Health affairs scholar最新文献

{"title":"Mental health care access in rural communities amid the expansion of telehealth.","authors":"Anja Gruber, Anders Van Sandt, Scott Loveridge, Craig Carpenter, Cris Meier","doi":"10.1093/haschl/qxag241","DOIUrl":"10.1093/haschl/qxag241","url":null,"abstract":"<p><strong>Introduction: </strong>Compared to metropolitan residents, rural residents face disparities in access to local mental health providers that are even larger than for other health care services. Telehealth appears to be a solution: patients should be able to more easily access providers from metro areas, reducing disparities in access. We consider how provider composition in telehealth or changes in provider behavior enabled by telehealth are associated with access to telehealth.</p><p><strong>Methods: </strong>We present descriptive evidence from multivariate regressions using National Health Interview Survey and Medical Expenditure Panel Survey data.</p><p><strong>Results: </strong>In recent years, rural and publicly insured patients have become relatively less likely to see a mental health provider. Simultaneously, access to any telehealth services is 8-9 percentage points lower for non-metro residents, even after accounting for potential differences in mental health care utilization and internet access. We also show that self-payment is associated with telehealth utilization.</p><p><strong>Conclusion: </strong>We caution that telehealth in mental health may disproportionately benefit patients with higher insurance reimbursement or higher probability of self-pay and thus not reduce the mental health access gap for rural patients. Expansions in telehealth need to be combined with policies to promote equitable reimbursement and reduce barriers for providers to bill insurance.</p>","PeriodicalId":94025,"journal":{"name":"Health affairs scholar","volume":"4 9","pages":"qxag241"},"PeriodicalIF":4.1,"publicationDate":"2026-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13602415/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149042843","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}

{"title":"Medicaid waiver-based housing supports in a safety-net setting: utilization and spending outcomes.","authors":"Nicole C McCann, Heather E Hsu, Stephanie Ettinger de Cuba, Jasper Frank, Paulina Lange, Michael D Stein, Paul R Shafer","doi":"10.1093/haschl/qxag244","DOIUrl":"10.1093/haschl/qxag244","url":null,"abstract":"<p><strong>Introduction: </strong>States have expanded Medicaid waiver-based housing support programs, but evidence on outcomes in safety-net settings is limited.</p><p><strong>Methods: </strong>We evaluated health care utilization and spending associated with Massachusetts Medicaid's Flexible Services Program housing supports (FSP-H), provided to Accountable Care Organization (ACO) members with housing-related needs and qualifying health risks (2021-2024). Within a Boston-based safety-net health system, we linked FSP-H data to claims and electronic health records. Using staggered difference-in-differences, we compared monthly probability of inpatient and emergency department (ED) utilization and per-patient spending in FSP-H recipients (<i>n</i> = 340) vs a contemporaneous comparison group with documented housing-related needs who were FSP-H-ineligible because they were in non-ACO plans (<i>n</i> = 425). We conducted clinical risk-based subgroup analyses.</p><p><strong>Results: </strong>Overall, FSP-H receipt was not associated with significant changes in monthly probability of inpatient utilization (-3.3 percentage points, <i>P</i> = 0.223), ED utilization (-1.5 percentage points, <i>P</i> = 0.569), or monthly spending (-$634, <i>P</i> = 0.053). Massachusetts Medicaid's Flexible Services Program housing supports (FSP-H) was significantly associated with lower monthly inpatient utilization in the substance use disorder and frailty subgroups and with lower monthly spending in the frailty subgroup.</p><p><strong>Conclusion: </strong>Findings offer evidence for state Medicaid plans implementing or adapting housing programs.</p>","PeriodicalId":94025,"journal":{"name":"Health affairs scholar","volume":"4 9","pages":"qxag244"},"PeriodicalIF":4.1,"publicationDate":"2026-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13587248/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149009611","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}

{"title":"Telehealth use among US adults with type 2 diabetes: differences in medication fill patterns and care processes.","authors":"Terrence T Liu, John Thomas Menchaca, Alexander Chaitoff, Boomer Olsen, Julia E Szymczak, Jorie Butler, Kensaku Kawamoto, Renuka Tipirneni, Molly B Conroy","doi":"10.1093/haschl/qxag230","DOIUrl":"10.1093/haschl/qxag230","url":null,"abstract":"<p><strong>Introduction: </strong>The expansion of telehealth following the COVID-19 pandemic has enhanced access to care, but questions remain about how well telehealth supports the delivery of comprehensive, guideline-concordant care for type 2 diabetes.</p><p><strong>Methods: </strong>We conducted an observational cross-sectional study using nationally representative survey data from the 2021-2023 Medical Expenditures Panel Survey to make unadjusted descriptive comparisons between adults with any diabetes-related telehealth use and those receiving only in-person diabetes care.</p><p><strong>Results: </strong>Of 4348 respondents who had at least one visit for type 2 diabetes from 2021 to 2023, 90.7% had only in-person visits, whereas 9.3% had ≥1 telehealth visits. Insulin prescriptions were more common among telehealth users compared to nonusers (47.5% [95% CI, 41.0%-54.1%] vs 34.4% [95%CI, 32.1%-36.7%]).</p><p><strong>Conclusion: </strong>Overall, this study provides current national data on patterns of telehealth use among US adults with type 2 diabetes. Differences in insulin prescription fill patterns may reflect greater clinical complexity and care needs among patients who use telehealth. These findings offer important context for policy-makers and health systems as they evaluate the role of telehealth in managing chronic disease and consider how virtual care models can be implemented while maintaining high-quality diabetes care.</p>","PeriodicalId":94025,"journal":{"name":"Health affairs scholar","volume":"4 9","pages":"qxag230"},"PeriodicalIF":4.1,"publicationDate":"2026-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13564211/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148956865","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}

{"title":"Cross-country differences in household healthcare spending.","authors":"Irene Papanicolas, Jonathan Cylus, Maecey Niksch, Luca Lorenzoni","doi":"10.1093/haschl/qxag234","DOIUrl":"10.1093/haschl/qxag234","url":null,"abstract":"<p><strong>Introduction: </strong>Health systems face financial pressures as populations age and economic growth slows, with implications for who pays for health care and for what drives expenditure growth.</p><p><strong>Methods: </strong>We examined changes in outpatient and pharmaceutical care financing across OECD countries from 2000 to 2023.</p><p><strong>Results: </strong>While overall health spending growth slowed across countries after the Great Recession, household spending grew modestly everywhere, averaging about half a percentage point growth annually. The United States stood out for persistently high out-of-pocket financing burden-over twice that of most peer countries-and for price growth, rather than utilization, driving out-of-pocket spending for pharmaceutical care. Other countries saw out-of-pocket spending driven more by volume growth and slower price growth.</p><p><strong>Conclusion: </strong>These patterns highlight potential affordability pressures from out-of-pocket healthcare payments, particularly in the US Policymakers should regularly monitor financial hardship from out-of-pocket payments and reconsider using cost-sharing to address health financing sustainability challenges.</p>","PeriodicalId":94025,"journal":{"name":"Health affairs scholar","volume":"4 9","pages":"qxag234"},"PeriodicalIF":4.1,"publicationDate":"2026-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13564218/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148957647","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}

{"title":"Beyond binary measures: introducing a safety net hospital index.","authors":"Fredric Blavin, Avani Pugazhendhi, Stephen Zuckerman, John Holahan","doi":"10.1093/haschl/qxag240","DOIUrl":"10.1093/haschl/qxag240","url":null,"abstract":"<p><strong>Introduction: </strong>Safety net hospitals (SNHs) disproportionately serve uninsured, Medicaid, and low-income Medicare patients, yet no universally accepted SNH definition exists. Existing binary measures frequently identify divergent hospital sets, creating research inconsistency and risking misaligned policy protections, concerns heightened by recent federal Medicaid cuts and site-neutral payment reforms.</p><p><strong>Methods: </strong>Using Medicare cost report data for community hospitals, we introduce and validate a continuous, multidimensional SNH Index constructed as a composite of Medicaid revenue share, uncompensated care burden, and low-income Medicare share.</p><p><strong>Results: </strong>Hospitals in the highest SNH Index quartile had substantially lower operating margins (-2.0% vs 3.1% in the lowest quartile), fewer days cash on hand (91 vs 158 days), and higher rates of financial distress (36% vs 21%). The SNH Index showed stronger correlations with financial performance than 5 binary SNH definitions and a proxy for MACPAC's Medicare SNH Index. Within each quartile, system-affiliated hospitals significantly outperformed independent hospitals financially.</p><p><strong>Conclusion: </strong>These findings suggest that policies protecting SNHs should incorporate composite, burden-based measures, and account for system-level financial resources rather than relying on binary classifications alone.</p>","PeriodicalId":94025,"journal":{"name":"Health affairs scholar","volume":"4 9","pages":"qxag240"},"PeriodicalIF":4.1,"publicationDate":"2026-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13587247/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149009548","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}

{"title":"Implementing a nicotine cap to make America Healthy Again.","authors":"Dana Mowls Carroll, Dorothy K Hatsukami, Olivia A Wackowski, Francis Joseph McClernon, Eric Donny, Mitch Zeller","doi":"10.1093/haschl/qxag239","DOIUrl":"10.1093/haschl/qxag239","url":null,"abstract":"<p><p>The US Department of Health and Human Services' (HHS) \"Make America Healthy Again\" initiative cannot eradicate the root causes of the nation's chronic disease epidemic without tackling cigarette smoking, which kills over 480 000 Americans and costs $600 billion annually. This commentary reinvigorates a pivotal 2017 FDA framework by urging the current administration to finalize the proposed rule establishing a maximum nicotine cap in all cigarettes and selected combusted tobacco. Evidence demonstrates that capping nicotine at nonaddictive levels (∼95% reduction) rapidly decreases dependence and accelerates smoking cessation. The FDA projects that a nicotine cap will prevent 4.3 million smoking-related deaths by 2100 while saving $1.1 trillion annually in healthcare and productivity costs over 40 years. To maximize these gains, we outline 2 supporting strategies. First, the administration must substantially fund the nation's under-resourced smoking cessation infrastructure to meet the inevitable surge in quitting. Second, provide adults who smoke evidence-based information on the full spectrum of quitting smoking options by communicating the tobacco/nicotine continuum of risk, that is, that combusted products (eg, cigarette) carry the greatest risk of disease, non-combusted products (eg, e-cigarettes) are likely to pose less risk than cigarettes, and medicinal nicotine products (eg, patches) are the safest option.</p>","PeriodicalId":94025,"journal":{"name":"Health affairs scholar","volume":"4 9","pages":"qxag239"},"PeriodicalIF":4.1,"publicationDate":"2026-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13602413/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149042884","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}

{"title":"Numerous overlapping programs add complexity, unpredictability to rural hospital finances.","authors":"Carolyn San Soucie, Michael E Chernew, Benjamin D Sommers","doi":"10.1093/haschl/qxag228","DOIUrl":"10.1093/haschl/qxag228","url":null,"abstract":"<p><strong>Introduction: </strong>Rural hospitals face unique financial challenges, prompting congressional action including multiple Medicare-specific payment programs. Medicare's programs to enhance rural hospital payment include critical access, sole community, Medicare-dependent, and low-volume hospitals.</p><p><strong>Methods: </strong>We examined the payments made through these programs and their resulting impact on hospitals' finances for 2942 rural hospitals from 1997 to 2024 using cost report data.</p><p><strong>Results: </strong>Almost four-fifths (82.4%) of rural hospitals received payment from one of the programs. From 2015 to 2024, 14.7% of participating hospitals churned between programs. In 34.6% of hospital-years, hospitals received no special payments from programs they were eligible for. Furthermore, payments received by sole community hospitals and Medicare-dependent hospitals fluctuated by more than 50% year-to-year for 16.0% of hospital-years. Financial reliance on these programs was larger in states that have not expanded Medicaid and for hospitals participating in 2 programs simultaneously.</p><p><strong>Conclusion: </strong>Overall, many rural hospitals rely on Medicare's special payment programs, but funding unpredictability, complicated and overlapping eligibility rules, and payment formulas based on historic costs create challenges for hospitals' finances. There is a need to streamline Medicare payment and make existing programs more efficient before layering on dozens of differing state-level policies through the recently created Rural Health Transformation Program.</p>","PeriodicalId":94025,"journal":{"name":"Health affairs scholar","volume":"4 9","pages":"qxag228"},"PeriodicalIF":4.1,"publicationDate":"2026-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13564216/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148957712","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}

{"title":"Marketplace coverage during pregnancy: what can we learn from state-level variation?","authors":"Julia C P Eddelbuettel, Alison A Galbraith, Sarah H Gordon, Anjali Kaimal, Laura F Garabedian","doi":"10.1093/haschl/qxag233","DOIUrl":"10.1093/haschl/qxag233","url":null,"abstract":"<p><strong>Introduction: </strong>Little is known about the role of the Affordable Care Act Marketplaces in providing health insurance coverage for pregnant women.</p><p><strong>Methods: </strong>Using PRAMS survey data from 2018-2019 from 36 states and Washington, DC, we estimated the percentage of women with a pregnancy resulting in live birth who had Marketplace coverage during pregnancy, overall, by state, by federal poverty level (FPL) categories, and by state-based vs federal Marketplace status. We also describe the preconception and postpartum insurance status and sociodemographic and health characteristics of pregnant Marketplace enrollees.</p><p><strong>Results: </strong>Overall, 4.9% of women who had a live birth had Marketplace coverage during pregnancy in 2018-2019. This percentage varied by state (1.6% in Iowa to 13.1% in Maryland) and was significantly higher in state-based Marketplaces vs federally-run/facilitated Marketplaces (8.0% vs 3.5%) and among premium subsidy-eligible women (ie, <400% FPL). Pregnant Marketplace enrollees were more similar to pregnant women with Medicaid than those with private insurance in terms of sociodemographic characteristics and clinical predictors of adverse pregnancy outcomes.</p><p><strong>Conclusion: </strong>Marketplace coverage is a small, but important coverage source for women who had a live birth, insuring 1 in 20 women in our sample. The extent to which pandemic-era and recent policies affected Marketplace coverage of this population merits further investigation.</p>","PeriodicalId":94025,"journal":{"name":"Health affairs scholar","volume":"4 9","pages":"qxag233"},"PeriodicalIF":4.1,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13596735/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149027200","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}

{"title":"Effects of the enhanced nurse licensure compact on interstate mobility and nursing employment.","authors":"Hong-Lun Tiunn, Qian Eric Luo, Jordan Herring, Patricia Pittman","doi":"10.1093/haschl/qxag221","DOIUrl":"https://doi.org/10.1093/haschl/qxag221","url":null,"abstract":"<p><strong>Introduction: </strong>The United States continues to face persistent nursing shortages, even as many licensed nurses are not employed in nursing roles. The enhanced Nurse Licensure Compact (NLC 2.0), a mutual licensure recognition agreement, is promoted as a strategy to increase workforce supply and flexibility, yet no prior research has assessed whether it helps licensed but nonpracticing nurses return to the profession.</p><p><strong>Methods: </strong>Using American Community Survey data (2010-2023) and state-level licensure and employment data (2015-2023), we evaluated whether NLC 2.0 adoption is associated with changes in interstate registered nurse (RN) inflows and in the license-employment mismatch-the share of active licenses not linked to payroll nursing employment-across 26 states.</p><p><strong>Results: </strong>We found no statistically significant effect on interstate migration (+0.27 percentage points; <i>P</i> = 0.67). However, adoption was associated with a 3.30-percentage-point reduction in the share of licensed nurses not employed in nursing (<i>P</i> = 0.054), with the effect strengthening over time. A staggered difference-in-differences robustness check confirmed this pattern.</p><p><strong>Conclusion: </strong>These findings suggest that while the compact does not draw nurses across state lines, it is associated with more licensed nurses working in nursing within adopting states. Licensure reform may therefore be one component of a broader strategy to support nurses' return to bedside roles.</p>","PeriodicalId":94025,"journal":{"name":"Health affairs scholar","volume":"4 9","pages":"qxag221"},"PeriodicalIF":4.1,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13655451/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149187095","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}

{"title":"Financing and health system capacity for precision medicine in Asia: a six country landscape analysis.","authors":"Adena Li Tyin Peh, Yot Teerawattananon, Jeanette Xue Yan Yuen, Nordin Charafi, Dicky Levenus Tahapary, Jiahua Leng, Alec Morton, Sheyu Li, Woo Jin Kim, Bin Alwi Zilfalil, Hidayati Husainy Hasbullah, Nusara Satproedprai, Shao-Tzu Li, Joanne Yuen Yie Ngeow, Yah Ru Juang, Yue Zhang, Minji Hong, Wenjia Chen","doi":"10.1093/haschl/qxag238","DOIUrl":"10.1093/haschl/qxag238","url":null,"abstract":"<p><strong>Background: </strong>Precision medicine (PM) adoption is accelerating across Asia, but implementation remains uneven due to differences in financing, infrastructure, governance, and health-system readiness.</p><p><strong>Objectives: </strong>To examine how six Asian countries (Singapore, South Korea, China, Malaysia, Thailand, and Indonesia) adopt, finance, and integrate PM technologies, and identify common implementation patterns and challenges.</p><p><strong>Methods: </strong>A landscape review of peer-reviewed literature, government publications, and HTA reports (2010-2026) was conducted, supplemented by stakeholder consultations. PM applications were grouped into public health screening (hereditary breast and ovarian cancer [HBOC] and familial hypercholesterolemia [FH] cascade testing), next-generation sequencing (NGS) applications (rare diseases, oncology, pharmacogenomics), and AI-enabled PM. Evidence was synthesized across access, awareness, reimbursement, and implementation.</p><p><strong>Results: </strong>Public health genomic screening demonstrated the highest implementation readiness, followed by precision oncology, while rare disease diagnostics remained infrastructure-dependent and pharmacogenomics and AI-enabled PM platforms were at earlier stages. Four readiness profiles emerged: highly aligned systems; reimbursement-constrained systems with strong governance and infrastructure; systems strengthening governance, public financing and infrastructure; and strategy-led systems expanding implementation through pilot programs and referral centers.</p><p><strong>Conclusions: </strong>PM implementation across Asia remains heterogeneous. The identified readiness profiles highlight governance, financing, and infrastructure priorities for sustainable and equitable PM diffusion.</p>","PeriodicalId":94025,"journal":{"name":"Health affairs scholar","volume":"4 9","pages":"qxag238"},"PeriodicalIF":4.1,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13564229/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148957676","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}