Health affairs scholar最新文献_第2页

Increasing fruit and vegetable access for young children and families: the critical impact of WIC policy. 增加幼儿和家庭获得水果和蔬菜的机会：妇女大会政策的关键影响。

IF 4.1

Health affairs scholar Pub Date : 2026-09-24 eCollection Date: 2026-10-01 DOI: 10.1093/haschl/qxag259

Shannon E Whaley, Rebecca Brough, Catherine E Yepez, Christopher E Anderson, Marianne Bitler

{"title":"Increasing fruit and vegetable access for young children and families: the critical impact of WIC policy.","authors":"Shannon E Whaley, Rebecca Brough, Catherine E Yepez, Christopher E Anderson, Marianne Bitler","doi":"10.1093/haschl/qxag259","DOIUrl":"10.1093/haschl/qxag259","url":null,"abstract":"The Special Supplemental Nutrition Program for Women, Infants and Children (WIC) has ensured access to healthy foods for participating low-income pregnant and postpartum women and children under age 5 for over 50 years. Serving ∼6.8 million individuals monthly, WIC-eligible foods align with dietary science and only include foods rich in nutrients known to be deficient in US diets. Fruits and vegetables (FV) were introduced to the WIC food package in 2009; the $8-$10/month for FV were associated with small increases in consumption. In 2021, WIC FV benefits increased to provide 50% of the recommended daily allowance for FV ($24/month for children). This marked a critical policy shift supporting FV access for young children and was associated with statistically significant increases in FV intake and household food security for WIC families. Despite these positive impacts, federal policymakers are considering reducing these to as little as $10/month. We present a brief history of the WIC food package; describe the impacts of the 2021 increase in FV benefits that align the WIC food package with dietary recommendations; and add new quasiexperimental analyses that suggest the expanded benefit for FV led to increased redemptions of FV and reductions would likely reduce FV access for WIC families.","PeriodicalId":94025,"journal":{"name":"Health affairs scholar","volume":"4 10","pages":"qxag259"},"PeriodicalIF":4.1,"publicationDate":"2026-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13678218/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149225770","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

Hospital add-on payments are associated with variation in Medicare and commercial payments. 医院附加支付与医疗保险和商业支付的变化有关。

IF 4.1

Health affairs scholar Pub Date : 2026-09-24 eCollection Date: 2026-10-01 DOI: 10.1093/haschl/qxag258

Roslyn C Murray, Andrew M Ryan, Christopher M Whaley

{"title":"Hospital add-on payments are associated with variation in Medicare and commercial payments.","authors":"Roslyn C Murray, Andrew M Ryan, Christopher M Whaley","doi":"10.1093/haschl/qxag258","DOIUrl":"10.1093/haschl/qxag258","url":null,"abstract":"Introduction: Medicare is the largest payer of hospital services in the United States. Under the inpatient prospective payment system, hospitals receive \"base\" and \"add-on\" payments that are adjusted for geographic and hospital-specific factors to reflect differences in costs. Variation in Medicare payments has received little attention, as research has primarily focused on commercial price variation. The relationship between Medicare and commercial payment variation is also not well understood and a topic of considerable controversy.Methods: We used 2023 data from the Centers for Medicare and Medicaid Services' Inpatient Prospective Payment System Impact File to estimate standardized Medicare base and final payments to inpatient prospective payment system hospitals in the United States.Results: We found that Medicare final payments vary more than base rates across both hospitals and states due largely to add-on payments. Commercial prices are positively correlated with Medicare add-on payments.Conclusion: Our study highlights the importance of add-ons in driving variation in Medicare payments, potentially influencing variation in commercial prices.","PeriodicalId":94025,"journal":{"name":"Health affairs scholar","volume":"4 10","pages":"qxag258"},"PeriodicalIF":4.1,"publicationDate":"2026-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13648202/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149140041","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

Sociodemographic disparities in semaglutide and tirzepatide prescription for obesity treatment. 西马鲁肽和替西帕肽治疗肥胖处方的社会人口差异。

IF 4.1

Health affairs scholar Pub Date : 2026-09-22 eCollection Date: 2026-10-01 DOI: 10.1093/haschl/qxag255

Minh Trung Le, Andrew C Stokes

{"title":"Sociodemographic disparities in semaglutide and tirzepatide prescription for obesity treatment.","authors":"Minh Trung Le, Andrew C Stokes","doi":"10.1093/haschl/qxag255","DOIUrl":"10.1093/haschl/qxag255","url":null,"abstract":"Introduction: Semaglutide and tirzepatide, the 2 most recently approved glucagon-like peptide-1 receptor agonists, have demonstrated substantial effectiveness in weight management. However, evidence on treatment inequities remains limited. This study assesses temporal trends and sociodemographic disparities in semaglutide and tirzepatide prescription.Methods: Using claims data from Komodo Health, we identified commercially insured individuals aged 18-64 years with overweight or obesity but without type 2 diabetes. We estimated 6-month cumulative incidence of semaglutide and tirzepatide prescription across sociodemographic groups and examined disparities by health care provider socioeconomic status.Results: Six-month cumulative incidence of prescription increased from 1.9% to 16.6% over the study period. Higher access was associated with being female, non-Hispanic White, in higher body mass index categories, and seen at a higher socioeconomic status (SES)-quartile provider. Uptake was significantly lower in lower provider neighborhood SES groups (lowest quartile adjusted odds ratio: 0.75; 95% CI: 0.73-0.78, compared with the highest quartile), and the differences widened over time. The SES disparities were more pronounced at lower BMI categories.Conclusion: Prescription of semaglutide and tirzepatide increased rapidly from 2021 to 2025. Sociodemographic disparities widened over time. Policies addressing provider-level resourcing and pharmaco-equity in drug benefit design are needed to prevent these therapies from exacerbating existing health disparities.","PeriodicalId":94025,"journal":{"name":"Health affairs scholar","volume":"4 10","pages":"qxag255"},"PeriodicalIF":4.1,"publicationDate":"2026-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13648207/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149140016","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 on the 2025 National Academies Pharmacy Workshop: pharmacy deserts in the United States. 以2025年国家科学院药学研讨会为基础：美国的药学沙漠。

IF 4.1

Health affairs scholar Pub Date : 2026-09-22 eCollection Date: 2026-10-01 DOI: 10.1093/haschl/qxag256

Lucas A Berenbrok, Delesha Carpenter, Teresa M Salgado, Marie Chisholm-Burns, Jenny S Guadamuz, Elizabeth Hall-Lipsy, Cherokee Layson-Wolf, Whitney D Maxwell, Heidi R Olson, Megan R Undeberg, Stevie Veach, Vicki L Ellingrod

{"title":"Building on the 2025 National Academies Pharmacy Workshop: pharmacy deserts in the United States.","authors":"Lucas A Berenbrok, Delesha Carpenter, Teresa M Salgado, Marie Chisholm-Burns, Jenny S Guadamuz, Elizabeth Hall-Lipsy, Cherokee Layson-Wolf, Whitney D Maxwell, Heidi R Olson, Megan R Undeberg, Stevie Veach, Vicki L Ellingrod","doi":"10.1093/haschl/qxag256","DOIUrl":"https://doi.org/10.1093/haschl/qxag256","url":null,"abstract":"Areas with no access or limited access to community pharmacies are routinely referred to as \"pharmacy deserts,\" which are of growing concern in the United States. In addition to medication dispensing, community pharmacies offer a variety of healthcare services that keep populations and individuals healthy. Our objective is to present an overview of pharmacy deserts in the United States, discuss the impact of reduced pharmacy access for Americans, and propose solutions discussed at the 2025 Innovations in Pharmacy Training and Sustainable Practice to Advance Patient Care: A Workshop at the National Academies in Washington, D.C. Policy and legislation that ensure the financial sustainability of community pharmacies as staples of healthcare delivery in local neighborhoods should consider these multimodal solutions to ensure pharmacy access for all populations in the United States.","PeriodicalId":94025,"journal":{"name":"Health affairs scholar","volume":"4 10","pages":"qxag256"},"PeriodicalIF":4.1,"publicationDate":"2026-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13653339/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149167629","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

Research letter: prenatal leave-taking in the US remains low despite expanded policy support. 研究信函：尽管政策支持力度加大，但美国的产前休假率仍很低。

IF 4.1

Health affairs scholar Pub Date : 2026-09-19 eCollection Date: 2026-10-01 DOI: 10.1093/haschl/qxag253

Julia M Goodman, William H Dow

引用次数: 0

Medicare spending and most-favored-nation pricing models. 医疗保险支出和最惠国定价模式。

IF 4.1

Health affairs scholar Pub Date : 2026-09-19 eCollection Date: 2026-10-01 DOI: 10.1093/haschl/qxag254

Matthew Vogel, Shiloh Liu, Vikram Sharma, Olivier J Wouters

引用次数: 0

Long-term growth in child mental health expenditures, 2004-2023. 2004-2023年儿童心理健康支出的长期增长。

IF 4.1

Health affairs scholar Pub Date : 2026-09-17 eCollection Date: 2026-09-01 DOI: 10.1093/haschl/qxag250

Joshua Breslau, Dar Alon, Alyssa Burnett, Jonathan Cantor, Ryan K McBain, Ateev Mehrotra, Bradley D Stein, Fang Zhang, Hao Yu

{"title":"Long-term growth in child mental health expenditures, 2004-2023.","authors":"Joshua Breslau, Dar Alon, Alyssa Burnett, Jonathan Cantor, Ryan K McBain, Ateev Mehrotra, Bradley D Stein, Fang Zhang, Hao Yu","doi":"10.1093/haschl/qxag250","DOIUrl":"10.1093/haschl/qxag250","url":null,"abstract":"Introduction: Investment in mental health treatment for children has grown substantially, but whether this reflects more treatment recipients, higher spending per user, or both has not been examined. To estimate trends in mental health expenditures, probability of use and expenditures per user for US children aged 2-17 from 2004 to 2023.Methods: Two-part models were estimated to predict inflation adjusted health expenditure data from the 2004-2023 Medical Expenditure Panel Survey (unweighted N = 153 622) to assess overall trends and variation by age-group and insurance coverage.Results: Total annual mental health expenditures increased from $10.9B to $37.9B, rising from 4.4% to 8.1% of total health expenditure per child (mean individual-level ratio among children with any health care expenditure). The probability of mental health service use more than doubled (6.3% to 13.0%, +0.35% points/year), while expenditure per user grew from $2816 to $5178 (+3.3%/year).Discussion: Relative to the 2004 baseline those ages 2-5 had the greatest growth in both service use and expenditure per user. Expenditure per user grew substantially faster for privately-insured than for Medicaid-covered children.Conclusions: Child mental health treatment expenditures have grown dramatically over the past 2 decades, with particularly large increases for those ages 2 to 5.","PeriodicalId":94025,"journal":{"name":"Health affairs scholar","volume":"4 9","pages":"qxag250"},"PeriodicalIF":4.1,"publicationDate":"2026-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13617661/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149077037","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

Closing the hospice gap: the value of home-based medical care. 缩小安宁疗护差距：居家医疗照护的价值。

IF 4.1

Health affairs scholar Pub Date : 2026-09-17 eCollection Date: 2026-10-01 DOI: 10.1093/haschl/qxag251

Katherine Ornstein, Bruce Leff, Maggie Salinger, Jennifer M Reckrey, Bian Liu, Zainab Toteh Osakwe, Martha Abshire Saylor, Arushi Arora, Melissa Aldridge, Krista Harrison, Abraham A Brody, Christine S Ritchie

{"title":"Closing the hospice gap: the value of home-based medical care.","authors":"Katherine Ornstein, Bruce Leff, Maggie Salinger, Jennifer M Reckrey, Bian Liu, Zainab Toteh Osakwe, Martha Abshire Saylor, Arushi Arora, Melissa Aldridge, Krista Harrison, Abraham A Brody, Christine S Ritchie","doi":"10.1093/haschl/qxag251","DOIUrl":"https://doi.org/10.1093/haschl/qxag251","url":null,"abstract":"Introduction: Home-based medical care (HBMC), longitudinal medical care provided in a patient's home led by physicians or advanced practice providers, addresses complex medical and social needs of seriously ill older adults, particularly those with dementia. We examined whether HBMC use is associated with hospice enrollment and length of stay and whether this varies by dementia status.Methods: We analyzed data from 100% fee-for-service Medicare decedents in 2019, who were eligible for HBMC prior to death. Models used inverse probability weighting, adjusting for clinical, demographic, and regional characteristics.Results: HBMC users had greater odds of hospice use (odds ratio: 1.34; 95% CI: 1.33-1.35) compared with nonusers, regardless of dementia status. For hospice enrollees, HBMC use minimized both ultra-short (<3 days) and prolonged (>180 days) stays, with a stronger reduction in short stays for patients with dementia.Conclusion: As more older adults age in the community and hospice services expand to support patients with complex illnesses such as dementia, HBMC may offer a valuable strategy for effectively navigating prognosis uncertainty and the complexities of hospice eligibility requirements and enrollment.","PeriodicalId":94025,"journal":{"name":"Health affairs scholar","volume":"4 10","pages":"qxag251"},"PeriodicalIF":4.1,"publicationDate":"2026-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13653336/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149172182","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

Characterizing the credentialed bachelor's-level behavioral health support workforce: a national descriptive study. 具有资格证书的学士级行为健康支持人员的特征：一项全国性的描述性研究。

IF 4.1

Health affairs scholar Pub Date : 2026-09-11 eCollection Date: 2026-09-01 DOI: 10.1093/haschl/qxag222

Brianna M Lombardi, Lisa D Zerden, Maria Gaiser

{"title":"Characterizing the credentialed bachelor's-level behavioral health support workforce: a national descriptive study.","authors":"Brianna M Lombardi, Lisa D Zerden, Maria Gaiser","doi":"10.1093/haschl/qxag222","DOIUrl":"10.1093/haschl/qxag222","url":null,"abstract":"Introduction: Persistent shortages of the behavioral health workforce have prompted interest in expanding roles for bachelor's-level behavioral health support workers as a strategy for increasing care. States vary in how they regulate this workforce. This study characterized how US states define the bachelor's-level behavioral health workforce through credentialing structures, educational requirements, and scope of practice.Methods: Data were systematically abstracted from credentialing authorities, state administrative codes, state Medicaid programs, and government webpages using a standardized extraction guide.Results: Twenty-nine states had at least one bachelor's-level credential. A total of 50 credentials met inclusion criteria and were grouped into 2 categories: 20 licensed or certified credentials (9 states); 30 roles were defined solely in state administrative codes or other state guidance (22 states). Educational requirements differed across states, with most roles specifying degrees in human services or related fields and required practice hours ranging from zero to 10 000 hours of supervised experience. Nearly half of credentialed roles permitted multiple entry pathways, allowing work experience to substitute for formal education.Conclusion: Findings reveal substantial variation in how states define and regulate this workforce, creating barriers to workforce planning, interstate mobility, and service delivery consistency.","PeriodicalId":94025,"journal":{"name":"Health affairs scholar","volume":"4 9","pages":"qxag222"},"PeriodicalIF":4.1,"publicationDate":"2026-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13655456/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149169400","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

Streamlining oversight in Medicare advantage: measuring coding intensity via contract rankings. 简化医疗保险优势的监管：通过合同排名衡量编码强度。

IF 4.1

Health affairs scholar Pub Date : 2026-09-11 eCollection Date: 2026-09-01 DOI: 10.1093/haschl/qxag209

Trenton Chang, Michelle Qiu, Zhiyi Hu, Dylan Zapzalka, Divya M Shanmugam, Daniel K Shenfeld, Ravi B Parikh, Maggie Makar, Ezekiel J Emanuel, Zach Brown, Amanda E Kowalski, Jenna Wiens

{"title":"Streamlining oversight in Medicare advantage: measuring coding intensity via contract rankings.","authors":"Trenton Chang, Michelle Qiu, Zhiyi Hu, Dylan Zapzalka, Divya M Shanmugam, Daniel K Shenfeld, Ravi B Parikh, Maggie Makar, Ezekiel J Emanuel, Zach Brown, Amanda E Kowalski, Jenna Wiens","doi":"10.1093/haschl/qxag209","DOIUrl":"10.1093/haschl/qxag209","url":null,"abstract":"Introduction: Risk-adjusted payments in Medicare Advantage (MA) incentivize insurers to maximize reported diagnoses, resulting in high coding intensity, a major source of Medicare overpayments. However, distinguishing justifiable coding intensity from misreporting is challenging: some approaches risk conflating coding intensity due to extraneous diagnoses with that due to variation in clinical practice or beneficiary health, while others assume specific overreporting mechanisms.Methods: We propose a data-driven method for ranking MA contracts by coding intensity using comparisons between geographically co-located contracts based on adjusted diagnosis rates among switchers from Traditional Medicare to MA. The approach is applied to a 20% sample of 2019 MA claims.Results: Health Maintenance Organization (HMO)-dominated contracts tend to rank higher than preferred provider option (PPO)-dominated contracts, echoing previous findings. Furthermore, highly ranked contracts administer procedures and prescriptions relevant to beneficiaries' diagnoses less often than lower-ranked contracts, supporting the validity of the ranking. A simulation study suggests even an imperfect ranking can recover overpayments faster than a random audit, if mean diagnosis rates are low (10%) and vary widely across contracts.Conclusion: As MA looks to expand auditing strategies, MA enrollment continues to grow. The proposed approach can facilitate payer-specific audits even as mechanisms driving coding intensity evolve.","PeriodicalId":94025,"journal":{"name":"Health affairs scholar","volume":"4 9","pages":"qxag209"},"PeriodicalIF":4.1,"publicationDate":"2026-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13564226/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148956843","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