JAMA Health Forum最新文献

{"title":"Insurance Churn and the COVID-19 Pandemic.","authors":"Sarah P Shubeck, Emily Crawford, Matthew J Notowidigdo","doi":"10.1001/jamahealthforum.2025.1467","DOIUrl":"10.1001/jamahealthforum.2025.1467","url":null,"abstract":"<p><strong>Importance: </strong>Many individuals in the US face a high risk of losing their health insurance coverage and experiencing insurance churn, especially those enrolled in Medicaid. Prior research has found that the risk of losing insurance coverage remains high in the US even after the Patient Protection and Affordable Care Act significantly reduced the number of uninsured individuals.</p><p><strong>Objective: </strong>To estimate whether the Families First Coronavirus Response Act (FFCRA) decreased insurance churn.</p><p><strong>Design, setting, and participants: </strong>This study used 2 quasi-experimental approaches: an interrupted time series approach and a difference-in-difference approach. Both approaches use individual-level data from the Medical Expenditure Panel Survey from January 2015 to December 2022. In the difference-in-difference analysis comparing individuals with Medicaid to individuals with private health insurance coverage, the probability that insured individuals aged 2 to 64 years lose insurance over the next 12 months before and after the FFCRA was estimated. Data were analyzed from January to November 2024.</p><p><strong>Main outcomes and measures: </strong>Primary outcome was the share of insured individuals who lost insurance coverage over the next 12 months. This measure was defined for all insured individuals and defined separately for individuals with Medicaid and for individuals with private insurance coverage.</p><p><strong>Results: </strong>The sample included 96 473 individuals. Of these, 46 779 (49.7%) were male, and the mean (SD) age was 31.9 (18.1) years. In the interrupted time series analysis, the FFCRA was associated with a reduction in insurance churn by 2.06 percentage points (β = -0.021; 95% CI, -0.024 to -0.018; P < .001). In the difference-in-difference analysis, the FFRCA reduced Medicaid churn by 5.51 percentage points (β = -0.055; 95% CI, -0.060 to -0.050; P < .001). Combining these estimates, 65.0% (95% CI, 54.8-75.3) of the reduction in insurance churn came from the reduction in Medicaid churn.</p><p><strong>Conclusions and relevance: </strong>In this study, the FFCRA was associated with a significantly decreased risk of losing health insurance. Without the FFCRA, an estimated 2.94 million individuals with Medicaid would have lost insurance coverage each year during the COVID-19 public health emergency.</p>","PeriodicalId":53180,"journal":{"name":"JAMA Health Forum","volume":"6 6","pages":"e251467"},"PeriodicalIF":9.5,"publicationDate":"2025-06-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12205398/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144509400","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Threats to Vaccinations in the US.","authors":"Lawrence O Gostin, Dorit Reiss","doi":"10.1001/jamahealthforum.2025.3290","DOIUrl":"https://doi.org/10.1001/jamahealthforum.2025.3290","url":null,"abstract":"","PeriodicalId":53180,"journal":{"name":"JAMA Health Forum","volume":"6 6","pages":"e253290"},"PeriodicalIF":9.5,"publicationDate":"2025-06-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144499122","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}

{"title":"Support for Care Economy Policies by Political Affiliation and Caregiving Responsibilities.","authors":"Katherine E M Miller, Jennifer L Wolff, Karen Shen, Sandro Galea, Catherine K Ettman","doi":"10.1001/jamahealthforum.2025.1204","DOIUrl":"10.1001/jamahealthforum.2025.1204","url":null,"abstract":"<p><strong>Importance: </strong>Identifying effective and financially viable strategies to meet the care needs of perons with impaired function is a policy challenge for high-income countries with aging populations. The 2022 National Strategy to Support Family Caregivers identified a range of actions to support caregivers, while family-oriented policies to promote the affordability of care were promoted by both candidates in the 2024 presidential election.</p><p><strong>Objective: </strong>To examine public perceptions of federal policies to support older adults, adults living with disabilities, and their family caregivers by political affiliation and caregiving status.</p><p><strong>Design, setting, and participants: </strong>This cohort study included adults in the CLIMB study, a nationally representative, longitudinal panel. Data were collected in March and April 2024. Data analyses occurred from September 2024 to February 2025.</p><p><strong>Exposures: </strong>Self-reported political party affiliation and caregiving responsibility.</p><p><strong>Main outcomes and measures: </strong>Endorsement of 6 policies. Responses based on a 5-point Likert scale were dichotomized to contrast \"strongly\" or \"somewhat support\" with \"strongly oppose,\" \"somewhat oppose,\" and \"neither support nor oppose.\" The probability of support and differences across political affiliations was presented.</p><p><strong>Results: </strong>Of 2059 respondents (1035 female individuals [50.9%]; mean [SD] age, 49.0 [18.2] years), 394 (20%) reported having caregiving responsibilities, with no significant difference across political affiliation. Endorsement was highest for policies to make care in facilities (1657 [79.0%]) and homes (1600 [75.4%]) more affordable, expand eligibility for financial access to care (1618 [77.3%]), and increase the capacity of the paid caregiving workforce (1649 [78.3%]) and was lower for expansion of paid family leave (1342 [65.4%]) and payment of family caregivers (1223 [61.2%]). Endorsement by political affiliation was most similar for policies to make care at home more affordable (13.7-percentage point difference; 95% CI, -20.4 to -7.1) and least similar for paid family leave (33.4-percentage point difference; 95% CI, -39.0 to -27.7). While respondents with caregiving responsibilities were more likely to support paying family caregivers, political affiliation was associated with the endorsement of policies to support the care economy that was stronger in magnitude than sociodemographic characteristics (eg, sex) or caregiving experiences.</p><p><strong>Conclusions and relevance: </strong>The results of this cohort study suggest that, despite some differences by political affiliation, there is high support of policies to support the adult care economy, suggesting a policy window to advance legislation and executive action to address the care needs of aging populations and populations with disabilities.</p>","PeriodicalId":53180,"journal":{"name":"JAMA Health Forum","volume":"6 6","pages":"e251204"},"PeriodicalIF":9.5,"publicationDate":"2025-06-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12144621/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144235952","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Errors in Results and Table 1.","authors":"","doi":"10.1001/jamahealthforum.2025.2603","DOIUrl":"10.1001/jamahealthforum.2025.2603","url":null,"abstract":"","PeriodicalId":53180,"journal":{"name":"JAMA Health Forum","volume":"6 6","pages":"e252603"},"PeriodicalIF":9.5,"publicationDate":"2025-06-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12166478/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144287116","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"AI Hype Cycles and Reality in Health Care.","authors":"Sherri Rose","doi":"10.1001/jamahealthforum.2025.1904","DOIUrl":"https://doi.org/10.1001/jamahealthforum.2025.1904","url":null,"abstract":"","PeriodicalId":53180,"journal":{"name":"JAMA Health Forum","volume":"6 6","pages":"e251904"},"PeriodicalIF":9.5,"publicationDate":"2025-06-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144287109","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}

{"title":"Early School Medicaid Expansions and Health Services for Children With Parental Opioid Use Disorder.","authors":"Angélica Meinhofer, Lindsey Rose Bullinger, Caroline Hope Kelly, Maria Fitzpatrick","doi":"10.1001/jamahealthforum.2025.1288","DOIUrl":"10.1001/jamahealthforum.2025.1288","url":null,"abstract":"<p><strong>Importance: </strong>Children experiencing parental opioid use disorder are a growing population at heightened risk of physical and mental health issues over the life course. Yet these children are less likely to receive comprehensive, ongoing health care and their parents are more likely to report barriers to access health care for their children. School-based health services have potential to overcome some of these health care access barriers, including parental burden, transportation, time, costs, and health care discontinuity. In 2014, Medicaid revoked its longstanding free care rule, expanding the scope of school-based health services eligible for Medicaid reimbursement. Subsequently, some states began to expand their school Medicaid programs to benefit from the new federal rule.</p><p><strong>Objective: </strong>To estimate the early effects of state school Medicaid expansions on the receipt of Medicaid-funded school-based health services among children who have experienced parental opioid use disorder.</p><p><strong>Design, setting, and participants: </strong>This cohort study using nationwide Medicaid claims data included Medicaid-enrolled children aged 5 to 18 years who experienced parental opioid use disorder at any point before age 19 years. A difference-in-differences design that exploits the staggered implementation of school Medicaid expansions between 2014 and 2019 was used. Data were analyzed between January 2023 and January 2025.</p><p><strong>Exposures: </strong>Children living in states implementing (treatment group) and not implementing (comparison group) school Medicaid expansions, before and after state-specific expansion dates.</p><p><strong>Main outcomes and measures: </strong>Binary measures indicating receipt of school-based health services, primary care, prevention, rehabilitative, dental, and mental health services, emergency department visits, and inpatient hospital stays.</p><p><strong>Results: </strong>The sample comprised 6 628 404 person-years from 1 700 304 children. The mean (SD) age was 10.5 (3.9) years and 3 371 918 (51%) were male. School Medicaid expansions increased the receipt of Medicaid-funded school-based health services by 8.9 percentage points (pp; P = .01). Growth was primarily driven by school claims for nursing services (difference, 7.4 pp; P = .02) and for Early and Periodic Screening, Diagnostic and Treatment services (difference, 8.6 pp; P = .04). Reductions in emergency department visits among children aged 5 to 11 years were also documented (difference, -1.8 pp; P = .02).</p><p><strong>Conclusions and relevance: </strong>This cohort study found that, given the complex health and health care needs of children growing up amid the opioid crisis, integrating health care into schools may offer a promising policy solution.</p>","PeriodicalId":53180,"journal":{"name":"JAMA Health Forum","volume":"6 6","pages":"e251288"},"PeriodicalIF":9.5,"publicationDate":"2025-06-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12166484/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144287114","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Artificial Intelligence and Health Care Waste-Promise or Peril?","authors":"William H Shrank, Suhas Gondi, David J Brailer","doi":"10.1001/jamahealthforum.2025.1637","DOIUrl":"https://doi.org/10.1001/jamahealthforum.2025.1637","url":null,"abstract":"","PeriodicalId":53180,"journal":{"name":"JAMA Health Forum","volume":"6 6","pages":"e251637"},"PeriodicalIF":9.5,"publicationDate":"2025-06-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144287110","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}

{"title":"Bridging the Gap Between Developers and Implementers in Health AI.","authors":"Michael J Pencina, Christina Silcox, Nicoleta Economou-Zavlanos, Mark McClellan","doi":"10.1001/jamahealthforum.2025.1692","DOIUrl":"10.1001/jamahealthforum.2025.1692","url":null,"abstract":"","PeriodicalId":53180,"journal":{"name":"JAMA Health Forum","volume":"6 6","pages":"e251692"},"PeriodicalIF":9.5,"publicationDate":"2025-06-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144334392","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}

{"title":"Private Equity Acquisition of Gastroenterology Practices and Colonoscopy Price and Quality.","authors":"Daniel R Arnold, Brent D Fulton, Ola A Abdelhadi, Arjun Teotia, Richard M Scheffler","doi":"10.1001/jamahealthforum.2025.1476","DOIUrl":"10.1001/jamahealthforum.2025.1476","url":null,"abstract":"<p><strong>Importance: </strong>Private equity (PE) has rapidly been acquiring physician practices in the US, but a full understanding of its association with health care prices, spending, utilization, and quality is still unknown.</p><p><strong>Objective: </strong>To examine changes in colonoscopy prices, spending, utilization, and quality associated with PE acquisition of gastroenterology practices.</p><p><strong>Design, setting, and participants: </strong>This difference-in-differences event study and economic evaluation analyzed data from US gastroenterology practices that were acquired by PE firms between 2015 and 2021. Commercial claims covering more than 50 million enrollees were used to calculate price, spending, utilization, and quality measures from 2012 to 2021. The data were analyzed between April 2024 and September 2024.</p><p><strong>Exposures: </strong>PE acquisition of gastroenterology practices.</p><p><strong>Main outcomes and measures: </strong>The main outcomes were price, spending per physician, number of colonoscopies per physician, number of unique patients per physician, and quality (polypectomy detection, incomplete colonoscopies, and 4 adverse event measures: cardiovascular, serious gastroenterology, nonserious gastroenterology, and any adverse event).</p><p><strong>Results: </strong>Data from more than 1.1 million patients (mean [SD] age, 47.1 [8.4] years; 47.8% male patients) undergoing 1.3 million colonoscopies were analyzed. The sample included 718 851 treated colonoscopies conducted by 1494 physicians among 590 900 patients across 1240 PE-acquired practice sites and 637 990 control colonoscopies conducted by 2550 physicians among 527 380 patients across 2657 independent practice sites. Colonoscopy prices at PE-acquired gastroenterology practices increased by 4.5% (95% CI, 2.5%-6.6%; P < .001) relative to independent gastroenterology practices. The estimated price effect increased to 6.7% (95% CI, 4.2%-9.3%; P < .001) when considering only colonoscopies performed by gastroenterologists in PE-acquired practices with market shares above the 75th percentile (24.4%) in 2021 as treated. Colonoscopy spending per physician increased by 16.0% (95% CI, 8.4%-24.0%; P < .001), while the number of colonoscopies and the number of unique patients per physician increased by 12.1% (95% CI, 5.3%-19.4%; P < .001) and 11.3% (95% CI, 4.4%-18.5%; P < .001), respectively; however, these spending and utilization measures were already increasing prior to PE acquisition. No statistically significant associations were detected for the 6 quality measures analyzed.</p><p><strong>Conclusions and relevance: </strong>In this economic evaluation, PE acquisition of gastroenterology practices led to higher prices and spending but had no discernible effect on quality. Policymakers may be well advised to monitor PE investment in physician practices given the increase in prices and spending without a commensurate increase in quality.</p>","PeriodicalId":53180,"journal":{"name":"JAMA Health Forum","volume":"6 6","pages":"e251476"},"PeriodicalIF":9.5,"publicationDate":"2025-06-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12181784/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144334395","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Children's Continuous Medicaid Eligibility During COVID-19 and Health Care Access, Use, and Barriers to Care.","authors":"Erica L Eliason, Daniel B Nelson, Jordan Wood, Doug Strane, Aditi Vasan","doi":"10.1001/jamahealthforum.2025.1376","DOIUrl":"10.1001/jamahealthforum.2025.1376","url":null,"abstract":"<p><strong>Importance: </strong>National continuous Medicaid eligibility under the Families First Coronavirus Response Act (FFCRA) may have differentially affected children's health care depending on whether states had preexisting 12-month continuous Medicaid eligibility for children.</p><p><strong>Objective: </strong>To estimate the association of states newly implementing continuous Medicaid eligibility under the FFCRA with children's health care access, health care use, and barriers to care.</p><p><strong>Design, setting, and participants: </strong>This survey study used a difference-in-differences research design comparing states before (2017-2019) and during (2020-2022) the FFCRA overall, by caregiver-reported race and ethnicity, and among publicly insured children. Analyses used data from the National Survey of Children's Health (NSCH), an annual household survey on the health and well-being of children 0 to 17 years old in the US. Data were analyzed from September 2024 to March 2025.</p><p><strong>Exposures: </strong>Whether states had pre-FFCRA 12-month continuous Medicaid eligibility for children.</p><p><strong>Main outcomes and measures: </strong>Insurance coverage, gaps in coverage, unmet health care needs, any health care visits, preventive visits, emergency department visits, hospitalizations, any time spent weekly arranging children's health care, and problems paying medical bills.</p><p><strong>Results: </strong>The sample included 215 884 children, with children in states with pre-FFCRA continuous eligibility being similar to children in states newly implementing continuous eligibility with respect to age (8.6 years old in both sets of states), gender (49.6% female compared to 48.5%), and nativity (66.7% third generation or longer with all parents born in the US vs 69.6%), with lower proportions who were non-Hispanic Black (11.9% compared to 13.8%) or non-Hispanic White (50.5% compared to 52.9%), and higher proportions who were Hispanic (25.5% compared to 23.9%). In adjusted difference-in-difference models, newly implementing continuous eligibility under the FFCRA was associated with a 0.7-percentage point (95% CI, -1.2 to -0.1 percentage point) reduction in children's unmet health care needs. There was no evidence of additional FFCRA-associated changes in outcomes overall. In subgroup analyses, there were reductions in coverage gaps, unmet health care needs, and time spent arranging care among Hispanic children and publicly insured children.</p><p><strong>Conclusions and relevance: </strong>In this survey study, newly implementing continuous eligibility for children under the FFCRA was associated with reductions in unmet health care needs and no additional changes in health care outcomes overall, with additional benefits for Hispanic children and publicly insured children. This could reflect expected changes under mandatory, national 12-month continuous eligibility for children implemented in January 2024.</p>","PeriodicalId":53180,"journal":{"name":"JAMA Health Forum","volume":"6 6","pages":"e251376"},"PeriodicalIF":9.5,"publicationDate":"2025-06-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12166482/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144287112","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}