Health Services Research最新文献

{"title":"From Locked Out to Opting in: How the Cures Act Reshaped Medicare Advantage Utilization for Beneficiaries With End-Stage Kidney Disease","authors":"Sih-Ting Cai,&nbsp;Hailemichael Shone,&nbsp;Kosali Simon,&nbsp;Daniel Polsky","doi":"10.1111/1475-6773.70150","DOIUrl":"10.1111/1475-6773.70150","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To describe how the characteristics of Medicare Advantage (MA) beneficiaries with end-stage kidney disease (ESKD) changed after the 21st Century Cures Act expanded MA eligibility, and to document accompanying changes in utilization.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Study Setting and Design</h3>\u0000 \u0000 <p>The 2021 Cures Act opened MA to previously diagnosed ESKD patients. Prior to 2021, ESKD patients were ineligible for MA unless diagnosed while enrolled. This cross-sectional descriptive study used 2017–2023 claims to compare enrollee characteristics before and after 2021, using interrupted time-series analysis of monthly hospitalizations, emergency department visits, and outpatient visits.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Data Sources and Analytic Sample</h3>\u0000 \u0000 <p>Optum's de-identified Clinformatics Data Mart Database (2017–2023) provided data on 216,205 MA beneficiaries with ESKD (359,172 beneficiary-years).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Principal Findings</h3>\u0000 \u0000 <p>Post-policy, enrollees were younger, had lower comorbidity burden and lower education attainment, and were more likely to report household incomes below $40,000. Hospitalization rates were lower immediately post-policy by 0.013 per beneficiary-month (6% relative decline; 95% CI, −0.022 to −0.003; <i>p</i> &lt; 0.05). ED visits showed no immediate difference but increased over time. Outpatient visits remained largely stable.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Expanded MA eligibility was associated with a substantial shift in the ESKD MA case mix toward younger, relatively healthier, and more socioeconomically vulnerable beneficiaries. Utilization changes reflect these compositional differences.</p>\u0000 </section>\u0000 </div>","PeriodicalId":55065,"journal":{"name":"Health Services Research","volume":"61 5","pages":""},"PeriodicalIF":3.0,"publicationDate":"2026-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148842262","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Transition Dynamics of County Obstetric Service Absence: Population Exposure and Status Changes in the United States, 2015–2023","authors":"Christina Laternser","doi":"10.1111/1475-6773.70160","DOIUrl":"10.1111/1475-6773.70160","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To quantify persistence and transition dynamics of county obstetric service absence and assess whether birth volume and physician supply add predictive information beyond prior-year status.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Study Setting and Design</h3>\u0000 \u0000 <p>National longitudinal county–year panel study (2015–2023). Obstetric service absence was defined using a 2-year confirmation rule, with contemporaneous status used for the 2015 baseline year to reduce misclassification. We estimated annual conditional transition probabilities (entry and exit) and modeled current-year absence as a function of prior-year absence and year fixed effects, with and without contemporaneous birth volume and physician supply.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Data Sources and Analytic Sample</h3>\u0000 \u0000 <p>All US counties (<i>N</i> = 3144) observed annually. Obstetric service availability was identified from Centers for Medicare &amp; Medicaid Services Provider of Services files. Residence-based births, physician supply, and bed capacity were obtained from the Area Health Resources Files. Population denominators for women aged 15–44 were drawn from the American Community Survey.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Principal Findings</h3>\u0000 \u0000 <p>Obstetric service absence was highly persistent. County prevalence was stable (34.2% in 2015 and 34.2% in 2023). Population exposure declined: the share of women aged 15–44 residing in counties without services decreased from 6.5% to 5.3%, and the share of births to residents of such counties decreased from 6.6% to 5.7%. Annual transitions were rare (entry ≤ 0.4%; exit ≤ 0.9%), and conditional stay probabilities were ≥ 0.991 for both presence and absence. In lagged-status models, prior-year absence strongly predicted current absence (0.994); adding birth volume and physician supply did not materially change the estimate (0.993).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>On policy-relevant timescales, obstetric service absence behaves as a high-inertia system state. Rare transitions and dominance of prior status suggest slow adjustment, with implications for closure prevention and targeting support near volume and workforce feasibility thresholds.</p>\u0000 </section>\u0000 </div>","PeriodicalId":55065,"journal":{"name":"Health Services Research","volume":"61 5","pages":""},"PeriodicalIF":3.0,"publicationDate":"2026-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148842294","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Medicare Advantage Plan Bid Risk Underestimates and Corresponding Insurer Revenues","authors":"David Scheinker,&nbsp;Kevin Schulman,&nbsp;Barak Richman,&nbsp;Arnold Milstein,&nbsp;Richard Kronick","doi":"10.1111/1475-6773.70158","DOIUrl":"https://doi.org/10.1111/1475-6773.70158","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To estimate the extent to which Medicare Advantage (MA) plans underestimate risk, the additional Part A and Part B (A&amp;B) revenue insurers receive as a result, and how this differs across insurers and over time.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Study Setting and Design</h3>\u0000 \u0000 <p>We compared projected risk in plan-level bids submitted by insurers to the actual plan-level risk as subsequently reported by the Centers for Medicare and Medicaid Services (CMS). We estimated the additional A&amp;B revenue MA insurers received due to underestimates.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Data Sources and Analytical Samples</h3>\u0000 \u0000 <p>A total of 34,604 MA plans offered by 317 insurers from 2008 to 2020 from MA Bid Data as well as MA enrollment and payment data, all from publicly available CMS sources.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Principal Findings</h3>\u0000 \u0000 <p>From 2008 to 2020, the average ratio of actual risk to projected risk was 1.01 (95% Confidence Interval, 1.009–1.011) and plans received additional A&amp;B revenue of $14.6 billion due to risk underestimates. The fraction of plans with a ratio above 1.0 rose from 45% in the smallest enrollment quintile to 62% in the largest enrollment quintile. Among the 10 largest insurers, Blue Cross Blue Shield Highmark underestimated risk by the largest amount, an average of 3% from 2008 to 2020, generating $272 per member per year in additional A&amp;B revenue, followed by Centene (2.1%, $202/member).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>From 2008 to 2020, MA plans systematically underestimated actual risk, reducing benefits for beneficiaries and generating additional A&amp;B revenue of approximately 1% of premiums. The frequency and magnitude of the underestimates increased with plan size. This additional A&amp;B revenue represents a significant fraction of reported MA profit margins, which averaged approximately 3.5% of premiums over the period. CMS should more closely scrutinize the projected risk scores in the annual bids. The Department of Justice should consider whether systematic risk underestimation is a violation of the False Claims Act.</p>\u0000 </section>\u0000 </div>","PeriodicalId":55065,"journal":{"name":"Health Services Research","volume":"61 5","pages":""},"PeriodicalIF":3.0,"publicationDate":"2026-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/1475-6773.70158","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148811250","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hospital Responses to New Disproportionate Share Payment Rules","authors":"Jenny Markell,&nbsp;Gerard Anderson,&nbsp;Mark Meiselbach","doi":"10.1111/1475-6773.70157","DOIUrl":"10.1111/1475-6773.70157","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To determine if a change in how Medicare disproportionate share payments were calculated increased the amount of uncompensated care reported by hospitals.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Study Setting and Design</h3>\u0000 \u0000 <p>In 2018, Medicare changed the formula for determining disproportionate share payments to include uncompensated care. A difference-in-differences analysis was used to determine if different categories of hospitals altered their uncompensated care reporting and received higher disproportionate share payments following the change.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Data Sources and Analytic Sample</h3>\u0000 \u0000 <p>We linked 2011–2023 hospital cost report data from RAND with hospital characteristics from the American Hospital Association (AHA)'s annual survey and state uninsurance rate data from KFF.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Principal Findings</h3>\u0000 \u0000 <p>Only some categories of hospitals responded to the policy change. System affiliated hospitals saw an 11% rise in UC reporting and a 20% rise in UC payments relative to individual hospitals. For-profit hospitals saw a 41% rise in UC reporting and a 4% rise in UC payments relative to nonprofit hospitals. Relative to nonprofit individual hospitals, for-profit hospital systems reported a 49% increase in uncompensated care reporting and an 18% increase in additional disproportionate share payments. Among for-profit health systems, the main effect was driven by the two largest hospital systems.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>This change benefitted hospitals that reported higher levels of uncompensated care, including those that altered their reporting following the policy change. CMS could monitor the level of hospitals' uncompensated care and within this, charity care and bad debt, to ensure that hospitals are accurately and consistently reporting the data. More information is needed in order to ascertain whether hospitals' reporting changes are translated into practice or are limited to reporting. If limited to reporting, changes may be needed to ensure that large hospital systems with better reporting capacity do not receive the majority of Medicare disproportionate share and uncompensated care payments.</p>\u0000 </section>\u0000 </div>","PeriodicalId":55065,"journal":{"name":"Health Services Research","volume":"61 4","pages":""},"PeriodicalIF":3.0,"publicationDate":"2026-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148714686","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of Primary Care Value-Based Payment Implementation on Low-Value Care Among Medicaid Beneficiaries in North Carolina","authors":"Aniyar Izguttinov,&nbsp;Marisa Elena Domino,&nbsp;Mark Holmes,&nbsp;Christopher M. Shea,&nbsp;Darren A. DeWalt,&nbsp;Carolyn T. Thorpe","doi":"10.1111/1475-6773.70149","DOIUrl":"10.1111/1475-6773.70149","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To assess the impact of primary care value-based payment implementation on low-value service use among Medicaid beneficiaries.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Study Setting and Design</h3>\u0000 \u0000 <p>On July 1, 2021, North Carolina Medicaid launched the Advanced Medical Home (AMH) program to improve care quality and coordination under managed care. Health plans are now required to include financial incentives for care coordination and performance in contracts with the highest-tier primary care practices (Tier 3 AMHs). Leveraging the tiered structure of the program and using a difference-in-differences design, we compared changes in low-value care utilization before and after the AMH rollout among beneficiaries attributed to Tier 3 AMHs versus those in lower-tier or non-AMH practices.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Data Sources and Analytic Sample</h3>\u0000 \u0000 <p>We used North Carolina Medicaid institutional and professional claims, managed care encounters, and enrollment and provider files, supplemented with information on provider characteristics. The analytic sample included 33.6 million beneficiary-months, representing 1.34 million nonelderly adult beneficiaries and 7903 primary care practices.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Principal Findings</h3>\u0000 \u0000 <p>Beneficiaries attributed to Tier 3 AMH practices and comparison practices had similar baseline rates of low-value care, with imaging for plantar fasciitis (31.2% vs. 28.9%), head imaging for uncomplicated headache (14.8% vs. 14.5%), and back imaging for nonspecific low back pain (13.8% vs. 13.8%) being the most commonly used low-value care services. Although rates for many low-value services declined over time, adjusted difference-in-differences estimates were small in magnitude and not statistically significant for low-value care outcomes included in the study.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The results suggest limited effectiveness of value-based payment reform in curbing low-value service use among Medicaid beneficiaries in North Carolina. However, more time may be needed to observe substantial effects, given the gradual nature of practice transformation. Strengthening financial and quality-based incentives, including specific low-value care benchmarks, also could enhance the program's effectiveness in reducing unnecessary care.</p>\u0000 </section>\u0000 </div>","PeriodicalId":55065,"journal":{"name":"Health Services Research","volume":"61 4","pages":""},"PeriodicalIF":3.0,"publicationDate":"2026-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148714691","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Implementation of High Reliability Organization Principles in a Nationally Integrated Healthcare System: Initial Associations With Staff Turnover and Retention","authors":"R. Neal Axon,&nbsp;Ralph Ward,&nbsp;Ahmed Mohamed,&nbsp;Patrick Mauldin,&nbsp;Casey Buchanan,&nbsp;Michelle Mengeling,&nbsp;James Rudolph,&nbsp;Amjed Baghdadi,&nbsp;Jennifer L. Sullivan","doi":"10.1111/1475-6773.70156","DOIUrl":"10.1111/1475-6773.70156","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To analyze associations between implementation of high reliability organization (HRO) programs at Veterans Health Administration (VA) medical centers (VAMC) and measures of employee turnover and retention.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Study Setting and Design</h3>\u0000 \u0000 <p>In 2018, VA began a phased multi-year national implementation of HRO principles to foster improvements in safety culture and quality of care. Interrupted time series analyses (ITSA) were used to estimate changes in employee turnover and retention pre- and post-HRO implementation. Primary analyses focused on each site's calendar time for program rollout. Secondary analyses estimated changes after training thresholds were attained based on the proportion of employees completing HRO training modules.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Data Sources and Analytic Sample</h3>\u0000 \u0000 <p>A retrospective cohort of 723,290 VA employees working at 125 VAMCs between January 2018 through June 2024 was included. Baseline and post-implementation (intercept and slope) rates of employee turnover and retention were estimated.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Principal Findings</h3>\u0000 \u0000 <p>ITSA model estimates showed prior to HRO rollout, VA turnover was increasing from 12.3% at baseline at an annual rate of +0.5% (95% CI: 0.2%, 1.0%, <i>p</i> &lt; 0.001), and after HRO implementation the annual rate dropped by −1.04% (95% CI: −0.8%, −1.3%, <i>p</i> &lt; 0.001). Similarly, retention across the VA was dropping from 86.8% at baseline at an annual rate of −0.8% (95% CI: −0.5%, −1.3%, <i>p</i> &lt; 0.001), and after HRO implementation, the annual rate increased by +1.6% (95% CI: 1.0%, 2.1%, <i>p</i> &lt; 0.001). For an “average” VAMC of 3056 employees at baseline, these changes in retention and turnover translated to 16 fewer positions lost and 24 additional employees retained per year. Models analyzing HRO training thresholds found similar results.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>HRO implementation was associated with temporary, modest but statistically significant reversals in the slope of employee turnover and retention rates. Although unobserved factors may have contributed to these results, this work provides initial information regarding potential associations between HRO implementation and workforce outcomes.</p>\u0000 </section>\u0000 </div>","PeriodicalId":55065,"journal":{"name":"Health Services Research","volume":"61 4","pages":""},"PeriodicalIF":3.0,"publicationDate":"2026-08-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148708558","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"From the Editor's Desk: Publishing in HSR in 2024","authors":"Austin Frakt,&nbsp;Chris Tachibana","doi":"10.1111/1475-6773.70146","DOIUrl":"10.1111/1475-6773.70146","url":null,"abstract":"","PeriodicalId":55065,"journal":{"name":"Health Services Research","volume":"61 4","pages":""},"PeriodicalIF":3.0,"publicationDate":"2026-08-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148671235","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Health Insurance Type and Lung Cancer Stage Shift Following Coverage of Screening","authors":"Min Lian,&nbsp;Timothy McBride,&nbsp;Benjamin Kozower,&nbsp;Maria Baggstrom,&nbsp;Ying Liu","doi":"10.1111/1475-6773.70154","DOIUrl":"10.1111/1475-6773.70154","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To examine the role of insurance coverage of lung cancer screening in driving shifts in lung cancer stage at diagnosis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Study Setting and Design</h3>\u0000 \u0000 <p>We performed difference-in-differences (DID) analyses to compare changes in the proportion of early-stage lung cancer diagnosis between pre-coverage (2007–2014) and post-coverage (2015–2019) periods across insurance groups.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Data Sources and Analytic Sample</h3>\u0000 \u0000 <p>Using the National Cancer Institute's Surveillance, Epidemiology, and End Results database, we identified patients with non-small cell lung cancer aged 55–77 years and diagnosed between 2007 and 2019. Health insurance at diagnosis was categorized as private, Medicare (fee-for-service [FFS], FFS with supplemental private coverage, FFS with Medicaid, and Medicare Advantage with and without Medicaid), Medicaid (FFS and managed care), military health plans, and uninsured.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Principal Findings</h3>\u0000 \u0000 <p>Among 227,112 patients, 63,676 (28.04%) had private insurance, 130,770 (57.58%) Medicare, 14,982 (6.60%) Medicaid, 5941 (2.62%) military health insurance, and 11,743 (5.17%) were uninsured. Compared with uninsured patients, a significantly greater increase in the proportion of early-stage lung cancer diagnosis between pre-coverage and post-coverage periods was observed among Medicaid patients (DID = 2.88 percentage points [ppt], 95% CI 0.73–5.02 ppt), but not patients with private insurance, Medicare, or military health insurance. Among Medicaid beneficiaries, those in managed care showed a significantly greater shift compared with those in FFS during 4–5 years post-coverage (DID = 8.22 ppt, 95% CI 4.51–11.93 ppt). Among Medicare FFS beneficiaries, dual enrollment in Medicaid was associated with a significantly smaller increase in the proportion of early-stage diagnosis compared with FFS-only enrollment during 4–5 years post-coverage (DID = −4.40 ppt, 95% CI [−6.40]–[−2.40] ppt).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The results suggest that beneficial stage shifts following the recommendation for lung cancer screening varied by health insurance status and type. Addressing patient, provider, and system-level barriers to lung cancer screening and downstream care is essential to translate lung cancer screening coverage into earlier-stage diagnosis.</p>\u0000 </section>\u0000 </div>","PeriodicalId":55065,"journal":{"name":"Health Services Research","volume":"61 4","pages":""},"PeriodicalIF":3.0,"publicationDate":"2026-08-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148686820","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of VA-Purchased Community Care on Polypharmacy and Potentially Inappropriate Medication Use in Older Adult Veterans","authors":"Catherine S. Hwang,&nbsp;Eric T. Roberts,&nbsp;Florentina E. Sileanu,&nbsp;Yaming Li,&nbsp;Carolyn T. Thorpe,&nbsp;Maria K. Mor,&nbsp;Thomas R. Radomski,&nbsp;John Cashy,&nbsp;Aaron L. Schwartz,&nbsp;Katie J. Suda,&nbsp;Loren J. Schleiden,&nbsp;Timothy S. Anderson,&nbsp;Megan E. Vanneman,&nbsp;Walid F. Gellad","doi":"10.1111/1475-6773.70152","DOIUrl":"10.1111/1475-6773.70152","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To investigate whether eligibility for Veterans Health Administration (VA)-purchased community care, which expanded Veterans' access to care outside VA, was associated with increased polypharmacy or potentially inappropriate medication use among older adult Veterans.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Study Setting and Design</h3>\u0000 \u0000 <p>Regression discontinuity design, leveraging the distance threshold for community care eligibility (residing &gt; 40 miles from the nearest VA facility with ≥ 1 or more full-time primary care physician), to examine the effects of community care eligibility on polypharmacy and potentially inappropriate medication use among Veterans aged ≥ 65 years.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Data Sources and Analytic Sample</h3>\u0000 \u0000 <p>VA pharmacy data for all prescriptions filled at VA facilities, VA Program Integrity Tool files for prescriptions paid by VA and filled in community pharmacies, and Medicare Part D data. Analyses included annual cross-sectional samples of Veterans 36–39 miles or 41–44 miles from their nearest VA facility during FY 2016–2019.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Principal Findings</h3>\u0000 \u0000 <p>The sample included 399,250 Veteran-year observations, of which 226,157 (56.6%) were 36–39 miles and 173,093 (43.4%) were 41–44 miles from the nearest eligible VA facility. Overall, we observed no discontinuities across the 40-mile threshold in the number of unique medications filled annually (−0.06 medications; 95% confidence interval [CI], −0.15 to 0.03). There were no discontinuities in proportions of Veterans filling ≥ 5 unique medications (−0.25 percentage points [pp]; 95% CI, −0.84 to 0.34), ≥ 10 medications (−0.55 pp.; 95% CI, −1.24 to 0.14), ≥ 1 medication on the Beers list (−0.02 pp.; 95% CI, −0.63 to 0.59), or ≥ 1 high-risk drug–drug interaction (−0.05 pp.; 95% CI, −0.17 to 0.07). Among Veterans with mental health conditions, exceeding the 40-mile threshold was associated with a higher likelihood of filling ≥ 10 unique medications annually (2.06 pp.; 95% CI, 0.42 to 3.70). We did not observe clinically or statistically significant discontinuities in other subgroups.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Overall, eligibility for VA-purchased community care was not associated with increased polypharmacy or potentially inappropriate medication use among older adult Veterans.</p>\u0000 </section>\u0000 </div>","PeriodicalId":55065,"journal":{"name":"Health Services Research","volume":"61 4","pages":""},"PeriodicalIF":3.0,"publicationDate":"2026-08-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148665114","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Economic Toll of Inequitable Dental Care Access: A Welfare Analysis of Racial and Ethnic Disparities","authors":"Chunxi Guo,&nbsp;John A. Rizzo","doi":"10.1111/1475-6773.70155","DOIUrl":"10.1111/1475-6773.70155","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To conduct a formal welfare analysis quantifying the economic costs of racial and ethnic disparities in dental care access among Hispanic and non-Hispanic Black, Asian, and multiracial adults relative to non-Hispanic White individuals in the United States.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Study Setting and Design</h3>\u0000 \u0000 <p>Cross-sectional, observational study using pooled nationally representative data from the 2014 to 2023 Medical Expenditure Panel Survey (MEPS). Two-part models were employed: generalized linear model (GLM) with log link for the probability of any dental visit and generalized linear gamma regression models with log link for modeling visit frequency, total annual expenditures, and expenditure per visit among users.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Data Sources</h3>\u0000 \u0000 <p>MEPS Full-Year Consolidated Data Files, 2014–2023. The final pooled cross-sectional analytic sample included 205,894 respondents aged 18 and older, representing a survey-weighted annual population of 251,029,718 US adults. Dollar figures are in constant 2023 US dollars.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Principal Findings</h3>\u0000 \u0000 <p>All examined minority groups experienced lower dental care access and higher expenditure per visit compared with White individuals. Estimated aggregate annual welfare losses ranged from $8.23 to $12.93 billion for Hispanics, $6.44 to $9.84 billion for non-Hispanic Blacks, $2.82 to $4.30 billion for Asians, and $1.57 to $2.57 billion for individuals of other or multiple racial identities (total $19.06–$29.64 billion).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Dental care disparities persist after adjusting for socioeconomic, demographic, and health characteristics, generating large aggregate welfare losses for minority communities. Addressing provider diversity, cultural competency, and structural barriers is essential to reducing these inequities.</p>\u0000 </section>\u0000 </div>","PeriodicalId":55065,"journal":{"name":"Health Services Research","volume":"61 4","pages":""},"PeriodicalIF":3.0,"publicationDate":"2026-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148632862","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}