Health affairs scholar最新文献_第4页

Relation of income to trends in well-being by age: implications for the future older "forgotten" lower middle class.

Health affairs scholar Pub Date : 2025-01-09 eCollection Date: 2025-02-01 DOI: 10.1093/haschl/qxae183

David H Rehkopf, Frank F Furstenberg, Christian Jackson, John W Rowe

{"title":"Relation of income to trends in well-being by age: implications for the future older \"forgotten\" lower middle class.","authors":"David H Rehkopf, Frank F Furstenberg, Christian Jackson, John W Rowe","doi":"10.1093/haschl/qxae183","DOIUrl":"10.1093/haschl/qxae183","url":null,"abstract":"The structure of social welfare policy has neglected a growing and increasingly economically marginalized segment of the American population-the lower middle class, a large group who are ineligible for many need-based social services. We examined 20-year time trends in physical well-being, mental well-being, and functional well-being by levels of household income. Our descriptive study used data from the Behavioral Risk Factor Surveillance System and is representative of the population of the United States, ages 40 to 74, from 2003 to 2022 (n = 5 308 256). We found dramatic and consistent differences in trends in well-being by income category. While well-being generally got worse over the 20-year period for all ages, the declines were most pronounced for lower-middle-income households for individuals age 50 to 59. These differential trends by income were similar for all 3 of the measures of well-being we examined, but were most different by income level for physical well-being and functional well-being. No major trends or levels were explained by race, body mass index, or smoking. If the observed trends persist, the current age 50-59-year-old lower-middle-income population will enter retirement ages with substantially worse well-being than previous generations.","PeriodicalId":94025,"journal":{"name":"Health affairs scholar","volume":"3 2","pages":"qxae183"},"PeriodicalIF":0.0,"publicationDate":"2025-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11829254/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143434807","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

Tracing value from social determinant solutions. 从社会决定性解决方案中追踪价值。

Health affairs scholar Pub Date : 2024-12-19 eCollection Date: 2025-01-01 DOI: 10.1093/haschl/qxae173

Len M Nichols, Timothy A Waidman, Lisa Clemans-Cope, Bowen Garrett, Kima Taylor

{"title":"Tracing value from social determinant solutions.","authors":"Len M Nichols, Timothy A Waidman, Lisa Clemans-Cope, Bowen Garrett, Kima Taylor","doi":"10.1093/haschl/qxae173","DOIUrl":"10.1093/haschl/qxae173","url":null,"abstract":"We develop and illustrate a framework to trace value from social determinants of health (SDOH) interventions across 4 dimensions: health, cost and quality, engagement, and equity. To provide context, we begin by estimating the societal value lost to premature deaths from homelessness and food insecurity, using recent longitudinal methods that offer greater precision. We then apply the value tracing framework to 2 example interventions: permanent supportive housing for chronically homeless people and medically tailored meals for dual eligibles. These examples are supported by a narrative review of relevant literature, highlighting evidence from high-quality studies of SDOH projects that often show a broader range of benefits to multiple stakeholders. Prior research frequently overlooks non-healthcare savings, concluding that interventions \"don't pay for themselves.\" In contrast, our findings show that when all beneficiaries are considered, many SDOH interventions yield a net positive value. Recognizing the public good nature of SDOH interventions is essential for reaching accurate policy conclusions. This paper advocates for greater recognition and estimation of the multiple sources of value in payment policies and investment decisions. Additional SDOH interventions and practical examples for local coalitions are provided in appendices.","PeriodicalId":94025,"journal":{"name":"Health affairs scholar","volume":"3 1","pages":"qxae173"},"PeriodicalIF":0.0,"publicationDate":"2024-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11739131/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143018866","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

Incorporating staffing instability in the nursing home Five-Star Staffing Composite. 将人员不稳定性纳入养老院五星级人员组合。

Health affairs scholar Pub Date : 2024-12-16 eCollection Date: 2024-12-01 DOI: 10.1093/haschl/qxae159

Dana B Mukamel, Debra Saliba, Heather Ladd, R Tamara Konetzka

{"title":"Incorporating staffing instability in the nursing home Five-Star Staffing Composite.","authors":"Dana B Mukamel, Debra Saliba, Heather Ladd, R Tamara Konetzka","doi":"10.1093/haschl/qxae159","DOIUrl":"10.1093/haschl/qxae159","url":null,"abstract":"Staffing is an important indicator of nursing home quality and resident health outcomes. The Five-Star staffing ratings in Nursing Home Care Compare, the report card published by the Centers for Medicare and Medicaid Services, is based on average hours per resident-day and turnover measures. Studies have shown that a new measure of staffing instability, capturing day-to-day staffing variation, is associated with resident outcomes and provides additional information about quality not reflected in the current Five-Star staffing ratings. In this paper we simulate the impact of including the new staffing instability measure on staffing ratings for 13 641 nursing homes nationwide, using data for the third quarter of 2023. We found that, under a conservative scenario, 21% of nursing homes perform well or poorly enough on instability that this addition would change their current staffing rating, providing consumers with additional information about quality for these facilities, with minimal disruptions to the rating system as a whole. We also demonstrate that the choice of weights for each of the measures included in the Five-Star ratings matters. These weights should reflect policy priorities. We conclude that the Centers for Medicare and Medicaid Services can and should add staffing instability to its Five-Star staffing ratings.","PeriodicalId":94025,"journal":{"name":"Health affairs scholar","volume":"2 12","pages":"qxae159"},"PeriodicalIF":0.0,"publicationDate":"2024-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11646700/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142840177","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

Public health implications of recent declines in fatal drug overdoses in New York State and the United States. 最近纽约州和美国致命药物过量减少对公共卫生的影响。

Health affairs scholar Pub Date : 2024-12-12 eCollection Date: 2024-12-01 DOI: 10.1093/haschl/qxae172

David R Holtgrave, Allan Clear, James V McDonald

引用次数: 0

Changes in coverage stability and churning for private, individual insurance under the Affordable Care Act. 在《合理医疗费用法案》下，私人和个人保险的覆盖面稳定性和流动性发生了变化。

Health affairs scholar Pub Date : 2024-12-10 eCollection Date: 2025-01-01 DOI: 10.1093/haschl/qxae169

Steven C Hill, Paul D Jacobs

{"title":"Changes in coverage stability and churning for private, individual insurance under the Affordable Care Act.","authors":"Steven C Hill, Paul D Jacobs","doi":"10.1093/haschl/qxae169","DOIUrl":"10.1093/haschl/qxae169","url":null,"abstract":"The Affordable Care Act (ACA) transformed the market for individual insurance. Using the 2-year panels of the Household Component of the Medical Expenditure Panel Survey covering the 2002-2022 period and controlling for the business cycle and other factors, we find the share of nonelderly adults enrolled in individual insurance doubled under the ACA. The percentage of adults covered by individual insurance 1-23 months more than doubled, and the percentage with at least 24 months rose 80% in states that did not expand Medicaid. Nearly all the gain came from adults who were uninsured immediately prior to enrolling. The prevalence of short individual market spells (<5 months) remained low after ACA implementation, and the ACA primarily helped cover individuals for longer spells. Individual insurance has always played a meaningful role in providing coverage for individuals ineligible for public programs and by bridging gaps between other forms of insurance. Because individual insurance is often temporary, more people may rely on individual insurance in their lifetimes than rely on it at a point in time. We document increases in individual coverage that suggest a strengthened role for this market after ACA implementation.","PeriodicalId":94025,"journal":{"name":"Health affairs scholar","volume":"3 1","pages":"qxae169"},"PeriodicalIF":0.0,"publicationDate":"2024-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11747866/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143018848","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

Americans' support for future pandemic policies: insights from a national survey. 美国人对未来流行病政策的支持：一项全国性调查的启示。

Health affairs scholar Pub Date : 2024-12-10 eCollection Date: 2024-12-01 DOI: 10.1093/haschl/qxae171

Gillian K SteelFisher, Mary G Findling, Hannah L Caporello, Jazmyne Sutton, Emma Dewhurst, Katherine Evans, Brian C Castrucci

{"title":"Americans' support for future pandemic policies: insights from a national survey.","authors":"Gillian K SteelFisher, Mary G Findling, Hannah L Caporello, Jazmyne Sutton, Emma Dewhurst, Katherine Evans, Brian C Castrucci","doi":"10.1093/haschl/qxae171","DOIUrl":"10.1093/haschl/qxae171","url":null,"abstract":"The arrival of bird flu (H5N1) is a poignant reminder of the need for public health leaders to understand Americans' evolving perspectives on pandemic mitigation policies. To guide response efforts, we conducted a nationally representative opinion survey among 1017 U.S. adults in 2024. Majorities said they would be likely to support each of 4 policies in a future pandemic scenario (related to masking requirements, school closures, restaurant closures, and healthcare worker vaccination requirements). About half (49%) were likely to support all 4 policies, while 32% expressed mixed support. Support varied by gender, age, race, ethnicity, income, metropolitan and parental status, political party, and COVID-specific comorbidities. Roughly 80% expressed concern that future pandemic policies would hurt the economy, be based on political or pharmaceutical company/business interests, pander to critics, or further polarize society. Results suggest public support for future pandemic policies may be wider than media reports suggest, though important divisions exist and concerns about design and implementation are widespread. The most appealing policies will explicitly consider economic impacts and target populations at risk during clear time frames, with scope for personal choice. Ensuring that policies are made without undue political or commercial influence will remain a central challenge for public health leaders.","PeriodicalId":94025,"journal":{"name":"Health affairs scholar","volume":"2 12","pages":"qxae171"},"PeriodicalIF":0.0,"publicationDate":"2024-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11683585/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142908022","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: American clusters: using machine learning to understand health and health care disparities in the United States. 更正：美国集群：使用机器学习来了解美国的健康和医疗保健差异。

Health affairs scholar Pub Date : 2024-12-09 eCollection Date: 2024-12-01 DOI: 10.1093/haschl/qxae146

引用次数: 0

Correction to: Disability inclusion in national surveys. 修正为：将残疾纳入全国调查。

Health affairs scholar Pub Date : 2024-12-09 eCollection Date: 2024-12-01 DOI: 10.1093/haschl/qxae145

引用次数: 0

Correction to: Increased spending on low-value care during the COVID-19 pandemic in Virginia. 更正：在弗吉尼亚州COVID-19大流行期间，低价值医疗支出增加。

Health affairs scholar Pub Date : 2024-12-09 eCollection Date: 2024-12-01 DOI: 10.1093/haschl/qxae166

引用次数: 0

State drug caps associated with fewer Medicaid-covered prescriptions for opioid use disorder, 2017-2022. 2017-2022 年与阿片类药物使用障碍的医疗补助承保处方减少相关的州药物上限。

Health affairs scholar Pub Date : 2024-12-06 eCollection Date: 2024-12-01 DOI: 10.1093/haschl/qxae165

Robert J Besaw, Carrie E Fry

{"title":"State drug caps associated with fewer Medicaid-covered prescriptions for opioid use disorder, 2017-2022.","authors":"Robert J Besaw, Carrie E Fry","doi":"10.1093/haschl/qxae165","DOIUrl":"10.1093/haschl/qxae165","url":null,"abstract":"The Medicaid program is the largest payer of opioid use disorder (OUD) treatment, including medications for OUD (MOUD). Because of budget neutrality requirements, some Medicaid programs use prescription drug caps to limit the monthly number of prescriptions an enrollee can fill. This study examined the association between Medicaid prescription drug caps and Medicaid-covered prescriptions for 2 forms of MOUD (buprenorphine and naltrexone) from 2017 to 2022 using fee-for-service and managed care data from Medicaid's State Drug Utilization Data. Ten states had monthly prescription drug caps, ranging from 3 to 6 prescriptions. Using multivariate linear regression, we estimated that enrollees in states with monthly drug caps filled 1489.3 fewer MOUD prescriptions per 100 000 enrollees. Further, compared with states with the smallest drug caps (3 drugs), enrollees in states with 4-, 5-, and 6-drug caps filled significantly more prescriptions per state-quarter (907.7, 562.6, and 438.9 more prescriptions, respectively). Our results were robust to sensitivity analyses. Monthly prescription drug caps were significantly associated with a reduction in Medicaid-covered MOUD prescriptions. Medicaid enrollees who need MOUD may be affected by indiscriminate prescription drug cap policies, potentially hindering ongoing efforts to mitigate the opioid crisis.","PeriodicalId":94025,"journal":{"name":"Health affairs scholar","volume":"2 12","pages":"qxae165"},"PeriodicalIF":0.0,"publicationDate":"2024-12-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11642619/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142831513","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