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Jiménez J, Kress M, Long T, Katz M. NYC Care: A Large Health Care Access Program for Uninsured New York City Residents. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2024; 30:E239-E246. [PMID: 38833664 DOI: 10.1097/phh.0000000000001915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2024]
Abstract
CONTEXT Millions of people living in the United States are excluded from health insurance due to income or immigration status. These 2 groups are more likely to lack access to health care or a regular source of care. PROGRAM NYC Health + Hospitals is addressing this need with NYC Care, a health care access program. The program is designed to be the single point of access for uninsured care citywide and includes a membership card, a 24-hour customer service line, and direct access to primary care medical homes. Health care is coordinated across NYC Health + Hospitals using integrated electronic referrals and a medical record system. IMPLEMENTATION The program uses a single enrollment process across safety net health care resources of NYC Health + Hospitals. A 24-hour call center was established to answer questions, make primary care appointments, and make warm handoffs to enrollment staff. Once eligibility is confirmed and patients are enrolled, they are mailed a membership card, a member handbook, and offered a primary care appointment. A multipronged public awareness campaign including citywide, multilingual marketing and outreach via community-based organizations was essential to build trust. OUTCOMES NYC Care had 119 203 members at the end of June 2023. Fifty-eight percent had not seen a primary care doctor in the NYC Health + Hospitals system in the prior 36 months. In total, 76 439 had completed 1 or more primary care visits; 53.1% of enrollees with diabetes had improved hemoglobin A 1c , and 73.4% of enrollees with hypertension had improved blood pressure control after 6 months of enrollment. DISCUSSION NYC Care demonstrates that municipalities can improve access to care for the uninsured by simplifying steps to affordable health care services, connecting patients directly to patient-centered medical homes, and improving the patient experience. A comprehensive public awareness campaign is also crucial.
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Affiliation(s)
- Jonathan Jiménez
- NYC Health + Hospitals, Duke University School of Medicine, Durham, North Carolina (Dr Jiménez); NYC Health + Hospitals, New York (Ms Kress and Dr Katz); and Health + Hospitals, NYU Grossman School of Medicine, New York (Dr Long)
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Jolin JR, Barsky BA, Wade CG, Rosenthal MB. Access to Care and Outcomes With the Affordable Care Act for Persons With Criminal Legal Involvement: A Scoping Review. JAMA HEALTH FORUM 2024; 5:e242640. [PMID: 39177982 PMCID: PMC11344231 DOI: 10.1001/jamahealthforum.2024.2640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Accepted: 06/30/2024] [Indexed: 08/24/2024] Open
Abstract
Importance By expanding health insurance to millions of people in the US, the Patient Protection and Affordable Care Act (ACA) may have important health, economic, and social welfare implications for people with criminal legal involvement-a population with disproportionately high morbidity and mortality rates. Objective To scope the literature for studies assessing the association of any provision of the ACA with 5 types of outcomes, including insurance coverage rates, access to care, health outcomes, costs of care, and social welfare outcomes among people with criminal legal involvement. Evidence Review The literature search included results from PubMed, CINAHL Complete, APA Psycinfo, Embase, Social Science Database, and Web of Science and was conducted to include articles from January 1, 2014, through December 31, 2023. Only original empirical studies were included, but there were no restrictions on study design. Findings Of the 3538 studies initially identified for potential inclusion, the final sample included 19 studies. These 19 studies differed substantially in their definition of criminal legal involvement and units of analysis. The studies also varied with respect to study design, but difference-in-differences methods were used in 10 of the included studies. With respect to outcomes, 100 unique outcomes were identified across the 19 studies, with at least 1 in all 5 outcome categories determined prior to the literature search. Health insurance coverage and access to care were the most frequently studied outcomes. Results for the other 3 outcome categories were mixed, potentially due to heterogeneous definitions of populations, interventions, and outcomes and to limitations in the availability of individual-level datasets that link incarceration data with health-related data. Conclusions and Relevance In this scoping review, the ACA was associated with an increase in insurance coverage and a decrease in recidivism rates among people with criminal legal involvement. Future research and data collection are needed to understand more fully health and nonhealth outcomes among people with criminal legal involvement related to the ACA and other health insurance policies-as well as the mechanisms underlying these relationships.
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Affiliation(s)
| | - Benjamin A. Barsky
- University of California College of the Law, San Francisco
- Interfaculty Initiative in Health Policy, Harvard University, Cambridge, Massachusetts
| | - Carrie G. Wade
- Countway Library, Harvard Medical School, Boston, Massachusetts
| | - Meredith B. Rosenthal
- Interfaculty Initiative in Health Policy, Harvard University, Cambridge, Massachusetts
- Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
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Douglass PL, Itchhaporia D, Bozkurt B, Roswell RO, Khandelwal A, Capers Q, Berlacher K, Ogunniyi MO, Bailey AL, Levy PD, Grant AJ, Tocco J, Natcheva A, Asare AG, Bhatt AB, Mieres JH, Disch MF, Echols MR. Achieving Equitable Cardiovascular Care for All: ACC Board of Trustees Health Equity Task Force Action Plan. JACC. ADVANCES 2024; 3:101050. [PMID: 39130032 PMCID: PMC11313050 DOI: 10.1016/j.jacadv.2024.101050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Revised: 05/15/2024] [Accepted: 05/17/2024] [Indexed: 08/13/2024]
Abstract
Advancements in cardiovascular (CV) disease management are notable, yet health inequities prevail, associated with increased morbidity and mortality noted among non-Hispanic African Americans in the United States. The 2002 Institute of Medicine Report revealed ongoing racial and ethnic health care disparities, spearheading a deeper understanding of the social determinants of health and systemic racism to develop strategies for CV health equity (HE). This article outlines the strategic HE approach of the American College of Cardiology, comprising 6 strategic equity domains: workforce pathway inclusivity, health care, data, science, and tools; education and training; membership, partnership, and collaboration; advocacy and policy; and clinical trial diversity. The American College of Cardiology's Health Equity Task Force champions the improvement of patients' lived experiences, population health, and clinician well-being while reducing health care costs-the Quadruple Aim of Health Equity. Thus, we examine multifaceted HE interventions and provide evidence for scalable real-world interventions to promote equitable CV care.
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Affiliation(s)
- Paul L. Douglass
- Chair, ACC BOT Health Equity Taskforce, Wellstar Health System, Morehouse School of Medicine, Atlanta, Georgia, USA
| | - Dipti Itchhaporia
- Chair of Cardiovascular Health, Hoag Memorial Hospital Presbyterian, Newport Beach, California, USA
| | - Biykem Bozkurt
- Winters Center for Heart Failure, Cardiovascular Research Institute, Baylor College of Medicine, Newport Beach, California, USA
| | - Robert O. Roswell
- Department of Science Education and Cardiology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New York, New York, USA
| | - Akshay Khandelwal
- System Chair, Department of Cardiovascular Medicine, Allegheny Health Network, Pittsburgh, Pennsylvania, USA
| | - Quinn Capers
- Chair of Medicine, Howard University, Washington, DC, USA
| | - Kathryn Berlacher
- University of Pittsburgh Medical Center, Heart and Vascular Institute
| | - Modele O. Ogunniyi
- Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
- Division of Cardiology, Department Medicine, Grady Health System, Atlanta, Georgia, USA
| | - Alison L. Bailey
- Center for Heart, Lung and Vascular Health at Parkridge, Parkridge Health System, Chattanooga, Tennessee, USA
| | - Phillip D. Levy
- Department of Emergency Medicine, Wayne State University, Detroit, Michigan, USA
| | - Aubrey J. Grant
- Division of Cardiology, Department Medicine, Medstar Heart and Vascular Institute, Washington, DC, USA
| | - Jack Tocco
- Department of Community and Population Health, Northwell Health, Brooklyn, New York, USA
| | - Angela Natcheva
- Division of Diversity Equity and Inclusion, American College of Cardiology, Washington, DC, USA
| | - Akua G. Asare
- Division of Diversity Equity and Inclusion, American College of Cardiology, Washington, DC, USA
| | - Ami B. Bhatt
- American College of Cardiology, Harvard Medical School, Boston, Massachusetts, USA
| | - Jennifer H. Mieres
- Department of Cardiology, Zucker School of Medicine at Hofstra/Northwell, Brooklyn, New York, USA
| | - Maghee F. Disch
- Division of Diversity Equity and Inclusion, American College of Cardiology, Washington, DC, USA
| | - Melvin R. Echols
- Chief Diversity, Equity and Inclusion Officer at American College of Cardiology, Morehouse School of Medicine, Atlanta, Georgia, USA
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Santos T, Young GJ. Evolution of Hospitals' Community Benefits: Addressing Social Determinants of Health Through Investments in Housing Security. Med Care 2024; 62:353-355. [PMID: 38652040 DOI: 10.1097/mlr.0000000000002007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2024]
Affiliation(s)
- Tatiane Santos
- School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA
| | - Gary J Young
- Center for Health Policy and Healthcare Research, Northeastern University, Boston, MA
- D'Amore McKim School of Business, Northeastern University, Boston, MA
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Karime C, Salazar M, Black CN, Caldera F, Okafor PN, Hammami MB, Hashash JG, Farraye FA. In Patients With Inflammatory Bowel Disease, Racial Disparities Exist in Burden of Vaccine-preventable Disease Hospitalizations and Outcomes. J Clin Gastroenterol 2024:00004836-990000000-00286. [PMID: 38619208 DOI: 10.1097/mcg.0000000000002005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Accepted: 03/11/2024] [Indexed: 04/16/2024]
Abstract
OBJECTIVE Patients with inflammatory bowel disease (IBD) are at increased risk of vaccine-preventable diseases (VPDs). Despite the increasing prevalence of IBD in non-white populations, little is known regarding racial disparities in VPD burden. METHODS Retrospectively analyzing the 2016 to 2020 National Inpatient Sample, we identified adults with IBD hospitalized for a principal diagnosis of VPD. The primary outcome investigated was hospitalization for VPD stratified by patient-reported race. Secondary outcomes were in-hospital morbidity, mortality, length of stay, and health care utilization. Multivariable regression analysis was performed to adjust for patient and hospital characteristics. RESULTS The search identified 554,114 hospitalizations for VPD, including 4170 hospitalizations in patients with IBD. Patients with IBD had significantly greater odds of hospitalization from herpes zoster virus (adjusted odds ratio [aOR]: 1.73) and varicella zoster virus (aOR: 2.31). Comparing white and non-white patients with IBD, significant racial disparities were noted. Non-white patients were at greater odds of hospitalization from influenza (aOR: 1.74), herpes zoster virus (aOR: 1.77), and varicella zoster virus (aOR: 1.62). In-hospital morbidity was greater in non-white patients, including greater odds of requiring intensive care unit stay (aOR: 1.18). Morbidity was elevated in African Americans, with greater odds of acute kidney injury (aOR: 1.25), venous thromboembolism (aOR: 1.17), respiratory failure (aOR: 1.16), and intensive care unit stay (aOR: 1.18). No differences were found in mortality, length of stay, and health care utilization. CONCLUSIONS Significant racial disparities in VPD hospitalization and in-hospital morbidity were found among adults with IBD in the United States. With the increasing prevalence of IBD in non-white populations, targeted efforts are needed to improve health equity.
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Affiliation(s)
| | - Miguel Salazar
- Department of Gastroenterology and Hepatology, University of California, Riverside, CA
| | | | - Freddy Caldera
- Department of Gastroenterology and Hepatology, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | | | - Muhammad B Hammami
- Department of Gastroenterology and Hepatology, University of California, Riverside, CA
| | - Jana G Hashash
- Department of Gastroenterology and Hepatology, Inflammatory Bowel Disease Center, Mayo Clinic, Jacksonville, FL
| | - Francis A Farraye
- Department of Gastroenterology and Hepatology, Inflammatory Bowel Disease Center, Mayo Clinic, Jacksonville, FL
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Adjei J, Tang M, Lipa S, Oyekan A, Woods B, Mesfin A, Hogan MV. Addressing the Impact of Race and Ethnicity on Musculoskeletal Spine Care in the United States. J Bone Joint Surg Am 2024; 106:631-638. [PMID: 38386767 DOI: 10.2106/jbjs.22.01155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/24/2024]
Abstract
➤ Despite being a social construct, race has an impact on outcomes in musculoskeletal spine care.➤ Race is associated with other social determinants of health that may predispose patients to worse outcomes.➤ The musculoskeletal spine literature is limited in its understanding of the causes of race-related outcome trends.➤ Efforts to mitigate race-related disparities in spine care require individual, institutional, and national initiatives.
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Affiliation(s)
- Joshua Adjei
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Melissa Tang
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Shaina Lipa
- Department of Orthopedic Surgery, Brigham and Woman's Hospital, Boston, Massachusetts
| | - Anthony Oyekan
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Barrett Woods
- Department of Orthopedic Surgery, Rothman Orthopedic Institute at Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Addisu Mesfin
- Department of Orthopaedic Surgery, Medstar Orthopaedic Institute, Georgetown University School of Medicine, Washington, DC
| | - MaCalus V Hogan
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
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Hatcher JB, Lin G, Moran CP, Al Awamlh SAH, Sulieman L, Morales NG, Berkowitz ST, Patel S, Lindsey J. Effects of Cost Sharing on Ophthalmic Care Utilization in the Affordable Care Act Marketplace. Ophthalmic Epidemiol 2024; 31:159-168. [PMID: 37042706 DOI: 10.1080/09286586.2023.2199849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Accepted: 04/01/2023] [Indexed: 04/13/2023]
Abstract
PURPOSE To determine the distribution and quantity of ophthalmic care consumed on Affordable Care Act (ACA) plans, the demographics of the population utilizing these services, and the relationship between ACA insurance coverage plan tier, cost sharing, and total cost of ophthalmic care consumed. METHODS This cross-sectional study analyzed ACA individual and small group market claims data from the Wakely Affordable Care Act (WACA) 2018 dataset, which contains detailed claims, enrollment, and premium data from Edge Servers for 3.9 million individual and small group market lives. We identified all enrollees with ophthalmology-specific billing, procedure, and national drug codes. We then analyzed the claims by plan type and calculated the total cost and out-of-pocket (OOP) cost. RESULTS Among 3.9 million enrollees in the WACA 2018 dataset, 538,169 (13.7%) had claims related to ophthalmology procedures, medications, and/or diagnoses. A total of $203 million was generated in ophthalmology-related claims, with $54 million in general services, $42 million in medications, $20 million in diagnostics and imaging, and $86 million in procedures. Average annual OOP costs were $116 per member, or 30.9% of the total cost, and were lowest for members with platinum plans (16% OOP) and income-driven cost sharing reduction (ICSR) subsidies (17% OOP). Despite stable ocular disease distribution across plan types, beneficiaries with silver ICSR subsidies consumed more total care than any other plan, higher than platinum plan enrollees and almost 1.5× the cost of bronze plan enrollees. CONCLUSIONS Ophthalmic care for enrollees on ACA plans generated substantial costs in 2018. Plans with higher OOP cost sharing may result in lower utilization of ophthalmic care.
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Affiliation(s)
- Jeremy B Hatcher
- Vanderbilt Eye Institute, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - George Lin
- Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Cullen P Moran
- Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | | | - Lina Sulieman
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | | | - Sean T Berkowitz
- Vanderbilt Eye Institute, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Shriji Patel
- Vanderbilt Eye Institute, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Jennifer Lindsey
- Vanderbilt Eye Institute, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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Abrantes T, Imbriano D, Reimann D, Sullivan J, Wisco O, Chan S, DiMarco C, Gehret N, Grenier N, Imbriano P, Kahn B, Lizbinski L, Massoud C, Negbenebor N, Parra S, Patel D, Reeder M, Robbins A, Takeshita J, Yang EJ, Braxton SC, Elston D. Performance measurement part I: Foundational knowledge for measure development. J Am Acad Dermatol 2024; 90:681-689. [PMID: 37343833 DOI: 10.1016/j.jaad.2023.01.054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Revised: 12/21/2022] [Accepted: 01/11/2023] [Indexed: 06/23/2023]
Abstract
As medicine is moving toward performance and outcome-based payment and is transitioning away from productivity-based systems, value is now being appraised in healthcare through "performance measures." Over the past few decades, assessment of clinical performance in health care has been essential in ensuring safe and cost-effective patient care. The Centers for Medicare & Medicaid Services is further driving this change with measurable, outcomes-based national payer incentive payment systems. With the continually evolving requirements in health care reform focused on value-based care, there is a growing concern that clinicians, particularly dermatologists, may not understand the scientific rationale of health care quality measurement. As such, in order to help dermatologists understand the health care measurement science landscape to empower them to engage in the performance measure development and implementation process, the first article in this 2-part continuing medical education series reviews the value equation, historic and evolving policy issues, and the American Academy of Dermatology's approach to performance measurement development to provide the required foundational knowledge for performance measure developers.
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Affiliation(s)
- Tatiana Abrantes
- The Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Dillon Imbriano
- University of New England College of Osteopathic Medicine, Biddeford, Maine
| | | | | | - Oliver Wisco
- The Warren Alpert Medical School of Brown University, Providence, Rhode Island.
| | - Stephanie Chan
- The Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Christopher DiMarco
- The Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Nicole Gehret
- The Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Nicole Grenier
- The Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Paul Imbriano
- Berkshire Medical Center of Massachusetts, Pittsfield, Massachusetts
| | - Benjamin Kahn
- The Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Leonardo Lizbinski
- The Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Cathy Massoud
- The Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Nicole Negbenebor
- The Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Sylvia Parra
- Dermatology and Skin Surgery Incorporated of Sumter, Sumter, South Carolina
| | | | - Margo Reeder
- The University of Wisconsin School of Medicine, Madison, Wisconsin
| | - Allison Robbins
- The Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Junko Takeshita
- The University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
| | - Eric J Yang
- The Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | | | - Dirk Elston
- The Medical University of South Carolina, Charleston, South Carolina
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Borja S, Valdovinos MG, Rivera KM, Giraldo-Santiago N, Gearing RE, Torres LR. "It's Not That We Care Less": Insights into Health Care Utilization for Comorbid Diabetes and Depression among Latinos. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:148. [PMID: 38397639 PMCID: PMC10887805 DOI: 10.3390/ijerph21020148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 01/04/2024] [Accepted: 01/16/2024] [Indexed: 02/25/2024]
Abstract
Despite robust knowledge regarding the socio-economic and cultural factors affecting Latino* access to healthcare, limited research has explored service utilization in the context of comorbid conditions like diabetes and depression. This qualitative study, embedded in a larger mixed-methods project, aimed to investigate perceptions held by Latinos and their social support systems (i.e., family members) regarding comorbid diabetes and depression and to identify barriers and facilitators to their help-seeking behaviors and treatment engagement. Bilingual and bicultural researchers conducted eight focus groups with 94 participants in a large U.S. metropolitan area and were primarily conducted in Spanish. The participants either had a diagnosis of diabetes and depression or were closely associated with someone who did. This study identified key individual and structural barriers and facilitators affecting healthcare access and treatment for Latinos living with comorbid diagnoses. A thematic analysis revealed structural barriers to healthcare access, including financial burdens and navigating healthcare institutions. Personal barriers included fears, personal responsibility, and negative family dynamics. Facilitators included accessible information, family support, and spirituality. These findings underscore the need to address these multi-level factors and for healthcare institutions and providers to actively involve Hispanic community members in developing services and interventions.
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Affiliation(s)
- Sharon Borja
- Graduate College of Social Work, University of Houston, Houston, TX 77004, USA;
| | | | - Kenia M. Rivera
- Department of Psychology, University of Denver, Denver, CO 80208, USA;
| | | | - Robin E. Gearing
- Graduate College of Social Work, University of Houston, Houston, TX 77004, USA;
| | - Luis R. Torres
- School of Social Work, University of Texas, Rio Grande Valley, Edinburg, TX 78539, USA;
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Lima HA, Endo Y, Moazzam Z, Alaimo L, Dillhoff M, Kim A, Beane J, Ejaz A, Cloyd J, Resende V, Pawlik TM. The Impact of Medicaid Expansion on Early-Stage Hepatocellular Carcinoma Care. Ann Surg Oncol 2023; 30:4589-4599. [PMID: 37142835 DOI: 10.1245/s10434-023-13562-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 03/16/2023] [Indexed: 05/06/2023]
Abstract
INTRODUCTION The impact of Medicaid expansion (ME) on hepatocellular carcinoma (HCC) remains controversial, and heterogeneous effects on care processes may relate to sociodemographic factors. We sought to evaluate the association between ME and receipt of surgery in early-stage HCC. METHODS Patients diagnosed with early-stage HCC between 40 and 64 years of age were identified from the National Cancer Database and divided into pre- (2004-2012) and post- (2015-2017) expansion cohorts. Logistic regression was used to identify predictors of surgical treatment. Difference-in-difference (DID) analysis assessed changes in surgical treatment between patients living in ME and non-ME states. RESULTS Among 19,745 patients, 12,220 (61.9%) were diagnosed before ME and 7525 (38.1%) after. Although overall utilization of surgery decreased after expansion (ME, pre-expansion: 62.2% versus post-expansion: 51.6%; non-ME, pre-expansion: 62.1% versus post-expansion: 50.8%, p < 0.001), this trend varied relative to insurance status. Notably, receipt of surgery increased among uninsured/Medicaid patients living in ME states after expansion (pre-expansion: 48.1%, post-expansion: 52.3%, p < 0.001). Moreover, treatment at academic or high-volume facilities increased the likelihood of undergoing surgery before expansion. After expansion, treatment at an academic facility and living in an ME state (OR 1.28, 95% CI 1.07-1.54, p < 0.01) were predictors of surgical treatment. DID analysis demonstrated increased utilization of surgery for uninsured/Medicaid patients living in ME states relative to non-ME states (uninsured/Medicaid: 6.4%, p < 0.05), although no differences were noted among patients with other insurance statuses (overall: 0.7%, private: -2.0%, other: 0.3%, all p > 0.05). CONCLUSIONS Implementation of ME heterogeneously impacted utilization of care in early-stage HCC. Notably, uninsured/Medicaid patients residing in ME states demonstrated increased utilization of surgical treatment after expansion.
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Affiliation(s)
- Henrique A Lima
- Department of Surgery, James Comprehensive Cancer Center, The Ohio State University Wexner Medical Center, Columbus, OH, USA
- Federal University of Minas Gerais School of Medicine, Belo Horizonte, Brazil
| | - Yutaka Endo
- Department of Surgery, James Comprehensive Cancer Center, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Zorays Moazzam
- Department of Surgery, James Comprehensive Cancer Center, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Laura Alaimo
- Department of Surgery, James Comprehensive Cancer Center, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Mary Dillhoff
- Department of Surgery, James Comprehensive Cancer Center, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Alex Kim
- Department of Surgery, James Comprehensive Cancer Center, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Joal Beane
- Department of Surgery, James Comprehensive Cancer Center, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Aslam Ejaz
- Department of Surgery, James Comprehensive Cancer Center, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Jordan Cloyd
- Department of Surgery, James Comprehensive Cancer Center, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Vivian Resende
- Federal University of Minas Gerais School of Medicine, Belo Horizonte, Brazil
| | - Timothy M Pawlik
- Department of Surgery, James Comprehensive Cancer Center, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
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Norris KC, Williams SF, Nee R. Flattening the Playing Field for Treatment of Diabetic Kidney Disease. Semin Nephrol 2023; 43:151428. [PMID: 37865981 DOI: 10.1016/j.semnephrol.2023.151428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2023]
Abstract
Diabetic kidney disease (DKD) remains a major health care issue and is beset with significant racial and ethnic disparities in regard to its incidence, progression, and complication rate. An individual's health is influenced strongly by an array of societal-level factors commonly called the social determinants of health. Among these, DKD is influenced highly by structured resources and opportunities, as well as an individual's socioeconomic status, health insurance status, access to care, education, health literacy, nutrition, green space exposure, level of trust in the medical community, and more. Health equity is considered a state in which everyone has a fair and just opportunity to attain his or her highest level of health. Conversely, health inequities are a consequence of a structured discriminatory system of inequitable allocation of social determinants of health. When this discriminatory system is race-based it is referred to as structural racism, which eventually leads to racial and ethnic health disparities. The further downstream sequela of structural racism, consciously or unconsciously, impacts health systems, providers, and patients, and can lead to disparities in DKD development, progression, and complications. In this article, we explore potential interventions at the societal, health system, and provider levels that can help flatten the playing field and reduce racial and ethnic disparities in DKD.
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Affiliation(s)
- Keith C Norris
- Department of Medicine, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA.
| | - Sandra F Williams
- Department of Integrated Medical Science, Florida Atlantic University, Boca Raton, FL
| | - Robert Nee
- Nephrology Service, Walter Reed National Military Medical Center, Department of Medicine, Uniformed Services University, Bethesda, MD
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Laditi F, Nie J, Hsiang W, Umer W, Haleem A, Marks V, Buck M, Leapman MS. Access to urologic cancer care for Medicaid-insured patients. Urol Oncol 2023; 41:206.e21-206.e27. [PMID: 36740488 DOI: 10.1016/j.urolonc.2023.01.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Revised: 12/28/2022] [Accepted: 01/16/2023] [Indexed: 02/07/2023]
Abstract
BACKGROUND The expansion of state Medicaid programs associated with the Affordable Care Act has led to significant increases in insurance coverage for economically vulnerable patients, however barriers to accessing cancer care still exist. To develop strategies to improve healthcare access, we characterized access to new urologic cancer care for patients with Medicaid insurance in the United States. METHODS Using a secret shopper approach, we contacted a representative sample of facilities designated for cancer care in United States. Trained volunteers posed as a family member seeking urologic cancer care using a simulated scenario of a parent with a new diagnosis of a localized kidney tumor. The primary study outcome was acceptance of Medicaid. In addition, we assessed facility characteristics associated with Medicaid acceptance relating to state Medicaid expansion status, Medicare reimbursement rates, and teaching hospital status using data from the Medicare & Medicaid Services Hospital General Information data file, the American Hospital Directory, and the American Medical Association of Colleges Organizational Characteristics Database. RESULTS We sampled a total of 389 facilities, of which 14.4% did not accept new Medicaid patients. Medicaid acceptance was higher in facilities located in states that elected to expand Medicaid through the ACA vs. non-expansion states (90.1% vs. 77.4% respectively, P < 0.001). Facilities accepting patients with Medicaid were located in states with higher mean Medicaid-to-Medicare fee indexes (0.70 for Medicaid-accepting vs. 0.65 for non-accepting facilities, P < 0.001). In addition, Medicaid acceptance was higher in teaching hospitals vs. non-teaching facilities (93.8% vs. 83.4% P = 0.02), and medical school affiliated facilities (89.2% vs. 79.7% P = 0.01). CONCLUSION We identified access disparities for patients with Medicaid insurance seeking urologic cancer care at centers. These findings highlight opportunities to improve the quality and timeliness of cancer care.
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Affiliation(s)
- Folawiyo Laditi
- Department of Urology, Yale University School of Medicine, New Haven, CT; Department of Urology, Yale University School of Medicine, New Haven, CT
| | - James Nie
- Department of Urology, Yale University School of Medicine, New Haven, CT; Department of Urology, Yale University School of Medicine, New Haven, CT
| | - Walter Hsiang
- Department of Urology, Yale University School of Medicine, New Haven, CT; Department of Urology, Yale University School of Medicine, New Haven, CT
| | - Waez Umer
- Department of Urology, Yale University School of Medicine, New Haven, CT
| | - Afash Haleem
- Department of Urology, Yale University School of Medicine, New Haven, CT
| | - Victoria Marks
- Department of Urology, Yale University School of Medicine, New Haven, CT
| | - Matthew Buck
- Department of Urology, Yale University School of Medicine, New Haven, CT; Department of Urology, Yale University School of Medicine, New Haven, CT
| | - Michael S Leapman
- Department of Urology, Yale University School of Medicine, New Haven, CT; Department of Urology, Yale University School of Medicine, New Haven, CT; Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, Yale School of Medicine, New Haven, CT.
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Impact of the Affordable Care Act on Presentation, Treatment, and Outcomes of Intrahepatic Cholangiocarcinoma. J Gastrointest Surg 2023; 27:262-272. [PMID: 36400904 DOI: 10.1007/s11605-022-05496-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2022] [Accepted: 10/20/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND The Affordable Care Act (ACA) transformed the US healthcare system, expanding healthcare insurance coverage. However, its impact on rare malignancies that lack an established screening strategy such as intrahepatic cholangiocarcinoma (ICC) remains ill-defined. METHODS Patients diagnosed with ICC were identified from the National Cancer Database and divided relative to ACA implementation. Multivariate logistic regression analyses were performed to evaluate association with stage at diagnosis, receipt of surgical and multimodal treatments, and survival. RESULTS Among the 9095 patients, 5636 (62.0%) were diagnosed before and 3459 (38.0%) after the implementation of the ACA. Across US regions, rates of early-stage diagnosis increased in the post-ACA era (Northeast, 62.9% vs. 85.2%; South, 63.7% vs. 78.5%; Midwest, 62.1% vs. 83.4%; West, 55.5% vs. 75.4%; p < 0.001). On multivariate analyses, the post-ACA era was associated with increased early-stage diagnosis (OR = 2.19; 95% CI 1.79-2.69), and receipt of surgical treatment (OR = 1.19, 95% CI 1.03-1.38) (both p < 0.01). Furthermore, the ACA's Medicaid expansion (ME) was also associated with improved overall survival (HR = 0.89, 95% CI 0.80-0.99, p = 0.038). Of note, although the odds of receiving surgical treatment increased after ACA for non-Hispanic White patients (OR = 1.34; 95% CI 1.20-1.49; p < 0.001), no such effect was observed in non-Hispanic Black (OR = 1.01, 95% CI 0.71-1.45), Hispanic (OR = 1.44, 95% CI 0.99-2.09), or others (OR = 1.43, 95% CI 0.98-2.10) (all p > 0.05). CONCLUSIONS The implementation of the ACA increased rates of early diagnosis and receipt of surgical treatment. Additionally, ME improved short- and long-term outcomes. However, racial and socioeconomic disparities persist, resulting in inequitable access to care and outcomes for patients with ICC.
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Franz B, Cronin CE, Yeager VA, Burns A, Singh SR. Overview of the Most Commonly Identified Public Health Needs and Strategies in a Nationally Representative Sample of Nonprofit Hospitals. Med Care Res Rev 2022; 80:342-351. [PMID: 36377207 DOI: 10.1177/10775587221135365] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Nonprofit hospitals have been required to conduct Community Health Needs Assessments and develop implementation strategies for almost a decade, yet little is known about this process on the national level. Using a nationally representative dataset of 2019 to 2021 nonprofit hospital community benefit reports, we assessed patterns in hospital identification of community health needs and investments in corresponding programs. The five most common needs identified by hospitals were mental health (identified by 87% of hospitals), substance use (76%), access (73%), social determinants of health (69%), and chronic disease (67%). The five most common needs addressed were: mental health (87%), access (81%), substance use (77%), chronic disease (72%), and obesity (71%). Institutional and community-level factors were associated with whether hospitals identified and addressed health needs. Hospitals often addressed needs that they did not identify, particularly related to the provision of medical services—which has important implications for population health improvement.
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Swider SM, Didion J, Campbell L, Stanley J, Price MM. Measuring Bachelor of Science in Nursing competencies in public/population health. J Prof Nurs 2022; 43:145-151. [PMID: 36496238 DOI: 10.1016/j.profnurs.2022.10.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 10/06/2022] [Accepted: 10/08/2022] [Indexed: 12/14/2022]
Abstract
Nurses have a long history of practice in public health. More recently basic population health knowledge and skills are being required across all nursing practice settings. To prepare nurses for this practice nursing education has long included public or community health nursing (PHN) content and skills as part of prelicensure education at the baccalaureate level and above. However, little work has been done to document student competency in these areas. Competency-based education is a process whereby students are held accountable for the mastery of knowledge and skills deemed critical for an area of study. The AACN Public/Population Health Workgroup addressed the challenge of measuring baccalaureate student nursing competencies in population health by developing an unfolding case study, with embedded questions assessing selected competencies. Lacking established population health competencies in nursing curriculum at the time of this work but wanting to assess students' basic competencies across the care continuum, the Workgroup selected relevant competencies from the Council of Public Health Nursing Organizations (formerly called the Quad Council) Competencies for Public Health Nurses. Utilizing these selected competencies, the Workgroup devised the unfolding case study and piloted it with 275 baccalaureate nursing education programs across the country. The findings from the Pilot demonstrated nursing student competency achievement and how this achievement changed as students progressed through the curriculum. The authors report implications and recommendations for competency measurement in population health based on the results of the pilot.
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Affiliation(s)
- Susan M Swider
- College of Nursing, Rush University, 600 S. Paulina St., Suite 1028B, Chicago, IL 60612, United States of America.
| | - Judy Didion
- School of Nursing, Oakland University, Human Health Building, Room 3027, 433 Meadow Brook Road, Rochester, MI 48309-4452, United States of America.
| | - Lisa Campbell
- School of Nursing, Texas Tech University Health Sciences Center, 3601 4th Street, MS 8212, Lubbock, TX 79430, United States of America.
| | - Joan Stanley
- American Association of Colleges of Nursing, 655 K Street, NW, Suite 750, Washington, DC 20001, United States of America.
| | - Marva Mizell Price
- School of Nursing, Duke University, 307 Trent Drive, Durham, NC 27710, United States of America.
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Wang XJ, Borah B, Rojas R, Kamath MJ, Moriarty J, Allen AM, Kamath PS. Patients Hospitalized for Complications of Cirrhosis may Have Benefited From Medicaid Expansion Under the Affordable Care Act. Mayo Clin Proc Innov Qual Outcomes 2022; 6:291-301. [PMID: 35722655 PMCID: PMC9198455 DOI: 10.1016/j.mayocpiqo.2022.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Objective The benefit of the Affordable Care Act (ACA) for patients with cirrhosis is unclear. We determined the impact of ACA expansion on outcomes in patients hospitalized for complications of cirrhosis. Patients and Methods We compared hospitalizations; in-hospital outcomes; and readmissions among patients with cirrhosis identified using International Classification of Diseases, Ninth Revision, and International Classification of Diseases, 10th Revision, codes in states that expanded Medicaid under ACA (expanded [E] states) and those that did not (nonexpanded [NE] states). Data from the State Inpatient Databases were obtained for 3 pairs of contiguous E and NE states with both pre-ACA expansion and post-ACA expansion data. The difference-in-difference analysis was performed to compare the pre- and post-ACA data between the E and NE states. The outcomes were admission rates, hospital complications, resource utilization, length of stay, in-hospital mortality, discharge destination, cost of initial hospitalization, and readmission characteristics. Results There were 228,349 admissions (E states, 149,705; NE states, 78,644). After ACA implementation, the E states had lower rates of admission increase per 100,000 population (22.9 in E states vs 25.5 in NE states, P=.005), sepsis (relative risk, 0.884; P=.0084), and hepatic coma (relative risk, 0.763; P<.001) than the NE states. The length of stay was lower by 0.21 days (P=.00028), with a $587.40 lower cost per hospitalization (P=.00091), in the E states than in the NE states. The readmission rates within 30, 60, and 90 days decreased in the E states after ACA implementation but increased in the NE states after ACA implementation. Conclusion Among patients hospitalized for cirrhosis, quality indicators, such as the rate of admission increase, complications, costs, and readmissions, were more favorable in the states that expanded Medicaid. Medicaid expansion under ACA may have benefited patients with cirrhosis.
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Affiliation(s)
- Xiao Jing Wang
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Mayo Clinic, Rochester, MN
| | - Bijan Borah
- Division of Health Care Policy and Research, Section of Health Sciences Research, Mayo Clinic, Rochester, MN
| | - Ricardo Rojas
- Division of Health Care Policy and Research, Section of Health Sciences Research, Mayo Clinic, Rochester, MN
| | | | - James Moriarty
- Division of Health Care Policy and Research, Section of Health Sciences Research, Mayo Clinic, Rochester, MN
| | - Alina M. Allen
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Mayo Clinic, Rochester, MN
| | - Patrick S. Kamath
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Mayo Clinic, Rochester, MN
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Catastrophic Health Expenditures With Pregnancy and Delivery in the United States. Obstet Gynecol 2022; 139:509-520. [PMID: 35271537 PMCID: PMC9124691 DOI: 10.1097/aog.0000000000004704] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 12/30/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To describe prevalence, trends, and risk factors for catastrophic health expenditures in the year of delivery among birth parents (delivering people). METHODS We conducted a retrospective, cross-sectional study of the Medical Expenditure Panel Survey from 2008-2016. We identified newborn birth parents and a 2:1 nearest-neighbor propensity-matched control cohort of nonpregnant reproductive-aged individuals, then assessed for catastrophic health expenditures (spending greater than 10% of family income) in the delivery year. We applied survey weights to extrapolate to the noninstitutionalized U.S. population and used the adjusted Wald test for significance testing. We compared risk of catastrophic health expenditures between birth parents and the control cohort and described time trends and risk factors for catastrophic spending with subgroup comparisons. RESULTS We analyzed 4,056 birth parents and 7,996 reproductive-aged females without pregnancy in a given year. Birth parents reported higher rates of unemployment (52.6% vs 46.6%, P<.001), and high rates of gaining (22.4%) and losing (25.6%) Medicaid in the delivery year. Birth parents were at higher risk of catastrophic health expenditures (excluding premiums: 9.2% vs 6.8%, odds ratio [OR] 1.95, 95% CI 1.61-2.34; including premiums: 21.3% vs 18.4%, OR 1.53, 95% CI 1.32-1.82). Birth parents living on low incomes had the highest risk of catastrophic health expenditures (18.8% vs 0.7% excluding premiums for 138% or less vs greater than 400% of the federal poverty level, relative risk [RR] 26.9; 29.8% vs 5.9% including premiums, RR 5.1). For birth parents living at low incomes, public insurance was associated with lower risks of catastrophic health expenditures than private insurance, particularly when including premium spending (incomes 138% of the federal poverty level or lower: 18.8% public vs 67.9% private, RR 0.28; incomes 139-250% of the federal poverty level: 6.5% public vs 41.1% private, RR 0.16). The risk of catastrophic spending for birth parents did not change significantly over time from before to after Affordable Care Act implementation. CONCLUSION Pregnancy and delivery are associated with increased risk of catastrophic health expenditures in the delivery year. Medicaid and public coverage were more protective from high out-of-pocket costs than private insurance, particularly among low-income families.
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Hooker RS, Kulo V, Kayingo G, Jun HJ, Cawley JF. Forecasting the physician assistant/associate workforce: 2020–2035. Future Healthc J 2022; 9:57-63. [DOI: 10.7861/fhj.2021-0193] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Albright BB, Nitecki R, Chino F, Chino JP, Havrilesky LJ, Aviki EM, Moss HA. Catastrophic health expenditures, insurance churn, and nonemployment among gynecologic cancer patients in the United States. Am J Obstet Gynecol 2022; 226:384.e1-384.e13. [PMID: 34597606 PMCID: PMC10016333 DOI: 10.1016/j.ajog.2021.09.034] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 09/23/2021] [Accepted: 09/23/2021] [Indexed: 01/19/2023]
Abstract
BACKGROUND In recent years, there has been growing recognition of the financial burden of severe illness, including associations with higher rates of nonemployment, uninsurance, and catastrophic out-of-pocket health spending. Patients with gynecologic cancer often require expensive and prolonged treatments, potentially disrupting employment and insurance coverage access, and putting patients and their families at risk for catastrophic health expenditures. OBJECTIVE This study aimed to describe the prevalence of insurance churn, nonemployment, and catastrophic health expenditures among nonelderly patients with gynecologic cancer in the United States, to compare within subgroups and to other populations and assess for changes associated with the Affordable Care Act. STUDY DESIGN We identified respondents aged 18 to 64 years from the Medical Expenditure Panel Survey, 2006 to 2017, who reported care related to gynecologic cancer in a given year, and a propensity-matched cohort of patients without cancer and patients with cancers of other sites, as comparison groups. We applied survey weights to extrapolate to the US population, and we described patterns of insurance churn (any uninsurance or insurance loss or change), catastrophic health expenditures (>10% annual family income), and nonemployment. Characteristics and outcomes between groups were compared with the adjusted Wald test. RESULTS We identified 683 respondents reporting care related to a gynecologic cancer diagnosis from 2006 to 2017, representing an estimated annual population of 532,400 patients (95% confidence interval, 462,000-502,700). More than 64% of patients reported at least 1 of 3 primary negative outcomes of any uninsurance, part-year nonemployment, and catastrophic health expenditures, with 22.4% reporting at least 2 of 3 outcomes. Catastrophic health spending was uncommon without nonemployment or uninsurance reported during that year (1.2% of the population). Compared with patients with other cancers, patients with gynecologic cancer were younger and more likely with low education and low family income (≤250% federal poverty level). They reported higher annual risks of insurance loss (8.8% vs 4.8%; P=.03), any uninsurance (22.6% vs 14.0%; P=.002), and part-year nonemployment (55.3% vs 44.6%; P=.005) but similar risks of catastrophic spending (12.6% vs 12.2%; P=.84). Patients with gynecologic cancer from low-income families faced a higher risk of catastrophic expenditures than those of higher icomes (24.4% vs 2.9%; P<.001). Among the patients from low-income families, Medicaid coverage was associated with a lower risk of catastrophic spending than private insurance. After the Affordable Care Act implementation, we observed reductions in the risk of uninsurance, but there was no significant change in the risk of catastrophic spending among patients with gynecologic cancer. CONCLUSION Patients with gynecologic cancer faced high risks of uninsurance, nonemployment, and catastrophic health expenditures, particularly among patients from low-income families. Catastrophic spending was uncommon in the absence of either nonemployment or uninsurance in a given year.
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Affiliation(s)
- Benjamin B Albright
- Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, NC.
| | - Roni Nitecki
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Fumiko Chino
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Junzo P Chino
- Department of Radiation Oncology, Duke University Medical Center, Durham, NC
| | - Laura J Havrilesky
- Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, NC
| | - Emeline M Aviki
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Haley A Moss
- Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, NC
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Ng Kamstra JS, Molina T, Halliday T. Compact for care: how the Affordable Care Act marketplaces fell short for a vulnerable population in Hawaii. BMJ Glob Health 2021; 6:bmjgh-2021-007701. [PMID: 34845000 PMCID: PMC8634008 DOI: 10.1136/bmjgh-2021-007701] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 11/08/2021] [Indexed: 11/12/2022] Open
Abstract
The Patient Protection and Affordable Care Act (ACA) was passed in 2010 to expand access to health insurance in the USA and promote innovation in health care delivery. While the law significantly reduced the proportion of uninsured, the market-based protection it provides for poor and vulnerable US residents is an imperfect substitute for government programs such as Medicaid. In 2015, residents of Hawaii from three Compact of Free Association nations (the Federated States of Micronesia, Palau and Marshall Islands) lost their eligibility for the state’s Medicaid program and were instructed to enrol in coverage via the ACA marketplace. This transition resulted in worsened access to health care and ultimately increased mortality in this group. We explain these changes via four mechanisms: difficulty communicating the policy change to affected individuals, administrative barriers to coverage under the ACA, increased out of pocket health care costs and short enrolment windows. To achieve universal health coverage in the USA, these challenges must be addressed by policy-makers.
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Affiliation(s)
- Joshua S Ng Kamstra
- The Queen's Health Systems, Honolulu, Hawaii, USA .,Department of Surgery, University of Hawai'i at Manoa John A Burns School of Medicine, Honolulu, Hawaii, USA
| | - Teresa Molina
- Department of Economics, University of Hawai'i at Manoa, Honolulu, Hawaii, USA.,IZA Institute of Labor Economics, Bonn, Nordrhein-Westfalen, Germany
| | - Timothy Halliday
- Department of Economics, University of Hawai'i at Manoa, Honolulu, Hawaii, USA.,IZA Institute of Labor Economics, Bonn, Nordrhein-Westfalen, Germany
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Racial/Ethnic and Socioeconomic Disparities in Adult Vaccination Coverage. Am J Prev Med 2021; 61:465-473. [PMID: 34334289 DOI: 10.1016/j.amepre.2021.03.023] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 03/24/2021] [Accepted: 03/25/2021] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Adults from racial and ethnic minorities and low-income groups are disproportionately affected by vaccine-preventable diseases. The objective of this study is to examine the trends in adult vaccination coverage in the U.S. by race/ethnicity and SES from 2010 to 2019. METHODS Temporal trends in influenza; pneumococcal; herpes zoster; and tetanus, diphtheria, and acellular pertussis vaccination coverage were examined by race/ethnicity and SES in 2020 using the National Health Interview Surveys from 2010 to 2019. RESULTS Influenza vaccination coverage differed by race/ethnicity among adults aged ≥65 years (61.4% for Black, 63.9% for Hispanic, 71.9% for Asian, and 72.4% for White adults). Race/ethnicity, household income, education level, and health insurance type were significantly associated with receipt of influenza; pneumococcal; tetanus, diphtheria, and acellular pertussis; and zoster vaccinations among adults aged ≥65 years in a multivariable-adjusted regression model. Socioeconomic differences in influenza vaccine uptake narrowed among adults aged 18-64 years from 2010 to 2019. By contrast, racial/ethnic and socioeconomic differences in vaccine uptake persisted from 2010 to 2019 among adults aged ≥65 years. CONCLUSIONS Racial and ethnic disparities in vaccine uptake persisted over the last decade. Socioeconomic disparities in influenza vaccine coverage narrowed among adults aged 18-64 years; however, disparities persisted among adults aged ≥65 years. Efforts are urgently needed to achieve equity in immunization rates.
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Albright BB, Chino F, Chino JP, Havrilesky LJ, Aviki EM, Moss HA. Associations of Insurance Churn and Catastrophic Health Expenditures With Implementation of the Affordable Care Act Among Nonelderly Patients With Cancer in the United States. JAMA Netw Open 2021; 4:e2124280. [PMID: 34495338 PMCID: PMC8427370 DOI: 10.1001/jamanetworkopen.2021.24280] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE Health insurance coverage is dynamic in the United States, potentially changing from month to month. The Patient Protection and Affordable Care Act (ACA) aimed to stabilize markets and reduce financial burden, particularly among those with preexisting conditions. OBJECTIVE To describe the risks of insurance churn (ie, gain, loss, or change in coverage) and catastrophic health expenditures among nonelderly patients with cancer in the United States, assessing for changes associated with ACA implementation. DESIGN, SETTING, AND PARTICIPANTS This retrospective, cross-sectional study uses data from the Medical Expenditure Panel Survey, a representative sample of the US population from 2005 to 2018. Respondents included were younger than 65 years, identified by health care use associated with a cancer diagnosis code in the given year. Statistical analysis was conducted from July 30, 2020, to January 5, 2021. EXPOSURES The Patient Protection and Affordable Care Act. MAIN OUTCOMES AND MEASURES Survey weights were applied to generate estimates for the US population. Annual risks of insurance churn (ie, any uninsurance or insurance change or loss) and catastrophic health expenditures (spending >10% income) were calculated, comparing subgroups with the adjusted Wald test. Weighted multivariable linear regression was used to assess for changes associated with ACA implementation. RESULTS From 6069 respondents, we estimated a weighted mean of 4.78 million nonelderly patients (95% CI, 4.55-5.01 million; female patients: weighted mean, 63.9% [95% CI, 62.2%-65.7%]; mean age, 50.3 years [95% CI, 49.7-50.8 years]) with cancer annually in the United States. Patients with cancer experienced lower annual risks of insurance loss (5.3% [95% CI, 4.5%-6.1%] vs 7.6% [95% CI, 7.4%-7.8%]) and any uninsurance (14.6% [95% CI, 13.3%-16.0%] vs 24.1% [95% CI, 23.5%-24.7%]) but increased risk of catastrophic health expenditures (expenses alone: 12.4% [95% CI, 11.2%-13.6%] vs 6.3% [95% CI, 6.2%-6.5%]; including premiums: 26.6% [95% CI, 25.0%-28.1%] vs 16.5% [95% CI, 16.1%-16.8%]; P < .001) relative to the population without cancer. Patients with cancer from low-income families and with full-year private coverage were at particularly high risk of catastrophic health expenditures (including premiums: 81.7% [95% CI, 74.6%-88.9%]). After adjustment, low income was the factor most strongly associated with both insurance churn and catastrophic spending, associated with annual risk increases of 6.5% (95% CI, 4.2%-8.8%) for insurance loss, 17.3% (95% CI, 13.4%-21.2%) for any uninsurance, and 37.4% (95% CI, 33.3%-41.6%) for catastrophic expenditures excluding premiums (P < .001). In adjusted models relative to 2005-2009, full ACA implementation (2014-2018) was associated with a decreased annual risk of any uninsurance (-4.2%; 95% CI, -7.4% to -1.0%; P = .01) and catastrophic spending by expenses alone (-3.0%; 95% CI, -5.3% to -0.8%; P = .008) but not including premiums (0.4%; 95% CI, -2.8% to 4.5%; P = .82). CONCLUSIONS AND RELEVANCE In this cross-sectional study, US patients with cancer faced significant annual risks of insurance churn and catastrophic health spending. Despite some improvements with ACA implementation, large burdens remained, and further reform is needed to protect this population from excessive hardship.
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Affiliation(s)
- Benjamin B. Albright
- Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, North Carolina
| | - Fumiko Chino
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Junzo P. Chino
- Department of Radiation Oncology, Duke University Medical Center, Durham, North Carolina
| | - Laura J. Havrilesky
- Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, North Carolina
| | - Emeline M. Aviki
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Haley A. Moss
- Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, North Carolina
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Albright BB, Chino F, Chino JP, Havrilesky LJ, Aviki EM, Moss HA. Medicaid Expansion Reduced Uninsured Surgical Hospitalizations And Associated Catastrophic Financial Burden. Health Aff (Millwood) 2021; 40:1294-1303. [PMID: 34339246 PMCID: PMC10077516 DOI: 10.1377/hlthaff.2020.02496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
An important function of health insurance is protecting enrollees from excessively burdensome charges for unanticipated medical events. Unexpected surgery can be financially catastrophic for uninsured people. By targeting the low-income uninsured population, Medicaid expansion had the potential to reduce the financial risks associated with these events. We used two data sources (state-level data for forty-four states and patient-level data for four states) to estimate the association of Medicaid expansion with uninsured surgical hospitalizations among nonelderly adults. Uninsured surgery cases were typically admitted through the emergency department-often for common emergency procedures-and 99 percent of them were estimated to be associated with financially catastrophic visit charges. We found that Medicaid expansion was associated with reductions in both the share (6.20 percent) and the population rate (7.85 per 10,000) of uninsured surgical discharges in expansion versus nonexpansion states. Our estimates suggest that in 2019 alone, adoption of Medicaid expansion in nonexpansion states could have prevented more than 50,000 incidences of catastrophic financial burden resulting from uninsured surgery.
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Affiliation(s)
- Benjamin B Albright
- Benjamin B. Albright is a gynecologic oncology fellow in the Department of Obstetrics and Gynecology, Duke University Medical Center, in Durham, North Carolina
| | - Fumiko Chino
- Fumiko Chino is an assistant attending in the Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, in New York, New York
| | - Junzo P Chino
- Junzo P. Chino is an associate professor in the Department of Radiation Oncology, Duke University Medical Center
| | - Laura J Havrilesky
- Laura J. Havrilesky is a professor in the Department of Obstetrics and Gynecology, Duke University Medical Center
| | - Emeline M Aviki
- Emeline M. Aviki is an assistant attending in the Department of Surgery, Memorial Sloan Kettering Cancer Center
| | - Haley A Moss
- Haley A. Moss is an assistant professor in the Department of Obstetrics and Gynecology, Duke University Medical Center
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Gotanda H, Kominski GF, Elashoff D, Tsugawa Y. Association Between the ACA Medicaid Expansions and Changes in Cardiovascular Risk Factors Among Low-Income Individuals. J Gen Intern Med 2021; 36:2004-2012. [PMID: 33483808 PMCID: PMC8298725 DOI: 10.1007/s11606-020-06417-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 12/08/2020] [Indexed: 01/14/2023]
Abstract
BACKGROUND Evidence is limited as to whether the introduction of the Affordable Care Act (ACA)'s Medicaid expansions was associated with improvements in cardiovascular risk factors at the population level. OBJECTIVE To examine the association between the ACA Medicaid expansions and changes in cardiovascular risk factors among low-income individuals during the first 3 years of the implementation of the ACA Medicaid expansions at the national level. DESIGN A quasi-experimental difference-in-differences (DID) analysis to compare outcomes before (2005-2012) and after (2015-2016) the implementation of the ACA Medicaid expansions between individuals in states that expanded Medicaid and individuals in non-expansion states. PARTICIPANTS A nationally representative sample of individuals aged 19-64 years with family incomes below 138% of the federal poverty level from the 2005-2016 National Health and Nutrition Examination Survey (NHANES). INTERVENTION ACA Medicaid expansions. MAIN MEASURES Cardiovascular risk factors included (1) systolic and diastolic blood pressure, (2) hemoglobin A1c (HbA1c) level, and (3) cholesterol levels (low-density lipoprotein cholesterol, triglyceride, and high-density lipoprotein cholesterol). KEY RESULTS A total of 9177 low-income individuals were included in our analysis. We found that the ACA Medicaid expansions were associated with a lower systolic blood pressure (DID estimate, - 3.03 mmHg; 95% CI, - 5.33 mmHg to - 0.73 mmHg; P = 0.01; P = 0.03 after adjustment for multiple comparisons) and lower HbA1c level (DID estimate, - 0.14 percentage points [pp]; 95% CI, - 0.24 pp to - 0.03 pp; P = 0.01; P = 0.03 after adjustment for multiple comparisons). We found no evidence that diastolic blood pressure and cholesterol levels changed following the ACA Medicaid expansions. CONCLUSION Using the nationally representative data of individuals who were affected by the ACA, we found that the ACA Medicaid expansions were associated with a modest improvement in cardiovascular risk factors related to hypertension and diabetes during the first 3 years of implementation.
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Affiliation(s)
- Hiroshi Gotanda
- Division of General Internal Medicine, Cedars-Sinai Medical Center, Los Angeles, 90048 CA USA
| | - Gerald F. Kominski
- Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, CA USA
- UCLA Center for Health Policy Research, UCLA Fielding School of Public Health, Los Angeles, CA USA
| | - David Elashoff
- Department of Biostatistics, UCLA Fielding School of Public Health, Los Angeles, CA USA
- Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at UCLA, Los Angeles, CA USA
| | - Yusuke Tsugawa
- Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, CA USA
- UCLA Center for Health Policy Research, UCLA Fielding School of Public Health, Los Angeles, CA USA
- Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at UCLA, Los Angeles, CA USA
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Liu C, Gotanda H, Khullar D, Rice T, Tsugawa Y. The Affordable Care Act's Insurance Marketplace Subsidies Were Associated With Reduced Financial Burden For US Adults. Health Aff (Millwood) 2021; 40:496-504. [PMID: 33646874 DOI: 10.1377/hlthaff.2020.01106] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Research suggests that the Affordable Care Act (ACA) Medicaid expansions improved financial protection for the poor. However, evidence is limited on whether subsidies offered through the ACA Marketplaces, the law's other major coverage expansion, were associated with reduced financial burden. Using national survey data from the period 2008-17, we examined changes in household health care spending among low-income adults eligible for both Marketplace premium subsidies and cost-sharing reductions (139-250 percent of the federal poverty level) and middle-income adults eligible only for premium subsidies (251-400 percent of the federal poverty level), using high-income adults ineligible for subsidies (greater than 400 percent of the federal poverty level) as controls. Among low-income adults, Marketplace subsidy implementation was associated with 17 percent lower out-of-pocket spending and 30 percent lower probability of catastrophic health expenditures. In contrast, middle-income adults did not experience reduced financial burden by either measure. These findings highlight the successes and limitations of Marketplace subsidies as debate continues over the ACA's future.
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Affiliation(s)
- Charles Liu
- Charles Liu is a general surgery resident in the Department of Surgery, Stanford University School of Medicine, in Stanford, California
| | - Hiroshi Gotanda
- Hiroshi Gotanda is an assistant professor of medicine at Cedars-Sinai Medical Center, in Los Angeles, California
| | - Dhruv Khullar
- Dhruv Khullar is a physician and an assistant professor in the Departments of Medicine and Population Health Sciences, Weill Cornell Medical Center, in New York, New York
| | - Thomas Rice
- Thomas Rice is a distinguished professor in the Department of Health Policy and Management, Fielding School of Public Health, University of California Los Angeles (UCLA), in Los Angeles, California
| | - Yusuke Tsugawa
- Yusuke Tsugawa is an assistant professor in the Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine, and the Department of Health Policy and Management, Fielding School of Public Health, UCLA
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Royce TJ, Jones GP, Muralidhar V, Chowdhary M, Holmes GM. US Primary Care vs Specialty Care Trainee Positions and Physician Incomes: Trends From 2001 to 2019. J Grad Med Educ 2021; 13:385-389. [PMID: 34178264 PMCID: PMC8207908 DOI: 10.4300/jgme-d-20-00941.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 10/23/2020] [Accepted: 02/24/2021] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Much of the Affordable Care Act (ACA) and subsequent US health care policies were designed to address deficiencies in health care access and enhance primary care services. How residency positions and physician incomes have changed in the post-ACA era is not well characterized. OBJECTIVE We evaluated the growth of US trainee positions and physician income, in the pre- vs post-ACA environment by specialty and among primary care vs specialty care. METHODS Total resident complement by specialty and year was extracted from the National Graduate Medical Education (GME) Census and stratified into primary care vs specialty care. Median incomes were extracted from Medical Group Management Association surveys. Piecewise linear regression with interaction terms (pre-ACA, 2001-2010, vs post-ACA, 2011-2019) assessed growth rate by specialty and growth rate differences between primary care and specialty care. Sensitivity analyses were performed by focusing on family medicine and excluding additional GME positions contributed by the introduction of the 2015 single GME accreditation system. RESULTS Resident complements increased for primary care (+0.16%/year pre-ACA to +2.06%/year post-ACA, P < .001) and specialty care (+1.49%/year to +2.07%/year, P = .005). Specialty care growth outpaced primary care pre-ACA (P < .001) but not post-ACA (P = .10). Family medicine had the largest increase in the pre- vs post-ACA era (-0.77%/year vs +2.09%/year, P < .001). Excluding positions contributed by the single GME accreditation system transition did not result in any statistically significant changes to the findings. Income growth increased for primary care (+0.84%/year to +1.37%/year, P = .044), but decreased for specialty care (+1.44%/year to +0.49%/year, P = .011). Specialty care income growth outpaced primary care pre-ACA (P < .001), but not post-ACA (P = .22). CONCLUSIONS We found significant growth differences in resident complement and income among primary care versus specialty care in the pre-/post-ACA eras.
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Affiliation(s)
- Trevor J. Royce
- Trevor J. Royce, MD, MS, MPH, is Assistant Professor, Department of Radiation Oncology, University of North Carolina at Chapel Hill
| | - Gavin P. Jones
- Gavin P. Jones, MD, is a Resident Physician, Department of Radiation Oncology, University of Kentucky
| | - Vinayak Muralidhar
- Vinayak Muralidhar, MD, MSc, is Chief Resident, Department of Radiation Oncology, Dana Farber Cancer Institute
| | - Mudit Chowdhary
- Mudit Chowdhary, MD, is a Resident Physician, Department of Radiation Oncology, Rush University
| | - George M. Holmes
- George M. Holmes, PhD, is Professor, Department of Health Policy and Management, University of North Carolina at Chapel Hill
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Albright BB, Chino F, Chino JP, Havrilesky LJ, Aviki EM, Moss HA. Association of Medicaid expansion with mortality from gynecologic cancers. Am J Obstet Gynecol 2021; 224:323-325. [PMID: 33221294 DOI: 10.1016/j.ajog.2020.11.024] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 11/03/2020] [Accepted: 11/13/2020] [Indexed: 10/23/2022]
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Sakhuja S, Fowler ME, Ojesina AI. Race/ethnicity, sex and insurance disparities in colorectal cancer screening among individuals with and without cardiovascular disease. Prev Med Rep 2021; 21:101263. [PMID: 33391980 PMCID: PMC7773575 DOI: 10.1016/j.pmedr.2020.101263] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 10/20/2020] [Accepted: 11/22/2020] [Indexed: 01/08/2023] Open
Abstract
Colorectal cancer (CRC) and cardiovascular diseases (CVD) share several risk factors. We examined the relationships between CRC screening and CVD history by race/ethnicity and sex. Data from 15 states across the United States with high age-adjusted CVD rates from the 2012-2016 Behavioral Risk Factor Surveillance System were used to examine prevalence of self-reported screening for CRC among 179,276 adults ages 50-75 years with and without history of CVD. Multivariable logistic regression was used to evaluate the association between socio-demographics and CRC screening in the expansion and stable phases of the Affordable Care Act (ACA) era. Prevalence of CRC screening was high among those with history of CVD. After multivariable adjustment, Whites and Hispanics with CVD had 19% (95%[CI]: 1.13-1.26) and 50% (95%[CI]: 1.10-2.06) higher odds for CRC screening, respectively, versus those without CVD. Individuals in both sexes with CVD had higher odds for CRC screening compared those without CVD. Strikingly, the odds for CRC screening in Hispanics with history of CVD were 72% higher in the stable phase of the ACA era for the fully adjusted model. Whites and Hispanics with history of CVD are more likely to undergo CRC screening, perhaps due to greater exposure to the healthcare system due to CVD. This association was not observed in Blacks. Interventions are needed to improve CRC screening rates among Blacks, especially due to their well-documented higher risk of CVD.
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Affiliation(s)
- Swati Sakhuja
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Mackenzie E. Fowler
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Akinyemi I. Ojesina
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
- O’Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL, USA
- HudsonAlpha Institute for Biotechnology, Huntsville, AL, USA
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Shrank WH, DeParle NA, Gottlieb S, Jain SH, Orszag P, Powers BW, Wilensky GR. Health Costs And Financing: Challenges And Strategies For A New Administration. Health Aff (Millwood) 2021; 40:235-242. [DOI: 10.1377/hlthaff.2020.01560] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- William H. Shrank
- William H. Shrank is chief medical and corporate affairs officer of Humana in Louisville, Kentucky
| | - Nancy-Ann DeParle
- Nancy-Ann DeParle is a managing partner and cofounder of Consonance Capital Partners, in New York, New York
| | - Scott Gottlieb
- Scott Gottlieb is a resident fellow at the American Enterprise Institute, in Washington, D.C
| | - Sachin H. Jain
- Sachin H. Jain is president and CEO of the SCAN Group and Health Plan and an adjunct professor of medicine, Stanford University School of Medicine, in Stanford, California
| | - Peter Orszag
- Peter Orszag is the CEO of Financial Advisory at Lazard Freres and Co., LLC, in New York, New York
| | - Brian W. Powers
- Brian W. Powers is deputy chief medical officer at Humana in Boston, Massachusetts
| | - Gail R. Wilensky
- Gail R. Wilensky is a senior fellow at Project HOPE, in Bethesda, Maryland
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The 2014 New York State Medicaid Expansion and Severe Maternal Morbidity During Delivery Hospitalizations. Anesth Analg 2021; 133:340-348. [PMID: 34257195 DOI: 10.1213/ane.0000000000005371] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Medicaid expansions under the Affordable Care Act have increased insurance coverage and prenatal care utilization in low-income women. However, it is not clear whether they are associated with any measurable improvement in maternal health outcomes. In this study, we compared the changes in the incidence of severe maternal morbidity (SMM) during delivery hospitalizations between low- and high-income women associated with the 2014 Medicaid expansion in New York State. METHODS Data for this retrospective cohort study came from the 2006-2016 New York State Inpatient Database, a census of discharge records from community hospitals. The outcome was SMM during delivery hospitalizations, as defined by the Centers for Disease Control and Prevention. We used regression coefficients (β) from multivariable logistic models: (1) to compare independently in low-income women and in high-income women the changes in slopes in the incidence of SMM before (2006-2013) and after (2014-2016) the expansion, and (2) to compare low- and high-income women for the changes in slopes in the incidence of SMM before and after the expansion. RESULTS A total of 2,286,975 delivery hospitalizations were analyzed. The proportion of Medicaid beneficiaries in parturients increased a relative 12.1% (95% confidence interval [CI], 11.8-12.4), from 42.9% in the preexpansion period to 48.1% in the postexpansion period, whereas the proportion of the uninsured decreased a relative 4.8% (95% CI, 2.8-6.8). Multivariable logistic modeling revealed that implementation of the 2014 Medicaid expansion was associated with a decreased slope during the postexpansion period both in low-income women (β = -0.0161 or 1.6% decrease; 95% CI, -0.0190 to -0.0132) and in high-income women (β = -0.0111 or 1.1% decrease; 95% CI, -0.0130 to -0.0091). The decrease in slope during the postexpansion period was greater in low- than in high-income women (β = -0.0042 or 0.42% difference; 95% CI, -0.0076 to -0.0007). CONCLUSIONS Implementation of the Medicaid expansion in 2014 in New York State is associated with a small but statistically significant reduction in the incidence of SMM in low-income women compared with high-income women.
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Stroumsa D, Kirkland AR. Health Coverage and Care for Transgender People - Threats and Opportunities. N Engl J Med 2020; 383:2397-2399. [PMID: 33314870 DOI: 10.1056/nejmp2032453] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Daphna Stroumsa
- From the Department of Obstetrics and Gynecology (D.S.), the Institute for Healthcare Policy and Innovation (D.S.), and the Institute for Research on Women and Gender (A.R.K.), University of Michigan, Ann Arbor
| | - Anna R Kirkland
- From the Department of Obstetrics and Gynecology (D.S.), the Institute for Healthcare Policy and Innovation (D.S.), and the Institute for Research on Women and Gender (A.R.K.), University of Michigan, Ann Arbor
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Galea S, Ettman CK, Abdalla SM. Access to health care and the 2020 US election. Lancet 2020; 396:803-805. [PMID: 32910909 DOI: 10.1016/s0140-6736(20)31874-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 08/27/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Sandro Galea
- Boston University School of Public Health, Boston, MA 02119, USA.
| | - Catherine K Ettman
- Boston University School of Public Health, Boston, MA 02119, USA; Brown University School of Public Health, Providence, RI, USA
| | - Salma M Abdalla
- Boston University School of Public Health, Boston, MA 02119, USA
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Smith DB. The Pandemic Challenge: End Separate and Unequal Healthcare. Am J Med Sci 2020; 360:109-111. [PMID: 32423751 PMCID: PMC7162756 DOI: 10.1016/j.amjms.2020.04.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Accepted: 04/10/2020] [Indexed: 11/25/2022]
Affiliation(s)
- David Barton Smith
- Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania.
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