Health affairs scholar最新文献_第3页

Treatment diversification is an essential strategy for mitigating antimicrobial resistance. 治疗方法多样化是减轻抗菌药耐药性的基本策略。

Health affairs scholar Pub Date : 2025-03-10 eCollection Date: 2025-03-01 DOI: 10.1093/haschl/qxaf032

Lao-Tzu Allan-Blitz, Jeffrey D Klausner

引用次数: 0

Examining selection in Affordable Care Act (ACA) Marketplaces: special enrollment periods. 检查平价医疗法案（ACA）市场的选择：特殊注册期。

Health affairs scholar Pub Date : 2025-03-07 eCollection Date: 2025-04-01 DOI: 10.1093/haschl/qxaf048

Saumya Chatrath, Alison A Galbraith, Laura F Garabedian

{"title":"Examining selection in Affordable Care Act (ACA) Marketplaces: special enrollment periods.","authors":"Saumya Chatrath, Alison A Galbraith, Laura F Garabedian","doi":"10.1093/haschl/qxaf048","DOIUrl":"https://doi.org/10.1093/haschl/qxaf048","url":null,"abstract":"Introduction: Affordable Care Act (ACA) Marketplace members who enroll through a special enrollment period (SEP) have significantly higher average monthly spending than members who enroll through the annual open enrollment period (OEP), driven primarily by higher inpatient spending.Methods: Using data from a large national insurer that participated in the federal ACA Marketplace from 2015 to 2016 in 24 US states, we examined differences between SEP and OEP Marketplace enrollees in time from enrollment to inpatient use of predictable and discretionary care (ie, hip and knee replacement), predictable and nondiscretionary care (ie, childbirth), and nonpredictable and nondiscretionary care (ie, acute myocardial infarction and stroke). We examined whether a 2016 policy that increased SEP eligibility verification requirements was associated with changes in utilization.Results: When compared with OEP Marketplace members, SEP members had significantly higher rates of care in all 3 categories. The 2016 policy was not associated with changes in utilization rates.Conclusion: Our results provide evidence that there is adverse selection in the SEP of the ACA Marketplaces. However, since SEP members were more likely to seek care for services that are predictable and nonpredictable, and discretionary and nondiscretionary, the optimal policy response to reduce adverse selection needs to be nuanced and multipronged.","PeriodicalId":94025,"journal":{"name":"Health affairs scholar","volume":"3 4","pages":"qxaf048"},"PeriodicalIF":0.0,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11976056/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143813255","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 macroeconomic indicators affected by COVID-19 containment policies in the United States: a scoping review. 了解受美国COVID-19遏制政策影响的宏观经济指标：范围审查。

Health affairs scholar Pub Date : 2025-03-06 eCollection Date: 2025-04-01 DOI: 10.1093/haschl/qxaf045

Jeong-Yeon Cho, Tejashree Prakash, Wayne Lam, Nathan Seegert, Matthew H Samore, Andrew T Pavia, Richard E Nelson, Nathorn Chaiyakunapruk

{"title":"Understanding macroeconomic indicators affected by COVID-19 containment policies in the United States: a scoping review.","authors":"Jeong-Yeon Cho, Tejashree Prakash, Wayne Lam, Nathan Seegert, Matthew H Samore, Andrew T Pavia, Richard E Nelson, Nathorn Chaiyakunapruk","doi":"10.1093/haschl/qxaf045","DOIUrl":"10.1093/haschl/qxaf045","url":null,"abstract":"Containment policies were essential in controlling the spread of the COVID-19 pandemic in the United States, but they also introduced significant economic challenges. This scoping review aimed to examine the macroeconomic indicators used to assess COVID-19 closure and containment policies in the United States. We reviewed 42 eligible studies from 4516 records identified across PubMed, Web of Science, and EconLit. These studies explored various economic impacts, focusing on employment, labor market indicators, consumer spendings, etc., primarily using publicly available sources. During the pandemic, high-frequency data (eg, mobility and card transactions) became newly accessible and played a key role in evaluating the real-time effects of mitigation policies. Our review summarizes macroeconomic indicators investigated and provides researchers and policymakers with a list of data sources for assessment of economic impacts in the future. This review emphasizes the need for comprehensive evaluations to balance public health measures with economic considerations in future pandemic responses.","PeriodicalId":94025,"journal":{"name":"Health affairs scholar","volume":"3 4","pages":"qxaf045"},"PeriodicalIF":0.0,"publicationDate":"2025-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11970021/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143797511","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

Integrated behavioral health care in pediatric practices: the dollars don't add up. 儿科实践中的综合行为卫生保健：钱不加起来。

Health affairs scholar Pub Date : 2025-03-06 eCollection Date: 2025-04-01 DOI: 10.1093/haschl/qxaf046

Jane M Zhu, Sandy Chung, Mary Giliberti

{"title":"Integrated behavioral health care in pediatric practices: the dollars don't add up.","authors":"Jane M Zhu, Sandy Chung, Mary Giliberti","doi":"10.1093/haschl/qxaf046","DOIUrl":"10.1093/haschl/qxaf046","url":null,"abstract":"Given the prevalence of behavioral health disorders in children and adolescents, and ongoing access gaps, clinicians and policymakers have pushed to expand integrated care models in pediatric primary care settings. Despite the evidence surrounding the efficacy of integrated behavioral health models for pediatric populations, uptake has been slow. Practices report many implementation barriers, including stand-up costs, training needs, and inadequate administrative support. In this Commentary, we argue that, perhaps even more fundamentally, ongoing financial challenges are restricting model adoption, scale, and sustainability, particularly for independent and smaller pediatric group practices. Two real-world case studies illustrate several key financial challenges and opportunity costs for such practices, including administrative barriers and lag times in contracting and credentialing behavioral health providers, reimbursement rates that fail to cover the costs of care delivery, opportunity costs for practice revenue, and persistent coding and billing restrictions. Policies aiming to fulfill the clinical promise of integrated behavioral health care must account for these fiscal realities, prioritizing billing and payment alignment with pediatric practices' bottom dollar.","PeriodicalId":94025,"journal":{"name":"Health affairs scholar","volume":"3 4","pages":"qxaf046"},"PeriodicalIF":0.0,"publicationDate":"2025-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11970018/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143797464","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 Part D insulin coverage: formulary strategies amid policy headwinds. 医疗保险D部分胰岛素覆盖：政策逆风中的处方策略。

Health affairs scholar Pub Date : 2025-03-03 eCollection Date: 2025-04-01 DOI: 10.1093/haschl/qxaf042

Christine Buttorff, Hannah O James, Melony E Sorbero, Rachel O Reid

{"title":"Medicare Part D insulin coverage: formulary strategies amid policy headwinds.","authors":"Christine Buttorff, Hannah O James, Melony E Sorbero, Rachel O Reid","doi":"10.1093/haschl/qxaf042","DOIUrl":"10.1093/haschl/qxaf042","url":null,"abstract":"In recent years, multiple insulin-related policies took effect for Medicare Part D plans, including the Part D Senior Savings Model test (2021-2023) and the 2022 Inflation Reduction Act, provisions of which were implemented between 2023 and 2025. These policies created a variety of financial incentives for plans that may influence insulin formulary design in Part D, potentially affecting beneficiary access to insulin. For example, while limiting cost-sharing lowers out-of-pocket costs for beneficiaries, it may also reduce plans' ability to use tiering to steer beneficiaries toward preferred insulins. Using Part D formulary files from 2020-2025 we examined plan insulin coverage separately for Medicare Advantage Prescription Drug Plans and stand-alone Prescription Drug Plans. We found that plans are moving insulins to a single tier but not broadly changing their utilization management tool strategies. Combination agents (insulins paired with GLP-1s) account for the majority of insulins with quantity limits, and concentrated insulins account for the bulk of insulins with prior authorization requirements. This study demonstrates strategic adjustments that insurers may be making in response to policy changes; ongoing study will be needed to monitor access to and spending on insulin in Medicare as the market and policy context continue to evolve.","PeriodicalId":94025,"journal":{"name":"Health affairs scholar","volume":"3 4","pages":"qxaf042"},"PeriodicalIF":0.0,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11959358/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143775170","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

Strengthening essential emergency departments: Transforming the safety net. 加强基本急诊科：改造安全网。

Health affairs scholar Pub Date : 2025-03-03 eCollection Date: 2025-03-01 DOI: 10.1093/haschl/qxaf044

Brian J Yun, Malini K Singh, Martin A Reznek, Greg Buehler, Stephen J Wolf, Lisa Vogel, Anthony A Ho, Elizabeth C Pino, Lisa Ellis, Christian Arbelaez

{"title":"Strengthening essential emergency departments: Transforming the safety net.","authors":"Brian J Yun, Malini K Singh, Martin A Reznek, Greg Buehler, Stephen J Wolf, Lisa Vogel, Anthony A Ho, Elizabeth C Pino, Lisa Ellis, Christian Arbelaez","doi":"10.1093/haschl/qxaf044","DOIUrl":"10.1093/haschl/qxaf044","url":null,"abstract":"Safety-net emergency departments (EDs) are a critical component of the US health care system, delivering emergency care for patients in need, including vulnerable populations. EDs provide unscheduled acute care for patients 24 hours a day, 7 days a week, regardless of a person's ability to pay. In addition, EDs have transformed beyond their traditional roles of providing emergency services and being the centers for regionalized trauma, cardiac, and stroke care, to also becoming stewards of public health by leading screening and treatment efforts for nonemergent conditions, such as HIV, hepatitis C, mental health, and opioid use disorder. Many safety-net hospitals and their EDs serve essential roles in urban and rural communities, making the impact of recent closures particularly concerning. In response, we convened clinical, operational, and administrative leaders of key safety-net EDs across the United States in order to develop expert consensus related to critical issues facing safety-net EDs. The goals were to help inform policymakers about current challenges and to offer timely recommendations so that together we can mend the safety net as the country works toward the goal of health equity for all.","PeriodicalId":94025,"journal":{"name":"Health affairs scholar","volume":"3 3","pages":"qxaf044"},"PeriodicalIF":0.0,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11904886/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143627263","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

Non-health care costs associated with neonatal intensive care unit visitation. 与新生儿重症监护病房探视相关的非卫生保健费用。

Health affairs scholar Pub Date : 2025-02-28 eCollection Date: 2025-03-01 DOI: 10.1093/haschl/qxaf043

Rebecca A Gourevitch, Evan Ellicott, Christine Kim, Maranna Yoder, Molly Passarella, Scott A Lorch, Michel Boudreaux

引用次数: 0

Environmental impact of colorectal cancer screening with colonoscopy and multi-target stool DNA (mt-sDNA) testing. 结直肠癌结肠镜筛查和多靶点粪便DNA （mt-sDNA）检测的环境影响。

Health affairs scholar Pub Date : 2025-02-28 eCollection Date: 2025-03-01 DOI: 10.1093/haschl/qxaf041

Rebecca Alcock, Aasma Shaukat, John B Kisiel, Lyndon V Hernandez, Benjo A Delarmente, Chris Estes, Jeff Bartels, Jason Lester, Vahab Vahdat, Paul J Limburg, A Mark Fendrick

{"title":"Environmental impact of colorectal cancer screening with colonoscopy and multi-target stool DNA (mt-sDNA) testing.","authors":"Rebecca Alcock, Aasma Shaukat, John B Kisiel, Lyndon V Hernandez, Benjo A Delarmente, Chris Estes, Jeff Bartels, Jason Lester, Vahab Vahdat, Paul J Limburg, A Mark Fendrick","doi":"10.1093/haschl/qxaf041","DOIUrl":"10.1093/haschl/qxaf041","url":null,"abstract":"The substantial carbon footprint imparted by medical services warrants increased attention to their environmental impact. National guideline organizations such as the US Preventive Services Task Force (USPSTF) recommend multiple modalities for average-risk colorectal cancer (CRC) screening with varying resource intensity. The aim of this study was to quantify the environmental burden for 2 of the most used CRC screening modalities, colonoscopy and the multi-target stool DNA (mt-sDNA) test. A validated CRC microsimulation model was used to estimate the number of screening and follow-up tests for a cohort of 1 million average-risk individuals who underwent screening between ages 45 and 75. Component resources used for mt-sDNA, including waste products, energy, and transportation for colonoscopy and mt-sDNA, were collected from January 1, 2023, to January 1, 2024, and converted to carbon-equivalent emissions. Resources used for colonoscopy were captured from the literature. Resources devoted to screening colonoscopy were substantially (59%) higher than those to mt-sDNA, even when including follow-up colonoscopy. Of note, follow-up colonoscopy accounted for the majority (64%) of total emissions for the mt-sDNA screening strategy. Compared with colonoscopy screening, mt-sDNA substantially reduces the carbon emissions attributable to population-level CRC screening. Environmental impact should be included as a factor when choosing among guideline-recommended CRC screening strategies.","PeriodicalId":94025,"journal":{"name":"Health affairs scholar","volume":"3 3","pages":"qxaf041"},"PeriodicalIF":0.0,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11897791/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143618115","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 antipsychotic prescribing among community-dwelling older adults with dementia, 2010-2018. 2010-2018年社区老年痴呆患者抗精神病药物处方趋势

Health affairs scholar Pub Date : 2025-02-26 eCollection Date: 2025-02-01 DOI: 10.1093/haschl/qxaf021

Annie W Yang, Mei Leng, Julia Cave Arbanas, Chi-Hong Tseng, A Mark Fendrick, Catherine Sarkisian, Cheryl L Damberg, Nina T Harawa, John N Mafi

{"title":"Trends in antipsychotic prescribing among community-dwelling older adults with dementia, 2010-2018.","authors":"Annie W Yang, Mei Leng, Julia Cave Arbanas, Chi-Hong Tseng, A Mark Fendrick, Catherine Sarkisian, Cheryl L Damberg, Nina T Harawa, John N Mafi","doi":"10.1093/haschl/qxaf021","DOIUrl":"10.1093/haschl/qxaf021","url":null,"abstract":"Due to an FDA \"black box\" warning for heightened risk of death, Choosing Wisely (CW) recommends avoiding antipsychotic prescription drugs as first-line treatment for dementia-related agitation. Yet, post-CW trends among community-dwelling patients with dementia remain unknown. In this retrospective cohort study, we used nationally representative Health and Retirement Study survey data linked to Medicare fee-for-service claims (January 1, 2010-December 31, 2018) to analyze prescribing trends during the pre-publication (2010-2012), publication (2013-2015), and post-publication (2016-2018) periods of CW recommendations. We included community-dwelling adults aged ≥65 years with dementia. We utilized multivariable mixed regression models to determine the percentage of patients prescribed any, potentially low-value, and potentially indicated antipsychotics. Among an estimated 2.4-2.7 million patients with dementia, any antipsychotic prescribing increased from 9.4% (95% CI, 6.4%-12.3%) during the pre-publication period (2010-2012) to 15.8% (95% CI, 12.8%-18.8%) (P < 0.001) during the publication period (2013-2015). Potentially low-value and potentially indicated prescriptions also increased. Post-publication period (2016-2018) prescribing of 16.0% (95% CI, 13.0%-19.1%) (P < 0.001) remained higher than pre-publication. Among older Americans with dementia, antipsychotic prescriptions increased after the publication of CW recommendations and held steady in the subsequent post-publication period. Stronger interventions, such as electronic clinical decision support tools and financial incentives, are needed to curb low-value antipsychotic prescribing for this vulnerable population.","PeriodicalId":94025,"journal":{"name":"Health affairs scholar","volume":"3 2","pages":"qxaf021"},"PeriodicalIF":0.0,"publicationDate":"2025-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11878382/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143560333","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

Strategic pathways to International Classification of Diseases, 11th Revision adoption in France and the United States. 《国际疾病分类》第11版的战略途径在法国和美国获得通过。

Health affairs scholar Pub Date : 2025-02-24 eCollection Date: 2025-03-01 DOI: 10.1093/haschl/qxaf037

Bastien Boussat, Robert Jakob, Laurent Boyer, Patrick S Romano

{"title":"Strategic pathways to International Classification of Diseases, 11th Revision adoption in France and the United States.","authors":"Bastien Boussat, Robert Jakob, Laurent Boyer, Patrick S Romano","doi":"10.1093/haschl/qxaf037","DOIUrl":"10.1093/haschl/qxaf037","url":null,"abstract":"The International Classification of Diseases, 11th Revision (ICD-11), developed by the World Health Organization, represents a transformative update to global health data classification systems. Building on the foundation of ICD-10, it introduces innovative features such as multilingual coding, advanced interoperability, postcoordination, and improved specificity, enabling better alignment with modern healthcare and digital information systems. This commentary explores the adoption pathways for ICD-11 in France and the United States, 2 countries with complex healthcare infrastructures and distinct implementation strategies. France's phased roadmap, led by the National Health Information Agency, prioritizes system readiness, workforce training, and pilot testing to ensure smooth integration with hospital information systems. In contrast, the United States, guided by the National Committee on Vital and Health Statistics, focuses on regulatory alignment, funding models, and system modifications to support a seamless transition. The manuscript underscores the critical role of academic research in refining ICD-11's applications, assessing its impact on healthcare quality, and optimizing tools for implementation. Drawing lessons from early adopters globally, we advocate for a coordinated, resource-driven approach to achieve full ICD-11 adoption within 5 years. This transition is poised to enhance health data accuracy, support clinical research, and improve population health outcomes worldwide.","PeriodicalId":94025,"journal":{"name":"Health affairs scholar","volume":"3 3","pages":"qxaf037"},"PeriodicalIF":0.0,"publicationDate":"2025-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11881687/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143574915","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