Health affairs scholar最新文献_第6页

The Affordable Care Act and income-based disparities in health care coverage and spending among nonelderly adults with cancer. 平价医疗法案》与非老年成人癌症患者在医疗保险和支出方面的收入差距。

Health affairs scholar Pub Date : 2024-04-25 eCollection Date: 2024-05-01 DOI: 10.1093/haschl/qxae050

Olajumoke A Olateju, Chan Shen, James Douglas Thornton

{"title":"The Affordable Care Act and income-based disparities in health care coverage and spending among nonelderly adults with cancer.","authors":"Olajumoke A Olateju, Chan Shen, James Douglas Thornton","doi":"10.1093/haschl/qxae050","DOIUrl":"10.1093/haschl/qxae050","url":null,"abstract":"The Patient Protection and Affordable Care Act (ACA) significantly reduced uninsured individuals and improved financial protection; however, escalating costs of cancer treatment has led to substantial out-of-pocket expenses, causing severe financial and mental health distress for individuals with cancer. Mixed evidence on the ACA's ongoing impact highlights the necessity of assessing health-spending changes across income groups for informed policy interventions. In our nationally representative survey evaluating the early- and long-term effects of the ACA on nonelderly adult patients with cancer, we categorized individuals-based income subgroups defined by the ACA for eligibility. We found that ACA implementation increased insurance coverage, which was particularly evident after 2 years of implementation. Early post-ACA (within two years of implementation), there were declines in out-of-pocket spending for the lowest and low-income groups by 26.52% and 38.31%, respectively, persisting long-term only for the lowest-income group. High-income groups experienced continuously increased out-of-pocket and premium spending by 25.39% and 34.28%, respectively, with a notable 122% increase in the risk of high-burden spending. This study provides robust evidence of income-based disparities in financial burden for cancer care, emphasizing the need for health care policies promoting equitable care and addressing spending disparities across income brackets.","PeriodicalId":94025,"journal":{"name":"Health affairs scholar","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11135644/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141177136","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

Variation in Processes of Care for Total Hip Arthroplasty across High-Income Countries 高收入国家全髋关节置换术护理流程的差异

Health affairs scholar Pub Date : 2024-04-24 DOI: 10.1093/haschl/qxae043

Laura Skopec, Robert A Berenson, Benedikt Simon, Irene Papanicolas

引用次数: 0

Piloting racial bias training for hospital emergency department providers treating patients with opioid use disorder. 对治疗阿片类药物使用障碍患者的医院急诊科服务提供者进行种族偏见培训试点。

Health affairs scholar Pub Date : 2024-04-24 eCollection Date: 2024-05-01 DOI: 10.1093/haschl/qxae049

Jason B Gibbons, Samantha J Harris, Olivia K Sugarman, Eric G Hulsey, Julie Rwan, Esther M Rosner, Brendan Saloner

{"title":"Piloting racial bias training for hospital emergency department providers treating patients with opioid use disorder.","authors":"Jason B Gibbons, Samantha J Harris, Olivia K Sugarman, Eric G Hulsey, Julie Rwan, Esther M Rosner, Brendan Saloner","doi":"10.1093/haschl/qxae049","DOIUrl":"https://doi.org/10.1093/haschl/qxae049","url":null,"abstract":"Racial disparities in opioid overdose have increased in recent years. Several studies have linked these disparities to health care providers' inequitable delivery of opioid use disorder (OUD) services. In response, health care policymakers and systems have designed new programs to improve equitable OUD care delivery. Racial bias training has been 1 commonly utilized program. Racial bias training educates providers about the existence of racial disparities in the treatment of people who use drugs and the role of implicit bias. Our study evaluates a pilot racial bias training delivered to 25 hospital emergency providers treating patients with OUDs in 2 hospitals in Detroit, Michigan. We conducted a 3-part survey, including a baseline assessment, post-training assessment, and a 2-month follow-up to evaluate the acceptability and feasibility of scaling the racial bias training to larger audiences. We also investigate preliminary data on changes in self-awareness of implicit bias, knowledge of training content, and equity in care delivery to patients with OUD. Using qualitative survey response data, we found that training participants were satisfied with the content and quality of the training and especially valued the small-group discussions, motivational interviewing, and historical context.","PeriodicalId":94025,"journal":{"name":"Health affairs scholar","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11095526/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140961359","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 Paid Sick Leave Mandates Associated with Increased Mental Health Disorder Prescriptions among Medicaid Enrollees 州带薪病假规定与医疗补助计划参保者精神疾病处方增加有关

Health affairs scholar Pub Date : 2024-04-23 DOI: 10.1093/haschl/qxae045

Johanna Catherine Maclean, Ezra Golberstein, Bradley Stein

引用次数: 0

Re-envisioning contributory health schemes to achieve equity in the design of financial protection mechanisms in low- and middle-income countries (LMICs) 重新审视缴费型医疗计划，在中低收入国家（LMICs）的财政保护机制设计中实现公平

Health affairs scholar Pub Date : 2024-04-17 DOI: 10.1093/haschl/qxae044

Muyiwa Tegbe, Kyle J. Moon, Saira Nawaz

{"title":"Re-envisioning contributory health schemes to achieve equity in the design of financial protection mechanisms in low- and middle-income countries (LMICs)","authors":"Muyiwa Tegbe, Kyle J. Moon, Saira Nawaz","doi":"10.1093/haschl/qxae044","DOIUrl":"https://doi.org/10.1093/haschl/qxae044","url":null,"abstract":"\u0000 Universal health coverage has emerged as a global health priority, requiring financing strategies that ensure low-income and medically and financially at-risk individuals, can access health services without the threat of financial catastrophe. Contributory financing schemes and social health insurance (SHI) schemes, in particular, predominate in low- and middle-income countries (LMICs), despite evidence that suggests the most vulnerable remain excluded from such schemes. In this commentary, we discuss the need to re-envision schemes to prioritize equity, offering three concrete recommendations: adopt participatory designs for the co-design of schemes with beneficiaries, establish linkages between contributory financial protection schemes with economic empowerment initiatives, and prioritize the needs and preferences of beneficiaries over political expediency. Co-design alone does not necessarily translate into more equitable schemes, underscoring the need for greater monitoring and evaluation of these schemes that consider differential impacts across contexts and subgroups. In doing so, SHI schemes can be both attractive and accessible to populations that have long been excluded from financial protections in LMICs, acting as one channel in a broader financing strategy to achieve universal health coverage.","PeriodicalId":94025,"journal":{"name":"Health affairs scholar","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140690313","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Social Determinants of Health Z Code Documentation Practices in Mental Health Settings: A Scoping Review 心理健康机构中的健康社会决定因素 Z 代码文档实践：范围审查

Health affairs scholar Pub Date : 2024-04-12 DOI: 10.1093/haschl/qxae046

Rachele M. Hendricks-Sturrup, Sandra Yankah, Christine Y Lu

{"title":"Social Determinants of Health Z Code Documentation Practices in Mental Health Settings: A Scoping Review","authors":"Rachele M. Hendricks-Sturrup, Sandra Yankah, Christine Y Lu","doi":"10.1093/haschl/qxae046","DOIUrl":"https://doi.org/10.1093/haschl/qxae046","url":null,"abstract":"\u0000 Mental health remains an urgent global priority, alongside efforts to address underlying social determinants of health (SDoH) that contribute to the onset or exacerbate mental illness. SDoH factors can be captured in the form of International Classification of Disease, Tenth Revision, Clinical Modification [ICD-10 CM] SDoH Z codes. In this scoping review, we describe current SDoH Z code documentation practices, with a focus on mental health care contexts. Among 2,743,061,374 health care encounters noted across 12 studies in the United States, SDoH Z code documentation rates ranged from 0.5% to 2.4%. Documentation often involved patients under 64 years of age who are publicly insured and experience comorbidities, including depression, bipolar disorder and schizophrenia, chronic pulmonary disease, and substance abuse disorders. Documentation varied across hospital types, number of beds per facility, patient race/ethnicity, and geographic region. Variation was observed regarding patient sex/gender, although SDoH Z codes were more frequently documented for males. Documentation was most observed in government, nonfederal and private not-for-profit hospitals. From these insights, we offer policy and practice recommendations, as well as considerations for patient data privacy, security, and confidentiality, to incentivize more routine documentation of Z codes to better assist patients with complex mental health care needs.","PeriodicalId":94025,"journal":{"name":"Health affairs scholar","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-04-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140709449","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Life Cycle of Private Equity Investments in Physician Practices: An Overview of Private Equity Exits 私募股权投资在医生诊所的生命周期：私募股权投资退出概述

Health affairs scholar Pub Date : 2024-04-10 DOI: 10.1093/haschl/qxae047

Yashaswini Singh, Megha Reddy, Jane M. Zhu

{"title":"Life Cycle of Private Equity Investments in Physician Practices: An Overview of Private Equity Exits","authors":"Yashaswini Singh, Megha Reddy, Jane M. Zhu","doi":"10.1093/haschl/qxae047","DOIUrl":"https://doi.org/10.1093/haschl/qxae047","url":null,"abstract":"\u0000 Private equity firms acquire and grow physician practices through add-on consolidation, generating outsized returns on the sale of the acquisition in 3-8 years (“exit”). PE’s abbreviated investment timeline and exit incentives may deter long-term investments in care delivery and workforce needed for high quality care. To our knowledge, there has been no published analyses of the nature or duration of PE exits from physician practices. We address this knowledge gap by using novel data to characterize PE exits from dermatology, ophthalmology, and gastroenterology, physician specialties with the largest number of acquisitions between 2016-2020. Of 807 acquisitions, over half (51.6%) of PE-acquired practices underwent an exit within 3 years of initial investment. In nearly all instances (97.8%), PE firms exited investments through secondary buyouts, where physician practices were resold to other PE firms with larger investment funds. Between investment and exit, PE firms increased the number of physician practices affiliated with the PE firm by an average of 595% in 3 years. Findings highlight the rapid scale of ownership change and consolidation under PE ownership and motivate evaluations by policymakers on the effects of PE ownership over the life cycle of PE investments.","PeriodicalId":94025,"journal":{"name":"Health affairs scholar","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140716857","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

National Trends in Billing Patient Portal Messages as E-Visit Services in Traditional Medicare 在传统医疗保险中将患者门户网站信息作为电子就诊服务计费的全国趋势

Health affairs scholar Pub Date : 2024-04-03 DOI: 10.1093/haschl/qxae040

Terrence Liu, Ziwei Zhu, A. J. Holmgren, Chad Ellimoottil

引用次数: 0

Nursing home finances associated with real estate investment trust and private equity investments 与房地产投资信托和私募股权投资相关的养老院财务

Health affairs scholar Pub Date : 2024-04-01 DOI: 10.1093/haschl/qxae037

Dunc Williams, Rahul Fernandez, David Stevenson, Mark Unruh, Robert Tyler Braun

{"title":"Nursing home finances associated with real estate investment trust and private equity investments","authors":"Dunc Williams, Rahul Fernandez, David Stevenson, Mark Unruh, Robert Tyler Braun","doi":"10.1093/haschl/qxae037","DOIUrl":"https://doi.org/10.1093/haschl/qxae037","url":null,"abstract":"\u0000 In 2021, real estate investment trusts (REITs) and private equity (PE) held investments in 1915 (16%) and 1569 (13%) US nursing homes (NHs), respectively. We created a database of REIT and PE investments in NHs, merged it with Medicare Cost Report data (2011–2019), and used a difference-in-differences approach within an event-study framework to compare NH spending and financial performance before and after REIT or PE investment to NHs that did not receive REIT or PE investment. REIT investments were associated with higher total wages (3%), total nursing wages (3%; both logged, per resident day [PRD]), and current ratio (81%). PE investments were associated with lower net patient service revenue (7%), total expenses (7%), and total wages (8%; all logged, PRD). The impact of REIT and PE investments in NHs may vary in different market conditions, as may occur in the current environment of low, falling NH profits, potentially higher minimum staffing requirements, and rising interest rates. Therefore, it is important for stakeholders to understand the impact of these large, growing investments on the financial performance of NHs.","PeriodicalId":94025,"journal":{"name":"Health affairs scholar","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140768550","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Socioeconomic and fiscal returns of expanded investment in immunization: a case for life-course vaccination in Colombia 扩大免疫接种投资的社会经济和财政回报：哥伦比亚终生免疫接种案例

Health affairs scholar Pub Date : 2024-04-01 DOI: 10.1093/haschl/qxae042

Jose Alejandro Soto-Moreno, Martha Coe, Cintia Parellada, Anupama Tantri, Maria Clara Angarita-Contreras, Paula Acosta

{"title":"Socioeconomic and fiscal returns of expanded investment in immunization: a case for life-course vaccination in Colombia","authors":"Jose Alejandro Soto-Moreno, Martha Coe, Cintia Parellada, Anupama Tantri, Maria Clara Angarita-Contreras, Paula Acosta","doi":"10.1093/haschl/qxae042","DOIUrl":"https://doi.org/10.1093/haschl/qxae042","url":null,"abstract":"\u0000 Despite the health, societal, and economic benefits of immunization, many countries focus primarily on childhood immunizations and lack robust policies and sufficient resources for immunizations that can benefit populations across the life course. While the benefits of childhood vaccination are well documented, there is limited evidence on the financial and social return on investment that policymakers can use to inform decisions around administering a life-course immunization program. We developed a cost-benefit model from a societal perspective to evaluate the inclusion of 5 vaccines across the life course in Colombia's national immunization program. This model estimated a return of US$1.3 per US$1.0 invested in the first 2 decades, increasing to US$3.9 after 60 years. Primary benefits were productivity gains, followed by fiscal savings and household averted expenditure on health care. Furthermore, vulnerable households are predicted to receive 3.2 times greater income protection than formally employed households under a life-course immunization program. Consequently, there is a potential to reduce Colombia's income inequality and poverty rate by increasing access to immunization for all ages.","PeriodicalId":94025,"journal":{"name":"Health affairs scholar","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140795660","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0