Health affairs (Project Hope)最新文献

Connecticut's Novel Prenatal Substance Exposure Policy Is Associated With Declining CPS Reports And Foster Placements. 康涅狄格州新的产前物质暴露政策与CPS报告和寄养安置的下降有关。

Health affairs (Project Hope) Pub Date : 2025-07-01 DOI: 10.1377/hlthaff.2024.01160

Margaret Lloyd Sieger, Lucas Godoy, Timothy E Moore, Cindy Nichols, Elizabeth J Goldsborough, Shiyi Chen, Mishka Terplan, Beth Ann Griffin, Stephen W Patrick

{"title":"Connecticut's Novel Prenatal Substance Exposure Policy Is Associated With Declining CPS Reports And Foster Placements.","authors":"Margaret Lloyd Sieger, Lucas Godoy, Timothy E Moore, Cindy Nichols, Elizabeth J Goldsborough, Shiyi Chen, Mishka Terplan, Beth Ann Griffin, Stephen W Patrick","doi":"10.1377/hlthaff.2024.01160","DOIUrl":"https://doi.org/10.1377/hlthaff.2024.01160","url":null,"abstract":"In 2019, Connecticut became the first state to implement a deidentified notification policy for infants with prenatal substance exposure in response to updated provisions contained in the federal Child Abuse Prevention and Treatment Act (CAPTA) of 1974. Our study aimed to test whether Connecticut's notification policy was associated with an increase in Child Protective Services (CPS) interactions for this population. We analyzed child welfare and vital records over the course of a sixty-six-month time frame starting two years before the policy took effect. We used interrupted time series models to estimate monthly reports to CPS and foster care placements for infants with prenatal substance exposure in Connecticut's eight counties between March 2017 and July 2022. Reports and foster placements decreased for newborns with prenatal substance exposure after policy implementation. After covariates were controlled for, the adjusted rate of reports per birth decreased by 7 percent per month after the policy's implementation. The proportion of prenatal substance exposure reports resulting in foster care placement decreased by 4 percent per month. These findings suggest that Connecticut's approach to CAPTA was associated with a reduction in child welfare encounters among infants with prenatal substance exposure.","PeriodicalId":519943,"journal":{"name":"Health affairs (Project Hope)","volume":"44 7","pages":"821-829"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144585984","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

Mixed Evidence That Rural Hospitals' Finances Improved With Participation In The Pennsylvania Rural Health Model. 混合证据表明，参与宾夕法尼亚州农村卫生模式后，农村医院的财务状况有所改善。

Health affairs (Project Hope) Pub Date : 2025-07-01 DOI: 10.1377/hlthaff.2024.01559

Paula Chatterjee, Michael Wang, Xinwei Chen, Seiyoun Kim, Norma B Coe, Karen E Joynt Maddox, Karen Murphy, Rachel M Werner

{"title":"Mixed Evidence That Rural Hospitals' Finances Improved With Participation In The Pennsylvania Rural Health Model.","authors":"Paula Chatterjee, Michael Wang, Xinwei Chen, Seiyoun Kim, Norma B Coe, Karen E Joynt Maddox, Karen Murphy, Rachel M Werner","doi":"10.1377/hlthaff.2024.01559","DOIUrl":"https://doi.org/10.1377/hlthaff.2024.01559","url":null,"abstract":"The voluntary Pennsylvania Rural Health Model (PARHM) provided participating rural hospitals with global budgets rather than traditional fee-for-service payments to improve financial stability. Whether participation in PARHM was associated with financial improvements is unknown. In this synthetic difference-in-differences study from the period 2014-23, we estimated changes in rural hospital finances associated with PARHM participation among seventeen PARHM participants and forty nonparticipating Pennsylvania comparison hospitals. In unadjusted models, participation was associated with a 4.5-percentage-point differential increase in operating margins and a 4.7-percentage-point differential increase in total margins; however, these changes were nonsignificant in adjusted models (3.0 and 3.2 percentage points, respectively). Results were similar when we compared PARHM participants with 160 border-state comparison hospitals and when we used alternative difference-in-differences estimators. These findings offer mixed evidence that global budgets may help stabilize rural hospital finances in the short term.","PeriodicalId":519943,"journal":{"name":"Health affairs (Project Hope)","volume":"44 7","pages":"788-795"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144586002","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

Qualified Medicare Beneficiary Program: Enrollment Trends And Characteristics Of Low-Income Beneficiaries. 合格的医疗保险受益人计划：低收入受益人的登记趋势和特征。

Health affairs (Project Hope) Pub Date : 2025-07-01 DOI: 10.1377/hlthaff.2024.01189

J Wyatt Koma, Zhiyou Yang, Mary Price, David Cheng, Felippe Marcondes, Kobi Khong, John Hsu, Margarita Alegría, Joseph P Newhouse, Vicki Fung

{"title":"Qualified Medicare Beneficiary Program: Enrollment Trends And Characteristics Of Low-Income Beneficiaries.","authors":"J Wyatt Koma, Zhiyou Yang, Mary Price, David Cheng, Felippe Marcondes, Kobi Khong, John Hsu, Margarita Alegría, Joseph P Newhouse, Vicki Fung","doi":"10.1377/hlthaff.2024.01189","DOIUrl":"https://doi.org/10.1377/hlthaff.2024.01189","url":null,"abstract":"To address low take-up of Medicare Savings Programs for low-income Medicare beneficiaries, the Centers for Medicare and Medicaid Services issued regulations in 2023 aimed at streamlining the enrollment process. We analyzed 2016-22 data from the Medicare Current Beneficiary Survey to examine recent take-up of the largest and most generous Medicare Savings Program, the Qualified Medicare Beneficiary (QMB) program. We compared beneficiary characteristics and cost-related barriers to care among QMB enrollees and beneficiaries who were eligible but not enrolled. QMB take-up rose from 62 percent in 2016 to 66 percent in 2022. QMB-eligible beneficiaries who were Asian or Hispanic were more likely than eligible White beneficiaries to enroll in the program. Eligible beneficiaries younger than age sixty-five were more likely to enroll than those ages sixty-five and older, and beneficiaries in Medicaid expansion states were more likely to enroll than those in nonexpansion states. QMB enrollees were less likely than Medicare beneficiaries who were eligible but not enrolled to report delaying care because of cost or having problems paying for care. These findings suggest that additional policies and programs may be needed to increase QMB take-up and to improve health care access and affordability for millions of low-income Medicare beneficiaries.","PeriodicalId":519943,"journal":{"name":"Health affairs (Project Hope)","volume":"44 7","pages":"878-886"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144586006","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

Administrative Claims Data Show Increased Morbidity Risk For US Adults In Same-Sex Versus Different-Sex Relationships. 行政索赔数据显示，美国成年人在同性关系中与异性关系中发病风险增加。

Health affairs (Project Hope) Pub Date : 2025-07-01 DOI: 10.1377/hlthaff.2024.01014

Landon Hughes, Gilbert Gonzales, Sarah McKetta, Alex McDowell, Brittany M Charlton

{"title":"Administrative Claims Data Show Increased Morbidity Risk For US Adults In Same-Sex Versus Different-Sex Relationships.","authors":"Landon Hughes, Gilbert Gonzales, Sarah McKetta, Alex McDowell, Brittany M Charlton","doi":"10.1377/hlthaff.2024.01014","DOIUrl":"10.1377/hlthaff.2024.01014","url":null,"abstract":"Studies have found that sexual minority populations more often report worse overall health, lower health-related quality of life, and greater risk for disability than their heterosexual counterparts. This study used a novel approach to identify people in same-sex relationships, using insurance administrative claims data, and compared the prevalence of morbidity in that population with its prevalence in the population of those in different-sex relationships. This observational retrospective cohort study used the Merative MarketScan Research Database, which pooled data from private insurers from the period 2016-22. We identified 340,728 people in same-sex relationships, making this one of the largest studies on sexual minority populations to date, and found that they had higher Elixhauser morbidity scores than their counterparts in different-sex relationships. Sexual minorities experienced a greater prevalence of mental health morbidities (that is, depression, psychoses, and alcohol and drug use disorders) than their peers in different-sex relationships, with adjusted prevalence risk ratios (PRRs) ranging from 1.23 to 2.07. Sexual minority men also were more likely to have HIV (PRR: 93.62) and lymphoma (PRR: 1.34) than their male counterparts in different-sex relationships. These findings support the survey literature that has documented that sexual minority populations experience greater mental health and HIV-related morbidity, and they offer a novel approach to identifying members of sexual minorities.","PeriodicalId":519943,"journal":{"name":"Health affairs (Project Hope)","volume":"44 7","pages":"846-854"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144585983","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

Obstetric Care Access Declined In Rural And Urban Hospitals Across US States, 2010-22. 2010-22年，美国各州农村和城市医院的产科护理机会下降。

Health affairs (Project Hope) Pub Date : 2025-07-01 DOI: 10.1377/hlthaff.2024.01552

Katy Backes Kozhimannil, Julia D Interrante, Caitlin Carroll, Emily C Sheffield, Alyssa H Fritz, Alecia J McGregor, Sara C Handley

引用次数: 0

Medicaid Managed Care: Substantial Shifts In Market Landscape And Acquisitions, 2006-20. 医疗补助管理医疗：市场格局和收购的重大转变，2006- 2020。

Health affairs (Project Hope) Pub Date : 2025-07-01 DOI: 10.1377/hlthaff.2024.01111

Bohan Li, Timothy J Layton

{"title":"Medicaid Managed Care: Substantial Shifts In Market Landscape And Acquisitions, 2006-20.","authors":"Bohan Li, Timothy J Layton","doi":"10.1377/hlthaff.2024.01111","DOIUrl":"https://doi.org/10.1377/hlthaff.2024.01111","url":null,"abstract":"There has been a significant shift in the composition of the Medicaid managed care market over the course of the past two decades. The market is consolidated among five national firms, and those firms have nearly half of all beneficiaries enrolled in managed care plans. State markets are even more consolidated, typically giving Medicaid beneficiaries only a few plan options. This article describes the Medicaid managed care market during the period 2006-20, using enrollment data and a novel data set on acquisitions. Our study found a marked decrease in the number of parent payers (unique firms that own at least one Medicaid managed care plan), despite an increase in total enrollment, as well as a high volume of acquisitions. In fact, approximately one in four plans were involved in at least one acquisition during the study period. National payers are playing an increasingly dominant role in Medicaid managed care, with both the number and the market share of local payers decreasing during the study period. Future research is needed to understand the consequences of these shifts for the level of competition in this market, state finances, and beneficiary health.","PeriodicalId":519943,"journal":{"name":"Health affairs (Project Hope)","volume":"44 7","pages":"862-868"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144585990","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

National Health Expenditure Projections, 2024-33: Despite Insurance Coverage Declines, Health To Grow As Share Of GDP. 国家卫生支出预测，2024-33：尽管保险覆盖率下降，卫生作为GDP的份额将增长。

Health affairs (Project Hope) Pub Date : 2025-07-01 Epub Date: 2025-06-25 DOI: 10.1377/hlthaff.2025.00545

Sean P Keehan, Andrew J Madison, John A Poisal, Gigi A Cuckler, Sheila D Smith, Andrea M Sisko, Jacqueline A Fiore, Kathryn E Rennie

引用次数: 0

Maternal Contact With Child Protective Services Associated With Less Postpartum Care In Wisconsin, 2010-19. 2010-19年威斯康星州母亲接触儿童保护服务与产后护理减少相关

Health affairs (Project Hope) Pub Date : 2025-07-01 DOI: 10.1377/hlthaff.2024.01250

Nicole Kovski, Lawrence Berger, Maria Cancian

引用次数: 0

Drug Coverage Policies And Clinical Guidelines Alignment: Most Coverage Decisions Include Additional Restrictions. 药物覆盖政策和临床指南的一致性：大多数覆盖决定包括额外的限制。

Health affairs (Project Hope) Pub Date : 2025-07-01 DOI: 10.1377/hlthaff.2024.01484

Julia A Rucker, Molly T Beinfeld, Katherine A Clifford, Jonathan D Campbell, James Motyka, James D Chambers

{"title":"Drug Coverage Policies And Clinical Guidelines Alignment: Most Coverage Decisions Include Additional Restrictions.","authors":"Julia A Rucker, Molly T Beinfeld, Katherine A Clifford, Jonathan D Campbell, James Motyka, James D Chambers","doi":"10.1377/hlthaff.2024.01484","DOIUrl":"https://doi.org/10.1377/hlthaff.2024.01484","url":null,"abstract":"Utilization management criteria influence patients' access to specialty drugs, yet the processes used by health plans to establish these criteria are not well understood. This study examined the alignment between clinical practice guidelines and plans' utilization management criteria. Using the Tufts Medicine Specialty Drug Evidence and Coverage Database (December 2023), we reviewed US-based guidelines for 389 drug-indication pairs, excluding oncology and biosimilar treatments. We categorized guidelines as recommending or not recommending utilization management, based on alignment with each drug's Food and Drug Administration label-specifically, line of therapy and clinical requirements (for example, disease severity). We analyzed 5,699 coverage policies from eighteen large commercial health plans. When guidelines recommended utilization management, 67 percent of plans' coverage decisions aligned with the recommendation; when guidelines did not recommend utilization management, only 37 percent of decisions were consistent. Most plans imposed utilization management criteria (61 percent of all decisions), and plans were more likely to be consistent with guideline recommendations when utilization management was recommended, indicating a weak alignment with guideline recommendations.","PeriodicalId":519943,"journal":{"name":"Health affairs (Project Hope)","volume":"44 7","pages":"839-845"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144585985","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

Medigap Regulations Provide Protections For Beneficiaries, Especially After Health Shocks, But May Raise Premiums. 医疗保险规定为受益人提供保护，特别是在健康危机之后，但可能会提高保费。

Health affairs (Project Hope) Pub Date : 2025-07-01 DOI: 10.1377/hlthaff.2024.01361

Jingwei Sun, Michael E Chernew, J Michael McWilliams, Boris Vabson, Timothy J Layton

引用次数: 0