Health affairs scholar最新文献_第2页

The fragile core of care: reframing the well-being of health professionals as critical infrastructure. 护理的脆弱核心：将卫生专业人员的福祉重新定义为关键的基础设施。

Health affairs scholar Pub Date : 2025-06-14 eCollection Date: 2025-07-01 DOI: 10.1093/haschl/qxaf123

Md Doulotuzzaman Xames

{"title":"The fragile core of care: reframing the well-being of health professionals as critical infrastructure.","authors":"Md Doulotuzzaman Xames","doi":"10.1093/haschl/qxaf123","DOIUrl":"10.1093/haschl/qxaf123","url":null,"abstract":"While global health policy often centers patient outcomes, a dangerous oversight persists: the neglect of healthcare professionals' well-being as foundational to system effectiveness. Burnout, attrition, and moral injury are mounting across countries, yet health systems continue to treat their workforce sustainability as peripheral. Drawing on evidence from workforce trends, burnout statistics, and systems engineering, this commentary argues that healthcare professionals' well-being must be reframed as critical infrastructure. The piece contends that sustainability in healthcare depends on policy architectures that embed protections for health professionals, including structural supports like real-time workload monitoring, enforceable staffing ratios, and integrated mental health services. The neglect of health professionals' well-being is not just a human resource challenge-it is a design flaw that compromises the viability of care delivery itself. Without urgent recalibration, health systems risk brittleness, inequity, and collapse under surging demands. This commentary urges a paradigm shift in how we conceptualize, design, and govern health systems, beginning with the foundational recognition that care cannot be sustainable if its health professionals are not.","PeriodicalId":94025,"journal":{"name":"Health affairs scholar","volume":"3 7","pages":"qxaf123"},"PeriodicalIF":0.0,"publicationDate":"2025-06-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12212195/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144546651","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

Income, health, and racial gaps between 340B hospitals, child sites, and nearby neighborhoods. 340B医院、儿童中心和附近社区之间的收入、健康和种族差距。

Health affairs scholar Pub Date : 2025-06-14 eCollection Date: 2025-07-01 DOI: 10.1093/haschl/qxaf121

Neal Masia, Darren Filson, Silas Martin, Ulrich Neumann

{"title":"Income, health, and racial gaps between 340B hospitals, child sites, and nearby neighborhoods.","authors":"Neal Masia, Darren Filson, Silas Martin, Ulrich Neumann","doi":"10.1093/haschl/qxaf121","DOIUrl":"10.1093/haschl/qxaf121","url":null,"abstract":"Objectives: To estimate neighborhood differences between 340B child sites, parent hospital covered entities (CEs), and other neighborhoods near CEs.Methods: We created a unique dataset that contains CE and child site characteristics, and Zip Code Tabulation Area (ZCTA) socioeconomic and health data in 2022 for over 12 000 out-of-ZCTA code 340B hospital child sites. We computed differences across key measures, including median income, uninsured and unemployment rates, age, and health metrics between each pair and between the child site's ZCTA and all other ZCTAs within a 10-mile radius of the CE.Results: The median child-site ZCTA income is 28% higher than CE ZCTA income and approximately 11% higher than CE neighborhood ZCTA income. Uninsured rates (11% lower than CE ZCTA and 10% lower than CE neighborhood ZCTA) and unemployment rates (17% and 15% for CE ZCTA and CE neighborhood ZCTA, respectively) are lower in child-site areas and where the share of White residents is higher (11% and 9%, respectively). Average health status is better in child-site ZCTAs despite a higher median age.Conclusion: Our analysis suggests that 340B entities place child sites in neighborhoods that are wealthier, healthier, better insured, and less diverse than the neighborhoods of both the CE and other neighborhoods within a 10-mile radius of the CE.","PeriodicalId":94025,"journal":{"name":"Health affairs scholar","volume":"3 7","pages":"qxaf121"},"PeriodicalIF":0.0,"publicationDate":"2025-06-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12266128/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144651654","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

Prescription for made in America? Tariffs and U.S. drug manufacturing. 美国制造的药方？关税和美国药品生产。

Health affairs scholar Pub Date : 2025-06-12 eCollection Date: 2025-07-01 DOI: 10.1093/haschl/qxaf122

Mariana P Socal, Maqbool Dada, Tinglong Dai

{"title":"Prescription for made in America? Tariffs and U.S. drug manufacturing.","authors":"Mariana P Socal, Maqbool Dada, Tinglong Dai","doi":"10.1093/haschl/qxaf122","DOIUrl":"10.1093/haschl/qxaf122","url":null,"abstract":"Tariffs on U.S. pharmaceutical imports have been recently proposed. This article examines the potential effects of tariffs on U.S. domestic drug manufacturing, focusing on the differential impact on branded and generic drugs. We contend that generic manufacturing is labor-intensive, operates on thin profit margins, and has strong competition that usually constrains price increases. However, where supply is dominated by a tariff-affected country, capacity limits may lead to spot-market prices increases. Unless tariff-driven global price increases outweigh the amortized costs of relocation and higher domestic production costs, U.S. reliance on foreign suppliers for generics is likely to continue. By contrast, branded manufacturers have greater incentives to reshore production. Branded manufacturers' patent-protected monopolies provide sufficient pricing power to absorb the costs of relocation. Branded manufacturers also have an incentive to relocate production of active pharmaceutical ingredients (APIs) to the U.S. Domestically-produced branded APIs could be exported for final processing at lower costs and imported back into the U.S. as finished drugs without incurring tariffs. Tariff policy uncertainty may influence manufacturers' relocation decisions. Among the possible unintended consequences from the added pressure from tariffs on global pharmaceutical manufacturers, compromised product quality, drug shortages, higher prices, retaliatory actions like export quotas or bans, and reciprocal tariffs stand out.","PeriodicalId":94025,"journal":{"name":"Health affairs scholar","volume":"3 7","pages":"qxaf122"},"PeriodicalIF":0.0,"publicationDate":"2025-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12218194/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144556256","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

Medicaid managed care organization service coverage and diagnosis and treatment of opioid use disorder: evidence from quasi-random auto-assignment in Kentucky. 医疗补助管理医疗组织服务覆盖和阿片类药物使用障碍的诊断和治疗：来自肯塔基州准随机自动分配的证据

Health affairs scholar Pub Date : 2025-06-11 eCollection Date: 2025-07-01 DOI: 10.1093/haschl/qxaf119

Shelby R Steuart, Miguel Antonio G Estrada, Christina M Andrews, Colleen M Grogan, Olivia M Hinds, Emily C Lawler, Lauren A Peterson, Felipe Lozano-Rojas, Melissa A Westlake, Coady Wing, Amanda J Abraham

{"title":"Medicaid managed care organization service coverage and diagnosis and treatment of opioid use disorder: evidence from quasi-random auto-assignment in Kentucky.","authors":"Shelby R Steuart, Miguel Antonio G Estrada, Christina M Andrews, Colleen M Grogan, Olivia M Hinds, Emily C Lawler, Lauren A Peterson, Felipe Lozano-Rojas, Melissa A Westlake, Coady Wing, Amanda J Abraham","doi":"10.1093/haschl/qxaf119","DOIUrl":"10.1093/haschl/qxaf119","url":null,"abstract":"Introduction: Opioid-related mortality continues to claim tens of thousands of American lives annually. Medicaid plays an outsized role in financing opioid use disorder (OUD) treatment, paying for almost 40% of all Americans who received OUD treatment in 2017.Methods: Using Medicaid T-MSIS Analytic Files data and a novel data set of Medicaid managed care organization (MCO) plan coverage, we examined the relationship between comprehensiveness of benefits for OUD treatment provided by Medicaid MCO plans and the likelihood of OUD diagnosis and medications for OUD (MOUD) receipt among newly enrolled Medicaid beneficiaries in Kentucky. We use two stage least squares to adjust for MCO plan choice that may be correlated with individual OUD risk or individual demand for OUD treatment.Results: Our findings show that Medicaid beneficiaries assigned to MCO plans with more comprehensive OUD benefits are more likely to be diagnosed with OUD and to receive MOUD.Conclusion: These results suggest that increasing Medicaid MCO plan coverage to include a broader array of OUD treatment services and medications may be an effective strategy for increasing both OUD diagnosis and MOUD receipt, which is crucial for combating the ongoing opioid epidemic.","PeriodicalId":94025,"journal":{"name":"Health affairs scholar","volume":"3 7","pages":"qxaf119"},"PeriodicalIF":0.0,"publicationDate":"2025-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12215311/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144556255","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 landscape of primary care: an analysis of payer-primary care integration. 初级保健的变化景观：支付方-初级保健一体化的分析。

Health affairs scholar Pub Date : 2025-06-11 eCollection Date: 2025-07-01 DOI: 10.1093/haschl/qxaf120

Loren Adler, Samantha Crow, Matthew Fiedler, Richard Frank, Rahul Fernandez, Derek Lake, Robert Tyler Braun

{"title":"The changing landscape of primary care: an analysis of payer-primary care integration.","authors":"Loren Adler, Samantha Crow, Matthew Fiedler, Richard Frank, Rahul Fernandez, Derek Lake, Robert Tyler Braun","doi":"10.1093/haschl/qxaf120","DOIUrl":"10.1093/haschl/qxaf120","url":null,"abstract":"Introduction: Insurer ownership of primary care practices has expanded rapidly in recent years, but its magnitude, geographic distribution, and market drivers remain unclear.Methods: Using corporate filings, M&A databases, and insurer directories, we identify medical groups operated by UnitedHealth's Optum, Humana, Elevance, Aetna-CVS Health, and Cigna from 2016 to 2023 and calculate each payer's share of the Medicare primary care market-encompassing both Traditional Medicare and Medicare Advantage-nationally and by county. We then compare primary care market penetration by payers in counties above vs below the population-weighted median for hospital and insurer concentration, Medicare Advantage penetration, UnitedHealth's share of the Medicare Advantage and employer insurance markets, and hospital-physician integration.Results: Payer-operated practices account for 4.2% of the national primary care market by service volume in 2023, up from 0.78% in 2016. Optum, the largest payer-affiliated entity, held 2.71% nationally and over 35% in 3 large counties. The prevalence of payer-operated primary care was positively associated with Medicare Advantage penetration and negatively associated with concentrated hospital and employer-based insurance markets.Conclusion: Insurer control of primary care is expanding, concentrated in areas with robust Medicare Advantage enrolment and less concentrated hospital markets. Further research should examine its impact on care delivery, spending, and competition.","PeriodicalId":94025,"journal":{"name":"Health affairs scholar","volume":"3 7","pages":"qxaf120"},"PeriodicalIF":0.0,"publicationDate":"2025-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12223493/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144562421","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

Off-label policy through the lens of trazodone usage and spending in the United States. 通过曲唑酮在美国的使用和消费的镜头来看标签外政策。

Health affairs scholar Pub Date : 2025-06-11 eCollection Date: 2025-07-01 DOI: 10.1093/haschl/qxaf114

Srikanth Kadiyala, Matthew Chenoweth, Jonathan H Watanabe

{"title":"Off-label policy through the lens of trazodone usage and spending in the United States.","authors":"Srikanth Kadiyala, Matthew Chenoweth, Jonathan H Watanabe","doi":"10.1093/haschl/qxaf114","DOIUrl":"10.1093/haschl/qxaf114","url":null,"abstract":"Off-label prescribing-when medications are used for indications not approved by the Food and Drug Administration-is widespread in the US health care system. This study used trazodone, a drug approved in 1981 for depression, as a case study to examine broader issues surrounding off-label utilization and spending. Although only approved to treat depression, trazodone is frequently prescribed off-label for indications of uncertain clinical value (insomnia, anxiety). Using nationally representative data from the Medical Expenditure Panel Survey, we estimated that approximately 24 million trazodone prescriptions were filled in 2019, with health care spending of $294 million. At least 85% of prescriptions (∼20 million) and 84% of spending ($247 million) were for off-label indications, primarily insomnia. Health plan reimbursement per prescription was nearly identical for on-label and off-label use, despite the significant evidence gap. These findings illustrate the scale and inefficiency of off-label prescribing and highlight challenges facing clinicians, patients, and payers. We propose a set of policy solutions-including public and private investment in evidence generation, pricing drugs to account for off-label use, and value-based reimbursement-to advance a more efficient system of off-label use. Trazodone presents a revealing case of the broader systemic problem of off-label prescribing for indications of uncertain clinical value.","PeriodicalId":94025,"journal":{"name":"Health affairs scholar","volume":"3 7","pages":"qxaf114"},"PeriodicalIF":0.0,"publicationDate":"2025-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12278056/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144683893","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

Local population characteristics and access equity of 340B contract pharmacies. 340B家合同药店当地人口特征及可及性公平。

Health affairs scholar Pub Date : 2025-06-11 eCollection Date: 2025-07-01 DOI: 10.1093/haschl/qxaf117

Maura Coughlin, Dibya Deepta Mishra

{"title":"Local population characteristics and access equity of 340B contract pharmacies.","authors":"Maura Coughlin, Dibya Deepta Mishra","doi":"10.1093/haschl/qxaf117","DOIUrl":"10.1093/haschl/qxaf117","url":null,"abstract":"The 340B Drug Pricing Program allows certain US medical entities with vulnerable patient populations to receive large discounts on outpatient prescriptions and use those savings at the entity's discretion. Since reforms in 2010, the number of pharmacies with whom 340B entities contract grew massively. This article explores the locations of 340B contract pharmacies and corresponding local populations within Texas. We measured and tested for statistical differences in population characteristics between 340B and non-340B pharmacies and the association with other local amenities. We focused on measures of pharmacy accessibility, local population social vulnerability, and local access to other crucial amenities, measures of population well-being previously not investigated in this debate. We found that 340B and non-340B pharmacies are located in fairly similar local populations, but 340B pharmacies are located in statistically significantly less-vulnerable populations than the facilities with which they contract. We found that comparisons of pharmacy accessibility measures are complicated by sensitivity to data sources. Our results suggest that the contract pharmacy program within Texas may target less-vulnerable populations through the shift from covered entity pharmacies to outside pharmacies. Impacts on the target patient population at the covered entity require further research to measure.","PeriodicalId":94025,"journal":{"name":"Health affairs scholar","volume":"3 7","pages":"qxaf117"},"PeriodicalIF":0.0,"publicationDate":"2025-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12230945/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144585969","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 utilization of remote monitoring in the United States. 美国使用远程监控的趋势。

Health affairs scholar Pub Date : 2025-06-06 eCollection Date: 2025-06-01 DOI: 10.1093/haschl/qxaf115

Joseph H Joo, Nadia Lieu, Yixin Tang, Danielle S Browne, Bethany Agusala, Joshua M Liao

{"title":"Trends in utilization of remote monitoring in the United States.","authors":"Joseph H Joo, Nadia Lieu, Yixin Tang, Danielle S Browne, Bethany Agusala, Joshua M Liao","doi":"10.1093/haschl/qxaf115","DOIUrl":"10.1093/haschl/qxaf115","url":null,"abstract":"Remote monitoring can help clinicians provide timely services and enable patients to engage in managing their medical conditions. Unfortunately, little is known about the national utilization of remote monitoring across the United States. Using 2019-2023 Medicare data encompassing 100% of professional services billed to and reimbursed by Medicare, we conducted a national analysis of remote-monitoring utilization. A total of 13 529 594 remote-monitoring services (remote patient monitoring and remote therapeutic monitoring), corresponding to $664 518 754, occurred between 2019 and 2023. Remote patient monitoring was most frequently delivered by primary care clinicians, accounting for 6 377 468 (48%) of all services, whereas remote therapeutic monitoring was most frequently delivered by other specialists, accounting for 173 621 (51%) services. With respect to place of service, most remote patient monitoring occurred in physician offices (12 135 569; 92%) compared with at home (540 219; 4%), or other care sites (515 302; 4%). Most remote therapeutic monitoring occurred in physician offices (322 156; 95%) compared with at home (12 560; 4%), or other care sites (3788; 1%). Our study results highlight the salient use of remote monitoring across clinical specialties and the need to address adoption barriers in certain care sites to further enhance utilization.","PeriodicalId":94025,"journal":{"name":"Health affairs scholar","volume":"3 6","pages":"qxaf115"},"PeriodicalIF":0.0,"publicationDate":"2025-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12198758/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144510081","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

Medicare Advantage benefits design and access to surgeons. 医疗保险优势为设计和获得外科医生提供福利。

Health affairs scholar Pub Date : 2025-05-30 eCollection Date: 2025-06-01 DOI: 10.1093/haschl/qxaf112

Jessica I Billig, Michael Wu, Elsa Zhang, Changchuan Jiang, Joshua M Liao

引用次数: 0

Low participation in voluntary period for patient-reported outcome performance measures for hip and knee replacement. 髋关节和膝关节置换术患者报告的结果表现测量的自愿期参与率低。

Health affairs scholar Pub Date : 2025-05-30 eCollection Date: 2025-06-01 DOI: 10.1093/haschl/qxaf111

Nicholas L Berlin, Zoey Chopra, Caroline Thirukumaran, Thomas C Tsai, David W Bates, Andrea L Pusic, Jason B Liu

引用次数: 0