Health affairs scholar最新文献_第5页

Institutional support for navigating abortion bans in pulmonary and critical care: a multistate qualitative study. 在肺部和重症监护中导航堕胎禁令的机构支持：一项多州定性研究。

Health affairs scholar Pub Date : 2025-05-02 eCollection Date: 2025-05-01 DOI: 10.1093/haschl/qxaf095

Katrina E Hauschildt, Avnee J Kumar, Elizabeth M Viglianti, Kelly C Vranas, Taylor Bernstein, Leslie Moroz, Theodore J Iwashyna

{"title":"Institutional support for navigating abortion bans in pulmonary and critical care: a multistate qualitative study.","authors":"Katrina E Hauschildt, Avnee J Kumar, Elizabeth M Viglianti, Kelly C Vranas, Taylor Bernstein, Leslie Moroz, Theodore J Iwashyna","doi":"10.1093/haschl/qxaf095","DOIUrl":"10.1093/haschl/qxaf095","url":null,"abstract":"Abortion bans enacted by numerous US states between 2022 and 2024 offered little guidance to health care systems on pragmatic implementation. Early studies identified meaningful impacts to obstetric and gynecological patients and clinicians and strategies for institutions to support clinicians in these specialties. There is widespread concern regarding the legal implications of these bans on all specialties, and the impact of institutional responses to abortion bans on clinicians outside of obstetrics and gynecology is unknown. We conducted semi-structured interviews with 29 physicians in pulmonary and/or critical care medicine-another specialty whose patients have acute, life-threatening conditions precipitated or complicated by reduced access to reproductive care-about institutional responses to abortion restrictions. Physicians reported 5 areas in which institutional responses varied: legal interpretation of bans, policy and procedural changes, communication with physicians about changes, public statements about bans, and harm-mitigation strategies. Health care organization responses to abortion bans considered most helpful shared key features, including unambiguous guidance, institutional support for physicians, and demonstrated commitment to patient-first care. Our findings suggest promising potential strategies for health care organizations to minimize impacts of abortion restrictions on clinicians and support them in providing the highest level of patient-centered care possible in the post-Dobbs era.","PeriodicalId":94025,"journal":{"name":"Health affairs scholar","volume":"3 5","pages":"qxaf095"},"PeriodicalIF":0.0,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12089030/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144113068","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

Impact of a multi-payer full-risk model on preserving primary care access for traditional medicare beneficiaries. 多支付方全风险模式对保留传统医疗保险受益人获得初级保健的影响。

Health affairs scholar Pub Date : 2025-04-30 eCollection Date: 2025-05-01 DOI: 10.1093/haschl/qxaf093

Benjamin S Kornitzer, Aaron Yao, Deborah N Peikes, Karthik Rao

{"title":"Impact of a multi-payer full-risk model on preserving primary care access for traditional medicare beneficiaries.","authors":"Benjamin S Kornitzer, Aaron Yao, Deborah N Peikes, Karthik Rao","doi":"10.1093/haschl/qxaf093","DOIUrl":"https://doi.org/10.1093/haschl/qxaf093","url":null,"abstract":"Introduction: Amid growing primary care shortages and increased use of value-based care (VBC), we evaluated whether adopting a multipayer, full-risk VBC model for Traditional Medicare (TM) and Medicare Advantage beneficiaries-supported by an enablement organization-affected primary care providers' (PCPs) acceptance of new patients with TM insurance.Methods: Using a difference-in-differences analysis of 2019-2023 claims, we compared 2 groups of PCPs with at least 50 TM patients in their panels: 208 PCPs who received support to adopt a VBC model for TM and Medicare Advantage patients in 2022, and 3657 similar PCPs who maintained their existing payment models.Between the preadoption period and 2023, access to new patient visits for patients with TM insurance declined more for nonadopters than adopters.Results: Primary care providers' in the VBC group saw, on average, 8 more new TM patients annually than nonadopters. This change is sizable relative to their 22.6 new TM patients in 2023. Additionally, the VBC group kept their panels open to new patients with TM insurance for 0.7 more months per year, on average, than nonadopters, relative to preadoption.Conclusion: These findings suggest that a VBC model with support may help sustain access to primary care for TM beneficiaries, even as overall availability declines.","PeriodicalId":94025,"journal":{"name":"Health affairs scholar","volume":"3 5","pages":"qxaf093"},"PeriodicalIF":0.0,"publicationDate":"2025-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12065130/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144046242","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

Commercial price variation for common imaging studies. 普通成像研究的商业价格变化。

Health affairs scholar Pub Date : 2025-04-30 eCollection Date: 2025-05-01 DOI: 10.1093/haschl/qxaf092

Alexander P Philips, Christopher Whaley

{"title":"Commercial price variation for common imaging studies.","authors":"Alexander P Philips, Christopher Whaley","doi":"10.1093/haschl/qxaf092","DOIUrl":"10.1093/haschl/qxaf092","url":null,"abstract":"Introduction: Commercial insurance payment rates for imaging studies have significant price variation, yet understanding this variation has been limited by lack of transparency and data limitations.Methods: Using newly available Transparency-in-Coverage insurer-posted data on negotiated rates, we analyzed price variation for the 2023 contract year across four major commercial insurers (Blue Cross Blue Shield, United, Cigna, and Aetna) for 30 imaging studies. Our analysis encompassed 12.7 million professional fee price points and 239 969 facility fee price points.Results: Our analysis revealed substantial variation in reimbursement rates. Key findings include greater variation in facility fees compared to professional fees, with facility coefficients of variation often 3 to 6 times higher than professional components. There was also substantial and inconsistent variation by payer. Geographic analysis revealed significant state-level variation, particularly in facility fees.Conclusion: These findings highlight the complex interplay of market dynamics and negotiating strategies in determining healthcare prices, with implications for policymakers, purchasers, and clinicians guiding patient care decisions.","PeriodicalId":94025,"journal":{"name":"Health affairs scholar","volume":"3 5","pages":"qxaf092"},"PeriodicalIF":0.0,"publicationDate":"2025-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12097484/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144129781","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

Medicaid expansion increased income among newly eligible adults. 医疗补助计划的扩大增加了新合格成年人的收入。

Health affairs scholar Pub Date : 2025-04-28 eCollection Date: 2025-05-01 DOI: 10.1093/haschl/qxaf091

Stacy Chen, Becky Staiger

{"title":"Medicaid expansion increased income among newly eligible adults.","authors":"Stacy Chen, Becky Staiger","doi":"10.1093/haschl/qxaf091","DOIUrl":"10.1093/haschl/qxaf091","url":null,"abstract":"The Affordable Care Act's Medicaid expansion improved health care access for low-income Americans; however, its impact on economic outcomes-particularly income-is less clear. We used US Census administrative income data that tracked 6120 cohorts covering 84% of working-age adults from 2005 to 2019. Using difference-in-differences, we compared changes in income among low-income adults living in expansion states, before and after expansion, with changes in income in low-income adults living in non-expansion states. Low-income adults living in Medicaid-expansion states experienced an average 9.5% relative increase in income in the 5 years after expansion. This impact was concentrated among adults who were likely newly eligible for Medicaid after the expansion. These adults experienced a 9.6% relative increase in income, as well as a 2.1 percentage point (7.3%) relative higher likelihood of having income in the 40th income percentile or higher. We found suggestive evidence that a reduction in unpaid time off from work drove a small part of this relative income increase among those newly eligible. While Medicaid funding faces substantial political uncertainty, this evidence suggests that welfare gains to newly eligible individuals include economic, as well as health, improvements.","PeriodicalId":94025,"journal":{"name":"Health affairs scholar","volume":"3 5","pages":"qxaf091"},"PeriodicalIF":0.0,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12096067/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144129764","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

Inpatient care experiences are better in critical access hospitals than in other hospitals. 危重通道医院的住院护理体验比其他医院更好。

Health affairs scholar Pub Date : 2025-04-28 eCollection Date: 2025-05-01 DOI: 10.1093/haschl/qxaf090

Megan K Beckett, Christopher W Cohea, Paul D Cleary, Laura A Giordano, Marc N Elliott

{"title":"Inpatient care experiences are better in critical access hospitals than in other hospitals.","authors":"Megan K Beckett, Christopher W Cohea, Paul D Cleary, Laura A Giordano, Marc N Elliott","doi":"10.1093/haschl/qxaf090","DOIUrl":"10.1093/haschl/qxaf090","url":null,"abstract":"Prior studies have found that critical access hospitals (CAHs), which serve patients who would otherwise have limited access to hospitals, provide lower-quality clinical care than inpatient prospective payment system (IPPS) hospitals; evidence is limited about the patient experiences they provide. Using linear mixed-effects regression models, we compared patient-mix-adjusted Hospital Consumer Assessment of Hospitals, Providers, and Systems (HCAHPS) survey scores for CAHs and IPPS hospitals and evaluated how much of the observed differences were associated with size, location, and other hospital characteristics. CAH patients were older, more often in the medical service line, had lower educational attainment, and worse self-rated health than their IPPS counterparts. Accounting for such differences, CAH patients had better experiences (+8 points on the 0-100 HCAHPS summary score, where differences >5 are considered large by patient experience heuristics), especially for staff responsiveness, cleanliness, quietness, and discharge information. CAHs do not outperform similarly small IPPS hospitals, which often have different missions (eg, for-profit surgical specialty hospitals). For-profit and teaching status, while uncommon among CAHs, predicted lower CAH HCAHPS performance. Despite the limited services provided by CAHs, their small scale may facilitate positive experiences for patients in areas with limited hospital choices. For-profit and teaching CAHs may benefit from quality-improvement efforts.","PeriodicalId":94025,"journal":{"name":"Health affairs scholar","volume":"3 5","pages":"qxaf090"},"PeriodicalIF":0.0,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12096449/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144129797","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

Changes in surgical quality and access after rural hospital closures. 农村医院关闭后手术质量和机会的变化。

Health affairs scholar Pub Date : 2025-04-25 eCollection Date: 2025-05-01 DOI: 10.1093/haschl/qxaf089

Cody Lendon Mullens, Patrick L Johnson, Janice C Probst, Justin B Dimick, Andrew M Ibrahim, Adrian Diaz

{"title":"Changes in surgical quality and access after rural hospital closures.","authors":"Cody Lendon Mullens, Patrick L Johnson, Janice C Probst, Justin B Dimick, Andrew M Ibrahim, Adrian Diaz","doi":"10.1093/haschl/qxaf089","DOIUrl":"https://doi.org/10.1093/haschl/qxaf089","url":null,"abstract":"There are rising concerns about the effects of rural hospital closure on access to and quality of care for impacted patients, but little remains known about surgical care. The objective of this study was to evaluate the association of hospital closure with outcomes and access to surgery for common surgical conditions. Using Medicare claims data from 2010-2020, we evaluated the impact of rural hospital closures on surgical quality and access for common operations (colectomy, cholecystectomy, appendectomy, and hernia repair). Using a dynamic difference-in-differences approach, we analyzed 36 884 and 41 185 beneficiaries who lost their nearest and second-nearest rural hospital, respectively. Our findings revealed no significant impacts on surgical quality as measured by 30-day mortality, complications, serious complications, reoperations, and readmissions. While rates of unplanned surgery did not change, median travel distance increased from 13.1 to 16.4 miles for beneficiaries who lost their nearest hospital but was unchanged for those losing their second-nearest hospital. These findings suggest that, while rural hospital closure does not adversely impact surgical quality, it does pose challenges in ensuring access to timely surgical care. Policymakers should consider tailored interventions to mitigate the persistent and growing travel disparities to obtain care in rural America.","PeriodicalId":94025,"journal":{"name":"Health affairs scholar","volume":"3 5","pages":"qxaf089"},"PeriodicalIF":0.0,"publicationDate":"2025-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12048781/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144052438","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 disparities persist for adults with developmental disabilities: NHIS insights, 1999-2018. 发育性残疾成年人的健康差距仍然存在：1999-2018年NHIS的见解。

Health affairs scholar Pub Date : 2025-04-22 eCollection Date: 2025-04-01 DOI: 10.1093/haschl/qxae158

Kiley J McLean, Jamie Koenig, Samara Wolpe, Wei Song, Lauren Bishop

{"title":"Health disparities persist for adults with developmental disabilities: NHIS insights, 1999-2018.","authors":"Kiley J McLean, Jamie Koenig, Samara Wolpe, Wei Song, Lauren Bishop","doi":"10.1093/haschl/qxae158","DOIUrl":"https://doi.org/10.1093/haschl/qxae158","url":null,"abstract":"This study assesses changes in self-reported health and healthcare status among adults with intellectual and developmental disabilities (I/DD) over the past 20 years, utilizing data from the National Health Interview Survey. We conducted a cross-sectional analysis of 601 464 adults 18 and older, categorized by disability status: no functional limitations, developmental disabilities, intellectual disabilities, and other functional limitations. We aimed to identify trends in health status, healthcare access, affordability, and utilization from 1999 to 2018, comparing outcomes across disability groups. Results indicate adults with intellectual disabilities reported poorer health compared to those without functional limitations, particularly in the most recent period (2014-2018). Adults with developmental disabilities exhibited increased odds of poor health during 2009-2013 compared to 1999-2003, but no significant differences occurred between other periods. Additionally, poverty rates for adults with I/DD were higher, with a substantial proportion of adults with intellectual disabilities living in poverty compared to those without functional limitations, indicating persistent disparities without significant trend improvements. Despite advancements in healthcare access and affordability, self-reported health outcomes for adults with I/DD have not improved, highlighting the need for policies to enhance care quality. Future research should focus on effective healthcare practices and provider training to address these persistent disparities.","PeriodicalId":94025,"journal":{"name":"Health affairs scholar","volume":"3 4","pages":"qxae158"},"PeriodicalIF":0.0,"publicationDate":"2025-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12013709/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144061002","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 life sentence of hunger": News coverage of state-level PRWORA SNAP restrictions for persons convicted of drug felonies. “无期徒刑的饥饿”：新闻报道了州一级的PRWORA SNAP限制被判犯有毒品重罪的人。

Health affairs scholar Pub Date : 2025-04-19 eCollection Date: 2025-05-01 DOI: 10.1093/haschl/qxaf087

Bengucan Gunen, Ann C Klassen

{"title":"\"A life sentence of hunger\": News coverage of state-level PRWORA SNAP restrictions for persons convicted of drug felonies.","authors":"Bengucan Gunen, Ann C Klassen","doi":"10.1093/haschl/qxaf087","DOIUrl":"https://doi.org/10.1093/haschl/qxaf087","url":null,"abstract":"The 1996 Personal Responsibility and Work Opportunity Reconciliation Act (PRWORA) revised eligibility for the Supplemental Nutrition Assistance Program (SNAP), permanently banning individuals with past felony drug-related convictions, but allowing states to opt out or modify bans. By 2024, 28 states and Washington, DC, fully opted out and 21 states modified PRWORA; only South Carolina maintains a full ban. However, because federal restrictions remain, state legislatures episodically consider reintroduction of restrictions or bans. Household food insecurity exacerbated by SNAP restrictions increases risk of both recidivism and adverse family health. To strengthen advocacy arguments for full SNAP access, we examined state-level public discourse regarding PRWORA policies, including stakeholders and arguments highlighted. We analyzed local media coverage of PRWORA/SNAP legislative and related activity, identifying 84 stories between 1997 and 2022. State-specific case studies compared coverage in states considering lifting (West Virginia), relaxing (Missouri), or tightening (Pennsylvania) PRWORA provisions. Although most coverage was positive towards lifting bans, stories lacked content on nutrition or health policy. Without repeal of the 1996 federal statute, state-specific PRWORA provisions continue to threaten SNAP access. Nutrition advocacy should monitor and influence public discourse about this social justice issue, to shape policies protecting vulnerable populations from food insecurity.","PeriodicalId":94025,"journal":{"name":"Health affairs scholar","volume":"3 5","pages":"qxaf087"},"PeriodicalIF":0.0,"publicationDate":"2025-04-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12065131/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144061110","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

Beyond licensure: systemic reforms to expand evidence-based addiction treatment. 除了执照：系统改革以扩大基于证据的成瘾治疗。

Health affairs scholar Pub Date : 2025-04-18 eCollection Date: 2025-05-01 DOI: 10.1093/haschl/qxaf086

David T Zhu, Suhanee Mitragotri

引用次数: 0

Experiences with Medicaid unwinding among low-income adults in 4 southern states. 南方4个州低收入成年人的医疗补助解除经验。

Health affairs scholar Pub Date : 2025-04-16 eCollection Date: 2025-05-01 DOI: 10.1093/haschl/qxaf083

Adrianna McIntyre, Benjamin D Sommers, Gabriella Aboulafia, E John Orav, Arnold M Epstein, Jose F Figueroa

{"title":"Experiences with Medicaid unwinding among low-income adults in 4 southern states.","authors":"Adrianna McIntyre, Benjamin D Sommers, Gabriella Aboulafia, E John Orav, Arnold M Epstein, Jose F Figueroa","doi":"10.1093/haschl/qxaf083","DOIUrl":"10.1093/haschl/qxaf083","url":null,"abstract":"After states initiated Medicaid redeterminations following the end of the Medicaid continuous coverage provision, millions of people lost Medicaid coverage. To date, there is limited evidence evaluating how people experienced this \"unwinding\" process. Using a survey of low-income adults in 4 southern states, we assessed awareness of unwinding, experience with state-based outreach, and understanding of coverage changes. Over half of respondents with some Medicaid enrollment experience (57%) reported having heard \"a little,\" \"some,\" or \"a lot\" about unwinding, with media as the most common source of information. Among respondents who reported losing Medicaid coverage, 55% reported that they thought this was because they were no longer eligible. The majority of those who lost Medicaid found out they had been disenrolled after communication from the state, but about one-quarter learned while trying to seek care. Last, nearly 50% of respondents reported losing coverage prior to April 2023, before the unwinding process began. Incomplete awareness of unwinding among people with Medicaid enrollment and confusion about enrollment status and termination timing underscore an imperative for clear communication about Medicaid benefits, particularly considering recent policies extending 12-month continuous coverage to children and postpartum enrollees. Additionally, policymakers may wish to consider new opportunities and strategies to provide enrollment resources at sites of clinical care (including pharmacies) when people unexpectedly learn about coverage loss at the point of service.","PeriodicalId":94025,"journal":{"name":"Health affairs scholar","volume":"3 5","pages":"qxaf083"},"PeriodicalIF":0.0,"publicationDate":"2025-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12083546/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144096579","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