Health affairs scholar最新文献

Democratizing care to care for democracy: community care workers and anti-racist public health.

Health affairs scholar Pub Date : 2025-04-08 eCollection Date: 2025-04-01 DOI: 10.1093/haschl/qxaf052

Raeghn Draper, Eric Reinhart

{"title":"Democratizing care to care for democracy: community care workers and anti-racist public health.","authors":"Raeghn Draper, Eric Reinhart","doi":"10.1093/haschl/qxaf052","DOIUrl":"https://doi.org/10.1093/haschl/qxaf052","url":null,"abstract":"The organization of care in the United States reflects a longstanding prioritization of medical interventions over broader social support systems. This has contributed to widening racial and class inequalities alongside poor health outcomes, weakened communities, and growing social isolation that has created fertile ground for rising authoritarianism. Following on Roy, Hamilton, and Chokshi (2024), who argue for the necessity of addressing the interconnected areas of capital, care, and culture to rebuild US public health, we outline how public investment in community care worker systems can address each of these areas by strengthening their synergistic overlaps and reframing the function of care in society. By recruiting residents of disinvested communities into career positions as publicly employed care workers in their own neighborhoods, such a program would implement a genuinely anti-racist model of public health. This approach is rooted in training and properly compensating members of disenfranchised communities to care for one another rather than perpetuating classist and racist models of care in which reliance on external actors is presumed necessary. By insisting on policies that support the essential interpersonal and political-economic functions of care as public infrastructure, care can obtain a collective ethical and spiritual significance beyond its material effects alone. Implementing community care programs designed to reanimate care in this way could not only dramatically improve health but also revitalize the twinned projects of American democracy and racial equality in a period during which both are under intensifying threat.","PeriodicalId":94025,"journal":{"name":"Health affairs scholar","volume":"3 4","pages":"qxaf052"},"PeriodicalIF":0.0,"publicationDate":"2025-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11977331/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143813254","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}

引用次数: 0

Impact of nurse home visiting on take-up of social safety net programs in a Medicaid population.

Health affairs scholar Pub Date : 2025-04-02 eCollection Date: 2025-04-01 DOI: 10.1093/haschl/qxaf038

Slawa Rokicki, Dea Oviedo, Nicolas Perreault, Mary Ann Bates, R Annetta Zhou, Katherine Baicker, Margaret A McConnell

{"title":"Impact of nurse home visiting on take-up of social safety net programs in a Medicaid population.","authors":"Slawa Rokicki, Dea Oviedo, Nicolas Perreault, Mary Ann Bates, R Annetta Zhou, Katherine Baicker, Margaret A McConnell","doi":"10.1093/haschl/qxaf038","DOIUrl":"10.1093/haschl/qxaf038","url":null,"abstract":"Childhood poverty can affect health and development across the life course. Access to social safety net programs may alleviate poverty-related hardships like food insecurity among low-income families, yet many eligible households do not enroll. We used a randomized controlled trial (n = 5670) to evaluate the impact of the Nurse-Family Partnership (NFP) home visiting program during pregnancy and the first 2 years after delivery on take-up of social programs including the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) and Supplemental Nutrition Assistance Program (SNAP). The NFP services were funded as part of a Medicaid Section 1915(b) waiver in South Carolina. We found that NFP participants were more likely to be enrolled in SNAP or WIC during pregnancy (87.8% vs 86.0%) and were enrolled in SNAP for 0.6 months longer in the first 2 years after delivery than control participants. Nurse home visiting moderately increased take-up of social safety net programs in pregnancy and the first years of life, even in a context with already high rates of participation. This study contributes important evidence on the effectiveness of Medicaid-funded initiatives for addressing social needs of low-income families.Clinical trial registration: ClinicalTrials.gov; ID NCT03360539 (https://clinicaltrials.gov/study/NCT03360539).","PeriodicalId":94025,"journal":{"name":"Health affairs scholar","volume":"3 4","pages":"qxaf038"},"PeriodicalIF":0.0,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11964293/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143775164","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}

引用次数: 0

Building a public-private partnership to confront the emergency department boarding crisis. 建立公私合作伙伴关系，应对急诊科寄宿危机。

Health affairs scholar Pub Date : 2025-04-02 eCollection Date: 2025-04-01 DOI: 10.1093/haschl/qxaf014

Sean S Michael, Sean Bruna, Laura L Sessums

引用次数: 0

Use of real-world evidence in the Medicare Drug Price Negotiation Program: A checklist for the Centers for Medicare and Medicaid Services and manufacturers.

Health affairs scholar Pub Date : 2025-03-21 eCollection Date: 2025-03-01 DOI: 10.1093/haschl/qxaf030

Sean R Tunis, Jason Shafrin, Kyi-Sin Than, Melanie D Whittington, Richard J Willke, Murtuza Bharmal

{"title":"Use of real-world evidence in the Medicare Drug Price Negotiation Program: A checklist for the Centers for Medicare and Medicaid Services and manufacturers.","authors":"Sean R Tunis, Jason Shafrin, Kyi-Sin Than, Melanie D Whittington, Richard J Willke, Murtuza Bharmal","doi":"10.1093/haschl/qxaf030","DOIUrl":"10.1093/haschl/qxaf030","url":null,"abstract":"Under the Inflation Reduction Act's (IRA's) - Medicare Drug Price Negotiation Program, the Centers for Medicare & Medicaid Services' (CMS's) \"maximum fair price\" must be informed by evidence on factors such as therapeutic advance of the selected drug compared with its alternative, comparative effectiveness across clinical and patient-reported outcomes, the impact on specific populations, and the ability to address unmet medical needs. This paper describes how real-world evidence could improve CMS decision-making and creates a best practices checklist to help CMS evaluate the quality of any manufacturer-submitted evidence. The checklist was developed in four steps: (i) identification of the IRA requirements for determining the maximum fair price through a review of official guidance from CMS, (ii) assessment of provisions that could be supported by real-world evidence (RWE) in addition to clinical trial evidence, (iii) literature review on existing best-practice guidelines relevant to RWE, and (iv) consolidation of these RWE guidelines into a checklist through a series of web conference discussions among experts. The checklist aims to improve the quality of the information available to CMS during the drug price negotiation process.","PeriodicalId":94025,"journal":{"name":"Health affairs scholar","volume":"3 3","pages":"qxaf030"},"PeriodicalIF":0.0,"publicationDate":"2025-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11926674/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143694948","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}

引用次数: 0

Correction to: Medicaid-covered health care visits during the postpartum year: Variation by enrollee characteristics and state.

Health affairs scholar Pub Date : 2025-03-21 eCollection Date: 2025-03-01 DOI: 10.1093/haschl/qxaf055

引用次数: 0

Trends in providers participating in Medicare oncology value-based care models.

Health affairs scholar Pub Date : 2025-03-20 eCollection Date: 2025-04-01 DOI: 10.1093/haschl/qxaf058

Arthur S Hong, Sofia Babool, Lesi He, Ethan A Halm

引用次数: 0

Correction to: What happens behind closed doors? Investigating care practices in nursing home and assisted living memory care units.

Health affairs scholar Pub Date : 2025-03-19 eCollection Date: 2025-03-01 DOI: 10.1093/haschl/qxaf053

引用次数: 0

Evidence available and used by the Food and Drug Administration for the approval of orphan and nonorphan drugs.

Health affairs scholar Pub Date : 2025-03-18 eCollection Date: 2025-04-01 DOI: 10.1093/haschl/qxaf057

Amanda J Koong, Veronica L Irvin, Aditya Narayan, Sujin Song, Robert M Kaplan

{"title":"Evidence available and used by the Food and Drug Administration for the approval of orphan and nonorphan drugs.","authors":"Amanda J Koong, Veronica L Irvin, Aditya Narayan, Sujin Song, Robert M Kaplan","doi":"10.1093/haschl/qxaf057","DOIUrl":"10.1093/haschl/qxaf057","url":null,"abstract":"There are substantial financial incentives to develop orphan drugs for rare diseases, but concerns about the quality and volume of supporting evidence have emerged. We compare evidence used to evaluate orphan and nonorphan drugs approved by the Food and Drug Administration (FDA) between 2016 and 2023. This retrospective cross-sectional analysis utilizes FDA data on approvals and study information from ClinicalTrials.gov to compare characteristics of studies relevant to orphan and nonorphan drugs approved between 2016 and 2023. Of the 368 total drugs approved, 50% were orphan drugs. The FDA-approved drugs based on significantly fewer studies for orphan (1.5 studies/drug) compared to nonorphan (2.4 studies/drug). Additionally, a significantly lower proportion of studies were completed before FDA approval for orphan drugs (25% vs 41%). Orphan drugs were significantly less likely to be evaluated in randomized clinical trials (RCTs) (34% vs 63%). Of these RCTs, there were significantly fewer completed before approval (40% vs 54%) and that had results posted (35% vs 53%). There was a significant difference in the available evidence for orphan and nonorphan drugs. As new legislation like Cures 2.0 is developed, it is critical to examine the balance between an expedited approval timeline and the standard of clinical evidence.","PeriodicalId":94025,"journal":{"name":"Health affairs scholar","volume":"3 4","pages":"qxaf057"},"PeriodicalIF":0.0,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11970248/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143797462","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}

引用次数: 0

Trends in hospital discharge outcomes among high-risk Medicare beneficiaries before and during the COVID-19 pandemic.

Health affairs scholar Pub Date : 2025-03-18 eCollection Date: 2025-04-01 DOI: 10.1093/haschl/qxaf056

Anthony I Roberts, Christopher M Santostefano, Zihan Chen, Brian E McGarry, Elizabeth M White, Linda J Resnik, Fangli Geng, David C Grabowski, Momotazur Rahman

{"title":"Trends in hospital discharge outcomes among high-risk Medicare beneficiaries before and during the COVID-19 pandemic.","authors":"Anthony I Roberts, Christopher M Santostefano, Zihan Chen, Brian E McGarry, Elizabeth M White, Linda J Resnik, Fangli Geng, David C Grabowski, Momotazur Rahman","doi":"10.1093/haschl/qxaf056","DOIUrl":"10.1093/haschl/qxaf056","url":null,"abstract":"Introduction: Medicare beneficiaries face significant health risks and care disruptions during public health emergencies, but little is known about how care patterns evolved throughout the COVID-19 pandemic or differed between traditional Medicare (TM) and Medicare Advantage (MA).Methods: Using Medicare claims data for over 20 million hospital discharges during 2018-2022, we examined trends in hospital length of stay, discharge disposition, and mortality among beneficiaries with 5 major comorbidities (dementia, diabetes, congestive heart failure, hip fracture, and stroke), stratified by COVID status and payer type.Results: We found that COVID patients initially experienced substantially longer hospital stays (8.3 vs 4.6 days) and higher 30-day mortality (34% vs 5%) compared to patients without COVID. MA beneficiaries showed consistently higher home health utilization but similar mortality patterns to TM enrollees. By mid-2022, most outcome differences had converged between COVID and non-COVID patients, suggesting health system adaptation to the pandemic.Conclusion: Our findings highlight how the pandemic was associated with shifts toward home-based post-acute care, emphasizing the need for policies supporting home-based care infrastructure and flexible care delivery models that could help health systems better adapt during future public health emergencies.","PeriodicalId":94025,"journal":{"name":"Health affairs scholar","volume":"3 4","pages":"qxaf056"},"PeriodicalIF":0.0,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11970246/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143797507","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}

引用次数: 0

Centering marginalized care: Home care cooperatives and system change.

Health affairs scholar Pub Date : 2025-03-17 eCollection Date: 2025-03-01 DOI: 10.1093/haschl/qxae184

Geoffrey M Gusoff, Lina Stepick, Aquilina Soriano-Versoza, Katrina Kazda

{"title":"Centering marginalized care: Home care cooperatives and system change.","authors":"Geoffrey M Gusoff, Lina Stepick, Aquilina Soriano-Versoza, Katrina Kazda","doi":"10.1093/haschl/qxae184","DOIUrl":"10.1093/haschl/qxae184","url":null,"abstract":"Home care workers (HCWs), who provide paid in-home support for daily activities, are at the center of the care received by millions of Americans. However, HCWs are profoundly marginalized professionally and economically within our political-economic system, which devalues care work, public goods, and the labor of women, immigrants, and workers of color. This systemic marginalization has contributed to the impoverishment of millions of HCWs and massive workforce shortages, which prevent millions of Americans from accessing the consistent care they need. Home care cooperatives-businesses co-owned and controlled by HCWs-represent an alternative approach that places HCWs at the center. By providing greater compensation, training opportunities, and control over workplace decisions, home care cooperatives have achieved greater continuity of care and half the turnover rates compared with traditional agencies. They demonstrate what is possible when HCWs are centered at an organizational level and what could be achieved if HCWs were centered at a system level. This latter possibility requires the following: (1) reclaiming care work as a public good and investing in it accordingly; (2) structurally empowering HCWs within the care team and broader economy; and (3) new narratives about HCWs that recognize their skills, value, and centrality in providing quality care.","PeriodicalId":94025,"journal":{"name":"Health affairs scholar","volume":"3 3","pages":"qxae184"},"PeriodicalIF":0.0,"publicationDate":"2025-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11909589/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143652882","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}

引用次数: 0