Health affairs scholar最新文献_第7页

Solvency extensions to the Medicare Hospital Insurance Trust Fund: what is driving them? 医疗保险医院保险信托基金偿付能力的延长：是什么在推动它们？

Health affairs scholar Pub Date : 2025-04-09 eCollection Date: 2025-04-01 DOI: 10.1093/haschl/qxaf079

Klara K Lou, Melinda J B Buntin

{"title":"Solvency extensions to the Medicare Hospital Insurance Trust Fund: what is driving them?","authors":"Klara K Lou, Melinda J B Buntin","doi":"10.1093/haschl/qxaf079","DOIUrl":"https://doi.org/10.1093/haschl/qxaf079","url":null,"abstract":"The annual Medicare Trustees Report projects when the Hospital Insurance Trust Fund will become insolvent, a key indicator of the Medicare program's fiscal health. Over the past 40 years, the Trust Fund insolvency date was extended 20 times. The Trustees estimated in 2012 that the Trust Fund would be completely exhausted by now; their latest estimate pushed the depletion date back to 2036. Our analysis of Medicare Trustees Reports from 1985 to 2024 revealed the factors affecting solvency projections. While annual adjustments to cost growth assumptions have triggered minor solvency extensions, major reforms such as the 1984 Deficit Reduction Act, 1997 Balanced Budget Act, and 2010 Affordable Care Act had larger, more sustained impacts than originally estimated. These policy reforms directly affected provider payments and indirectly constrained growth in other parts of the program, including payments to private health plans. In light of recent growth in US health spending, the challenge for policymakers seeking to improve Medicare's financial outlook is to enact and sustain substantive legislative changes rather than short-term solutions.","PeriodicalId":94025,"journal":{"name":"Health affairs scholar","volume":"3 4","pages":"qxaf079"},"PeriodicalIF":0.0,"publicationDate":"2025-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12022393/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144061075","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

Democratizing care to care for democracy: community care workers and anti-racist public health. 民主化护理为民主护理：社区护理工作者和反种族主义公共卫生。

Health affairs scholar Pub Date : 2025-04-08 eCollection Date: 2025-04-01 DOI: 10.1093/haschl/qxaf052

Raeghn Draper, Eric Reinhart

{"title":"Democratizing care to care for democracy: community care workers and anti-racist public health.","authors":"Raeghn Draper, Eric Reinhart","doi":"10.1093/haschl/qxaf052","DOIUrl":"10.1093/haschl/qxaf052","url":null,"abstract":"The organization of care in the United States reflects a longstanding prioritization of medical interventions over broader social support systems. This has contributed to widening racial and class inequalities alongside poor health outcomes, weakened communities, and growing social isolation that has created fertile ground for rising authoritarianism. Following on Roy, Hamilton, and Chokshi (2024), who argue for the necessity of addressing the interconnected areas of capital, care, and culture to rebuild US public health, we outline how public investment in community care worker systems can address each of these areas by strengthening their synergistic overlaps and reframing the function of care in society. By recruiting residents of disinvested communities into career positions as publicly employed care workers in their own neighborhoods, such a program would implement a genuinely anti-racist model of public health. This approach is rooted in training and properly compensating members of disenfranchised communities to care for one another rather than perpetuating classist and racist models of care in which reliance on external actors is presumed necessary. By insisting on policies that support the essential interpersonal and political-economic functions of care as public infrastructure, care can obtain a collective ethical and spiritual significance beyond its material effects alone. Implementing community care programs designed to reanimate care in this way could not only dramatically improve health but also revitalize the twinned projects of American democracy and racial equality in a period during which both are under intensifying threat.","PeriodicalId":94025,"journal":{"name":"Health affairs scholar","volume":"3 4","pages":"qxaf052"},"PeriodicalIF":0.0,"publicationDate":"2025-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11977331/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143813254","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

Institute for Clinical and Economic Review's role in the US health care system: Centering the patient perspective. 临床和经济评论研究所在美国医疗保健系统中的作用：以病人的角度为中心。

Health affairs scholar Pub Date : 2025-04-08 eCollection Date: 2025-04-01 DOI: 10.1093/haschl/qxaf071

Sarah K Emond, Catherine K Fischer

引用次数: 0

Increasing access to school-based mental health services for youth subsequent to the COVID-19 pandemic. 在2019冠状病毒病大流行之后，增加青少年获得学校精神卫生服务的机会。

Health affairs scholar Pub Date : 2025-04-05 eCollection Date: 2025-04-01 DOI: 10.1093/haschl/qxaf073

Charles Brown, N'Daisha K Carrington

引用次数: 0

Early childhood education and handgun carrying, serious fighting, and assault charges: a retrospective cohort study. 儿童早期教育与携带手枪、严重打架和攻击指控：一项回顾性队列研究。

Health affairs scholar Pub Date : 2025-04-05 eCollection Date: 2025-04-01 DOI: 10.1093/haschl/qxaf070

Julia P Schleimer, Anjum Hajat, Gail Joseph, Frederick Rivara, Min Sun, Ali Rowhani-Rahbar

{"title":"Early childhood education and handgun carrying, serious fighting, and assault charges: a retrospective cohort study.","authors":"Julia P Schleimer, Anjum Hajat, Gail Joseph, Frederick Rivara, Min Sun, Ali Rowhani-Rahbar","doi":"10.1093/haschl/qxaf070","DOIUrl":"https://doi.org/10.1093/haschl/qxaf070","url":null,"abstract":"High-quality early childhood education may buffer against social and structural drivers of interpersonal violence. We examined the association of Head Start-a large-scale early childhood education program for low-income children, launched in 1965 as part of the War on Poverty-with handgun carrying, serious fighting, and assault charges among 4281 individuals born between 1980 and 1984 in the National Longitudinal Survey of Youth 1997. We found that attending Head Start vs other childcare was associated with 0.77 times the risk of handgun carrying by age 31 (95% CI: 0.60, 0.99) and 0.79 times the risk of serious fighting by age 24 (95% CI: 0.64, 0.98) among Black males. No reduction in the risk of outcomes was observed among other subpopulations or when comparing Head Start with solely parental childcare. Expanding access to high-quality early childhood education programs may reduce later-life handgun carrying and serious fighting among those at highest risk, thus reducing racialized disparities. Results suggest that early-life investments in the social, economic, and human capital of structurally disadvantaged children and families may be effective and equitable tools to prevent violence and firearm-related harms.","PeriodicalId":94025,"journal":{"name":"Health affairs scholar","volume":"3 4","pages":"qxaf070"},"PeriodicalIF":0.0,"publicationDate":"2025-04-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12036515/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144029182","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

Racial, ethnic, and rural disparities in access to Medicaid offices. 获得医疗补助办公室的种族、民族和农村差异。

Health affairs scholar Pub Date : 2025-04-04 eCollection Date: 2025-05-01 DOI: 10.1093/haschl/qxaf072

Kenneth Lim, Demetri Goutos, Monica Aswani, Joseph Benitez, Kathryn Thompson, Paul R Shafer

{"title":"Racial, ethnic, and rural disparities in access to Medicaid offices.","authors":"Kenneth Lim, Demetri Goutos, Monica Aswani, Joseph Benitez, Kathryn Thompson, Paul R Shafer","doi":"10.1093/haschl/qxaf072","DOIUrl":"https://doi.org/10.1093/haschl/qxaf072","url":null,"abstract":"Physical Medicaid offices may play an important role in supporting beneficiaries and alleviating administrative burdens during critical enrollment or redetermination periods. Limited research has explored whether racial, ethnic, and rural disparities in access to Medicaid offices exist. Leveraging a county-level data set of geocoded Medicaid offices merged with American Community Survey data, we examined variation in Medicaid office density. We used a choropleth map to demonstrate variability within and across states and linear probability models to explore the association between demographic characteristics and having at least 1 Medicaid office in the county. Over three-fourths of US counties had an office, but access to such offices varied by race, ethnicity, and rurality. Counties with high Hispanic (≥40%) and rural (>50%) populations were associated with a 14.3 and 18.7 percentage point lower probability of having at least 1 Medicaid office (both P < 0.001), respectively. Findings can be used to prioritize areas for investment in physical infrastructure, specific group outreach, or technological advancements by state Medicaid programs. While the unwinding from the COVID-19 public health emergency may have highlighted these vulnerabilities and inequities, our findings reflect long-standing differences in investment across states that influence individuals' access to Medicaid.","PeriodicalId":94025,"journal":{"name":"Health affairs scholar","volume":"3 5","pages":"qxaf072"},"PeriodicalIF":0.0,"publicationDate":"2025-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12053252/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144055461","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 nurse home visiting on take-up of social safety net programs in a Medicaid population. 护士家访对医疗补助人群社会安全网项目的影响。

Health affairs scholar Pub Date : 2025-04-02 eCollection Date: 2025-04-01 DOI: 10.1093/haschl/qxaf038

Slawa Rokicki, Dea Oviedo, Nicolas Perreault, Mary Ann Bates, R Annetta Zhou, Katherine Baicker, Margaret A McConnell

{"title":"Impact of nurse home visiting on take-up of social safety net programs in a Medicaid population.","authors":"Slawa Rokicki, Dea Oviedo, Nicolas Perreault, Mary Ann Bates, R Annetta Zhou, Katherine Baicker, Margaret A McConnell","doi":"10.1093/haschl/qxaf038","DOIUrl":"10.1093/haschl/qxaf038","url":null,"abstract":"Childhood poverty can affect health and development across the life course. Access to social safety net programs may alleviate poverty-related hardships like food insecurity among low-income families, yet many eligible households do not enroll. We used a randomized controlled trial (n = 5670) to evaluate the impact of the Nurse-Family Partnership (NFP) home visiting program during pregnancy and the first 2 years after delivery on take-up of social programs including the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) and Supplemental Nutrition Assistance Program (SNAP). The NFP services were funded as part of a Medicaid Section 1915(b) waiver in South Carolina. We found that NFP participants were more likely to be enrolled in SNAP or WIC during pregnancy (87.8% vs 86.0%) and were enrolled in SNAP for 0.6 months longer in the first 2 years after delivery than control participants. Nurse home visiting moderately increased take-up of social safety net programs in pregnancy and the first years of life, even in a context with already high rates of participation. This study contributes important evidence on the effectiveness of Medicaid-funded initiatives for addressing social needs of low-income families.Clinical trial registration: ClinicalTrials.gov; ID NCT03360539 (https://clinicaltrials.gov/study/NCT03360539).","PeriodicalId":94025,"journal":{"name":"Health affairs scholar","volume":"3 4","pages":"qxaf038"},"PeriodicalIF":0.0,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11964293/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143775164","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

Building a public-private partnership to confront the emergency department boarding crisis. 建立公私合作伙伴关系，应对急诊科寄宿危机。

Health affairs scholar Pub Date : 2025-04-02 eCollection Date: 2025-04-01 DOI: 10.1093/haschl/qxaf014

Sean S Michael, Sean Bruna, Laura L Sessums

引用次数: 0

Area-Level socioeconomic disadvantage and access to primary care: A rapid review. 地区层面的社会经济劣势与初级保健的可及性：快速回顾。

Health affairs scholar Pub Date : 2025-04-02 eCollection Date: 2025-04-01 DOI: 10.1093/haschl/qxaf066

Jonathan A Staloff, Anna M Morenz, Sophia A Hayes, Ananya L Bhatia-Lin, Joshua M Liao

{"title":"Area-Level socioeconomic disadvantage and access to primary care: A rapid review.","authors":"Jonathan A Staloff, Anna M Morenz, Sophia A Hayes, Ananya L Bhatia-Lin, Joshua M Liao","doi":"10.1093/haschl/qxaf066","DOIUrl":"https://doi.org/10.1093/haschl/qxaf066","url":null,"abstract":"Social drivers of health aggregate geographically, contributing to health inequities that primary care access may mitigate. Two area-level measures of social disadvantage are the Area Deprivation Index and Social Vulnerability Index. This rapid review aimed to assess the association between these measures and primary care access. We conducted a rapid review of US studies published through February 11, 2025. Included studies were categorized as defining primary care access by self-reported access to primary care, geographic accessibility, or utilization. We analyzed 31 studies, of which 68% (N = 9/13 Area Deprivation Index, N = 12/18 Social Vulnerability Index) found that greater area-level social disadvantage was consistently associated with reduced primary care access. This association was most consistently observed in studies measuring primary care access via self-report (N = 2/2), vaccine uptake (N = 5/7), and via a higher odds of using telephone vs audio-visual or in-person primary care in areas of high socioeconomic disadvantage (N = 5/5). These findings have implications for telemedicine payment policy and care redesign. The possible expiration of Medicare's expanded telemedicine reimbursement may disproportionately reduce access points to primary care for individuals living in high socioeconomic disadvantage areas. These findings also support the need for community-level interventions to increase access to primary care administered vaccines.","PeriodicalId":94025,"journal":{"name":"Health affairs scholar","volume":"3 4","pages":"qxaf066"},"PeriodicalIF":0.0,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12013819/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144034987","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

Participation and attrition in the Medicare Shared Savings Program. 医疗保险共同储蓄计划的参与和减员情况。

Health affairs scholar Pub Date : 2025-04-01 DOI: 10.1093/haschl/qxaf067

Adam A Markovitz, Pedro L Gozalo, Andrew M Ryan

引用次数: 0