Health affairs scholar最新文献_第2页

A practitioner's guide to using data on private equity hospital acquisitions. 使用私募股权医院收购数据的执业指南。

IF 2.7

Health affairs scholar Pub Date : 2026-04-07 eCollection Date: 2026-04-01 DOI: 10.1093/haschl/qxag071

Sungil Kim, Mark Naslund, Xingzhi Wang, Abid Hasan, Hongbin Huang, Hyong-Gu Hwang, Ambar La Forgia, Riley League, Ryan C McDevitt, Kelly Kaili Yang

{"title":"A practitioner's guide to using data on private equity hospital acquisitions.","authors":"Sungil Kim, Mark Naslund, Xingzhi Wang, Abid Hasan, Hongbin Huang, Hyong-Gu Hwang, Ambar La Forgia, Riley League, Ryan C McDevitt, Kelly Kaili Yang","doi":"10.1093/haschl/qxag071","DOIUrl":"https://doi.org/10.1093/haschl/qxag071","url":null,"abstract":"Introduction: Private equity (PE) investment in US hospitals has attracted substantial policy and research attention, but empirical work has been limited by fragmented and inconsistent transaction data. We aimed to construct a more comprehensive and validated dataset of PE ownership of US hospitals and to provide a practical guide for using these data in research.Methods: We integrated 6 major commercial deal databases to identify PE investments in US hospitals from 2000 to 2024. We filtered transactions to PE-related hospital deals, matched targets to American Hospital Association (AHA) and the Centers for Medicare & Medicaid Services (CMS) hospital identifiers, manually verified uncertain matches, reconciled duplicate transactions across sources, expanded system-level deals to constituent hospitals, and verified deal and exit dates.Results: We identified 141 unique PE deals involving 555 unique short-term acute care hospitals, corresponding to 721 hospital-deal observations. The 6 databases differed substantially in deal coverage, deal type, and whether transactions were reported at the hospital or system level. Reliance on a single source would therefore omit many valid deals and could produce biased or incomplete analytic samples. We also found that linking transactions to stable hospital identifiers required substantial manual verification due to system-level transactions, inconsistent reporting, and identifier changes over time.Conclusion: Accurate study of PE ownership in hospitals requires multisource data construction, transparent validation, and careful linkage to stable hospital identifiers. This harmonized dataset and workflow provide infrastructure for more accurate, transparent, and replicable research on PE ownership in the US hospital sector.","PeriodicalId":94025,"journal":{"name":"Health affairs scholar","volume":"4 4","pages":"qxag071"},"PeriodicalIF":2.7,"publicationDate":"2026-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13089501/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147725167","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

The changing Part D landscape. 变化中的D部分景观。

IF 2.7

Health affairs scholar Pub Date : 2026-04-07 eCollection Date: 2026-04-01 DOI: 10.1093/haschl/qxag078

Geoffrey Joyce, Beier Chen, Barbara Blaylock

{"title":"The changing Part D landscape.","authors":"Geoffrey Joyce, Beier Chen, Barbara Blaylock","doi":"10.1093/haschl/qxag078","DOIUrl":"https://doi.org/10.1093/haschl/qxag078","url":null,"abstract":"Introduction: Differences in how Medicare advantage prescription drug plans (MA-PDs) and stand-alone prescription drug plans (PDPs) are financed may contribute to fewer coverage options for traditional Medicare beneficiaries. The Inflation Reduction Act (IRA) capped annual out-of-pocket spending and reduced government reinsurance, thereby placing more cost responsibility on plans and manufacturers and potentially further limiting coverage.Methods: This study draws on 2020-2025 data from the CMS public use files to compare coverage options by cost-sharing categories (defined by mean premium and deductible) across plan types and plan sponsors.Results: A majority of MA-PDs maintained low-premium and low-deductible designs (2020 = 66.0%, 2025 = 62.4%), reflecting cross-subsidies from integrated medical benefits, while enhanced PDPs increasingly pursued low-premium and high-deductible structures (38.2%, 51.5%), and basic/actuarially equivalent (AE) PDPs maintained high-premium and high-deductible structures (66.0%, 65.1%). In 2025, more than half of brand-only drugs in unprotected classes were excluded from Part D formularies (enhanced MA-PDs = 51.8%, enhanced PDPs = 57.3%, basic/AE PDPs = 60.0%), especially in high-spending therapeutic areas.Conclusions: Results reflect increasing consolidation and reduced plan diversity, with potential consequences for access and affordability among traditional Medicare beneficiaries. Policymakers may need to reconsider subsidy and risk-adjustment mechanisms to preserve competition and equitable access across plan types in the evolving Part D marketplace.","PeriodicalId":94025,"journal":{"name":"Health affairs scholar","volume":"4 4","pages":"qxag078"},"PeriodicalIF":2.7,"publicationDate":"2026-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13070726/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147694078","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

Racial disparities in drug toxicology testing among pregnant women & infants: a meta-analysis and systematic review. 孕妇和婴儿药物毒理学检测中的种族差异：荟萃分析和系统回顾。

IF 2.7

Health affairs scholar Pub Date : 2026-04-07 eCollection Date: 2026-04-01 DOI: 10.1093/haschl/qxag079

Sugy Choi, Elizabeth Knopf, Kwanbo Shim, Megan Sanico, Erinn M Hade, Mishka Terplan, Davida Schiff, Leah Habersham, Carolyn A Berry, Charles J Neighbors, Jennifer McNeely

{"title":"Racial disparities in drug toxicology testing among pregnant women & infants: a meta-analysis and systematic review.","authors":"Sugy Choi, Elizabeth Knopf, Kwanbo Shim, Megan Sanico, Erinn M Hade, Mishka Terplan, Davida Schiff, Leah Habersham, Carolyn A Berry, Charles J Neighbors, Jennifer McNeely","doi":"10.1093/haschl/qxag079","DOIUrl":"https://doi.org/10.1093/haschl/qxag079","url":null,"abstract":"Introduction: We synthesized evidence on racial disparities in perinatal toxicology testing among Black and White women and their infants in the United States, including testing practices and downstream consequences such as child welfare involvement.Methods: We systematically searched PubMed and PsycINFO for peer-reviewed studies published before January 2023 that examined perinatal toxicology testing and reported racial outcomes. Eligible studies assessed testing practices or related consequences. A random-effects meta-analysis estimated pooled rate ratios (RRs) and 95% confidence intervals (CIs) for disparities in testing. Thematic synthesis summarized qualitative findings on downstream outcomes. Sixteen studies (1993-2023) met inclusion criteria; six contributed to the meta-analysis, encompassing over 50 000 pregnant women and/or their infants.Results: Black women and their infants were significantly more likely to be tested than their White counterparts (RR = 2.58; 95% CI: 2.03-3.29). While recent studies suggest disparities in referral to child welfare services after positive tests may be narrowing, earlier research indicates disproportionate reporting and child removal among Black and Hispanic families.Conclusion: Racial inequities in perinatal and infant toxicology testing persist, with implications for maternal and child health. Future research should investigate multilevel drivers of these disparities and inform equitable policy and practice.","PeriodicalId":94025,"journal":{"name":"Health affairs scholar","volume":"4 4","pages":"qxag079"},"PeriodicalIF":2.7,"publicationDate":"2026-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13071810/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147693799","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

Payer mix shifts and profitability at critical access hospitals, 2011 to 2023. 2011年至2023年关键准入医院的付款人组合班次和盈利能力。

IF 2.7

Health affairs scholar Pub Date : 2026-04-07 eCollection Date: 2026-04-01 DOI: 10.1093/haschl/qxag083

Yusheng Jia, Yue Li, Xueya Cai, Samuel J Enumah

{"title":"Payer mix shifts and profitability at critical access hospitals, 2011 to 2023.","authors":"Yusheng Jia, Yue Li, Xueya Cai, Samuel J Enumah","doi":"10.1093/haschl/qxag083","DOIUrl":"https://doi.org/10.1093/haschl/qxag083","url":null,"abstract":"Introduction: Critical Access Hospitals (CAHs) are essential providers in rural communities but face persistent financial challenges due to narrow operating margins and dependence on public payers. This study examines how changes in payer mix affect both overall and payer-specific profit margins in CAHs from 2011 to 2023.Methods: Using data from the National Academy for State Health Policy Hospital Cost Tool and the American Hospital Association Annual Survey, we analyzed 15 819 hospital-year observations from 1384 CAHs. We estimated multivariable linear mixed-effects models with profit margin as the dependent variable and 4 payer categories (Commercial, Medicare, Medicaid, and Uncompensated Care) as independent variables. Regression models included fixed year and state effects.Results: Each percentage point increase in Medicare and Medicaid payer mix relative to Commercial payer mix was associated with a 0.10% and 0.09% point increase in overall hospital operating margin. Higher Medicare, Medicaid, and Uncompensated Care payer mixes corresponded to higher Commercial profit margins.Conclusion: Hospitals with high public-payer dependence may need high margins on their Commercial cases to offset losses from public payers. Policy efforts to sustain Medicaid coverage and preserve Medicare's cost-based payments are essential to the financial viability of critical access hospitals.","PeriodicalId":94025,"journal":{"name":"Health affairs scholar","volume":"4 4","pages":"qxag083"},"PeriodicalIF":2.7,"publicationDate":"2026-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13101979/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147792937","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-Medicare Advantage vertical integration and medical loss ratios. 医院-医疗保险优势垂直整合和医疗损失率。

IF 2.7

Health affairs scholar Pub Date : 2026-04-06 eCollection Date: 2026-04-01 DOI: 10.1093/haschl/qxag085

Geronimo Bejarano, David J Meyers, Meredith B Rosenthal, Jeffrey Marr

引用次数: 0

Cost-effectiveness thresholds used in the United States vs most favored nations. 美国与最惠国的成本效益阈值。

IF 2.7

Health affairs scholar Pub Date : 2026-04-03 eCollection Date: 2026-04-01 DOI: 10.1093/haschl/qxag081

Hanxuan Yu, Peter J Neumann, David D Kim, Joshua T Cohen, Ashley A Leech

{"title":"Cost-effectiveness thresholds used in the United States vs most favored nations.","authors":"Hanxuan Yu, Peter J Neumann, David D Kim, Joshua T Cohen, Ashley A Leech","doi":"10.1093/haschl/qxag081","DOIUrl":"https://doi.org/10.1093/haschl/qxag081","url":null,"abstract":"Objectives: Cost-effectiveness thresholds inform whether health interventions represent good value for money, yet their use varies across countries. This study compares thresholds cited in published cost-effectiveness analyses (CEAs) in the United States with those in countries designated as the Most Favored Nations (MFNs) under the 2025 President's Executive Order on prescription drug pricing.Methods: We analyzed 6876 cost-per-QALY studies published between 1979 and 2023 from the Tufts CEA Registry. We standardized thresholds as multiples of each country's GDP per capita, and used logistic regression to estimate the probability of citing a threshold >1 × GDP per capita, adjusting for region, intervention type, disease area, and study period.Results: Over time, MFN studies shifted toward citing lower thresholds, whereas US thresholds consistently cited thresholds >1 × GDP per capita. After adjusting for other factors, MFN studies were less likely to cite higher thresholds than US studies. Cancer-related CEAs and CEAs of pharmaceutical interventions were more likely to cite higher thresholds.Conclusions: CEAs in the United States and peer high-income nations cite remarkably different thresholds, with MFNs citing lower value benchmarks over time. Policymakers should be cautious about adopting pricing policies that would implicitly subject US pharmaceutical spending to benchmarks developed in different institutional and fiscal contexts.","PeriodicalId":94025,"journal":{"name":"Health affairs scholar","volume":"4 4","pages":"qxag081"},"PeriodicalIF":2.7,"publicationDate":"2026-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13093214/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147792976","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

Workplace violence against nurses is a patient safety crisis, not "part of the job". 工作场所针对护士的暴力是一场病人安全危机，而不是“工作的一部分”。

IF 2.7

Health affairs scholar Pub Date : 2026-03-31 eCollection Date: 2026-04-01 DOI: 10.1093/haschl/qxag077

Kathryn A Connell, Juliana Gabrielle Byers, K Jane Muir

{"title":"Workplace violence against nurses is a patient safety crisis, not \"part of the job\".","authors":"Kathryn A Connell, Juliana Gabrielle Byers, K Jane Muir","doi":"10.1093/haschl/qxag077","DOIUrl":"https://doi.org/10.1093/haschl/qxag077","url":null,"abstract":"Workplace violence in healthcare settings has become widely normalized, which obscures its severity and undermines meaningful attempts at prevention. Thousands of healthcare workers a year experience workplace violence-related injuries, and many incidences go unreported altogether. As a result, the true risk and frequency of workplace violence are concealed and unaddressed, leading to inadequate allocation of resources toward prevention. The consequences of workplace violence extend beyond physical injury; lasting psychological harm such as post-traumatic stress symptoms and moral distress is common. State-level responses, including expanded criminal penalties and mandated employer-run prevention programs, have emerged in the absence of enforceable federal standards. Despite being framed as an unavoidable consequence of working in healthcare, workplace violence should be seen instead as an outcome of chronic mistreatment of healthcare workers, poor security infrastructure, and weak regulatory oversight. In hostile and dangerous work environments, patient safety and healthcare quality inevitably suffer. Workplace violence is therefore an urgent patient safety issue, and addressing it is integral to providing quality healthcare.","PeriodicalId":94025,"journal":{"name":"Health affairs scholar","volume":"4 4","pages":"qxag077"},"PeriodicalIF":2.7,"publicationDate":"2026-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13071812/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147694283","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

Illicit drug supply, naloxone availability, and overdose mortality in the fentanyl era: a systematic review. 芬太尼时代的非法药物供应、纳洛酮可用性和过量死亡率：一项系统综述。

IF 2.7

Health affairs scholar Pub Date : 2026-03-27 eCollection Date: 2026-04-01 DOI: 10.1093/haschl/qxag074

Mehrdad Khezri, Julie Holm, Alex Dahlen, Christian Johnson, Kofi Agyabeng, Frederick Lei, José A Pagán, Cheryl Healton, Tilda Farhat

{"title":"Illicit drug supply, naloxone availability, and overdose mortality in the fentanyl era: a systematic review.","authors":"Mehrdad Khezri, Julie Holm, Alex Dahlen, Christian Johnson, Kofi Agyabeng, Frederick Lei, José A Pagán, Cheryl Healton, Tilda Farhat","doi":"10.1093/haschl/qxag074","DOIUrl":"https://doi.org/10.1093/haschl/qxag074","url":null,"abstract":"Background: The overdose crisis is shaped by increasing synthetic opioids and expanding access to naloxone. We synthesized evidence on associations between illicit drug supply, naloxone availability/distribution, and overdose mortality.Methods: Following PRISMA, we searched 4 databases for studies between 2015 and 2025. Eligible studies examined associations of drug supply indicators or naloxone interventions, and overdose mortality. Data were extracted and synthesized narratively.Results: Forty-seven studies met inclusion criteria. Eighteen studies assessed drug supply changes and all but 2 found significant positive associations between increased fentanyl reports in drug seizures and overdose mortality. Drug seizure data were interpreted as indicators of supply trends or as enforcement disruptions. Thirty-one studies assessed naloxone availability. Thirteen studies reported naloxone access laws, take-home naloxone programs, and/or community interventions were associated with reductions in overdose deaths. Nine studies reported null effects, particularly during the COVID-19 pandemic.Conclusions: Fentanyl reports in drug seizures and drug potency are key drivers of overdose mortality. This review highlights variability in interpreting drug seizure data and the need for clearer conceptualization in future research. Naloxone interventions show promise but depend on consistent implementation and effective targeting of high-risk populations. Coordinated public health strategies are needed to monitor the drug market and strengthen overdose prevention.","PeriodicalId":94025,"journal":{"name":"Health affairs scholar","volume":"4 4","pages":"qxag074"},"PeriodicalIF":2.7,"publicationDate":"2026-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13070727/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147694478","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

Variation in supplemental benefits in Medicare Advantage affinity plans, 2022-2024. 医疗保险优势亲和计划补充福利的变化，2022-2024。

IF 2.7

Health affairs scholar Pub Date : 2026-03-27 eCollection Date: 2026-03-01 DOI: 10.1093/haschl/qxag058

Allison Dorneo, Carlos Irwin A Oronce, Melissa M Garrido, Jose F Figueroa, Kevin H Nguyen

引用次数: 0

Associations between income and coping strategies among households at risk of food insecurity in a high cost-of-living region. 高生活成本地区面临粮食不安全风险的家庭的收入与应对策略之间的关系。

IF 2.7

Health affairs scholar Pub Date : 2026-03-27 eCollection Date: 2026-04-01 DOI: 10.1093/haschl/qxag076

Ana Altares, Laura L Bellows, Rebecca Cleary, Carrie Chennault, Megan P Mueller

引用次数: 0