Health affairs scholar最新文献_第2页

Sustainable solutions to the continuous threat of antimicrobial resistance.

Health affairs scholar Pub Date : 2025-01-24 eCollection Date: 2025-02-01 DOI: 10.1093/haschl/qxaf012

Brad Spellberg, David N Gilbert, Michael Baym, Gonzalo Bearman, Tom Boyles, Arturo Casadevall, Graeme N Forrest, Sarah Freling, Bassam Ghanem, Fergus Hamilton, Brian Luna, Jessica Moore, Daniel M Musher, Travis B Nielsen, Priya Nori, Matthew C Phillips, Liise-Anne Pirofski, Andrew F Shorr, Steven Y C Tong, Todd C Lee, Emily G McDonald

{"title":"Sustainable solutions to the continuous threat of antimicrobial resistance.","authors":"Brad Spellberg, David N Gilbert, Michael Baym, Gonzalo Bearman, Tom Boyles, Arturo Casadevall, Graeme N Forrest, Sarah Freling, Bassam Ghanem, Fergus Hamilton, Brian Luna, Jessica Moore, Daniel M Musher, Travis B Nielsen, Priya Nori, Matthew C Phillips, Liise-Anne Pirofski, Andrew F Shorr, Steven Y C Tong, Todd C Lee, Emily G McDonald","doi":"10.1093/haschl/qxaf012","DOIUrl":"10.1093/haschl/qxaf012","url":null,"abstract":"To combat antimicrobial resistance (AMR), advocates have called for passage of the Pioneering Antimicrobial Subscriptions To End Upsurging Resistance (PASTEUR) Act in the United States, which would appropriate $6 billion in new taxpayer-funded subsidies for antibiotic development. However, the number of antibiotics in clinical development, and US Food and Drug Administration approvals of new antibiotics, have already markedly increased in the last 15 years. Thus, instead of focusing on more economic subsidies, we recommend reducing selective pressure driving AMR by (1) establishing pay-for-performance mechanisms that disincentivize overprescribing of antibiotics, (2) focusing existing research and development funding on strategies that decrease reliance on antibiotics, and (3) changing regulation or law to require specialized training in antibiotic stewardship for a clinician to be able to prescribe new antibiotics that target unmet AMR need. To stabilize the antibiotic market, we recommend (1) establishment of an advisory board of clinical practitioners to more accurately target existing antibiotic incentives and (2) endowment of nonprofit companies that sustainably self-fund antibiotic discovery, creating a bench of molecules that can be partnered with industry at later stages of development.","PeriodicalId":94025,"journal":{"name":"Health affairs scholar","volume":"3 2","pages":"qxaf012"},"PeriodicalIF":0.0,"publicationDate":"2025-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11798182/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143367103","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

Letter to the Editor in response to Performance of the Washington Group questions in measuring blindness and deafness by Landes et al.

Health affairs scholar Pub Date : 2025-01-23 eCollection Date: 2025-01-01 DOI: 10.1093/haschl/qxae177

Jennifer Madans, Daniel Mont, Nanette Goodman

引用次数: 0

Economic and equity evaluation of age restrictions on over-the-counter diet pills and muscle-building supplements.

Health affairs scholar Pub Date : 2025-01-22 eCollection Date: 2025-01-01 DOI: 10.1093/haschl/qxaf002

Cynthia A Tschampl, Masami Tabata-Kelly, Mary R Lee, Elena Soranno, Upanita Barman, Amanda Raffoul, S Bryn Austin

{"title":"Economic and equity evaluation of age restrictions on over-the-counter diet pills and muscle-building supplements.","authors":"Cynthia A Tschampl, Masami Tabata-Kelly, Mary R Lee, Elena Soranno, Upanita Barman, Amanda Raffoul, S Bryn Austin","doi":"10.1093/haschl/qxaf002","DOIUrl":"10.1093/haschl/qxaf002","url":null,"abstract":"Over-the-counter diet pills and muscle-building supplements are linked to increased eating disorder diagnoses, especially among youth. With limited regulatory oversight, minors may unknowingly consume harmful substances leading to other adverse effects. Massachusetts has proposed restricting sales to individuals under 18 years. However, concerns about health equity and unintended consequences arise when proposing new policies. We conducted a cost-effectiveness analysis of the proposed age-restriction policy compared to the status quo, focusing on 2 closed cohorts of males and females aged 0-17 years in Massachusetts over a 30-year time horizon. We evaluated the impact from both societal and health systems' perspectives and further assessed equity implications by modeling 3 racial/ethnic subgroups. The policy is projected to prevent 57 034 eating disorder cases and over 46 000 additional adverse medical events (eg, liver injuries). It would yield 51 749 quality-adjusted life years and generate healthcare savings of $14 million and societal savings of $30 million annually. The Latine subpopulation would see the highest per capita health benefits followed by Black and White residents, respectively. Restricting the sale of these supplements to minors offers both health and economic benefits. These findings underscore the policy's effectiveness, fiscal responsibility, and positive equity impacts, providing confidence for policymakers and the public.","PeriodicalId":94025,"journal":{"name":"Health affairs scholar","volume":"3 1","pages":"qxaf002"},"PeriodicalIF":0.0,"publicationDate":"2025-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11751689/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143026158","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

Sanctuary policies and type 2 diabetes medication prescription trends among community health center patients. 社区卫生中心患者的庇护政策和2型糖尿病药物处方趋势。

Health affairs scholar Pub Date : 2025-01-21 eCollection Date: 2025-01-01 DOI: 10.1093/haschl/qxae178

Salome Goglichidze, Wanjiang Wang, Louisa H Smith, David Ezekiel-Herrera, John D Heintzman, Miguel Marino, Jennifer A Lucas, Danielle M Crookes

{"title":"Sanctuary policies and type 2 diabetes medication prescription trends among community health center patients.","authors":"Salome Goglichidze, Wanjiang Wang, Louisa H Smith, David Ezekiel-Herrera, John D Heintzman, Miguel Marino, Jennifer A Lucas, Danielle M Crookes","doi":"10.1093/haschl/qxae178","DOIUrl":"10.1093/haschl/qxae178","url":null,"abstract":"Immigrants in the United States are at increased risk of diabetes-related complications due to delayed diagnoses compared with US-born individuals. Immigration-related federal policies may support immigration enforcement activities and restrict some immigrants' access to health insurance and other publicly funded resources. Conversely, state and county-level sanctuary policies may reduce the fear of deportation and increase mobility in the community, improving the accessibility of essential pharmacological treatment for type 2 diabetes patients. This retrospective cohort study estimated the odds of receiving glucose-lowering medication prescriptions by the county's sanctuary policy environment for patients within a nationwide network of community health centers. We did not find statistically significant associations between sanctuary policies and annual prescription rates. The associations were not modified by nativity or race/ethnicity. Notably, compared to US-born patients, immigrants had higher odds of receiving prescriptions regardless of the sanctuary policy environment, emphasizing other potential influences on the receipt of anti-diabetes prescriptions for community health center patients.","PeriodicalId":94025,"journal":{"name":"Health affairs scholar","volume":"3 1","pages":"qxae178"},"PeriodicalIF":0.0,"publicationDate":"2025-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11747669/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143018861","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

Understanding health care price variation: evidence from Transparency-in-Coverage data.

Health affairs scholar Pub Date : 2025-01-21 eCollection Date: 2025-02-01 DOI: 10.1093/haschl/qxaf011

Christopher Whaley, Nandita Radhakrishnan, Michael Richards, Kosali Simon, Benjamin Chartock

{"title":"Understanding health care price variation: evidence from Transparency-in-Coverage data.","authors":"Christopher Whaley, Nandita Radhakrishnan, Michael Richards, Kosali Simon, Benjamin Chartock","doi":"10.1093/haschl/qxaf011","DOIUrl":"10.1093/haschl/qxaf011","url":null,"abstract":"Competition in health care markets should lead to lower prices and less dispersion, with consumer choice as the driving mechanism. Several studies document price variation, suggesting room for improvement; however, they relied on selected data from insurers who provide access to data, limiting generalizability. We document the nature of price variation in the private US market across geography, payer, and provider by leveraging a new dataset, implementing a descriptive analysis using the most comprehensive data available: Transparency-in-Coverage. We measured health care prices in 3 ways: percentile distribution prices for common services, state-level and insurer-level facility fee price indices, and regression-adjusted mean inpatient and outpatient prices. Variation is large: the mean facility fee for a foot X-ray, for example, is $86 at Anthem and $190 at UnitedHealth. Pricing does not appear to be uniform; there is just 22% correlation between an insurer's inpatient price and outpatient facility price. And there is little difference in ordering of high-price states depending on alternative measures, such as relative to Medicare. Results suggest greater consideration of policies to address high and variable prices for US health care.","PeriodicalId":94025,"journal":{"name":"Health affairs scholar","volume":"3 2","pages":"qxaf011"},"PeriodicalIF":0.0,"publicationDate":"2025-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11798183/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143367069","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

Estimating financial and health burden by initial Medicare plan choice and history of cancer. 根据最初的医疗保险计划选择和癌症病史估算财务和健康负担。

Health affairs scholar Pub Date : 2025-01-21 eCollection Date: 2025-01-01 DOI: 10.1093/haschl/qxaf001

Shelley A Jazowski, Emma M Achola, Lauren Hersch Nicholas, William A Wood, Christopher R Friese, Stacie B Dusetzina

{"title":"Estimating financial and health burden by initial Medicare plan choice and history of cancer.","authors":"Shelley A Jazowski, Emma M Achola, Lauren Hersch Nicholas, William A Wood, Christopher R Friese, Stacie B Dusetzina","doi":"10.1093/haschl/qxaf001","DOIUrl":"10.1093/haschl/qxaf001","url":null,"abstract":"Understanding the downstream consequences of initial Medicare plan selection is necessary to ensure access to and affordability of health care services, especially for older adults with serious illness. We used 2008-2020 data from the Health and Retirement Study to estimate financial and health burden by initial Medicare plan selection (traditional Medicare without supplemental coverage, traditional Medicare plus supplemental coverage, or Medicare Advantage) and self-reported history of cancer. Initially choosing benefits with greater financial protections (either traditional Medicare plus supplemental coverage or Medicare Advantage) relative to traditional Medicare without supplemental coverage was associated with lower levels of out-of-pocket spending and a lower likelihood of reporting cost-related medication nonadherence and fair or poor health. Policymakers should consider improving the adequacy of traditional Medicare coverage to ensure the affordability of health care services and reduce the burden of serious illness among older adults, especially those with a history of cancer.","PeriodicalId":94025,"journal":{"name":"Health affairs scholar","volume":"3 1","pages":"qxaf001"},"PeriodicalIF":0.0,"publicationDate":"2025-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11747364/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143018852","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

Implementation challenges of the new federal nursing home staffing rules will vary across states.

Health affairs scholar Pub Date : 2025-01-17 eCollection Date: 2025-02-01 DOI: 10.1093/haschl/qxaf009

Deepon Bhaumik, David C Grabowski

引用次数: 0

How do hospitals exert market power? Evidence from health systems and commercial health plan prices. 医院如何发挥市场力量？来自卫生系统和商业卫生计划价格的证据。

Health affairs scholar Pub Date : 2025-01-16 eCollection Date: 2025-01-01 DOI: 10.1093/haschl/qxae179

Suhui Evelyn Li, David Jones, Eugene Rich, Aimee Lansdale

{"title":"How do hospitals exert market power? Evidence from health systems and commercial health plan prices.","authors":"Suhui Evelyn Li, David Jones, Eugene Rich, Aimee Lansdale","doi":"10.1093/haschl/qxae179","DOIUrl":"10.1093/haschl/qxae179","url":null,"abstract":"Consolidation of independent hospitals and physician practices into integrated health systems has reshaped the delivery of health care. While the literature suggests that provider consolidation raises prices, few studies have examined the interplay of health systems and insurers in relation to prices. Using negotiated price data that commercial insurers recently released under the Transparency in Coverage Final Rule, we examined the association between hospital concentration under health systems and prices for outpatient procedures in local health care markets with different levels of insurer concentration. We found that hospital prices are higher in more concentrated hospital markets, while lower in more concentrated insurer markets. However, the negative relationship between insurer concentration and hospital prices is attenuated in highly concentrated hospital markets, suggesting that insurers' bargaining leverage is lessened at greater levels of hospital consolidation. Considering the continued consolidation among hospitals and vertical integration of physician practices into health systems, our findings suggest that commercial payers may encounter increased challenges in controlling health care spending for their beneficiaries as providers' bargaining power continues to grow.","PeriodicalId":94025,"journal":{"name":"Health affairs scholar","volume":"3 1","pages":"qxae179"},"PeriodicalIF":0.0,"publicationDate":"2025-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11736714/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143018856","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

Coding intensity variation in Medicare Advantage. 医疗保险优势的编码强度变化。

Health affairs scholar Pub Date : 2025-01-16 eCollection Date: 2025-01-01 DOI: 10.1093/haschl/qxae176

Vilsa E Curto, Eran Politzer, Timothy S Anderson, John Z Ayanian, Jeffrey Souza, Alan M Zaslavsky, Bruce E Landon

{"title":"Coding intensity variation in Medicare Advantage.","authors":"Vilsa E Curto, Eran Politzer, Timothy S Anderson, John Z Ayanian, Jeffrey Souza, Alan M Zaslavsky, Bruce E Landon","doi":"10.1093/haschl/qxae176","DOIUrl":"10.1093/haschl/qxae176","url":null,"abstract":"Enrollment in Medicare Advantage (MA) plans rose to over 50% of eligible Medicare patients in 2023. Payments to MA plans incorporate risk scores that are largely based on patient diagnoses from the prior year, which incentivizes MA plans to code diagnoses more intensively. We estimated coding inflation rates for individual MA contracts using a method that allows for differential selection into contracts based on patient health. We illustrate the method using data on MA risk scores and health conditions from the most recent year available, 2014. This approach could also be used beginning in 2022, when Medicare transitioned to MA risk scores based on MA Encounter records. Several existing methods assess coding intensity, but this study's approach is novel in its use of plan-level mortality rates to infer plan-level coding intensity. We found an enrollment-weighted mean coding inflation rate of 8.4%, with rates ranging from 3.4% to 12.7% for the largest 8 MA insurers and from 1.1% to 22.2% for the largest 20 MA contracts in 2014. We found higher coding intensity for health plans that were HMOs, provider-owned, large, older, or had high star ratings. Approximately 68.1% of MA enrollees were in contracts with coding inflation rates larger than Medicare's coding intensity adjustment.","PeriodicalId":94025,"journal":{"name":"Health affairs scholar","volume":"3 1","pages":"qxae176"},"PeriodicalIF":0.0,"publicationDate":"2025-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11736778/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143018850","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

Paying for home care out-of-pocket is common and costly across the income spectrum among older adults. 在收入水平不同的老年人中，自付家庭护理费用是一种普遍而昂贵的做法。

Health affairs scholar Pub Date : 2025-01-16 eCollection Date: 2025-01-01 DOI: 10.1093/haschl/qxae180

Karen Shen, Yang Yang, Katherine A Ornstein, Regina A Shih, Jennifer M Reckrey

{"title":"Paying for home care out-of-pocket is common and costly across the income spectrum among older adults.","authors":"Karen Shen, Yang Yang, Katherine A Ornstein, Regina A Shih, Jennifer M Reckrey","doi":"10.1093/haschl/qxae180","DOIUrl":"10.1093/haschl/qxae180","url":null,"abstract":"Many older adults with personal care needs rely on paid caregivers to remain in the community (\"home care\"). Those without Medicaid or private long-term-care insurance must pay out-of-pocket for care. We used the Health and Retirement Study to identify the prevalence and financial burden of paying for home care out-of-pocket in 2002-2018, by income and dementia status. Over 600 000 people with personal care needs paid out-of-pocket for home care in a given year, 45% of whom have dementia. The quantity and cost of this care were substantial for people with dementia in particular: 51% of those with dementia paying out-of-pocket for home care spent ≥$1000/month. While the probability of paying out-of-pocket for home care increased sharply with income, 52% of people paying out-of-pocket for home care had incomes below 200% of the federal poverty line; this group faced high financial burdens of care. Policies aimed at easing the financial burden of home care are essential, particularly for low-income individuals with dementia who experience the greatest financial burden.","PeriodicalId":94025,"journal":{"name":"Health affairs scholar","volume":"3 1","pages":"qxae180"},"PeriodicalIF":0.0,"publicationDate":"2025-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11736716/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143018858","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