Health Affairs Scholar最新文献_第2页

Relationship between health system quality and racial and ethnic equity in diabetes care 医疗系统质量与糖尿病护理中的种族和民族公平之间的关系

Health Affairs Scholar Pub Date : 2024-06-04 DOI: 10.1093/haschl/qxae073

Michelle S Wong, Chi-Hong Tseng, Ernest Moy, Kenneth T Jones, Amit J Kothari, Donna L. Washington

{"title":"Relationship between health system quality and racial and ethnic equity in diabetes care","authors":"Michelle S Wong, Chi-Hong Tseng, Ernest Moy, Kenneth T Jones, Amit J Kothari, Donna L. Washington","doi":"10.1093/haschl/qxae073","DOIUrl":"https://doi.org/10.1093/haschl/qxae073","url":null,"abstract":"\u0000 Failing to consider disparities in quality measures, such as by race and ethnicity, may obscure inequities in care, which could exist in facilities with overall high-quality ratings. We examined the relationship between overall quality and racial and ethnic disparities in diabetes care quality by healthcare facility-level performance on a diabetes-related quality measure within a national dataset of Veterans using Veterans Health Administration (VA) ambulatory care between 10/1/2019-9/31/2020, and were eligible for diabetes quality assessment. We found racial and ethnic disparities in diabetes care quality existed in top-performing VA medical centers (VAMCs) among American Indian or Alaska Native (AIAN; predicted probability = 30%), Black (predicted probability = 29%) and Hispanic VA-users (predicted probability = 30%)versus White VA-users (predicted probability = 26%). While disparities among Black and Hispanic VA-users were similar relative to white VA-users across VAMCs at all performance levels, disparities were exacerbated for AIAN and Native Hawaiian or Other Pacific Islander VA-users in bottom-performing VAMCs. Equity remains an issue even in facilities providing overall high-quality care. Integrating equity as a component of quality measures can incentivize greater focus on equity in quality improvement.","PeriodicalId":502462,"journal":{"name":"Health Affairs Scholar","volume":"2 5","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141266210","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

Acquisitions of Behavioral Health Treatment Facilities from 2010-2021 2010-2021 年行为健康治疗机构收购情况

Health Affairs Scholar Pub Date : 2024-06-04 DOI: 10.1093/haschl/qxae080

Benjamin Thornburg, Emma E. McGinty, Julia C P Eddelbuettel, Alene Kennedy-Hendricks, Robert Tyler Braun, Matthew D Eisenberg

{"title":"Acquisitions of Behavioral Health Treatment Facilities from 2010-2021","authors":"Benjamin Thornburg, Emma E. McGinty, Julia C P Eddelbuettel, Alene Kennedy-Hendricks, Robert Tyler Braun, Matthew D Eisenberg","doi":"10.1093/haschl/qxae080","DOIUrl":"https://doi.org/10.1093/haschl/qxae080","url":null,"abstract":"\u0000 Private equity and other for-profit ownership of behavioral health (mental health and substance use) treatment facilities has become increasingly prevalent, but data on these acquisitions are not readily available. In this study, we describe a novel database that contains information on the universe of behavioral health acquisitions that occurred between 2010-2021. We found that the frequency of behavioral health facilities involved in acquisitions increased substantially, from 32 facilities in 2010 to 1,330 in 2021. The total number of facilities involved in acquisitions was 2,806. Most of these facilities provided outpatient services only (N=2,073) and offered only mental health services (N=1,428). Private equity-backed acquisitions accounted for around 60% of all acquisition activity (N=1,678 facilities private equity, N=1,128 facilities other for-profit). 25% of acquired facilities were located within 20 miles of one another (N=561), 50% occurred within 80 miles (N=1,403), and 75% occurred within 319 miles (N=2,104). Future research should evaluate the effects of this consolidation on behavioral healthcare access, quality, spending, and patient outcomes.","PeriodicalId":502462,"journal":{"name":"Health Affairs Scholar","volume":"86 18","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141267890","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

Inaccuracies in Provider Directories Persist for Long Periods of Time 医疗服务提供者目录中的不准确之处长期存在

Health Affairs Scholar Pub Date : 2024-06-04 DOI: 10.1093/haschl/qxae079

Simon F. Haeder, Jane M Zhu

引用次数: 0

Capturing and harvesting in Medicare Advantage plan design 医疗保险优势计划设计中的捕捉和收获

Health Affairs Scholar Pub Date : 2024-06-04 DOI: 10.1093/haschl/qxae077

Keaton Miller

引用次数: 0

Why Does the Cost of Employer Sponsored Coverage Keep Rising? 为什么雇主赞助的保险费用不断上涨？

Health Affairs Scholar Pub Date : 2024-06-04 DOI: 10.1093/haschl/qxae078

Salpy Kanimian, Vivian Ho

{"title":"Why Does the Cost of Employer Sponsored Coverage Keep Rising?","authors":"Salpy Kanimian, Vivian Ho","doi":"10.1093/haschl/qxae078","DOIUrl":"https://doi.org/10.1093/haschl/qxae078","url":null,"abstract":"\u0000 Over the past 25 years, the gap between the increase in health insurance costs and workers’ wages has significantly expanded. This trend has led to significant concerns about healthcare affordability, with surveys revealing conflicting opinions regarding whether hospitals or health insurance companies bear the blame for escalating costs. To better understand these dynamics, we examined consumer price indices for health insurance, hospital services, and professional services over from 2006 to 2023 using Bureau of Labor Statistics data. Our analysis shows that the hospital price index rose steadily between 2006 and 2023, faster than insurance premiums or professional services. To examine whether differences in underlying costs are driving higher hospital price increases, we evaluated the profit margins of hospitals and health insurance companies using the National Academy for State Health Policy's Hospital Cost Tool and National Association of Insurance Commissioners Industry Reports. Our findings reveal that hospitals (for-profit and non-profit) have consistently maintained higher profit margins than insurance companies. As health insurance costs continue to weigh heavily on working Americans, our analysis suggests that high hospital prices drive insurance premiums.","PeriodicalId":502462,"journal":{"name":"Health Affairs Scholar","volume":"90 22","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141268063","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

Perceptions of Stimulant and Buprenorphine Diversion and Strategies to Address It 对兴奋剂和丁丙诺啡转用的看法及应对策略

Health Affairs Scholar Pub Date : 2024-06-03 DOI: 10.1093/haschl/qxae074

L. Uscher-Pines, Jessica Sousa, Pushpa Raja, A. Mehrotra, Alisa B. Busch, H. Huskamp

{"title":"Perceptions of Stimulant and Buprenorphine Diversion and Strategies to Address It","authors":"L. Uscher-Pines, Jessica Sousa, Pushpa Raja, A. Mehrotra, Alisa B. Busch, H. Huskamp","doi":"10.1093/haschl/qxae074","DOIUrl":"https://doi.org/10.1093/haschl/qxae074","url":null,"abstract":"\u0000 There is ongoing policy debate on the prescribing of controlled substances such as buprenorphine and stimulants via telemedicine. The goal of federal and state policymakers is to ensure access to care while limiting diversion risk. However, there is little evidence on how clinicians view and address diversion and on telemedicine's role in diversion. From December 2023-January 2024, we conducted semi-structured interviews with 21 psychiatrists and primary care physicians engaged in hybrid (telemedicine and in-person) care models in which we explored perceptions of diversion and strategies used to monitor for diversion. Most physicians reported monitoring for diversion, but there was little consistency on how monitoring was done and reported strategies did not differ between telemedicine vs. in-person care. When physicians suspected diversion, there was also wide variation in responses. Few physicians had ever reported a case of suspected diversion to law enforcement. Our findings suggest that the Drug Enforcement Administration could clarify reporting requirements and professional societies could provide additional guidance on how to respond to suspected diversion, given the current variation in practice across clinicians could be exploited by individuals who want to divert.","PeriodicalId":502462,"journal":{"name":"Health Affairs Scholar","volume":"29 30","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141270756","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

Selecting Patient-Reported Outcome Measures: “What” and “For Whom” 选择患者报告的结果指标："什么 "和 "为谁"

Health Affairs Scholar Pub Date : 2024-03-27 DOI: 10.1093/haschl/qxae038

Jason B Liu, Nan E. Rothrock, Maria O Edelen

引用次数: 0

Measuring Value in Healthcare: Lessons from Accountable Care Organizations 衡量医疗保健的价值：责任医疗组织的经验教训

Health Affairs Scholar Pub Date : 2024-03-01 DOI: 10.1093/haschl/qxae028

Chenzhang Bao, I. Bardhan

{"title":"Measuring Value in Healthcare: Lessons from Accountable Care Organizations","authors":"Chenzhang Bao, I. Bardhan","doi":"10.1093/haschl/qxae028","DOIUrl":"https://doi.org/10.1093/haschl/qxae028","url":null,"abstract":"\u0000 Accountable care organizations (ACOs) were created to promote healthcare value by improving health outcomes while curbing healthcare expenditures. Although a decade has passed, the value of care delivered by ACOs is yet to be fully understood. We proposed a novel measure of healthcare value using data envelopment analysis and examined its association with ACO organizational characteristics and social determinants of health (SDOH). We observed that the value of care delivered by ACOs stagnated in recent years, which may be partially attributed to challenges in care continuity and coordination across providers. ACOs that were solely led by physicians and included more participating entities exhibited lower value, highlighting the role of coordination across ACO networks. Furthermore, SDOH factors, such as economic well-being, healthy food consumption, and access to health resources, were significant predictors of ACO value. Our findings suggest a “skinny in scale, broad in scope” approach for ACOs to improve the value of care. Healthcare policy should also incentivize ACOs to work with local communities and enhance care coordination of vulnerable patient populations across siloed and disparate care delivery systems.","PeriodicalId":502462,"journal":{"name":"Health Affairs Scholar","volume":"81 16","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140087302","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

The Role of Race and Ethnicity in Healthcare Crowdfunding: an exploratory analysis 种族和民族在医疗众筹中的作用：探索性分析

Health Affairs Scholar Pub Date : 2024-02-28 DOI: 10.1093/haschl/qxae027

Sara Machado, Beatrice Perez, Irene Papanicolas

{"title":"The Role of Race and Ethnicity in Healthcare Crowdfunding: an exploratory analysis","authors":"Sara Machado, Beatrice Perez, Irene Papanicolas","doi":"10.1093/haschl/qxae027","DOIUrl":"https://doi.org/10.1093/haschl/qxae027","url":null,"abstract":"\u0000 Medical crowdfunding is a key source of finance for individuals facing high out of pocket costs, including organ transplant candidates. However, little is known about racial disparities in campaigning activity and outcomes, or how these relate to access to care. In this exploratory nationwide cross-sectional study, we examined racial disparities in campaigning activity across states and the association between U.S. campaigners’ race and ethnicity and crowdfunding outcomes using a novel database of organ-transplant related campaigns, and an algorithm to identify race and ethnicity based on name and geographic location. This analysis suggests that there are racial disparities in individuals’ ability to successfully raise requested funds, with Black and Hispanic campaigners fundraising lower amounts and less likely to achieve their monetary goals. We also find that crowdfunding among White, Black, and Hispanic populations exhibit different patterns of activity at the state level, and in relation to race specific uninsurance and wait list additions, highlighting potential differences in fundraising need across the three groups. Policy efforts should consider not only how inequalities in fundraising ability for associated costs influences accessibility to care, but also how to identify clinical need among minorities.","PeriodicalId":502462,"journal":{"name":"Health Affairs Scholar","volume":"27 3","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140423042","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

Association of Licensure and Relationship Requirement Waivers with Out-of-State Tele-Mental Healthcare, 2019-2021 2019-2021 年与州外远程心理保健的执照和关系要求豁免协会

Health Affairs Scholar Pub Date : 2024-02-28 DOI: 10.1093/haschl/qxae026

Antonios M. Koumpias, Owen Fleming, Lewei Allison Lin

{"title":"Association of Licensure and Relationship Requirement Waivers with Out-of-State Tele-Mental Healthcare, 2019-2021","authors":"Antonios M. Koumpias, Owen Fleming, Lewei Allison Lin","doi":"10.1093/haschl/qxae026","DOIUrl":"https://doi.org/10.1093/haschl/qxae026","url":null,"abstract":"\u0000 During the COVID-19 public health emergency, states waived in-state licensure and pre-existing patient-physician relationship requirements to increase access to care. We exploit this state telehealth policy variation to estimate the association of in-state licensure requirement waivers and pre-existing patient-physician relationship requirement waivers with out-of-state tele-mental healthcare utilization of patients diagnosed with COVID-19. Using claims from January 2019 till December 2021 of 2,037,977 commercially insured individuals in 3 metropolitan statistical areas (MSA) straddling Midwestern state borders, we find increased out-of-state telehealth utilization as a share of out-of-state mental healthcare by 0.1411 and 0.0575 visits per month or 1,679.76% and 467.48% after licensure and relationship waivers, respectively. Within-MSA analyses illustrate an urban-rural digital divide in out-of-state utilization as a share of total or telehealth mental healthcare. Our findings indicate waivers primarily enhance access to care of established patients by enabling the transition of in-person out-of-state healthcare online. Interstate medical licensure compact participation may provide broader access to out-of-state tele-mental healthcare than emergency waivers.","PeriodicalId":502462,"journal":{"name":"Health Affairs Scholar","volume":"73 3","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140421245","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