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Chen BK, Yang YT, Eggleston K. Patient Copayments, Provider Incentives and Income Effects: Theory and Evidence from the Essential Medications List under China's 2009 Healthcare Reform. WORLD MEDICAL & HEALTH POLICY 2017; 9:24-44. [PMID: 29075552 PMCID: PMC5654551 DOI: 10.1002/wmh3.222] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Expanding access through insurance expansion can increase healthcare utilization through moral hazard. Reforming provider incentives to introduce more supply-side cost sharing is increasingly viewed as crucial for affordable, sustainable access. Using both difference-in-differences and segmented regression analyses on a panel of 1,466 hypertensive and diabetic patients, we empirically examine Shandong province's initial implementation of China's 2009 Essential Medications List policy. The policy reduced drug sale markups to providers but also increased drug coverage benefits for patients. We find that providers appeared to compensate for lost drug revenues by increasing office visits, for which no fee reduction occurred. At the same time, physician agency (yielding to patient demand for pharmaceuticals) may have tempered provider incentives to reduce drug expenditures at the visit level. Taken together, the policy may have increased total spending or total out-of-pocket expenditures. Mandating payment reductions in a service that comprises a large portion of provider income may have unintended consequences.
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102
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Yang YT, Kozhimannil KB. Whole Woman's Health v. Hellerstedt and the Current Implications for Abortion Access. Birth 2017; 44:3-6. [PMID: 27933647 DOI: 10.1111/birt.12271] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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103
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Yang YT, Larochelle MR, Haffajee RL. Managing Increasing Liability Risks Related to Opioid Prescribing. Am J Med 2017; 130:249-250. [PMID: 27644150 DOI: 10.1016/j.amjmed.2016.08.041] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Revised: 08/26/2016] [Accepted: 08/26/2016] [Indexed: 01/25/2023]
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104
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Yang YT, Studdert DM. Linking Immunization Status and Eligibility for Welfare and Benefits Payments: The Australian "No Jab, No Pay" Legislation. JAMA 2017; 317:803-804. [PMID: 28245331 DOI: 10.1001/jama.2017.0123] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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105
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Grinshteyn E, Yang YT. The Association Between Electronic Bullying and School Absenteeism Among High School Students in the United States. THE JOURNAL OF SCHOOL HEALTH 2017; 87:142-149. [PMID: 28076925 DOI: 10.1111/josh.12476] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/12/2015] [Revised: 04/27/2016] [Accepted: 08/11/2016] [Indexed: 05/27/2023]
Abstract
BACKGROUND We examined the relationship between exposure to electronic bullying and absenteeism as a result of being afraid. METHODS This multivariate, multinomial regression analysis of the 2013 Youth Risk Behavior Survey data assessed the association between experiencing electronic bullying in the past year and how often students were absent in the last month due to feeling unsafe at/in transit to school. The model controlled for other predictors of school absence including demographics, physical/behavioral health, and risk factors. Missing data were multiply imputed. RESULTS Electronic bullying was significantly associated with absences. Controlling for model covariates, the relative risk of missing 1 day of school was 1.77 times higher, the relative risk of missing 2 to 3 days of school per month increased by a factor of 2.08, and the relative risk of missing 4 or more days of school per month increased by a factor of 1.77 for those who experienced electronic bullying in the past year compared with those who were not electronically bullied. CONCLUSIONS Electronic bullying's association with absenteeism places it among already recognized negative influences such as depression and binge drinking, necessitating schools to implement policies to mediate the resulting harmful effects.
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Bennett CL, Nagai S, Yang YT, Chen BK, Sartor O, Armitage JO. Generic drugs in oncology – Authors' reply. Lancet Oncol 2017; 18:e64. [DOI: 10.1016/s1470-2045(17)30016-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2016] [Accepted: 01/05/2017] [Indexed: 10/20/2022]
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107
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Yang YT, Chen B, Bennett CL. Federal 340B Program Payment Scheme for Drugs Designated As Orphan Products: Congressional Clarification Needed to Close the Government-Industry Revolving Door. J Clin Oncol 2016; 34:4320-4322. [PMID: 27998222 PMCID: PMC6366246 DOI: 10.1200/jco.2016.68.2989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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108
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Chen BK, Yang YT, Yang CY. Trends in amenable deaths based on township income quartiles in Taiwan, 1971-2008: did universal health insurance close the gap? J Public Health (Oxf) 2016; 38:e524-e536. [PMID: 28158683 DOI: 10.1093/pubmed/fdv156] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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109
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Yang YT, Sarfaty M. Zika virus: A call to action for physicians in the era of climate change. Prev Med Rep 2016; 4:444-6. [PMID: 27617189 PMCID: PMC5007542 DOI: 10.1016/j.pmedr.2016.07.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Accepted: 07/04/2016] [Indexed: 11/26/2022] Open
Abstract
In February 2016, the World Health Organization declared the mosquito-borne Zika virus to be a "public health emergency of international concern" as the disease linked to thousands of birth defects in Brazil spreads rapidly. The distribution of the Aedes mosquitos has drastically increased over the past few decades, which have been the hottest decades on Earth in more than 1000 years based on climate proxy measures. Although a combination of factors explains the current Zika virus outbreak, it's highly likely that the changes in the climate contribute to the spread of Aedes vector carrying the Zika virus, the pathogen causing serious birth defects. Physicians, both individually and collectively, as trusted and educated members of society have critical roles to play. In addition to clinical management and prevention of Zika, physicians should communicate about the health benefits of addressing climate change in straightforward evidence-based language to their local communities and policymakers, and make clear their support for policies mitigating climate change.
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Leslie TF, Street EJ, Delamater PL, Yang YT, Jacobsen KH. Variation in Vaccination Data Available at School Entry Across the United States. Am J Public Health 2016; 106:2180-2182. [PMID: 27736214 PMCID: PMC5105002 DOI: 10.2105/ajph.2016.303455] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/20/2016] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To compile substate-level data on US school-age children's vaccination rates. METHODS For states that did not have suitable data online, in 2015 we submitted information requests to the state health department and followed up with the state's Freedom of Information Act when necessary. RESULTS The accessibility, scale, and types of vaccination data varied considerably. Whereas 26 states provided data online, 14 released data only after a Freedom of Information Act request. School or school-district data were available for 24 states, 19 at the county level, 2 at the health department level, and 6 provided no substate-level data. CONCLUSIONS Effective vaccination policy requires a robust understanding of vaccination behavior. Some states make it difficult to access data or provide low-resolution data of limited value for identifying vaccination behavior.
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111
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Shaw J, Yang YT. Sudden Infant Death Syndrome, Attention-Deficit/Hyperactivity Disorder and Vaccines: Population-Level Analyses, 2003–2013. Open Forum Infect Dis 2016. [DOI: 10.1093/ofid/ofw172.656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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112
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Yang YT, Grinshteyn E. Safer Cyberspace Through Legal Intervention: A Comparative Review of Cyberbullying Legislation. WORLD MEDICAL & HEALTH POLICY 2016. [DOI: 10.1002/wmh3.206] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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113
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Yang YT, Wiley E, Duvivier RJ. US policy on blood donation by men who have sex with men. Lancet 2016; 388:2236-2237. [PMID: 27825503 DOI: 10.1016/s0140-6736(16)32073-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Accepted: 09/12/2016] [Indexed: 10/20/2022]
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114
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Berman ML, Yang YT. E-Cigarettes, Youth, and the US Food and Drug Administration's "Deeming" Regulation. JAMA Pediatr 2016; 170:1039-1040. [PMID: 27668949 DOI: 10.1001/jamapediatrics.2016.2255] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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115
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Delamater PL, Leslie TF, Yang YT. A spatiotemporal analysis of non-medical exemptions from vaccination: California schools before and after SB277. Soc Sci Med 2016; 168:230-238. [PMID: 27567288 PMCID: PMC6626670 DOI: 10.1016/j.socscimed.2016.08.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Revised: 07/01/2016] [Accepted: 08/06/2016] [Indexed: 11/23/2022]
Abstract
Childhood vaccination programs are considered one of the most beneficial public health programs in modern history. In the United States, the increasing use of non-medical exemptions (NMEs) from school entry vaccination requirements has garnered attention and scrutiny in the popular press, academic literature, and policy forums. In 2016, California law SB277 goes into effect, eliminating the NME option for students attending the state's public and private schools. Whereas SB277 is a strong move to increase vaccination coverage within California's schools, the new law contains an important caveat - students already having a valid NME (obtained prior to the 2016 school year) are "grandfathered" in until their next grade checkpoint (seventh grade). Although no new students will enter the California school system with a NME after 2016, the law's grandfather clause will allow NMEs to persist within the state school system until 2022. This analysis demonstrates how the past "build up" of students with pre-SB277 NMEs and the law's grandfather clause will act in combination to affect NME rates across the state after the implementation of SB277. We construct spatially explicit, yearly models of all students (K-12) enrolled in the California school system from 2011 to 2022. Our analysis finds that, although all regions of the state will eventually reach an NME rate of 0% by 2022, SB277's effect will be highly spatially and temporally variable. Some school districts will continue to experience elevated NME rates and increased risk of disease outbreak for years after SB277 is implemented. Our analysis highlights the potential spatially variant consequences of SB277's grandfather clause, providing important information for other states considering similar policy initiatives.
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Yang YT, Swinburne M. New Produce Safety Regulations: Promises and Challenges. Public Health Rep 2016; 131:754-757. [PMID: 28123220 DOI: 10.1177/0033354916669495] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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117
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Yang YT, Haffajee RL. Murder Liability for Prescribing Opioids: A Way Forward? Mayo Clin Proc 2016; 91:1331-1335. [PMID: 27502463 PMCID: PMC7490802 DOI: 10.1016/j.mayocp.2016.06.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2016] [Revised: 06/14/2016] [Accepted: 06/24/2016] [Indexed: 10/21/2022]
Abstract
In February 2016, Dr. Hsiu-Ying Tseng was sentenced to 30-years to life in prison after a jury found her guilty of second-degree murder for three patient drug overdose deaths in California. For the first time in American history, a physician was held criminally liable for the murder of a patient by means of extreme recklessness in opioid prescribing. Although Dr. Tseng’s unique conviction reflects her outlier prescribing practices, the conviction and sentencing has sent ripples through the medical community, causing concerns for many physicians who now worry they will be held criminally liable when their patients abuse and misuse opioid prescriptions. However, physicians—particularly the majority that prescribe opioids in an earnest attempt to alleviate legitimate patient pain—may take comfort that the legal risks can be managed. Prescribers can take a number of steps to minimize criminal liability concerns, including following available guidelines, such as those recently issued on opioid prescribing for chronic pain by the Centers for Disease Control and Prevention. While outlier physicians like Dr. Tseng may meet the standards for criminal liability, criminal prosecution may do little to curb prescription opioid abuse—an epidemic that calls for more upstream prevention measures.
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Yang YT, Bhoobun S, Itani T, Jacobsen KH. Europe Should Consider Mandatory Measles Immunization for School Entry. J Pediatric Infect Dis Soc 2016; 5:319-22. [PMID: 26907813 DOI: 10.1093/jpids/piw003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2015] [Accepted: 01/09/2016] [Indexed: 11/14/2022]
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119
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Barraza L, Weidenaar K, Campos-Outcalt D, Yang YT. Human Papillomavirus and Mandatory Immunization Laws: What Can We Learn From Early Mandates? Public Health Rep 2016; 131:728-731. [PMID: 28123214 DOI: 10.1177/0033354916663184] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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120
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Kels CG, Bernstein JA, Yang YT. Mental Illness and Firearms Background Checks-Combatting Violence Without Inhibiting Care. JAMA Psychiatry 2016; 73:767-8. [PMID: 27410396 DOI: 10.1001/jamapsychiatry.2016.1485] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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121
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Yang YT, Kels CG. Does the Shoe Fit? Ethical, Legal, and Policy Considerations of Global Positioning System Shoes for Individuals with Alzheimer's Disease. J Am Geriatr Soc 2016; 64:1708-15. [DOI: 10.1111/jgs.14265] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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122
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Yang YT, Chen B. Medical record privacy and state health reform after Gobeille v. Liberty Mutual Insurance Co. THE AMERICAN JOURNAL OF MANAGED CARE 2016; 22:472-474. [PMID: 27442202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
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123
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Yang YT, Painter JE, Meier BM. Coordinated regulatory efforts needed to strengthen travel related immunization requirements against importation of infectious diseases. Vaccine 2016; 34:3921-2. [PMID: 27344292 DOI: 10.1016/j.vaccine.2016.06.047] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2016] [Revised: 06/09/2016] [Accepted: 06/13/2016] [Indexed: 10/21/2022]
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124
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Delamater PL, Leslie TF, Yang YT. California Senate Bill 277's Grandfather Clause and Nonmedical Vaccine Exemptions in California, 2015-2022. JAMA Pediatr 2016; 170:619-20. [PMID: 27018540 DOI: 10.1001/jamapediatrics.2015.4856] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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125
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Delamater PL, Leslie TF, Yang YT, Jacobsen KH. An approach for estimating vaccination coverage for communities using school-level data and population mobility information. APPLIED GEOGRAPHY (SEVENOAKS, ENGLAND) 2016; 71:123-132. [PMID: 31327881 PMCID: PMC6641576 DOI: 10.1016/j.apgeog.2016.04.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Childhood vaccination data are made available at a school level in some U.S. states. These data can be geocoded and may be considered as having a high spatial resolution. However, a school only represents the destination location for the set of students that actually reside and interact within some larger areal region, creating a spatial mismatch. Public school districts are often used to represent these regions, but fail to account for private schools and school of choice programs. We offer a new approach to estimate childhood vaccination coverage rates at a community level by integrating school level data with population commuting information. The resulting mobility-adjusted vaccine coverage estimates resolve the spatial mismatch problem and are more aligned with the geographic scale at which public health policies are implemented. We illustrate the utility of our approach using a case study on diphtheria, tetanus, and pertussis (DTP) vaccination coverage for kindergarten students in California. The modeled community-level DTP coverage estimates yield a statewide coverage of 92.37%, which is highly similar to the 92.44% coverage rate calculated from the original school-level data.
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