

{"title":"Regional Variation in Length of Stay for Stroke Inpatient Rehabilitation in Traditional Medicare and Medicare Advantage","authors":"D. Luo, M. Ouayogodé, John Mullahy, Ying (Jessica) Cao","doi":"10.1093/haschl/qxae089","DOIUrl":"https://doi.org/10.1093/haschl/qxae089","url":null,"abstract":"\u0000 Regional variation in healthcare use threatens efficient and equitable resource allocation. Within the Medicare program, variation in care delivery may differ between centrally administered traditional Medicare (TM) and privately managed Medicare Advantage (MA) plans which rely on different strategies to control care utilization. As MA enrollment grows, it is particularly important for program design and long-term healthcare equity to understand regional variation between TM and MA plans. This study examined regional variation in length of stay (LOS) for stroke inpatient rehabilitation between TM and MA plans in 2019 and how that changed in 2020, the first year of the COVID-19 pandemic. Results showed that MA plans had larger across-region variations than TM (standard deviation (SD)=0.26 vs. 0.24 days, 11% relative difference). In 2020, across-region variation for MA further enlarged but the trend for TM stayed relatively stable. Market competition among all inpatient rehabilitation facilities (IRFs) within a region was associated with a moderate increase in within-region variation of LOS (elasticity=0.46). Policies reducing administrative variation across MA plans or increasing regional market competition among IRFs can mitigate regional variation in healthcare use.","PeriodicalId":502462,"journal":{"name":"Health Affairs Scholar","volume":"3 10","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141642558","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}

引用次数: 0

Who Participates in Value-Based Care Models? Physician Characteristics and Implications for Value-based Care 谁参与了价值导向型医疗模式？医生特点及对价值医疗的影响

Health Affairs Scholar Pub Date : 2024-07-16 DOI: 10.1093/haschl/qxae087

Debra R Winberg, Matthew C Baker, Xiaochu Hu, Keith A Horvath

{"title":"Who Participates in Value-Based Care Models? Physician Characteristics and Implications for Value-based Care","authors":"Debra R Winberg, Matthew C Baker, Xiaochu Hu, Keith A Horvath","doi":"10.1093/haschl/qxae087","DOIUrl":"https://doi.org/10.1093/haschl/qxae087","url":null,"abstract":"\u0000 Value-Based Care (VBC) payment models are becoming increasingly prevalent as alternatives to the traditional fee-for-service paradigm. This research quantifies the relationship between physician characteristics and participation in VBC payment models using the Association of American Medical Colleges’ 2022 National Sample Survey of Physicians. We specified logistic regressions using physician-level variables to assess associations with current and new participation in Accountable Care Organizations, Primary Care First (PCF) model, capitation, and bundled payments. Our results indicate that most respondents engaged in at least one VBC. Participation varied based on several characteristics, and physician specialty was highly predictive of overall participation. Compared to primary care physicians (PCPs), hospital-based physicians (OR=0.6, p<0.001), medical specialists (OR=0.5, p<0.001), psychiatrists (OR=0.4, p<0.001), and surgeons (OR=0.5, p<0.001) were less likely to participate in VBC models. Medical specialists and surgeons were less likely to participate in commercial capitation than PCPs while medical specialists and obstetricians/gynecologists were more likely to participate in certain bundles than PCPs. We suggest several policies to close the cross-specialty participation gap by including specialists and appealing to providers and patients.","PeriodicalId":502462,"journal":{"name":"Health Affairs Scholar","volume":"63 19","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141643533","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}

引用次数: 0

Medicare Advantage Enrollment and Outcomes of Post-Acute Nursing Home Care Among Patients with Dementia 痴呆症患者参加联邦医疗保险优势计划的情况与急性期后疗养院护理的结果

Health Affairs Scholar Pub Date : 2024-06-13 DOI: 10.1093/haschl/qxae084

Daeho Kim, David J Meyers, L. Keohane, Hiren Varma, Emma M Achola, Amal N Trivedi

引用次数: 0

Access to Care for Patients with Chronic Pain Receiving Prescription Opioids, Cannabis, or Other Treatments 接受处方类阿片、大麻或其他治疗的慢性疼痛患者获得护理的机会

Health Affairs Scholar Pub Date : 2024-06-12 DOI: 10.1093/haschl/qxae086

M. Bicket, Elizabeth M Stone, Kayla N. Tormohlen, Reekarl Pierre, Emma E. McGinty

{"title":"Access to Care for Patients with Chronic Pain Receiving Prescription Opioids, Cannabis, or Other Treatments","authors":"M. Bicket, Elizabeth M Stone, Kayla N. Tormohlen, Reekarl Pierre, Emma E. McGinty","doi":"10.1093/haschl/qxae086","DOIUrl":"https://doi.org/10.1093/haschl/qxae086","url":null,"abstract":"\u0000 Changes chronic noncancer pain treatment have led to decreases in prescribing of opioids and increases in the availability of medical cannabis, despite its federal prohibition. Patients may face barriers to establishing new care with a physician based on use of these treatments. We compared physician willingness to accept patients based on prescription opioid, cannabis, or other pain treatment use. This study of 36 states and DC with active medical cannabis programs surveyed physicians who treat patients with chronic noncancer pain between July 13 and August 4, 2023. Of 1,000 physician respondents (34.5% female, 63.2% white, 78.1% primary care), 852 reported accepting new patients with chronic pain. Among those accepting new patients with chronic pain, more physicians reported that they would not accept new patients taking prescription opioids (20.0%) or cannabis (12.7%) than non-opioid prescription analgesics (0.1%). In contrast, 68.1% reported willingness to accept new patients using prescribed opioids on a daily basis. For cannabis, physicians were more likely to accept new patients accessing cannabis through medical programs (81.6%) than from other sources (60.2%). Access to care for persons with chronic noncancer pain appears the most restricted among those taking prescription opioids, though patients taking cannabis may also encounter reduced access.","PeriodicalId":502462,"journal":{"name":"Health Affairs Scholar","volume":"119 37","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141351955","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}

引用次数: 0

Market Landscape and Insurer-Provider Integration: The Case of Ambulatory Surgery Centers 市场格局与保险商-提供商一体化：非住院手术中心案例

Health Affairs Scholar Pub Date : 2024-06-11 DOI: 10.1093/haschl/qxae081

Xiaoxi Zhao, Michael R Richards, C. Damberg, Christopher M Whaley

引用次数: 0

Access to Treatment Before and After Medicare Coverage of Opioid Treatment Programs 在医疗保险覆盖阿片类药物治疗计划之前和之后获得治疗的情况

Health Affairs Scholar Pub Date : 2024-06-06 DOI: 10.1093/haschl/qxae076

Ruijie Liu, Tamara Beetham, Helen Newton, Susan H Busch

{"title":"Access to Treatment Before and After Medicare Coverage of Opioid Treatment Programs","authors":"Ruijie Liu, Tamara Beetham, Helen Newton, Susan H Busch","doi":"10.1093/haschl/qxae076","DOIUrl":"https://doi.org/10.1093/haschl/qxae076","url":null,"abstract":"\u0000 Since January 2020, Medicare has covered opioid use disorder (OUD) treatment services at opioid treatment programs (OTPs), the only outpatient settings allowed to dispense methadone for treating OUD. This study examined policy-associated changes in Medicare acceptance and the availability of four OUD treatment services (ongoing buprenorphine, HIV/AIDS education, employment services, and comprehensive mental health assessment), by for-profit status, and county-level changes in Medicare-accepting-OTPs access, by sociodemographic characteristics (racial composition, poverty rate, and rurality). Using data from the 2019-2022 National Directory of Drug and Alcohol Abuse Treatment Facilities, we found Medicare acceptance increased from 21.31% in 2018 to 80.76% in 2021. The availability of the four treatment services increased but no increases were significantly associated with Medicare coverage. While county-level OTP access significantly improved, counties with higher rates of nonwhite residents experienced an additional average increase of 0.86 Medicare-accepting-OTPs (95% CI: [0.05, 1.67]) compared to those without higher rates of nonwhite populations. Overall, Medicare coverage was associated with improved OTP access, not ancillary services.","PeriodicalId":502462,"journal":{"name":"Health Affairs Scholar","volume":"1 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141380316","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}

引用次数: 0

Follow the Money: A Global Analysis of Funding Dynamics for Global Health Security 跟着钱走：全球卫生安全筹资动态分析

Health Affairs Scholar Pub Date : 2024-06-06 DOI: 10.1093/haschl/qxae083

H. Robertson, E. Graeden, Justin Kerr, Michael Van Maele, Rebecca Katz

{"title":"Follow the Money: A Global Analysis of Funding Dynamics for Global Health Security","authors":"H. Robertson, E. Graeden, Justin Kerr, Michael Van Maele, Rebecca Katz","doi":"10.1093/haschl/qxae083","DOIUrl":"https://doi.org/10.1093/haschl/qxae083","url":null,"abstract":"\u0000 Global financing for health security was dramatically impacted by COVID-19. Here, we provide an empirical analysis of how that funding changed. Using data from Global Health Security (GHS) Tracking (ghscosting.tracking.org), we analyzed disbursements of direct financial assistance for global health security from 2016 to 2022 to compare pre-pandemic funding (2016-2019) to post-pandemic (2020-2022) funding for preparedness and response during each of the seven World Health Organization (WHO)-declared public health emergencies of international concern (PHEICs) from 2009 to 2022. Over $165B was disbursed for capacity-building and preparedness activities between January 2016 and December 2022, and over $76B was provided for PHEIC response. Preparedness funding remained evenly distributed since 2016 across regions, with the African region receiving about 70% of total preparedness funding. Indeed, how capacity-building and preparedness funding is distributed has changed remarkably little since 2016, despite unprecedented changes to the funding environment – including markedly increased spending – in response to COVID-19. This suggests we now have a unique opportunity to restructure how funds are tracked for accountability and assessing return on investment moving forward.","PeriodicalId":502462,"journal":{"name":"Health Affairs Scholar","volume":"29 48","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141379560","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}

引用次数: 0

Regional Variation in Financial Hardship Among US Veterans During the COVID-19 Pandemic COVID-19 大流行期间美国退伍军人经济困难的地区差异

Health Affairs Scholar Pub Date : 2024-06-05 DOI: 10.1093/haschl/qxae075

Katrina E Hauschildt, David P Bui, D. Govier, Tammy L Eaton, E. Viglianti, Catherine K. Ettman, H. McCready, Valerie A Smith, A. O’Hare, Thomas F. Osborne, Edward J. Boyko, George N Ioannou, Matthew L. Maciejewski, A. Bohnert, Denise M. Hynes, Theodore J. Iwashyna

{"title":"Regional Variation in Financial Hardship Among US Veterans During the COVID-19 Pandemic","authors":"Katrina E Hauschildt, David P Bui, D. Govier, Tammy L Eaton, E. Viglianti, Catherine K. Ettman, H. McCready, Valerie A Smith, A. O’Hare, Thomas F. Osborne, Edward J. Boyko, George N Ioannou, Matthew L. Maciejewski, A. Bohnert, Denise M. Hynes, Theodore J. Iwashyna","doi":"10.1093/haschl/qxae075","DOIUrl":"https://doi.org/10.1093/haschl/qxae075","url":null,"abstract":"\u0000 Geographic variation in hardship, especially health-related hardship, was identified prior to and during the pandemic, but we do not know whether this variation is consistent among Veterans Health Administration (VHA)-enrolled Veterans, who reported markedly high rates of financial hardship during the pandemic, despite general and Veteran-specific federal policy efforts aimed at reducing hardship. In a nationwide, regionally stratified sample of VHA-enrolled Veterans, we examined whether the prevalence of financial hardship during the pandemic varied by Census region. We found Veterans in the South, compared to those in other Census regions, reported higher rates of severe-to-extreme financial strain, using up all or most of their savings, being unable to pay for necessities, being contacted by collections, and changing their employment due to the kind of work they could perform. Regional variation in Veteran financial hardship demonstrates a need for further research about the role and interaction of federal- and state- financial assistance policies in shaping risks for financial hardship as well as potential opportunities to mitigate risks among Veterans and reduce variation across regions.","PeriodicalId":502462,"journal":{"name":"Health Affairs Scholar","volume":"341 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141386113","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}

引用次数: 0