JAMA Health Forum最新文献

{"title":"Health Care Workforce Immigration to the UK After Its European Union Membership Referendum.","authors":"Tarun Ramesh, Alison Leary, Fang Zhang, Hao Yu","doi":"10.1001/jamahealthforum.2026.2868","DOIUrl":"10.1001/jamahealthforum.2026.2868","url":null,"abstract":"<p><strong>Importance: </strong>The UK relies heavily on internationally trained physicians and nurses. The 2016 UK European Union (EU) membership referendum (Brexit referendum) introduced uncertainty regarding future migration policy, with unclear implications for health care workforce supply and National Health Service (NHS) staffing.</p><p><strong>Objective: </strong>To evaluate changes in immigration of internationally trained physicians and nurses to the UK after the Brexit referendum and to assess associated changes in NHS vacancies.</p><p><strong>Design, setting, and participants: </strong>A controlled interrupted time-series study was conducted to assess changes in physician and nurse immigration to the UK after the 2016 Brexit referendum, using annual data for 2008 through 2019 from the Organization for Economic Cooperation and Development (OECD) with 32 high-income OECD countries as the control group; an interrupted time-series study was undertaken to estimate changes in NHS England vacancies due to the Brexit referendum, using monthly vacancy data from April 2015 to December 2019. Data were analyzed from January 2024 to June 2025.</p><p><strong>Exposures: </strong>2016 Brexit referendum.</p><p><strong>Main outcomes and measures: </strong>Annual inflow of EU-origin, non-EU-origin, and total physicians and nurses to the UK; monthly NHS England physician and nursing vacancies.</p><p><strong>Results: </strong>The analysis included 418 962 physicians and 358 122 nurses who emigrated to an OECD country from 2008 to 2019. In 2016, the Brexit referendum was associated with immediate reductions of 825 EU physicians (95% CI, -983 to -668) and 2771 EU nurses (95% CI, -2952 to -2590) relative to prereferendum trends. Non-EU immigration also fell in 2016 (-416 physicians [95% CI, -746 to -83]; -2912 nurses [95% CI, -3463 to -2362]) but increased significantly thereafter from 2017 to 2019 (added 3110 physicians per year [95% CI, 2745 to 3474] and 1437 nurses [95% CI, 1036 to 1838]). Overall, total physician inflow rose, while total nurse inflow declined. NHS England physician vacancies increased by 383 posts (95% CI, 88 to 679) immediately after the referendum; nursing vacancies showed no significant changes.</p><p><strong>Conclusions and relevance: </strong>In this cross-sectional study, the Brexit referendum's policy uncertainty produced a sustained decline in EU-origin health care worker immigration, partially offset by recruitment from non-EU countries. This substitution did not prevent increases in physician vacancies and persistent nursing shortfalls, underscoring the sensitivity of health workforce supply to migration policy. Policymakers considering similar restrictions should account for anticipatory effects, substitution dynamics, and potential consequences for global health equity.</p>","PeriodicalId":53180,"journal":{"name":"JAMA Health Forum","volume":"7 8","pages":"e262868"},"PeriodicalIF":12.5,"publicationDate":"2026-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13499005/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148801515","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":"Prescription to Over-the-Counter Switching as a Policy Tool.","authors":"T Joseph Mattingly, Rena M Conti","doi":"10.1001/jamahealthforum.2026.2594","DOIUrl":"https://doi.org/10.1001/jamahealthforum.2026.2594","url":null,"abstract":"","PeriodicalId":53180,"journal":{"name":"JAMA Health Forum","volume":"7 8","pages":"e262594"},"PeriodicalIF":12.5,"publicationDate":"2026-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148851964","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":"Errors in Figure 1.","authors":"","doi":"10.1001/jamahealthforum.2026.3064","DOIUrl":"10.1001/jamahealthforum.2026.3064","url":null,"abstract":"","PeriodicalId":53180,"journal":{"name":"JAMA Health Forum","volume":"7 8","pages":"e263064"},"PeriodicalIF":12.5,"publicationDate":"2026-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13451978/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148686613","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":"Hospital Quality Is a Choice-Policymakers Should Insist on It.","authors":"Sherry Glied","doi":"10.1001/jamahealthforum.2026.3727","DOIUrl":"https://doi.org/10.1001/jamahealthforum.2026.3727","url":null,"abstract":"","PeriodicalId":53180,"journal":{"name":"JAMA Health Forum","volume":"7 8","pages":"e263727"},"PeriodicalIF":12.5,"publicationDate":"2026-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148762329","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":"Clinical Trial of the Year, JAMA Health Forum.","authors":"Sandro Galea","doi":"10.1001/jamahealthforum.2026.2634","DOIUrl":"https://doi.org/10.1001/jamahealthforum.2026.2634","url":null,"abstract":"","PeriodicalId":53180,"journal":{"name":"JAMA Health Forum","volume":"7 8","pages":"e262634"},"PeriodicalIF":12.5,"publicationDate":"2026-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148765671","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":"Mental Health and Construction-Intervening to Prevent Collapse.","authors":"Rosa M Gonzalez-Guarda, Molly Hayes, Luke Smith","doi":"10.1001/jamahealthforum.2026.3974","DOIUrl":"https://doi.org/10.1001/jamahealthforum.2026.3974","url":null,"abstract":"","PeriodicalId":53180,"journal":{"name":"JAMA Health Forum","volume":"7 8","pages":"e263974"},"PeriodicalIF":12.5,"publicationDate":"2026-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148841796","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":"Administrative Burden Documented in Medicaid Care Coordination.","authors":"Sanjay Basu, Aaron Baum, Kiiera Robinson, Rajaie Batniji","doi":"10.1001/jamahealthforum.2026.2932","DOIUrl":"10.1001/jamahealthforum.2026.2932","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Importance: &lt;/strong&gt;Administrative burdens, the time, effort, and stress of navigating bureaucratic requirements, impede Medicaid beneficiaries and persist even when care is obtained, yet their frequency and patient time costs are largely invisible in claims data.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To measure administrative burdens documented in Medicaid care coordination notes by type, quantify the patient time costs they entail at multiple wage valuations, and characterize differences by race and ethnicity.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design, setting, and participants: &lt;/strong&gt;Retrospective cohort study of Medicaid managed care beneficiaries in a single community-based care coordination program across Washington, Virginia, and Ohio from January 2023 through November 2025. Natural language processing classifiers identified administrative burdens in encounter notes.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Exposures: &lt;/strong&gt;Four documented administrative burden types: scheduling difficulties, transportation problems, paperwork and documentation requirements, and prior authorization delays.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Main outcomes and measures: &lt;/strong&gt;Patient-level prevalence and incidence by burden type; encounter-normalized rates; patient time costs at the federal minimum wage ($7.25/h), a state-weighted living wage ($22.00/h), and the Resource-Based Relative Value Scale conversion factor ($33.40/h); and differences by race and ethnicity.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Of 142 473 Medicaid beneficiaries (mean [SD] age, 31.6 [18.5] years; 55.3% female; 44.7% male) enrolled in the 4 participating managed care plans during the study period, 49 282 beneficiaries (34.6%; mean [SD] age, 33.7 [18.8] years; 60.5% female; 26.2% African American; 1.1% American Indian or Alaska Native; 3.8% Asian; 7.6% Hispanic; 0.9% Native Hawaiian or Other Pacific Islander; 35.0% White; 2.2% other race and ethnicity; 23.2% unknown ethnicity), completed at least 1 care coordination encounter. Patient-level prevalences were 6.1% (95% CI, 5.9%-6.3%) (transportation), 25.3% (95% CI, 24.9%-25.7%) (paperwork), 16.2% (95% CI, 15.8%-16.5%) (scheduling), and 9.8% (95% CI, 9.6%-10.1%) (prior authorization). Per affected patient, the mean time cost at the clinician-equivalent valuation was highest for transportation ($47.58; 95% CI, $45.75-$49.52) and lowest for scheduling ($12.35; 95% CI, $11.99-$12.73); documented burdens corresponded to 18 822 patient-hours cohortwide ($628 665). Encounter-normalized rates preserved this ordering, which was also robust to classifier misclassification. After excluding the 23.2% of beneficiaries with unknown ethnicity, a higher unadjusted burden prevalence was found in African American beneficiaries than White beneficiaries (rate ratio, 1.22; 95% CI, 1.18-1.25); payer-stratified analysis indicated this aggregate difference reflected enrollment in higher-burden plans rather than within-plan differences (&lt;2 percentage points). Beneficiaries who engaged with care coordinators were older,","PeriodicalId":53180,"journal":{"name":"JAMA Health Forum","volume":"7 8","pages":"e262932"},"PeriodicalIF":12.5,"publicationDate":"2026-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13525461/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148851880","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":"Out-of-Pocket Costs and Adherence to Semaglutide for Obesity Among Commercially Insured Adults.","authors":"Eunhae Shin, Hanna Kim, Jinae Lee, Daniel B Hall, Janani Rajbhandari","doi":"10.1001/jamahealthforum.2026.3113","DOIUrl":"10.1001/jamahealthforum.2026.3113","url":null,"abstract":"","PeriodicalId":53180,"journal":{"name":"JAMA Health Forum","volume":"7 8","pages":"e263113"},"PeriodicalIF":12.5,"publicationDate":"2026-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13525458/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148852003","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":"Medicaid Work-Reporting Requirements Under HR 1 and Insufficient or Inconsistent Work Hours.","authors":"Paul R Shafer, Timothy H Callaghan, David M Anderson","doi":"10.1001/jamahealthforum.2026.2938","DOIUrl":"10.1001/jamahealthforum.2026.2938","url":null,"abstract":"<p><strong>Importance: </strong>House Resolution 1 (HR 1) of the 119th US Congress (2025-2026), known as the One Big Beautiful Bill Act, created national work-reporting requirements for adult Medicaid expansion enrollees starting by January 1, 2027. Although many expect the administrative burdens associated with work-reporting requirements to be the primary source of disenrollment, the impact of variable work hours and/or part-time work on potential disenrollment from Medicaid among low-income working adults is unknown.</p><p><strong>Objective: </strong>To assess the risk of noncompliance with national Medicaid work-reporting requirements due to insufficient and/or variable work hours after enactment of HR 1.</p><p><strong>Design, setting, and participants: </strong>This cross-sectional study used data from the 2023 to 2025 Current Population Survey (US) to describe employment of adults between 18 and 64 years of age who were plausible Medicaid-expansion enrollees. The prevalence of being at risk of noncompliance was estimated, and modified Poisson regression models were used to assess differential risk based on demographic characteristics. Data were analyzed from February through June 2026.</p><p><strong>Exposure: </strong>Work-reporting requirements under HR 1.</p><p><strong>Main outcomes and measures: </strong>Risk of noncompliance due to usually being near the 20-hours-per-week threshold and/or for reporting variable hours.</p><p><strong>Results: </strong>The analytic sample comprised 19 476 observations, representing a mean annual weighted population of more than 16 million individuals (mean age, 41.1 [95% CI, 40.8-41.3] years; 49.8% female and 50.2% male individuals), most of whom were unmarried (71.8%) and non-Hispanic White (47.9%) with a high school level or equivalent education (41.0%). Among them, we estimated that 19.8% of those potentially subject to work reporting requirements and working are at risk of noncompliance, by usually being near the hours threshold (13.6%) and/or reporting variable hours (7.6%). Female individuals had a 22% higher probability (adjusted risk ratio [aRR], 1.22; 95% CI, 1.11-1.35) of being at risk of noncompliance, whereas married respondents had an 18% lower probability (aRR, 0.82; 95% CI, 0.74-0.92). Significant variation was also observed by race and ethnicity and by education level.</p><p><strong>Conclusions and relevance: </strong>This cross-sectional study found near full-time mean hours per week among working adults age 18 to 64 years enrolled in or likely eligible for Medicaid expansion. However, nearly one-fifth were at risk of noncompliance due to insufficient or variable hours.</p>","PeriodicalId":53180,"journal":{"name":"JAMA Health Forum","volume":"7 8","pages":"e262938"},"PeriodicalIF":12.5,"publicationDate":"2026-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13525457/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148852016","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":"State Eviction Moratoria and Foster Care Entries.","authors":"Yi Wang, Liwei Zhang, Lawrence M Berger","doi":"10.1001/jamahealthforum.2026.2855","DOIUrl":"10.1001/jamahealthforum.2026.2855","url":null,"abstract":"<p><strong>Importance: </strong>Foster care entry is associated with long-term adverse outcomes for children and substantial public costs. Housing hardship is common among child welfare-involved families, and eviction moratoria implemented during the COVID-19 pandemic may have stabilized housing for at-risk families. Little is known about whether population-level housing policies, which are generalizable to the broader population, are associated with foster care entries.</p><p><strong>Objective: </strong>To assess whether state eviction moratoria are associated with foster care entries.</p><p><strong>Design, setting, and participants: </strong>This cohort study used a biweekly county panel spanning January 1, 2019, through mid-August 2021, comprising 59 counties across 16 states and Washington, DC (60 jurisdictions total). Counties were categorized as always-treated (states with eviction moratoria continuously in effect from mid-March 2020 through mid-August 2021) or never-treated (states with no statewide moratorium during the study window). A sensitivity analysis expanded the sample to include all-treated vs never-treated counties. Data were analyzed from January 1 to May 29, 2026.</p><p><strong>Exposures: </strong>State eviction moratorium status in each county-biweekly period.</p><p><strong>Main outcomes and measures: </strong>Biweekly counts of foster care entries overall and by recorded reasons. Adjusted negative binomial difference-in-differences models compared changes in entries in always-treated vs never-treated counties before vs after mid-March 2020, when moratoria were initiated.</p><p><strong>Results: </strong>The analytic sample comprised 42 always-treated and 18 never-treated jurisdictions. In the primary analysis (always-treated vs never-treated counties), eviction moratoria were associated with a 31% reduction in foster care entries attributed to inadequate housing (incidence rate ratio [IRR], 0.69; 95% CI, 0.48-0.99), a 23% reduction in caregiver inability to cope (IRR, 0.77; 95% CI, 0.64-0.93), and a 20% reduction in physical abuse (IRR, 0.80; 95% CI, 0.64-0.99). The findings for total entries were directionally consistent (IRR, 0.88; 95% CI, 0.70-1.12) but were not statistically significant. In the expanded analysis (all-treated vs never-treated), caregiver inability to cope (17%; IRR, 0.83; 95% CI, 0.72-0.96) and inadequate housing (16%; IRR, 0.84; 95% CI, 0.74-0.95) were associated with reductions in foster care entries.</p><p><strong>Conclusion and relevance: </strong>In this study, state eviction moratoria were associated with fewer foster care entries attributed to inadequate housing, caregiver inability to cope, and physical abuse. These findings suggest that housing stabilization policies may reduce foster care entries through direct housing-related and indirect stress-related pathways.</p>","PeriodicalId":53180,"journal":{"name":"JAMA Health Forum","volume":"7 8","pages":"e262855"},"PeriodicalIF":12.5,"publicationDate":"2026-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13476842/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148762788","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}