Health affairs scholar最新文献_第3页

Increasing competition, improving access, and lowering the cost of naloxone in California.

Health affairs scholar Pub Date : 2025-01-16 eCollection Date: 2025-02-01 DOI: 10.1093/haschl/qxaf007

Emily Estus, Robin Figueroa, Helen Lee, Vishaal Pegany, Lemeneh Tefera, Mariana Socal

{"title":"Increasing competition, improving access, and lowering the cost of naloxone in California.","authors":"Emily Estus, Robin Figueroa, Helen Lee, Vishaal Pegany, Lemeneh Tefera, Mariana Socal","doi":"10.1093/haschl/qxaf007","DOIUrl":"10.1093/haschl/qxaf007","url":null,"abstract":"Naloxone is an opioid antagonist that can reverse opioid overdoses and save lives. In 2023, the California Department of Health Care Access and Information mobilized its affordable drug manufacturing program, CalRx, to develop a more affordable naloxone nasal product that could help increase access for all Californians. Partnering with a new market entrant, CalRx offered a stable demand forecast for an initial 3-year agreement. In exchange, the selected manufacturer launched a new generic over-the-counter naloxone nasal product at a transparent price 40% lower than the state's previously contracted rate. In its first 6 months, internal calculations suggest that the CalRx generic naloxone has saved the state over $2.6 million, which could be used to provide more than 108 000 additional units of naloxone free of charge to communities across California. Overall generic naloxone prices declined by 22% in a single quarter immediately following CalRx entry. The CalRx experience has helped disrupt the naloxone market by increasing competition and reducing prices. The experience also demonstrates that leveraging states' substantial purchasing power to negotiate lower prescription drug prices can have immediate market impact.","PeriodicalId":94025,"journal":{"name":"Health affairs scholar","volume":"3 2","pages":"qxaf007"},"PeriodicalIF":0.0,"publicationDate":"2025-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11797390/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143367100","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

Services and payments associated with the medicare new technology add-on payment program. 与医疗保险新技术附加支付计划相关的服务和支付。

Health affairs scholar Pub Date : 2025-01-16 eCollection Date: 2025-01-01 DOI: 10.1093/haschl/qxae182

Sarah Tsuruo, Jamie Schlacter, Sanket S Dhruva, Joseph S Ross, Leora I Horwitz

引用次数: 0

Growth of the Program of All-Inclusive Care for the Elderly and the role of for-profit programs. “全包养老”项目的发展和营利性项目的作用。

Health affairs scholar Pub Date : 2025-01-16 eCollection Date: 2025-01-01 DOI: 10.1093/haschl/qxae174

Katherine E M Miller, Ravi Gupta, Daniel Polsky

{"title":"Growth of the Program of All-Inclusive Care for the Elderly and the role of for-profit programs.","authors":"Katherine E M Miller, Ravi Gupta, Daniel Polsky","doi":"10.1093/haschl/qxae174","DOIUrl":"10.1093/haschl/qxae174","url":null,"abstract":"The Program of All-Inclusive Care for the Elderly (PACE) is a managed care program financed by capitated government payments that primarily serves adults aged 55 or older requiring nursing home level of care who are dual-eligible for Medicare and Medicaid. While PACE programs have historically been nonprofit entities, in 2016, a regulation change allowed for-profit PACE programs to help expand the program. We describe PACE program growth from 2010 to 2022. Both the number of PACE programs and enrollees grew from 2010 to 2022. Yet, after allowing for-profits to enter the market, the enrollment rate of growth slowed overall (13.4% vs 7.0%), though for-profit program enrollment grew more rapidly compared to nonprofit programs (13.2% vs 5.7%). Entry of new programs drove for-profit growth primarily. Despite the growth of for-profit programs, most enrollees continued to receive care from nonprofit programs (78%) by 2022. Allowing for-profit programs did not increase PACE enrollment rates overall. Given emerging evidence that for-profit ownership in other health care sectors may reduce quality compared to nonprofits, policymakers should carefully monitor care quality and patient outcomes in PACE as for-profit entities increase.","PeriodicalId":94025,"journal":{"name":"Health affairs scholar","volume":"3 1","pages":"qxae174"},"PeriodicalIF":0.0,"publicationDate":"2025-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11736723/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143018854","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

State-level LGBTQ+ policies and health: the role of political determinants in shaping health equity.

Health affairs scholar Pub Date : 2025-01-15 eCollection Date: 2025-01-01 DOI: 10.1093/haschl/qxaf005

Ellesse-Roselee L Akré, Nicole Rapfogel, Gabe H Miller

{"title":"State-level LGBTQ+ policies and health: the role of political determinants in shaping health equity.","authors":"Ellesse-Roselee L Akré, Nicole Rapfogel, Gabe H Miller","doi":"10.1093/haschl/qxaf005","DOIUrl":"https://doi.org/10.1093/haschl/qxaf005","url":null,"abstract":"Lesbian, gay, bisexual, transgender, and queer/questioning (LGBTQ+) individuals in the United States experience higher rates of discrimination and stressors that negatively impact health compared with their straight, cisgender counterparts. Using 2022 Behavioral Risk Factor Surveillance Survey (BRFSS) data, estimating multilevel mixed-effects logistic regressions, we examined the relationship between state LGBTQ+ policies and health among LGBT people. Findings reveal a statistically significant inverse link between protective (high) state policy scores and poor self-rated health, poor mental health days, and poor physical health days. Specifically, with each 1-point increase in policy score, the odds of poor self-rated health are reduced by 0.03%, high mental health burden by 0.02%, and high physical health burden by 0.02%. Inequalities in self-rated health, high mental health burden, and high physical health burden are greater in policy environments with fewer state-level protections, with LGBT individuals reporting better health where there are more protections. These results indicate that discriminatory state policies are linked to poorer health for LGBT individuals and suggest that protective policies could improve health. Further research with comprehensive data is needed to deepen understanding.","PeriodicalId":94025,"journal":{"name":"Health affairs scholar","volume":"3 1","pages":"qxaf005"},"PeriodicalIF":0.0,"publicationDate":"2025-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11779039/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143070398","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

Is access to crisis teams associated with changes in behavioral health mortality?

Health affairs scholar Pub Date : 2025-01-15 eCollection Date: 2025-01-01 DOI: 10.1093/haschl/qxaf003

Helen Newton, Tamara Beetham, Susan H Busch

{"title":"Is access to crisis teams associated with changes in behavioral health mortality?","authors":"Helen Newton, Tamara Beetham, Susan H Busch","doi":"10.1093/haschl/qxaf003","DOIUrl":"10.1093/haschl/qxaf003","url":null,"abstract":"Behavioral health-related mortality-deaths from suicide, drug overdose, and acute alcohol injury-are leading causes of death among US adults. Crisis teams, trained behavioral health professionals who serve as first responders to assess and stabilize clients in crisis, as well as refer to treatment as necessary, have been shown to reduce psychiatric hospitalizations, but whether crisis teams reduce behavioral health mortality has not been studied. We assessed the association between changes in access to crisis team programs and changes in county-level suicide, drug overdose, and acute alcohol injury mortality from 2014 through 2019. We found that 250 (9%) of counties experienced crisis team program entry and another 237 (9%) experienced crisis team program closure. Access to crisis team programs was associated with significant changes in county-level drug overdose deaths, but not suicide or acute alcohol injury. Compared with counties with no change in access, crisis team program entry was associated with a 7% reduction in county-level drug overdose death rates, and crisis team program closure was associated with a 13% increase in drug overdose death rates. These findings may support the use of crisis teams as 1 intervention to address substance use disorder treatment gaps in the United States.","PeriodicalId":94025,"journal":{"name":"Health affairs scholar","volume":"3 1","pages":"qxaf003"},"PeriodicalIF":0.0,"publicationDate":"2025-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11772998/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143060949","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

Health workforce issues and challenges in the post-pandemic era. 大流行后时代的卫生人力问题和挑战。

Health affairs scholar Pub Date : 2025-01-13 eCollection Date: 2025-01-01 DOI: 10.1093/haschl/qxae168

David Armstrong

引用次数: 0

Medicaid billing for community health worker services growing, but remains low, 2016-2020. 2016-2020年，社区卫生工作者服务的医疗补助账单在增长，但仍然很低。

Health affairs scholar Pub Date : 2025-01-13 eCollection Date: 2025-01-01 DOI: 10.1093/haschl/qxae164

Clese Erikson, Hong-Lun Tiunn, Jordan Herring, Eric Luo, Patricia Pittman

{"title":"Medicaid billing for community health worker services growing, but remains low, 2016-2020.","authors":"Clese Erikson, Hong-Lun Tiunn, Jordan Herring, Eric Luo, Patricia Pittman","doi":"10.1093/haschl/qxae164","DOIUrl":"10.1093/haschl/qxae164","url":null,"abstract":"Despite the recognized value of Community Health Workers (CHWs) in improving health outcomes, the integration of CHWs into Medicaid continues to be a challenge. This study examines the trends in CHW billing for Medicaid services across states from 2016 to 2020. We conducted an exploratory descriptive analysis of the Transformed Medicaid Statistical Information System (T-MSIS) Analytic Files (TAF) 2016-2020 to identify trends in direct billing for CHW services, including beneficiaries served, total services rendered, payment type, place of service, and procedure codes used for services billed by CHWs. The number of CHWs billing Medicaid increased by 638% between 2016 and 2020. However, by 2020, there were still only 731 CHWs billing Medicaid in the 9 states examined with one state (Ohio) accounting for 77.7% of all Medicaid beneficiaries identified with CHW direct billing. The total number of CHW services grew nearly 23-fold, with 37.7% overall provided in patient homes. Significant billing inconsistencies were observed, including the use of non-designated procedure codes. Overall CHW billing in Medicaid remained low as of 2020, with the exception of Ohio. Understanding factors associated with Ohio's expansion could yield important insights for current efforts to improve access to CHWs for Medicaid beneficiaries.","PeriodicalId":94025,"journal":{"name":"Health affairs scholar","volume":"3 1","pages":"qxae164"},"PeriodicalIF":0.0,"publicationDate":"2025-01-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11726829/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142985397","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

Family physicians' perspectives on outcomes, processes, and policies in dementia care. 家庭医生对痴呆护理结果、过程和政策的看法。

Health affairs scholar Pub Date : 2025-01-13 eCollection Date: 2025-01-01 DOI: 10.1093/haschl/qxae167

Alissa B Sideman, Alma Hernandez de Jesus, Sharifa Brooks-Smith-Lowe, Na'amah Razon, Melissa K Filippi, Julie Wood, Soo Borson

{"title":"Family physicians' perspectives on outcomes, processes, and policies in dementia care.","authors":"Alissa B Sideman, Alma Hernandez de Jesus, Sharifa Brooks-Smith-Lowe, Na'amah Razon, Melissa K Filippi, Julie Wood, Soo Borson","doi":"10.1093/haschl/qxae167","DOIUrl":"10.1093/haschl/qxae167","url":null,"abstract":"The rapid rise in numbers of people living with Alzheimer's disease and related disorders (ADRD) poses major challenges to health systems and policy. Although primary care clinicians provide ongoing medical care for 80% of affected individuals, they face persistent barriers to providing high-quality dementia care. We conducted qualitative interviews with family physicians (n = 20) to understand what core outcomes they consider most important and what care processes and systems and policy strategies they propose to achieve them. Participants identified processes and outcomes pertaining to their relationships with patients and families, involvement in overall medical care, and efforts to mitigate harm as key components of dementia care. Participants also identified overarching patient care values: making active efforts to maintain continuity in the doctor-patient-family relationship, communicating clearly, building and sustaining trust, and responding to health-related social needs. Policy recommendations included work to create health care systems capable of providing comprehensive dementia care, full integration of caregivers into psychosocial care and medical management, adjustments to care cadence, and payment models that support team-based primary care. Findings could help refocus care improvement efforts on implementing the vital conditions for optimal health that can be achieved in primary care and sustained through the course of dementia.","PeriodicalId":94025,"journal":{"name":"Health affairs scholar","volume":"3 1","pages":"qxae167"},"PeriodicalIF":0.0,"publicationDate":"2025-01-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11726825/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142985862","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 factors associated with job satisfaction among dental hygienists and assistants in the United States. 工作场所因素对美国牙科保健员和助理工作满意度的影响。

Health affairs scholar Pub Date : 2025-01-13 eCollection Date: 2025-01-01 DOI: 10.1093/haschl/qxae147

Nozomi Sasaki, Jinman Pang, Simona Surdu, Rachel W Morrissey, Marko Vujicic, Jean Moore

{"title":"Workplace factors associated with job satisfaction among dental hygienists and assistants in the United States.","authors":"Nozomi Sasaki, Jinman Pang, Simona Surdu, Rachel W Morrissey, Marko Vujicic, Jean Moore","doi":"10.1093/haschl/qxae147","DOIUrl":"10.1093/haschl/qxae147","url":null,"abstract":"Previous research has assessed job satisfaction and related workplace factors among healthcare workers. However, studies on dental care professionals are limited. This study aimed to evaluate job satisfaction among US dental hygienists (DHs) and assistants (DAs) and identify workplace factors contributing to their job satisfaction or dissatisfaction. A cross-sectional study was conducted using survey data collected from DHs (n = 4078) and DAs (n = 2945) actively working in 2022. Descriptive statistics and multivariable logistic regressions were used to assess associations between workplace factors and job satisfaction, adjusting for demographics, practice patterns, and geography. Over 80% of DHs and DAs reported being satisfied with their jobs. Positive workplace culture, practice philosophy, opportunities for growth and advancement, good communication in practice, work-life balance, fair pay, a reasonable workload, and flexible work schedules are associated with job satisfaction. Overwork was associated with job dissatisfaction among DAs. Most DHs and DAs were satisfied with their current jobs, with positive workplace culture, growth opportunities, and effective communication being key factors contributing to their satisfaction. This study highlights the importance of developing strategies to improve workplace environments and promote the well-being and retention of oral health providers.","PeriodicalId":94025,"journal":{"name":"Health affairs scholar","volume":"3 1","pages":"qxae147"},"PeriodicalIF":0.0,"publicationDate":"2025-01-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11726826/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142985493","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

Association between governmental spending on social services and health care use among low-income older adults.

Health affairs scholar Pub Date : 2025-01-10 eCollection Date: 2025-01-01 DOI: 10.1093/haschl/qxae181

Carlos Irwin A Oronce, Ninez A Ponce, Catherine A Sarkisian, Frederick J Zimmerman, Yusuke Tsugawa

{"title":"Association between governmental spending on social services and health care use among low-income older adults.","authors":"Carlos Irwin A Oronce, Ninez A Ponce, Catherine A Sarkisian, Frederick J Zimmerman, Yusuke Tsugawa","doi":"10.1093/haschl/qxae181","DOIUrl":"10.1093/haschl/qxae181","url":null,"abstract":"Prior research demonstrates that local government spending on social policies, excluding health care, is linked to improved population health. Whether such spending is associated with better access to primary care and reduced acute care utilization remains unclear. In this cross-sectional study, we evaluated the associations between county-level social spending and individual-level health care utilization among low-income Medicare beneficiaries, aged ≥65 years, from 2016 to 2018. We linked claims data to 4 categories of county-level government expenditures from the US Government Finance Database, including (1) public welfare, (2) public transit, (3) housing/community development, and (4) infrastructure-related social services. The main outcomes were annual primary care visit rates, emergency department visits, and preventable hospitalizations. After adjusting for patient and county characteristics, beneficiaries living in counties with higher spending on housing/community development had 11% higher primary care visit rates. Additionally, those living in counties with higher public transit and housing/community development spending experienced 6%-10% lower preventable hospitalization rates. Lower preventable hospitalization rates were especially pronounced among acute conditions. These findings suggest that investments in social services that address the health-related social needs of low-income older adults may be an important factor to consider in population-level efforts to reduce acute care utilization.","PeriodicalId":94025,"journal":{"name":"Health affairs scholar","volume":"3 1","pages":"qxae181"},"PeriodicalIF":0.0,"publicationDate":"2025-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11770339/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143054589","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