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Ogunbameru A, Gebretekle GB, Perryman A, Hassan M, Farrell A, Liu K, Mishra S, Sander B. Health and non-health benefits and equity impacts of individual-level economic relief programs during epidemics/pandemics in high income settings: a scoping review. BMC Public Health 2024; 24:2106. [PMID: 39103834 DOI: 10.1186/s12889-024-19493-8] [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: 10/03/2023] [Accepted: 07/15/2024] [Indexed: 08/07/2024] Open
Abstract
BACKGROUND Economic relief programs are strategies designed to sustain societal welfare and population health during a regional or global scale infectious disease outbreak. While economic relief programmes are considered essential during a regional or global health crisis, there is no clear consensus in the literature about their health and non-health benefits and their impact on promoting equity. METHODS We conducted a scoping review, searching eight electronic databases from January 01, 2001, to April 3, 2023, using text words and subject headings for recent pathogens (coronavirus (COVID-19), Ebola, Influenza, Middle East Respiratory Syndrome (MERS), severe acute respiratory syndrome (SARS), HIV, West Nile, and Zika), and economic relief programs; but restricted eligibility to high-income countries and selected diseases due to volume. Title and abstract screening were conducted by trained reviewers and Distiller AI software. Data were extracted in duplicates by two trained reviewers using a pretested form, and key findings were charted using a narrative approach. RESULTS We identified 27,263 de-duplicated records, of which 50 were eligible. Included studies were on COVID-19 and Influenza, published between 2014 and 2023. Zero eligible studies were on MERS, SARS, Zika, Ebola, or West Nile Virus. We identified seven program types of which cash transfer (n = 12) and vaccination or testing incentive (n = 9) were most common. Individual-level economic relief programs were reported to have varying degrees of impact on public health measures, and sometimes affected population health outcomes. Expanding paid sick leave programs had the highest number of studies reporting health-related outcomes and positively impacted public health measures (isolation, vaccination uptake) and health outcomes (case counts and the utilization of healthcare services). Equity impact was most often reported for cash transfer programs and incentive for vaccination programs. Positive effects on general well-being and non-health outcomes included improved mental well-being and quality of life, food security, financial resilience, and job security. CONCLUSIONS Our findings suggest that individual-level economic relief programs can have significant impacts on public health measures, population health outcomes and equity. As countries prepare for future pandemics, our findings provide evidence to stakeholders to recognize health equity as a fundamental public health goal when designing pandemic preparedness policies.
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Affiliation(s)
- Adeteju Ogunbameru
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.
- Toronto Health Economics and Technology Assessment (THETA) Collaborative, University Health Network, Toronto, ON, Canada.
| | - Gebremedhin Beedemariam Gebretekle
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- Toronto Health Economics and Technology Assessment (THETA) Collaborative, University Health Network, Toronto, ON, Canada
| | - Adrianna Perryman
- Toronto Health Economics and Technology Assessment (THETA) Collaborative, University Health Network, Toronto, ON, Canada
- School of Global Health, York University - Keele Campus, Toronto, ON, Canada
| | - Marian Hassan
- Toronto Health Economics and Technology Assessment (THETA) Collaborative, University Health Network, Toronto, ON, Canada
| | - Ashley Farrell
- Library & Information Services, University Health Network, Toronto, ON, Canada
| | - Kuan Liu
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Sharmistha Mishra
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Department of Medicine, Division of Infectious Disease, University of Toronto, Toronto, ON, Canada
- Centre of Urban Health Solutions, St, Michael's Hospital, Toronto, ON, Canada
- ICES, Toronto, ON, Canada
| | - Beate Sander
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- Toronto Health Economics and Technology Assessment (THETA) Collaborative, University Health Network, Toronto, ON, Canada
- Public Health Ontario, Toronto, ON, Canada
- ICES, Toronto, ON, Canada
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Hauschildt KE, Bui DP, Govier DJ, Eaton TL, Viglianti EM, Ettman CK, McCready H, Smith VA, O’Hare AM, Osborne TF, Boyko EJ, Ioannou GN, Maciejewski ML, Bohnert ASB, Hynes DM, Iwashyna TJ. Regional variation in financial hardship among US veterans during the COVID-19 pandemic. HEALTH AFFAIRS SCHOLAR 2024; 2:qxae075. [PMID: 38938272 PMCID: PMC11210296 DOI: 10.1093/haschl/qxae075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/17/2024] [Accepted: 06/04/2024] [Indexed: 06/29/2024]
Abstract
Geographic variation in hardship, especially health-related hardship, was identified prior to and during the pandemic, but we do not know whether this variation is consistent among Veterans Health Administration (VHA)-enrolled veterans, who reported markedly high rates of financial hardship during the pandemic, despite general and veteran-specific federal policy efforts aimed at reducing hardship. In a nationwide, regionally stratified sample of VHA-enrolled veterans, we examined whether the prevalence of financial hardship during the pandemic varied by US Census region. We found veterans in the South, compared with those in other census regions, reported higher rates of severe-to-extreme financial strain, using up all or most of their savings, being unable to pay for necessities, being contacted by collections, and changing their employment due to the kind of work they could perform. Regional variation in veteran financial hardship demonstrates a need for further research about the role and interaction of federal and state financial-assistance policies in shaping risks for financial hardship as well as potential opportunities to mitigate risks among veterans and reduce variation across regions.
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Affiliation(s)
- Katrina E Hauschildt
- VA Center for Clinical Management Research, Ann Arbor VA, Ann Arbor, MI 48109, United States
- Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD 21205, United States
| | - David P Bui
- Center to Improve Veteran Involvement in Care, VA Portland Health Care System, Portland, OR 97239, United States
| | - Diana J Govier
- Center to Improve Veteran Involvement in Care, VA Portland Health Care System, Portland, OR 97239, United States
- Oregon Health & Science University—Portland State University School of Public Health, Portland, OR 97201, United States
| | - Tammy L Eaton
- VA Center for Clinical Management Research, Ann Arbor VA, Ann Arbor, MI 48109, United States
- University of Michigan Institute for Healthcare Policy & Innovation, Ann Arbor, MI 48109, United States
- Division of Hospital Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MI 48109, United States
| | - Elizabeth M Viglianti
- VA Center for Clinical Management Research, Ann Arbor VA, Ann Arbor, MI 48109, United States
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MI 48109, United States
| | - Catherine K Ettman
- School of Public Health, Johns Hopkins University, Baltimore, MD 21205, United States
| | - Holly McCready
- Center to Improve Veteran Involvement in Care, VA Portland Health Care System, Portland, OR 97239, United States
| | - Valerie A Smith
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham Veterans Affairs Health Care System, Durham, NC 27705, United States
- Department of Medicine, Duke University, Durham, NC 27710, United States
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC 27710, United States
| | - Ann M O’Hare
- Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs Puget Sound Healthcare System, Seattle, WA 98108, United States
- Hospital and Specialty Medicine Service, Veterans Affairs Puget Sound Health Care System, Seattle, WA 98108, United States
- Department of Medicine, University of Washington, Seattle, WA 98195, United States
| | - Thomas F Osborne
- VA Palo Alto Healthcare System, Palo Alto, CA 94304, United States
- Department of Radiology, Stanford University School of Medicine, Stanford, CA 94305, United States
| | - Edward J Boyko
- Seattle Epidemiologic Research and Information Center, VA Puget Sound Health Care System, Seattle, WA 98108, United States
| | - George N Ioannou
- Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs Puget Sound Healthcare System, Seattle, WA 98108, United States
- Division of Gastroenterology, Department of Medicine, University of Washington, Seattle, WA 98195, United States
| | - Matthew L Maciejewski
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham Veterans Affairs Health Care System, Durham, NC 27705, United States
- Department of Medicine, Duke University, Durham, NC 27710, United States
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC 27710, United States
| | - Amy S B Bohnert
- VA Center for Clinical Management Research, Ann Arbor VA, Ann Arbor, MI 48109, United States
- Department of Anesthesiology, University of Michigan Medical School, Ann Arbor, MI 48109, United States
| | - Denise M Hynes
- Center to Improve Veteran Involvement in Care, VA Portland Health Care System, Portland, OR 97239, United States
- College of Health, and Center for Quantitative Life Sciences, Oregon State University, Corvallis, OR 97331, United States
- School of Nursing, Oregon Health and Science University, Portland, OR 97201, United States
| | - Theodore J Iwashyna
- VA Center for Clinical Management Research, Ann Arbor VA, Ann Arbor, MI 48109, United States
- Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD 21205, United States
- School of Public Health, Johns Hopkins University, Baltimore, MD 21205, United States
- Department of Medicine, University of Michigan Medical School, Ann Arbor, MI 48109, United States
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Hermosilla M, Alexander C, Polsky D. COVID-19 unemployment and access to statin medications in the United States. Front Public Health 2023; 11:1124151. [PMID: 37064694 PMCID: PMC10097886 DOI: 10.3389/fpubh.2023.1124151] [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: 12/14/2022] [Accepted: 02/15/2023] [Indexed: 03/31/2023] Open
Abstract
ObjectiveTo quantify the effect of the unemployment created by COVID-19 on access to (sales of) statin drugs in the United States population.MethodsApproximately half a billion transactions for statin drugs in the United States between January 2018 and September 2020 are analyzed. We studied the potential causal relation between abnormal levels of unemployment during the first wave of COVID-19 in the U.S. and abnormal levels of sales of statin products (both variables defined at the state/week level). Variables are analyzed using the Two-Stage Least Squares (2SLS) method, which exploits comparisons of statin sales between states where, given the occupational distribution of their workforce, unemployment was more structurally vulnerable to mobility restrictions derived from COVID-19 against states where it was less structurally vulnerable.ResultsWhile we do not find unemployment effects on statin sales on most of the population, our estimates link COVID-fueled unemployment with a sharp sales reduction among Medicaid-insured populations, particularly those in working age. For the period between March and August of 2020, these estimates imply a 31% drop of statin sales among this population.DiscussionCOVID-fueled unemployment may have had a negative and significant effect on access to statin populations among Medicaid-insured populations.
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Affiliation(s)
- Manuel Hermosilla
- Carey Business School, Johns Hopkins University, Baltimore, MD, United States
- *Correspondence: Manuel Hermosilla
| | - Caleb Alexander
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States
- School of Medicine, Johns Hopkins University, Baltimore, MD, United States
| | - Dan Polsky
- Carey Business School, Johns Hopkins University, Baltimore, MD, United States
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States
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Evangelist M, Wu P, Shaefer HL. Emergency unemployment benefits and health care spending during Covid. Health Serv Res 2022; 57:15-26. [PMID: 34517427 PMCID: PMC8652441 DOI: 10.1111/1475-6773.13772] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 07/14/2021] [Accepted: 07/15/2021] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To estimate the impact of the $600 per week Federal Pandemic Unemployment Compensation (FPUC) payments on health care services spending during the Covid pandemic and to investigate if this impact varied by state Medicaid expansion status. DATA SOURCES This study leverages novel, publicly available data from Opportunity Insights capturing consumer credit and debit card spending on health care services for January 18-August 15, 2020 as well as information on unemployment insurance claims, Covid cases, and state policy changes. STUDY DESIGN Using triple-differences estimation, we leverage two sources of variation-within-state change in the unemployment insurance claims rate and the introduction of FPUC payments-to estimate the moderating effect of FPUC on health care spending losses as unemployment rises. Results are stratified by state Medicaid expansion status. EXTRACTION METHODS Not applicable. PRINCIPAL FINDINGS For each percentage point increase in the unemployment insurance claims rate, health care spending declined by 1.0% (<0.05) in Medicaid expansion states and by 2.0% (<0.01) in nonexpansion states. However, FPUC partially mitigated this association, boosting spending by 0.8% (<0.001) and 1.3% (<0.05) in Medicaid expansion and nonexpansion states, respectively, for every percentage point increase in the unemployment insurance claims rate. CONCLUSIONS We find that FPUC bolstered health care spending during the Covid pandemic, but that both the negative consequences of unemployment and moderating effects of federal income supports were greatest in states that did not adopt Medicaid expansion. These results indicate that emergency federal spending helped to sustain health care spending during a period of rising unemployment. Yet, the effectiveness of this program also suggests possible unmet demand for health care services, particularly in states that did not adopt Medicaid expansion.
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Affiliation(s)
- Michael Evangelist
- Department of Sociology, Poverty SolutionsUniversity of MichiganAnn ArborMichiganUSA
| | - Pinghui Wu
- Gerald R. Ford School of Public Policy, Poverty SolutionsUniversity of MichiganAnn ArborMichiganUSA
| | - H. Luke Shaefer
- Gerald R. Ford School of Public Policy, Poverty SolutionsUniversity of MichiganAnn ArborMichiganUSA
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