Health affairs scholar最新文献

Integrated impact of climate change on health outcomes and economic stability in PEPFAR-supported African countries. 气候变化对总统防治艾滋病紧急救援计划支持的非洲国家的卫生成果和经济稳定的综合影响。

IF 2.7

Health affairs scholar Pub Date : 2026-04-28 eCollection Date: 2026-04-01 DOI: 10.1093/haschl/qxag050

Sachin Silva, Veronique Whittaker, Eric Goosby, Michael J A Reid

{"title":"Integrated impact of climate change on health outcomes and economic stability in PEPFAR-supported African countries.","authors":"Sachin Silva, Veronique Whittaker, Eric Goosby, Michael J A Reid","doi":"10.1093/haschl/qxag050","DOIUrl":"https://doi.org/10.1093/haschl/qxag050","url":null,"abstract":"Introduction: Health impacts of global warming in sub-Saharan African countries that received President's Emergency Plan for AIDS Relief (PEPFAR)-funded HIV support are not known.Methods: Assuming the narrative of the Shared Socioeconomic Pathway 2, we estimated excess deaths, life expectancy losses at birth, and economic welfare losses in terms of full income. We relied on the MAGICC climate model for temperature predictions from 2025-2100 and net all-cause mortality risks estimated by others.Results: Surface temperature increases could reduce life expectancy at birth by 0.057 years in 2025 (95% CI: 0.024-0.095). By 2050, the reduction could increase by 30.7%, to 0.075 years (95% CI: 0.0311-0.1247). By 2100, it could further increase by 44.5%, to 0.083 years (95% CI: 0.034-0.138). Corresponding full income losses are US$11.44 billion in 2025 (95% CI: $4.77-$19.07 billion), which increases by 4-fold in 2050 to US$44.62 billion (95% CI: $18.65-$74.36 billion). By 2100, a 30-fold increase is possible, to US$353.56 billion (95% CI: $148.84-$588.32 billion). On a per capita basis, the highest full income losses consistently accrue to Lesotho between 2025 and 2100 (US$20.51, or 0.70% of per capita GDP, to US$355.39, or 0.80%).Conclusion: Adjusted investment is needed to address climate impacts, especially in countries such as Lesotho that may bear damage due to other regional emitters.","PeriodicalId":94025,"journal":{"name":"Health affairs scholar","volume":"4 4","pages":"qxag050"},"PeriodicalIF":2.7,"publicationDate":"2026-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13122613/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147792900","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

Invisible staffing churn in nursing homes: CMS turnover metrics miss a growing short-term workforce. 疗养院中无形的人员流动：CMS的人员流动指标忽略了不断增长的短期劳动力。

IF 2.7

Health affairs scholar Pub Date : 2026-04-18 eCollection Date: 2026-05-01 DOI: 10.1093/haschl/qxag094

Stephen Petterson, Katherine M Winter, J William Kerns, Danya M Qato, Linda Wastila, Nicole Brandt, Yu-Hua Fu, Roy T Sabo, YoonKyung Chung, Adam J Funk, Alex H Krist, Jonathan D Winter

{"title":"Invisible staffing churn in nursing homes: CMS turnover metrics miss a growing short-term workforce.","authors":"Stephen Petterson, Katherine M Winter, J William Kerns, Danya M Qato, Linda Wastila, Nicole Brandt, Yu-Hua Fu, Roy T Sabo, YoonKyung Chung, Adam J Funk, Alex H Krist, Jonathan D Winter","doi":"10.1093/haschl/qxag094","DOIUrl":"https://doi.org/10.1093/haschl/qxag094","url":null,"abstract":"Introduction: Federal policy mandates adequate nursing home (NH) staffing, yet staffing adequacy remains difficult to define and measure. In 2022, the Centers for Medicare & Medicaid Services (CMS) incorporated annual turnover into Five-Star Ratings but adopted a definition excluding staff below a 120-hour-in-90-days threshold, potentially underestimating turnover and weakening validity.Methods: Using Payroll-Based Journal and CareCompare data (2020Q2-2024Q1), we replicated CMS-reported turnover and constructed an inclusive measure counting new hires. We assessed divergence between definitions, associations with ten standardized CMS quality indicators, and changes in facility rankings.Results: By 2022-2023, 45% of nursing hires were excluded under CMS's definition. As short-term staffing increased, CMS-specification and inclusive turnover diverged (correlation 0.91-0.82). Associations with quality outcomes were modest and similar across definitions. However, facility rankings differed substantially: only 30% of facilities remained in the same turnover decile, with reclassification concentrated among NHs with high short-term attrition, greater contract use, and distinct ownership and payer mix.Conclusion: CMS turnover metrics miss nearly half of turnover, understating instability and reshaping facility comparisons without improving associations with quality outcomes. As short-term staffing expands, the CMS measure risks becoming less informative about workforce instability, underscoring how metric definitions shape oversight and reporting.","PeriodicalId":94025,"journal":{"name":"Health affairs scholar","volume":"4 5","pages":"qxag094"},"PeriodicalIF":2.7,"publicationDate":"2026-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13143168/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147847871","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

How segregation, low birth weight, unemployment, and violence link to low life expectancy in Chicago. 芝加哥的种族隔离、低出生体重、失业和暴力是如何与低预期寿命联系在一起的。

IF 2.7

Health affairs scholar Pub Date : 2026-04-17 eCollection Date: 2026-04-01 DOI: 10.1093/haschl/qxag080

John Rich, Edward Miech, Kate Mackie, Deborah Cragun, Eve Shapiro, Sage Kim, Minyoung Do, Jessica Bishop-Royse, David Ansell, Theodore Corbin

{"title":"How segregation, low birth weight, unemployment, and violence link to low life expectancy in Chicago.","authors":"John Rich, Edward Miech, Kate Mackie, Deborah Cragun, Eve Shapiro, Sage Kim, Minyoung Do, Jessica Bishop-Royse, David Ansell, Theodore Corbin","doi":"10.1093/haschl/qxag080","DOIUrl":"https://doi.org/10.1093/haschl/qxag080","url":null,"abstract":"Introduction: Life expectancy gaps between downtown Chicago and communities on the west and south approach 25 years. Multiple social factors relate to this gap, but identifying which are \"difference-makers\" is challenging.Methods: Using data from the Chicago Health Atlas, we analyzed 34 social factors using a configurational approach to identify the minimum set of factors necessary and sufficient for low life expectancy across Chicago's 77 community areas.Results: We identified 3 factors-high rates of low birth weight, high unemployment, and high non-fatal shootings-that were directly linked to low life expectancy across 3 pathways: (1) high rates of low birth weight AND high unemployment OR (2) high non-fatal shootings AND high rates of low birth weight OR (3) high non-fatal shootings AND high unemployment. We then explored whether high residential segregation was an antecedent to these pathways, and found that it directly linked to high rates of low birth weight, which, when combined with high unemployment and high non-fatal shootings, linked to low life expectancy.Conclusion: Understanding how the interplay of social factors contributes to the complex phenomenon of low life expectancy can help policymakers add precision and nuance to public health efforts to close life expectancy gaps.","PeriodicalId":94025,"journal":{"name":"Health affairs scholar","volume":"4 4","pages":"qxag080"},"PeriodicalIF":2.7,"publicationDate":"2026-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13093907/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147792767","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

Personalized prevention for all: changing how we approach the future of prevention. 人人享有个性化预防：改变我们对待预防未来的方式。

IF 2.7

Health affairs scholar Pub Date : 2026-04-16 eCollection Date: 2026-05-01 DOI: 10.1093/haschl/qxag089

Robb Rowley, Nephi A Walton

{"title":"Personalized prevention for all: changing how we approach the future of prevention.","authors":"Robb Rowley, Nephi A Walton","doi":"10.1093/haschl/qxag089","DOIUrl":"https://doi.org/10.1093/haschl/qxag089","url":null,"abstract":"Advances in genomics, informatics, and artificial intelligence (AI) are reshaping preventive medicine by enabling risk-stratified, personalized approaches to disease prevention. This paper argues for a systemic transformation in US health care policy to support equitable access to personalized prevention. We critique the inefficiencies of current age-based screening paradigms and highlight the potential of integrating polygenic risk scores, multi-omic data, and AI-driven analytics to optimize preventive strategies. However, without concurrent innovation in financing models, these advances risk exacerbating existing health disparities. Drawing on lessons from the rare disease community, we propose policy solutions, including expanded, equitably funded health savings accounts, transparent pricing, and patient-centered decision-support tools, to democratize access to personalized prevention. We advocate for a healthcare ecosystem that aligns technological innovation with flexible, patient-directed funding mechanisms, enabling all persons, not just the well-resourced, to benefit from precision prevention. The Human Genome Project promised to unlock the complete genetic blueprint of humans to revolutionize medicine through personalized care, disease prevention, and new biotechnologies. Realizing this goal requires coordinated action across science, policy, and payment systems to ensure that personalized prevention becomes a standard, equitable component of modern health care.","PeriodicalId":94025,"journal":{"name":"Health affairs scholar","volume":"4 5","pages":"qxag089"},"PeriodicalIF":2.7,"publicationDate":"2026-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13143009/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147847852","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 on hospitals of price reductions for physician-administered biologics. 医生管理的生物制剂降价对医院的影响。

IF 2.7

Health affairs scholar Pub Date : 2026-04-16 eCollection Date: 2026-04-01 DOI: 10.1093/haschl/qxag090

James C Robinson, Mark Thomson, Ari D Kosorukov, Christopher M Whaley

{"title":"Impact on hospitals of price reductions for physician-administered biologics.","authors":"James C Robinson, Mark Thomson, Ari D Kosorukov, Christopher M Whaley","doi":"10.1093/haschl/qxag090","DOIUrl":"https://doi.org/10.1093/haschl/qxag090","url":null,"abstract":"The prices of physician-administered drugs and biologics are coming under downward pressures from Medicare price negotiations, Most Favored Nation policies, and competition from biosimilars. These will reduce manufacturer sales revenue but potentially increase revenues for the hospitals that acquire these products at one price and are reimbursed by insurers at a higher price. This paper uses 2020-2024 Blue Cross Blue Shield insurer data on expenditures, pricing, and utilization to estimate the impact of manufacturer price decreases for 20 major biologics. Hospital margins for these 20 products increased from $2.37 billion in 2020 (55% of insurer expenditures) to $2.97 billion in 2024 (59%). A 20% manufacturer price reduction would increase hospital buy-and-bill margins to $4.84 billion, 52% of insurer expenditures, while a 40% reduction would increase hospital margins to $5.97 billion, 64% of insurer expenditures. The shift in insurer expenditures from drug manufacturers to hospitals is estimated to reduce research and development (R&D) investments between $282 and $564 million in 2028. A large share of insurer expenditures for physician-administered drugs and biologics are retained by hospital intermediaries rather than accruing to pharmaceutical manufacturers.","PeriodicalId":94025,"journal":{"name":"Health affairs scholar","volume":"4 4","pages":"qxag090"},"PeriodicalIF":2.7,"publicationDate":"2026-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13126657/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147824825","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

Exposure to the new Medicare Advantage risk adjustment model varies across insurers. 对新的医疗保险优势风险调整模型的敞口因保险公司而异。

IF 2.7

Health affairs scholar Pub Date : 2026-04-16 eCollection Date: 2026-05-01 DOI: 10.1093/haschl/qxag092

Jeffrey Marr, Andrew M Ryan, David J Meyers

{"title":"Exposure to the new Medicare Advantage risk adjustment model varies across insurers.","authors":"Jeffrey Marr, Andrew M Ryan, David J Meyers","doi":"10.1093/haschl/qxag092","DOIUrl":"https://doi.org/10.1093/haschl/qxag092","url":null,"abstract":"Introduction: Medicare Advantage plan payment depends on the health of enrolled patients. As a result, the extent to which beneficiary clinical severity is documented administratively-known as coding intensity-is greater in Medicare Advantage (MA) than in traditional Medicare, which inflates payment to plans. In 2024, the Centers for Medicare and Medicaid Services began phasing in a new risk adjustment model intended to reduce the susceptibility of MA payments to higher coding intensity.Methods: Using 2021 data, we compared average MA contract risk scores under the new model and the old model.Results: Risk scores were 5.8% lower under the new risk adjustment model. Differences between average risks scores under the new and old model varied substantially across contracts and insurers. For example, 1 large insurer's risk scores were essentially unchanged across models while another large insurer's risk score was 18% lower under the new model. Contracts with higher estimated coding intensity had greater exposure to the new risk adjustment model.Conclusion: Our results suggest that the new risk adjustment model will likely reduce MA payments due to enhanced coding intensity, with these reductions appropriately targeting insurers that code more intensely.","PeriodicalId":94025,"journal":{"name":"Health affairs scholar","volume":"4 5","pages":"qxag092"},"PeriodicalIF":2.7,"publicationDate":"2026-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13143170/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147847897","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

Reporting rates of topped-out merit-based incentive payment system (MIPS) quality measures, 2017-2023. 2017-2023年绩效激励支付系统（MIPS）质量指标的完成率报告。

IF 2.7

Health affairs scholar Pub Date : 2026-04-12 eCollection Date: 2026-04-01 DOI: 10.1093/haschl/qxag061

YoonKyung Chung, Lauren P Nicola, Elizabeth Y Rula

{"title":"Reporting rates of topped-out merit-based incentive payment system (MIPS) quality measures, 2017-2023.","authors":"YoonKyung Chung, Lauren P Nicola, Elizabeth Y Rula","doi":"10.1093/haschl/qxag061","DOIUrl":"https://doi.org/10.1093/haschl/qxag061","url":null,"abstract":"Introduction: Merit-based Incentive Payment System (MIPS) quality measures are designated as \"topped-out\" when reporting clinicians consistently achieve high performance, resulting in potential scoring caps and eventual removal. However, self-selected measure reporting may not provide a representative assessment.Methods: Using CMS Quality Payment Program Experience datasets from 2017 to 2023 linked with MIPS Quality Measures Lists and Benchmark data, we examined reporting rates of all MIPS topped-out quality measures among eligible physicians and by specialty at the time of their first \"topped-out\" designation.Results: Between 2017 and 2023, 643,558 physicians reported specialty-relevant measures across 37 specialties and 275 measures, of which 137 (49%) were topped-out. Over half of the topped-out measures had reporting rates below 5%. Only 11 measures were reported by more than half of eligible physicians. The median reporting rate was 7.1% (IQR [1.3%, 28.2%]) and varied across specialties, ranging from 0.6% in geriatric medicine to 40.4% in pathology.Conclusion: Our findings suggest CMS topped-out designations may not reflect universally high performance for a measure and highlight challenges of MIPS measure self-selection and topped-out designation. Opportunities exist within MIPS design to maintain measures that broadly promote high quality care for all Medicare beneficiaries and continued improvement.","PeriodicalId":94025,"journal":{"name":"Health affairs scholar","volume":"4 4","pages":"qxag061"},"PeriodicalIF":2.7,"publicationDate":"2026-04-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13071504/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147694110","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

Eroding the foundation: health and social needs of adult SNAP participants in an era of policy change. 侵蚀基础：政策变化时代成年SNAP参与者的健康和社会需求。

IF 2.7

Health affairs scholar Pub Date : 2026-04-10 eCollection Date: 2026-04-01 DOI: 10.1093/haschl/qxag086

Kevin H Nguyen, Cristina M Gago, Stephanie Ettinger de Cuba

{"title":"Eroding the foundation: health and social needs of adult SNAP participants in an era of policy change.","authors":"Kevin H Nguyen, Cristina M Gago, Stephanie Ettinger de Cuba","doi":"10.1093/haschl/qxag086","DOIUrl":"https://doi.org/10.1093/haschl/qxag086","url":null,"abstract":"In 2025, the Supplemental Nutrition Assistance Program (SNAP) was at the center of policy debate. SNAP-specific provisions within the \"One Big Beautiful Bill Act\" (OBBBA) will affect about 42 million low-income participants. To ground policy proposals and national discourse in evidence, we (1) summarize the characteristics of adult SNAP participants and then (2) describe how recent legislation and proposals may affect them. Using data from 34 states and the District of Columbia, approximately 1 in 10 adults in our sample reported SNAP participation in the last 12 months. Compared to non-participants, adult SNAP participants were significantly more likely to report fair/poor health status, inability to see a doctor because of cost, and health-related social needs (eg, food insecurity, inability to pay bills, lack of reliable transportation), conflicting with some public perceptions of participant characteristics. Provisions within OBBBA will impose financial burdens on states and create barriers to eligibility (eg, excluding previously eligible populations) and enrollment/recertification (eg, adding administrative burdens) for participants. Considering adult SNAP participants face concurrent material hardship, changes to the program may exacerbate existing disparities in health and economic stability of low-income households nationwide on SNAP benefits to assist in meeting basic needs.","PeriodicalId":94025,"journal":{"name":"Health affairs scholar","volume":"4 4","pages":"qxag086"},"PeriodicalIF":2.7,"publicationDate":"2026-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13094737/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147792721","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

Do policy context and structural disadvantage shape SNF VBP performance? Evidence from national facility-year data. 政策背景和结构性劣势影响SNF VBP绩效吗？来自国家设施年数据的证据。

IF 2.7

Health affairs scholar Pub Date : 2026-04-10 eCollection Date: 2026-04-01 DOI: 10.1093/haschl/qxag087

Juhi B Shahani, Kathryn D Thompson

{"title":"Do policy context and structural disadvantage shape SNF VBP performance? Evidence from national facility-year data.","authors":"Juhi B Shahani, Kathryn D Thompson","doi":"10.1093/haschl/qxag087","DOIUrl":"https://doi.org/10.1093/haschl/qxag087","url":null,"abstract":"Introduction: Skilled nursing facility (SNF) performance under the Centers for Medicare and Medicaid Services (CMS) Skilled Nursing Facility Value-Based Purchasing (SNF VBP) program is intended to reflect quality of care but may also be shaped by broader policy and structural contexts. This study evaluates whether Medicaid expansion status and structural disadvantage, measured using the Structural Racism Effects Index (SREI), are associated with high SNF performance.Methods: We conducted a pooled repeated cross-sectional analysis of facility-level data from fiscal years 2019-2021 and 2024, including 57 816 facility-year observations. High performance was defined as a total SNF VBP score ≥50 (upper quartile). Multivariable logistic regression estimated associations between Medicaid expansion, SREI, and high performance, adjusting for ownership, facility size, resident census, nurse staffing, prior penalties, and year.Results: Facilities in Medicaid expansion states had higher odds of high performance (aOR = 1.19; 95% CI: 1.13-1.24), while greater structural disadvantage was associated with lower odds (OR = 0.87; 95% CI: 0.85-0.89). Higher registered nurse staffing was associated with better performance, while ownership, LPN staffing, and penalties were not significant.Conclusion: SNF performance reflects both policy and structural conditions. Without accounting for these factors, value-based payment models may reinforce existing inequities.","PeriodicalId":94025,"journal":{"name":"Health affairs scholar","volume":"4 4","pages":"qxag087"},"PeriodicalIF":2.7,"publicationDate":"2026-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13101974/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147792725","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

Implementing Title X: policy design, administration, and geographic access to care. 实施标题X：政策设计、管理和地理上的医疗服务。

IF 2.7

Health affairs scholar Pub Date : 2026-04-09 eCollection Date: 2026-04-01 DOI: 10.1093/haschl/qxag082

Tracee M Saunders, Kellen A Kane, Candis Watts Smith

{"title":"Implementing Title X: policy design, administration, and geographic access to care.","authors":"Tracee M Saunders, Kellen A Kane, Candis Watts Smith","doi":"10.1093/haschl/qxag082","DOIUrl":"https://doi.org/10.1093/haschl/qxag082","url":null,"abstract":"Background: Title X of the Public Health Service Act is a critical federal program-the only one dedicated exclusively to providing affordable, confidential, evidence-based reproductive health care to low-income populations, yet its capacity to fulfill this mandate depends on political, administrative, and fiscal decisions made across multiple levels of governance-from Congress and federal regulators to state and regional grantees and their sub-grantee clinic networks.Methods: This study assesses geographic access to Title X-funded clinics across all 50 states and the District of Columbia in 2024, a period with significant program and regulatory disruption. Using the Integrated Two-Step Floating Catchment Area (I2SFCA) method-which employs road-network-based drive time thresholds calibrated to urban-rural context-applied to 2024 clinic locations and census-tract-level demographic data, we identify a confluence of spatial and nonspatial barriers to Title X.Results: Findings reveal widespread and substantial gaps in geographic access, a challenge faced by people across all racial groups, rural and urban residents, and individuals with low incomes.Conclusion: These findings offer a precise geographic account of where Title X's reach falls shortest-documenting the ramifications of policy retrenchment and establishing a baseline against which future policy changes can be measured.","PeriodicalId":94025,"journal":{"name":"Health affairs scholar","volume":"4 4","pages":"qxag082"},"PeriodicalIF":2.7,"publicationDate":"2026-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13101994/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147792889","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