Health Affairs最新文献_第8页

Nursing Homes Increasingly Rely On Staffing Agencies For Direct Care Nursing. 养老院越来越多地依赖人事代理机构提供直接护理服务。

IF 8.6 1区医学

Health Affairs Pub Date : 2024-03-01 Epub Date: 2024-02-14 DOI: 10.1377/hlthaff.2023.01101

John R Bowblis, Christopher S Brunt, Huiwen Xu, Robert Applebaum, David C Grabowski

{"title":"Nursing Homes Increasingly Rely On Staffing Agencies For Direct Care Nursing.","authors":"John R Bowblis, Christopher S Brunt, Huiwen Xu, Robert Applebaum, David C Grabowski","doi":"10.1377/hlthaff.2023.01101","DOIUrl":"10.1377/hlthaff.2023.01101","url":null,"abstract":"When nursing homes experience a shortage in directly employed nursing staff, they may rely on temporary workers from staffing agencies to fill this gap. This article examines trends in the use of staffing agencies among nursing homes during the prepandemic and COVID-19 pandemic era (2018-22). In 2018, 23 percent of nursing homes used agency nursing staff, accounting for about 3 percent of all direct care nursing hours worked. When used, agency staff were commonly present for ninety or fewer days in a year. By 2022, almost half of all nursing homes used agency staff, accounting for 11 percent of all direct care nursing staff hours. Agency staff were increasingly used to address chronic staffing shortages, with 13.8 percent of nursing homes having agency staff present every day. Agency staff were 50-60 percent more expensive per hour than directly employed nursing staff, and nursing homes that used agency staff often had lower five-star ratings. Policy makers need to consider postpandemic changes to the nursing home workforce as part of nursing home reform, as increased reliance on agency staff may reduce the financial resources available to increase nursing staff levels and improve the quality of care.","PeriodicalId":50411,"journal":{"name":"Health Affairs","volume":null,"pages":null},"PeriodicalIF":8.6,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10955789/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139736591","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

County-Level Mandates Were Generally Effective At Slowing COVID-19 Transmission. 县级强制措施在减缓 COVID-19 传播方面基本有效。

IF 8.6 1区医学

Health Affairs Pub Date : 2024-03-01 DOI: 10.1377/hlthaff.2023.00431

Courtney E Baird, Derek Lake, Orestis A Panagiotou, Pedro Gozalo

{"title":"County-Level Mandates Were Generally Effective At Slowing COVID-19 Transmission.","authors":"Courtney E Baird, Derek Lake, Orestis A Panagiotou, Pedro Gozalo","doi":"10.1377/hlthaff.2023.00431","DOIUrl":"10.1377/hlthaff.2023.00431","url":null,"abstract":"Throughout the COVID-19 pandemic in the US, counties adopted numerous nonpharmaceutical interventions, such as mask mandates and stay-at-home orders, to slow COVID-19 transmission and prevent hospitals from reaching full capacity. Early evidence has been mixed about whether these interventions are effective. However, most studies only covered the early waves of COVID-19 and did not account for county-level variation in the adoption and repeal of such policies. Using daily county-level data from the Centers for Disease Control and Prevention, we evaluated the joint impact of bans on large gatherings, stay-at-home orders, mask mandates, and bar and restaurant closures on slowing COVID-19 transmission during waves 1-4 of the pandemic in the US (March 1, 2020-June 30, 2021). Our survival analysis showed that these interventions were generally effective at slowing COVID-19 transmission during this period. The mitigating effect was particularly strong during waves 2 and 3 and less substantial during waves 1 and 4. We also found strong evidence of the overall protective effect of mask mandates and, to a lesser degree, anticongregation policies. These study findings provide crucial evidence for public health officials to reference for support when using nonpharmaceutical interventions to flatten the curve of future waves of COVID-19 or other infectious disease outbreaks.","PeriodicalId":50411,"journal":{"name":"Health Affairs","volume":null,"pages":null},"PeriodicalIF":8.6,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140029474","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

COVID-19 Medicaid Continuous Enrollment Provision Yielded Gains In Postpartum Continuity Of Coverage. COVID-19 《医疗补助连续注册规定》在产后连续承保方面取得了进展。

IF 8.6 1区医学

Health Affairs Pub Date : 2024-03-01 DOI: 10.1377/hlthaff.2023.00580

Sarah H Gordon, Lucy Chen, Nancy DeLew, Benjamin D Sommers

引用次数: 0

Gaps In Quality Of Care Not Consistent Between Traditional Medicare, Medicare Advantage For Racial And Ethnic Groups. 对于种族和民族群体而言，传统医疗保险和医疗保险优势计划在护理质量方面的差距并不一致。

IF 8.6 1区医学

Health Affairs Pub Date : 2024-03-01 DOI: 10.1377/hlthaff.2023.00428

Jeah Jung, Hansoo Ko, Roger Feldman, Caroline S Carlin, Ge Song

{"title":"Gaps In Quality Of Care Not Consistent Between Traditional Medicare, Medicare Advantage For Racial And Ethnic Groups.","authors":"Jeah Jung, Hansoo Ko, Roger Feldman, Caroline S Carlin, Ge Song","doi":"10.1377/hlthaff.2023.00428","DOIUrl":"10.1377/hlthaff.2023.00428","url":null,"abstract":"The quality of care experienced by members of racial and ethnic minority groups in Medicare Advantage, which is an increasingly important source of Medicare coverage for these groups, has critical implications for health equity. Comparing gaps in Medicare Advantage and traditional Medicare for three quality-of-care outcomes, measured by adverse health events, between minority and non-Hispanic White populations, we found that the relative magnitude of the gaps varied both by racial and ethnic minority group and by quality measure. Hispanic versus non-Hispanic White gaps were smaller in Medicare Advantage than in traditional Medicare for all outcomes: avoidable emergency department use, preventable hospitalizations, and thirty-day hospital readmissions. The gap between non-Hispanic Black and non-Hispanic White populations was larger in Medicare Advantage than in traditional Medicare for avoidable emergency department use but was no different for hospital readmissions and was smaller for preventable hospitalizations. The Asian versus non-Hispanic White gap was similar in Medicare Advantage and traditional Medicare for avoidable emergency department use and preventable hospitalizations but was larger in Medicare Advantage for hospital readmissions. As Medicare Advantage enrollment expands, monitoring the quality of care for enrollees who are members of racial and ethnic minority groups will remain important.","PeriodicalId":50411,"journal":{"name":"Health Affairs","volume":null,"pages":null},"PeriodicalIF":8.6,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140029477","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

New CMS Nursing Home Ownership Data: Major Gaps And Discrepancies. 新的 CMS 养老院所有权数据：主要差距和差异。

IF 8.6 1区医学

Health Affairs Pub Date : 2024-03-01 DOI: 10.1377/hlthaff.2023.01110

Amanda C Chen, Robert J Skinner, Robert Tyler Braun, R Tamara Konetzka, David G Stevenson, David C Grabowski

{"title":"New CMS Nursing Home Ownership Data: Major Gaps And Discrepancies.","authors":"Amanda C Chen, Robert J Skinner, Robert Tyler Braun, R Tamara Konetzka, David G Stevenson, David C Grabowski","doi":"10.1377/hlthaff.2023.01110","DOIUrl":"10.1377/hlthaff.2023.01110","url":null,"abstract":"Nursing home ownership has become increasingly complicated, partly because of the growth of facilities owned by institutional investors such as private equity (PE) firms and real estate investment trusts (REITs). Although the ownership transparency and accountability of nursing homes have historically been poor, the Biden administration's nursing home reform plans released in 2022 included a series of data releases on ownership. However, our evaluation of the newly released data identified several gaps: One-third of PE and fewer than one-fifth of REIT investments identified in the proprietary Irving Levin Associates and S&P Capital IQ investment data were present in Centers for Medicare and Medicaid Services (CMS) publicly available ownership data. Similarly, we obtained different results when searching for the ten top common owners of nursing homes using CMS data and facility survey reports of chain ownership. Finally, ownership percentages were missing in the CMS data for 82.40 percent of owners in the top ten chains and 55.21 percent of owners across all US facilities. Although the new data represent an important step forward, we highlight additional steps to ensure that the data are timely, accurate, and responsive. Transparent ownership data are fundamental to understanding the adequacy of public payments to provide patient care, enable policy makers to make timely decisions, and evaluate nursing home quality.","PeriodicalId":50411,"journal":{"name":"Health Affairs","volume":null,"pages":null},"PeriodicalIF":8.6,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140029484","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Effects Of Medicaid Expansions On Coverage, Prenatal Care, And Health Among American Indian/Alaska Native Women. 医疗补助扩展对美国印第安人/阿拉斯加原住民妇女的保险、产前护理和健康的影响。

IF 8.6 1区医学

Health Affairs Pub Date : 2024-03-01 DOI: 10.1377/hlthaff.2023.00672

Kate W Strully, Pinka Chatterji, Han Liu, Soojin Han, Lawrence Schell

{"title":"Effects Of Medicaid Expansions On Coverage, Prenatal Care, And Health Among American Indian/Alaska Native Women.","authors":"Kate W Strully, Pinka Chatterji, Han Liu, Soojin Han, Lawrence Schell","doi":"10.1377/hlthaff.2023.00672","DOIUrl":"10.1377/hlthaff.2023.00672","url":null,"abstract":"American Indian/Alaska Native (AI/AN) women experience distinct political and health care environments and possess unique health risks and resources. We tested whether state Medicaid expansions under the Affordable Care Act were associated with health insurance, prenatal care, health conditions, and birth outcomes among AI/AN women. Using data from the 2010-19 American Community Survey and 2010-19 US birth certificates, we used a difference-in-differences study design to compare outcomes among AI/AN women before and after Medicaid expansions. Medicaid expansions increased the proportion of AI/AN women reporting health care coverage from both Medicaid and the Indian Health Service (IHS), with larger effects among women living in areas with relatively high percentages of reservation land. Consistent with prior research on the broader population of women, Medicaid expansions had no effects on first-trimester prenatal care usage or birthweight among AI/AN women. We found mixed evidence of increased rates of prepregnancy chronic conditions after the expansions. Our findings demonstrate the importance of Medicaid, the IHS, and tribal health systems as sources of health care coverage for AI/AN women of childbearing age.","PeriodicalId":50411,"journal":{"name":"Health Affairs","volume":null,"pages":null},"PeriodicalIF":8.6,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11340263/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140029476","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Georgia's Reinsurance Waiver Associated With Decreased Premium Affordability And Enrollment. 佐治亚州的再保险豁免与保费负担能力和注册人数下降有关。

IF 8.6 1区医学

Health Affairs Pub Date : 2024-03-01 DOI: 10.1377/hlthaff.2023.00971

David M Anderson, Ezra Golberstein, Coleman Drake

{"title":"Georgia's Reinsurance Waiver Associated With Decreased Premium Affordability And Enrollment.","authors":"David M Anderson, Ezra Golberstein, Coleman Drake","doi":"10.1377/hlthaff.2023.00971","DOIUrl":"10.1377/hlthaff.2023.00971","url":null,"abstract":"Sixteen states have used Section 1332 waivers to implement reinsurance programs that aim to reduce premiums and increase enrollment in the Affordable Care Act's health insurance Marketplaces. Although reinsurance programs have successfully reduced premiums for unsubsidized enrollees, little is known about how reinsurance affects Marketplace premiums, minimum cost of coverage, and enrollment for the large majority of Marketplace enrollees who receive premium subsidies. Using a difference-in-differences analysis of matched counties straddling Georgia's borders to examine Georgia's 2022 implementation of its reinsurance program, we found that reinsurance increased the minimum cost of enrolling in subsidized Marketplace coverage by approximately 30 percent and decreased enrollment by roughly a third for Marketplace enrollees with incomes of 251-400 percent of the federal poverty level. Marketplace reinsurance programs may have the unintended consequences of increasing the minimum cost of subsidized coverage and reducing enrollment. These outcomes are especially relevant in the present policy context of enhanced subsidies, which have substantially reduced the number of unsubsidized enrollees who would benefit most from reinsurance.","PeriodicalId":50411,"journal":{"name":"Health Affairs","volume":null,"pages":null},"PeriodicalIF":8.6,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140029478","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Hospital Facility Prices Declined As A Result Of Oregon's Hospital Payment Cap. 俄勒冈州医院支付上限导致医院设施价格下降。

IF 8.6 1区医学

Health Affairs Pub Date : 2024-03-01 DOI: 10.1377/hlthaff.2023.01021

Roslyn C Murray, Zach Y Brown, Sarah Miller, Edward C Norton, Andrew M Ryan

引用次数: 0

Private Equity-Acquired Physician Practices And Market Penetration Increased Substantially, 2012-21. 私募股权收购的医生诊所和市场渗透率大幅提高，2012-21 年。

IF 8.6 1区医学

Health Affairs Pub Date : 2024-03-01 DOI: 10.1377/hlthaff.2023.00152

Ola Abdelhadi, Brent D Fulton, Laura Alexander, Richard M Scheffler

引用次数: 0

Higher Rates Of Emergency Surgery, Serious Complications, And Readmissions In Primary Care Shortage Areas, 2015-19. 2015-19 年初级保健短缺地区的急诊手术、严重并发症和再入院率较高。

IF 8.6 1区医学

Health Affairs Pub Date : 2024-03-01 DOI: 10.1377/hlthaff.2023.00843

Sara L Schaefer, Shukri H A Dualeh, Nicholas Kunnath, John W Scott, Andrew M Ibrahim

{"title":"Higher Rates Of Emergency Surgery, Serious Complications, And Readmissions In Primary Care Shortage Areas, 2015-19.","authors":"Sara L Schaefer, Shukri H A Dualeh, Nicholas Kunnath, John W Scott, Andrew M Ibrahim","doi":"10.1377/hlthaff.2023.00843","DOIUrl":"10.1377/hlthaff.2023.00843","url":null,"abstract":"Primary care physicians are often the first to screen and identify patients with access-sensitive surgical conditions that should be treated electively. These conditions require surgery that is preferably planned (elective), but, when access is limited, treatment may be delayed and worsening symptoms lead to emergency surgery (for example, colectomy for cancer, abdominal aortic aneurysm repair, and incisional hernia repair). We evaluated the rates of elective versus emergency surgery for patients with three access-sensitive surgical conditions living in primary care Health Professional Shortage Areas during 2015-19. Medicare beneficiaries in more severe primary care shortage areas had higher rates of emergency surgery compared with rates in the least severe shortage areas (37.8 percent versus 29.9 percent). They were also more likely to have serious complications (14.9 percent versus 11.7 percent) and readmissions (15.7 percent versus 13.5 percent). When we accounted for areas with a shortage of surgeons, the findings were similar. Taken together, these findings suggest that residents of areas with greater primary care workforce shortages may also face challenges in accessing elective surgical care. As policy makers consider investing in Health Professional Shortage Areas, our findings underscore the importance of primary care access to a broader range of services.","PeriodicalId":50411,"journal":{"name":"Health Affairs","volume":null,"pages":null},"PeriodicalIF":8.6,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140029479","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0