JAMA Health Forum最新文献

{"title":"Make American Health Care Affordable Again.","authors":"Larry Levitt","doi":"10.1001/jamahealthforum.2025.2864","DOIUrl":"https://doi.org/10.1001/jamahealthforum.2025.2864","url":null,"abstract":"","PeriodicalId":53180,"journal":{"name":"JAMA Health Forum","volume":"6 6","pages":"e252864"},"PeriodicalIF":9.5,"publicationDate":"2025-06-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144227599","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":"How to Unleash the States to Fix Medicaid Spending.","authors":"Stuart M Butler","doi":"10.1001/jamahealthforum.2025.3011","DOIUrl":"https://doi.org/10.1001/jamahealthforum.2025.3011","url":null,"abstract":"","PeriodicalId":53180,"journal":{"name":"JAMA Health Forum","volume":"6 6","pages":"e253011"},"PeriodicalIF":9.5,"publicationDate":"2025-06-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144276628","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":"On Making US Health Care Great and Affordable.","authors":"Sandro Galea","doi":"10.1001/jamahealthforum.2025.1156","DOIUrl":"https://doi.org/10.1001/jamahealthforum.2025.1156","url":null,"abstract":"","PeriodicalId":53180,"journal":{"name":"JAMA Health Forum","volume":"6 6","pages":"e251156"},"PeriodicalIF":9.5,"publicationDate":"2025-06-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144287118","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":"Medicare Advantage Part B Premium Givebacks and Enrollment.","authors":"Mark K Meiselbach, Andrew Anderson, Laura J Samuel, Kali S Thomas","doi":"10.1001/jamahealthforum.2025.1215","DOIUrl":"10.1001/jamahealthforum.2025.1215","url":null,"abstract":"<p><strong>Importance: </strong>In Medicare Advantage (MA), the private component of the Medicare program that enrolls more than half of beneficiaries, an increasing share of plans are offering Part B premium givebacks to pay for part or all of the at least $174.70 Part B monthly premium. Millions of dollars of Medicare expenditures are attributable to this benefit, yet little is known about its association with member enrollment or other plan characteristics.</p><p><strong>Objective: </strong>To document trends and expenditures in MA Part B premium givebacks and examine their association with plan enrollment.</p><p><strong>Design, setting, and participants: </strong>This longitudinal difference-in-differences analysis compared MA plan enrollment before and after the offer of a Part B giveback among plans that offered the giveback vs plans that did not. January MA plan enrollment and characteristics data from 2018 through 2024 were included. Data were analyzed from May 2024 to February 2025.</p><p><strong>Exposure: </strong>Adoption of a Part B giveback.</p><p><strong>Main outcomes and measures: </strong>Total plan enrollment.</p><p><strong>Results: </strong>A sample of 18 627 plan-years representing more than 130 million enrollee-years was included in the analysis. The percentage of MA plans offering a Part B premium giveback increased from 4.3% (93 of 2187) in 2018 to 18.7% (737 of 3940) in 2024. Plans offering Part B premium givebacks had lower median enrollment, belonged to newer, higher rated contracts, had higher cost-sharing, and had lower enrollee risk scores compared with plans that did not offer givebacks. In 2024, the 3.4 million enrollees in plans with Part B givebacks received a mean (SD) of $77 ($42), amounting to as much as approximately $261 million in total monthly expenditures across the MA program. Adoption of a Part B giveback was associated with a 33.3% (95% CI, 9.3-56.9) increase in enrollment, robust to all model specifications. There was a dose-response association between the size of the giveback and enrollment.</p><p><strong>Conclusions and relevance: </strong>In this study, the adoption of Part B premium givebacks among MA plans was associated with a substantial increase in plan enrollment. Further research will be needed to understand the total value to enrollees of Part B givebacks, which confers hundreds of millions of dollars monthly to Medicare beneficiaries.</p>","PeriodicalId":53180,"journal":{"name":"JAMA Health Forum","volume":"6 6","pages":"e251215"},"PeriodicalIF":9.5,"publicationDate":"2025-06-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12144618/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144235950","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":"Primary Care Physician Characteristics and Low-Value Care Provision in Japan.","authors":"Atsushi Miyawaki, John N Mafi, Kazuhiro Abe, Alexandra Klomhaus, Rei Goto, Kei Kitajima, Daichi Sato, Yusuke Tsugawa","doi":"10.1001/jamahealthforum.2025.1430","DOIUrl":"10.1001/jamahealthforum.2025.1430","url":null,"abstract":"<p><strong>Importance: </strong>Evidence is limited regarding the physician characteristics associated with the provision of low-value services in primary care, especially outside of the US.</p><p><strong>Objective: </strong>To measure physician-level use of 10 low-value care services that provide no net clinical benefit and to investigate the characteristics of primary care physicians who frequently provide low-value care in Japan.</p><p><strong>Design, setting, and participants: </strong>This cross-sectional analysis used a nationwide electronic health record database linked with claims data in Japan to assess visits by adult patients (age ≥18 years) to a solo-practice primary care physician from October 1, 2022, through September 30, 2023. Data analysis was performed from June 2024 to February 2025.</p><p><strong>Main outcomes and measures: </strong>Multivariable-adjusted composite rate of low-value care services delivered per 100 patients per year, aggregated across 10 low-value measures, after accounting for case mix and other characteristics.</p><p><strong>Results: </strong>Among 2 542 630 patients (mean [SD] age, 51.6 [19.8] years; 58.2% female) treated by 1019 primary care physicians (mean [SD] age 56.4 [10.2] years; 90.4% male), 436 317 low-value care services were identified (17.2 cases per 100 patients overall). Nearly half of these low-value care services were provided by 10% of physicians. After accounting for patient case mix, older physicians (age ≥60 years) delivered 2.1 per 100 patients (95% CI, 1.0-3.3) more low-value care services than those younger than 40 years; not board-certified physicians delivered 0.8 per 100 patients (95% CI, 0.2-1.5) more than general internal medicine board-certified physicians; physicians with higher patient volumes delivered 2.3 per 100 patients (95% CI, 1.5-3.2) more than those with low patient volumes; and physicians practicing in Western Japan delivered 1.0 per 100 patients (95% CI, 0.5-1.5) more than those in Eastern Japan.</p><p><strong>Conclusions and relevance: </strong>The findings of this cross-sectional analysis suggest that low-value care services were common and concentrated among a small number of primary care physicians in Japan, with older physicians and not board-certified physicians being more likely to provide low-value care. Policy interventions targeting at a small number of certain types of physicians providing large quantities of low-value care may be more effective and efficient than those targeting all physicians uniformly.</p>","PeriodicalId":53180,"journal":{"name":"JAMA Health Forum","volume":"6 6","pages":"e251430"},"PeriodicalIF":9.5,"publicationDate":"2025-06-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12144622/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144235951","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":"JAMA Health Forum.","authors":"","doi":"10.1001/jamahealthforum.2024.4964","DOIUrl":"https://doi.org/10.1001/jamahealthforum.2024.4964","url":null,"abstract":"","PeriodicalId":53180,"journal":{"name":"JAMA Health Forum","volume":"6 6","pages":"e244964"},"PeriodicalIF":9.5,"publicationDate":"2025-06-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144235949","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":"Medigap Protection and Plan Switching Among Medicare Advantage Enrollees With Cancer.","authors":"Youngmin Kwon, Shelley A Jazowski, Xin Hu, Emma M Achola, John A Graves, Laura M Keohane, Stacie B Dusetzina","doi":"10.1001/jamahealthforum.2025.2018","DOIUrl":"10.1001/jamahealthforum.2025.2018","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Importance: &lt;/strong&gt;An increasing number of Medicare beneficiaries with cancer report Medicare Advantage (MA) coverage, but certain features of MA (eg, utilization management) may impede access to cancer care. MA beneficiaries may desire to switch to traditional Medicare (TM), which imposes little to no utilization restrictions, but switching may be challenging because access to Medigap-providing financial protections against high cost sharing in TM-is limited by medical underwriting of beneficiaries applying after initial Medicare enrollment in most states.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To examine associations of Medigap guaranteed issue protections that prohibit medical underwriting with MA disenrollment among beneficiaries newly diagnosed with cancer.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design, setting, and participants: &lt;/strong&gt;This retrospective cohort study examined Medicare beneficiaries 69 years and older who were newly diagnosed with cancer from 2014 to 2019 in the Surveillance, Epidemiology, and End Results Program-linked Medicare database. Beneficiaries continuously enrolled in Medicare Parts A and B for 4 years before to 1 year after diagnosis were included. Data were analyzed from October 2024 to April 2025.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Exposure: &lt;/strong&gt;A new cancer diagnosis.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Main outcomes and measures: &lt;/strong&gt;The outcome was switching to TM. Among those who were initially enrolled in MA, a difference-in-differences design was implemented to compare changes in the probability of MA disenrollment between beneficiaries diagnosed in 3 guaranteed issue states (New York, Connecticut, and Massachusetts) vs other 13 states contributing to the Surveillance, Epidemiology, and End Results Program registry, before and after diagnosis.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The study included 180 057 MA beneficiaries 69 years and older who were newly diagnosed with cancer (44.5% diagnosed at age 69-75 years; 51.5% male; 8.0% Hispanic; 7.4% non-Hispanic Black; 78.5% non-Hispanic White; and 6.1% another or unknown race and ethnicity). The rate of switching in guaranteed issue states increased from 2.1% to 4.7% following diagnosis but remained unchanged in other states (1.8% to 1.7%), corresponding to a difference-in-differences of 2.5 percentage points (95% CI, 1.9-3.2 percentage points; P &lt; .001), or a 120% relative change. This differential increase was concentrated among beneficiaries who were younger, non-Hispanic White, diagnosed with distant-stage or rarer cancers, or enrolled in plans with more generous coverage (eg, PPO plans) or lower plan star ratings.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions and relevance: &lt;/strong&gt;In this cohort study, state Medigap guaranteed issue protections were associated with higher rates of switching to TM among MA beneficiaries newly diagnosed with cancer. These findings underscore the protective association of state Medigap regulations in facilitating a switch to TM (especially among beneficiaries who likely desired more flexibility","PeriodicalId":53180,"journal":{"name":"JAMA Health Forum","volume":"6 6","pages":"e252018"},"PeriodicalIF":9.5,"publicationDate":"2025-06-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12145528/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144250782","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":"Puerto Rico's Specialist Crisis-A Wake-Up Call for Health Equity and Action.","authors":"Rafael Santini-Dominguez, Jorge Martinez-Trabal, Gabriel Gonzalez-Diaz","doi":"10.1001/jamahealthforum.2025.1949","DOIUrl":"https://doi.org/10.1001/jamahealthforum.2025.1949","url":null,"abstract":"","PeriodicalId":53180,"journal":{"name":"JAMA Health Forum","volume":"6 6","pages":"e251949"},"PeriodicalIF":9.5,"publicationDate":"2025-06-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144509402","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":"Payment Source Shift for Surgical Care Among Veterans Enrolled in Medicare Advantage Plans.","authors":"Winta T Mehtsun, Yanlei Ma, Ellen Latsko, Jie Zheng, Jessica Phelan, E John Orav, Thomas C Tsai, Austin B Frakt, Steven D Pizer, Melissa M Garrido, Jose F Figueroa","doi":"10.1001/jamahealthforum.2025.0827","DOIUrl":"10.1001/jamahealthforum.2025.0827","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Importance: &lt;/strong&gt;There is growing concern that Medicare Advantage (MA) plans are shifting the costs of care to the Veterans Health Administration (VHA) for veterans dually enrolled in both systems, particularly in high-veteran MA plans that disproportionately enroll veterans. However, empirical evidence evaluating the sources of payment for veterans' surgical care is lacking.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To evaluate differences in payment sources for surgical care between high-veteran MA plans and other MA plans.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design, setting, and participants: &lt;/strong&gt;This cross-sectional study used 2021 US national MA and VHA data from veterans dually enrolled in MA and VHA care for inpatient surgical episodes at VHA facilities (VHA-paid direct care), non-VHA community hospitals paid by VHA (VHA-paid community care), and community hospitals paid by MA (MA-paid community care) among veterans dually enrolled in MA and VHA care. Data were analyzed from April 1, 2024, to November 30, 2024.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Exposure: &lt;/strong&gt;Enrollment in high-veteran MA plans.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Main outcomes and measures: &lt;/strong&gt;Likelihood of utilizing VHA-direct care, VHA-paid community care, and MA-paid community care. High-veteran MA plans were defined as plans with 20% or more veteran enrollees; others were categorized as other MA plans. Multinomial logistic regression was used to evaluate the association of veteran enrollment in high-veteran MA plans with the likelihood of surgical care paid by each payment source, adjusting for veteran and surgery characteristics, and state fixed effects. Stratified analyses were conducted based on surgical complexity and source of admission.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;A total of 54 754 inpatient surgical episodes were analyzed, including 53 036 male (96.9%); 3133 Hispanic (5.7%), 47344 non-Hispanic Black (13.4%), 2933 non-Hispanic White (78.4%), and 1354 other or unknown race and ethnicity (2.5%); 601 (1.1%) were younger than 55 years, 3301(6.0%) aged 55 to 64 years, 22 381 (40.9%) aged 65 to 74 years, and 28471 (52%) aged 75 or older. Among these episodes, 52.1% were through MA-paid community care, 18.8% through VHA-direct care, and 29.1% through VHA-paid community care. Veteran enrollees in high-veteran MA plans were significantly less likely to have MA-paid surgeries (adjusted difference, -25.7 percentage points; 95% CI, -26.7 to 24.6 percentage points) and more likely to have surgeries paid through VHA-direct care (adjusted difference, 11.0 percentage points; 95% CI, 10.0-12.0 percentage points) and VHA-paid community care (adjusted difference, 14.7 percentage points; 95% CI, 13.6-15.8 percentage points) compared with veterans in other MA plans. As surgical complexity increased, differences in the use of VHA-paid direct care narrowed between high-veteran MA and other MA plans. Payment source differences were also less pronounced for nonelective surgeries admitted through emergency departments.&lt;/p&gt;&lt;p","PeriodicalId":53180,"journal":{"name":"JAMA Health Forum","volume":"6 6","pages":"e250827"},"PeriodicalIF":9.5,"publicationDate":"2025-06-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12150190/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144259404","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":"Hospitalization and Credit Scores Among Medicaid Beneficiaries in Louisiana.","authors":"Brigham Walker, Gael Compta, Alexander Siebert, Andrew Anderson, Kevin Callison, Chima D Ndumele, Jacob Wallace","doi":"10.1001/jamahealthforum.2025.1570","DOIUrl":"10.1001/jamahealthforum.2025.1570","url":null,"abstract":"","PeriodicalId":53180,"journal":{"name":"JAMA Health Forum","volume":"6 6","pages":"e251570"},"PeriodicalIF":9.5,"publicationDate":"2025-06-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12144616/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144235948","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}