Health affairs scholar最新文献_第3页

Electronic health record market consolidation and implications for cybersecurity. 电子健康记录市场整合及其对网络安全的影响。

IF 2.7

Health affairs scholar Pub Date : 2025-08-18 eCollection Date: 2025-08-01 DOI: 10.1093/haschl/qxaf164

A Jay Holmgren, Nate C Apathy, Genevieve P Kanter

{"title":"Electronic health record market consolidation and implications for cybersecurity.","authors":"A Jay Holmgren, Nate C Apathy, Genevieve P Kanter","doi":"10.1093/haschl/qxaf164","DOIUrl":"10.1093/haschl/qxaf164","url":null,"abstract":"Over the past decade, the electronic health record (EHR) market has become increasingly consolidated, with the majority of care delivery organizations now using 1 of 2 vendors -Epic and Oracle Health. This consolidation creates a \"single-point-of-failure\" tail risk for cybersecurity: 1 successful attack could expose millions of patients' private data and could potentially impact documentation, billing, and clinical care across thousands of sites. Moreover, dependence on other technology vendors, such as shared cloud hosts, broadens the potential attack surface beyond vendors' core firewalls. Given that reversing consolidation is unlikely due to high EHR switching costs, it is critical that policymakers establish safeguards that ensure robust protections for patients' sensitive data. The Assistant Secretary for Technology Policy plays a critical role in mandating certain security features through the Certified Electronic Health Record Technology Program, and this role should be expanded to provide additional oversight, given the risks presented by the current market structure. Sustained investment in regulatory oversight and continued partnerships between policymakers, care delivery organizations, and EHR vendors are essential to contain the catastrophic risk involved from this ongoing market consolidation.","PeriodicalId":94025,"journal":{"name":"Health affairs scholar","volume":"3 8","pages":"qxaf164"},"PeriodicalIF":2.7,"publicationDate":"2025-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12394940/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144983974","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

A cross-country analysis of the effects of spousal migration on health care access for families left behind. 配偶移徙对留守家庭获得医疗保健影响的跨国分析。

IF 2.7

Health affairs scholar Pub Date : 2025-08-14 eCollection Date: 2025-08-01 DOI: 10.1093/haschl/qxaf150

Heidi West, Randall Kuhn, James Macinko, Corrina Moucheraud

{"title":"A cross-country analysis of the effects of spousal migration on health care access for families left behind.","authors":"Heidi West, Randall Kuhn, James Macinko, Corrina Moucheraud","doi":"10.1093/haschl/qxaf150","DOIUrl":"10.1093/haschl/qxaf150","url":null,"abstract":"Introduction: Health care utilization is affected by outmigration in communities around the world.Methods: This quantitative cross-sectional study evaluated the impact of male spousal migration on women and children's health care access and utilization in high-outmigration contexts using nationally representative Demographic and Health Surveys from Bangladesh, Indonesia, Nepal, and the Philippines (71 045 married women aged 15-49 years).Results: Having a migrant spouse was associated with a significant reduction in the probability of experiencing any barriers to care (adjusted odds ratio [aOR]: 0.83; P < .001), permission (aOR: 0.864; P < .01), financial (aOR: 0.839; P < .0001), and traveling-alone barriers (aOR: 0.899; P < .001). The greatest reductions in the odds of experiencing any barriers, and the specific permission, distance, and not being able to go alone barriers, were seen in Indonesia. In Bangladesh and Nepal, financial barriers were the most sensitive to migration. Despite these improvements in access to care, spousal migration was not a significant predictor of postpartum care utilization or health care use for children experiencing fever or diarrhea.Conclusion: These results suggest health systems and policies may need to attend to maternal and child health care needs and gender inequalities that outmigration does not directly address through accompaniment programs, telehealth policies, and interventions at multiple levels of society to improve women's status.","PeriodicalId":94025,"journal":{"name":"Health affairs scholar","volume":"3 8","pages":"qxaf150"},"PeriodicalIF":2.7,"publicationDate":"2025-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12352391/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144877549","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 relationship between state-level abortion policy and maternal mortality in the United States: a scoping review. 美国州一级堕胎政策与孕产妇死亡率之间的关系：范围审查。

IF 2.7

Health affairs scholar Pub Date : 2025-08-14 eCollection Date: 2025-08-01 DOI: 10.1093/haschl/qxaf146

Gaia Zori, Stuart Case, Courtney Pyche, Linda Beckman

{"title":"The relationship between state-level abortion policy and maternal mortality in the United States: a scoping review.","authors":"Gaia Zori, Stuart Case, Courtney Pyche, Linda Beckman","doi":"10.1093/haschl/qxaf146","DOIUrl":"10.1093/haschl/qxaf146","url":null,"abstract":"Introduction: The United States has a high rate of maternal mortality compared to similar countries. Following the overturning of Roe v. Wade and federal protections to abortion, multiple US states have adopted new policies related to legal abortion access. No published scoping or systematic reviews have comprehensively examined existing literature related to state-level abortion policy and maternal mortality in the United States. This study seeks to assess the extent of evidence on the relationship between state-level abortion policy and maternal mortality in the United States.Methods: The scoping review is guided by the Joanna Briggs Institute (JBI) methodology and had no publication date restriction to capture pre- and post-Roe v. Wade studies.Results: Ten articles met inclusion criteria, with years of analysis from 1959 to 2020. Studies consistently found that restrictive abortion policies are associated with increases in maternal mortality at the state level. Limitations with the ability to compare findings across studies should be considered.Conclusion: Across published studies, policies that restrict access to abortion are consistently associated with increases in maternal mortality, underscoring the significant impact of policy decisions on maternal health outcomes. Future research with updated policy and health outcomes data is needed as the policy landscape evolves.","PeriodicalId":94025,"journal":{"name":"Health affairs scholar","volume":"3 8","pages":"qxaf146"},"PeriodicalIF":2.7,"publicationDate":"2025-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12352390/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144877625","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

Correction to: Medigap-guaranteed issue associated with Medicare Advantage disenrollment for beneficiaries administered a part B drug. 更正：医疗保险保障问题与医疗保险优惠受益人取消登记有关，受益人服用B部分药物。

IF 2.7

Health affairs scholar Pub Date : 2025-08-14 eCollection Date: 2025-08-01 DOI: 10.1093/haschl/qxaf116

引用次数: 0

Research and development financing models for new biopharmaceuticals in the United States. 美国新型生物制药的研发融资模式。

IF 2.7

Health affairs scholar Pub Date : 2025-08-13 eCollection Date: 2025-08-01 DOI: 10.1093/haschl/qxaf161

So-Yeon Kang, Branden Lee, Ravi Gupta, Jeromie Ballreich, Gerard Anderson

引用次数: 0

Medical debt and collections in the United States. 美国的医疗债务和催收。

IF 2.7

Health affairs scholar Pub Date : 2025-08-11 eCollection Date: 2025-08-01 DOI: 10.1093/haschl/qxaf159

Scott L Fulford, Eric Wilson

{"title":"Medical debt and collections in the United States.","authors":"Scott L Fulford, Eric Wilson","doi":"10.1093/haschl/qxaf159","DOIUrl":"10.1093/haschl/qxaf159","url":null,"abstract":"Introduction: Medical debt and collections are common and large, but estimates differ widely.Methods: We used 2 nationally representative surveys in 2024 that are associated with respondents' credit records to measure medical debt and medical collections from survey participants directly and compare their responses with the medical collections reported to the credit bureau.Results: In 2024, 36% of US households had medical debt, 21% had a past-due medical bill, and 23% were paying a medical bill over time to a provider. Medical and dental providers are thus one of the most common sources of credit to households. At the same time, 15% of people were contacted by someone other than their medical provider to collect a medical debt while only 12% had any medical collection on their credit record and 5% had a new collection. Active medical collections only partially overlap with medical collections on credit reports and neither represents all medical debt. We bound the mean total debt in active medical collection for people with such collections as between $2456 and $7931.Conclusion: These debts are not interchangeable, so future policy and research should distinguish carefully between them.","PeriodicalId":94025,"journal":{"name":"Health affairs scholar","volume":"3 8","pages":"qxaf159"},"PeriodicalIF":2.7,"publicationDate":"2025-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12394938/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144983593","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

Time to use large-scale biobank databases in health policy and public health research. 是时候在卫生政策和公共卫生研究中使用大规模生物银行数据库了。

IF 2.7

Health affairs scholar Pub Date : 2025-08-09 eCollection Date: 2025-08-01 DOI: 10.1093/haschl/qxaf158

José A Pagán, Vivian Hsing-Chun Wang, Hannah Sur

引用次数: 0

Trends in hospital administrative costs: urban-rural disparities, barriers, and reduction strategies. 医院行政费用的趋势：城乡差异、障碍和降低策略。

IF 2.7

Health affairs scholar Pub Date : 2025-08-08 eCollection Date: 2025-08-01 DOI: 10.1093/haschl/qxaf149

Lauree Handlon, Kit Simpson, Larry Leaming, Dunc Williams

{"title":"Trends in hospital administrative costs: urban-rural disparities, barriers, and reduction strategies.","authors":"Lauree Handlon, Kit Simpson, Larry Leaming, Dunc Williams","doi":"10.1093/haschl/qxaf149","DOIUrl":"10.1093/haschl/qxaf149","url":null,"abstract":"Introduction: Administrative expenses represent a growing portion of hospital costs in the United States. However, the distribution of these costs remains underexamined. This study examines trends in administrative and general (A&G) spending among hospitals and evaluates the broader impact on expenses.Methods: We conducted a sequential explanatory mixed methods study, analyzing Medicare cost report data from 2011 to 2022 for all US short-term acute care hospitals. Quantitative analysis focused on A&G salary expenses and total A&G costs as a percentage of overall hospital expenditures. Findings were supplemented with qualitative interviews with hospital executives to contextualize observed trends.Results: While urban hospitals reported higher total A&G expenses, rural hospitals consistently allocated a larger proportion of spending to A&G salaries, 18% more on average. Across all hospital types, A&G salary costs declined as a share of total expenses while total administrative costs increased, reflecting a shift toward nonsalary drivers.Conclusions: Rising administrative costs are primarily driven by systemic and structural demands, rather than salaries. Addressing these challenges will require targeted policy responses that simplify processes and support the unique needs of hospitals with limited resources, particularly in rural communities. Such reforms may enhance financial resilience and promote sustainable access to care.","PeriodicalId":94025,"journal":{"name":"Health affairs scholar","volume":"3 8","pages":"qxaf149"},"PeriodicalIF":2.7,"publicationDate":"2025-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12359134/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144884587","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

Effectiveness of Washington State's hub and spoke model to improve opioid use disorder outcomes. 华盛顿州中心辐条模式改善阿片类药物使用障碍结果的有效性。

IF 2.7

Health affairs scholar Pub Date : 2025-08-07 eCollection Date: 2025-08-01 DOI: 10.1093/haschl/qxaf157

Sharon Reif, Maureen T Stewart, Shay M Daily, Lee Panas, Grant A Ritter, Mary F Brolin, Margaret T Lee, Jennifer J Wicks

{"title":"Effectiveness of Washington State's hub and spoke model to improve opioid use disorder outcomes.","authors":"Sharon Reif, Maureen T Stewart, Shay M Daily, Lee Panas, Grant A Ritter, Mary F Brolin, Margaret T Lee, Jennifer J Wicks","doi":"10.1093/haschl/qxaf157","DOIUrl":"10.1093/haschl/qxaf157","url":null,"abstract":"Introduction: Innovative strategies remain necessary to increase utilization of medications for opioid use disorder (MOUD), an effective approach to reduce overdoses and deaths. The hub and spoke (HS) model is increasingly used to improve MOUD treatment, yet the impact is relatively unknown. We assessed the effectiveness of Washington State's hub and spoke (WA-HS) model on 6-month outcomes of MOUD continuity and health care utilization.Methods: We analyzed 25 368 adult Medicaid beneficiaries with new MOUD episodes in 2016-2019, comparing HS and non-HS cohorts in the 6 months after starting MOUD.Results: Across both cohorts, 26% stayed on MOUD for 6 months, and within 6 months of MOUD initiation, 42% had an emergency department (ED) visit, 14% had any hospitalization, and 13% entered intensive substance use treatment. No significant differences were found between cohorts for all outcomes.Conclusion: Our null findings likely reflect the complexity of the OUD crisis, the many needs of people with OUD that require flexible approaches at the individual and systems levels, and the WA-HS focus on MOUD initiation. Findings highlight the need to ensure HS models incorporate strategies to address MOUD continuity to drive long-term recovery for people with OUD.","PeriodicalId":94025,"journal":{"name":"Health affairs scholar","volume":"3 8","pages":"qxaf157"},"PeriodicalIF":2.7,"publicationDate":"2025-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12392894/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144983921","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

Inflation reduction act impact on pharmaceutical investment: insights from investor interviews. 通货膨胀降低法案对医药投资的影响：来自投资者访谈的见解。

IF 2.7

Health affairs scholar Pub Date : 2025-08-07 eCollection Date: 2025-09-01 DOI: 10.1093/haschl/qxaf156

William J Canestaro, Julie A Patterson, Jonathan D Campbell

{"title":"Inflation reduction act impact on pharmaceutical investment: insights from investor interviews.","authors":"William J Canestaro, Julie A Patterson, Jonathan D Campbell","doi":"10.1093/haschl/qxaf156","DOIUrl":"10.1093/haschl/qxaf156","url":null,"abstract":"Introduction: There is limited direct measurement of whether the Inflation Reduction Act (IRA) is beginning to influence investment strategy and decisions.Methods: Using a standardized guide, we interviewed life science investors from a range of stages, investment sizes, and fund types to explore how incentives under the IRA have impacted investment decisions.Results: We interviewed 31 active investors. Over 90% had discussed the law within their firm. While 71% reported a lack of firm-wide consensus as to the IRA's precise potential impacts, 87% reported that the IRA was making it more challenging to bring innovative new medicines to market. All but one investor reported they were more likely to consider a larger launch indication for products they invest in, and 77% reported the IRA influenced small molecule investing.Conclusion: Early signals of IRA impact on investor strategy include favoring a larger population launch and reduced small molecule investing. Noting stated preference and other study limitations, investors signaled continued interest in certain high Medicare utilization drugs. Buy-side investment impacts remain understudied.","PeriodicalId":94025,"journal":{"name":"Health affairs scholar","volume":"3 9","pages":"qxaf156"},"PeriodicalIF":2.7,"publicationDate":"2025-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12409402/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145014891","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