When People You Love Are The Unintended Consequences Of Opioid Policy

After the release of federal guidelines to curb opioid misuse, a patient is unable to obtain effective pain treatment and dies from complications.

Financial Integration's Impact On Care Delivery And Payment Reforms: A Survey Of Hospitals And Physician Practices

Health systems continue to grow in size. Financial integration-the ownership of hospitals or physician practices-often has anticompetitive effects that contribute to the higher prices for health care seen in the US. To determine whether the potential harms of financial integration are counterbalanced by improvements in quality, we surveyed nationally representative samples of hospitals (n = 739) and physician practices (n = 2,189), stratified according to whether they were independent or were owned by complex systems, simple systems, or medical groups. The surveys included nine scales measuring the level of adoption of diverse, quality-focused care delivery and payment reforms. Scores varied widely across hospitals and practices, but little of this variation was explained by ownership status. Quality scores favored financially integrated systems for four of nine hospital measures and one of nine practice measures, but in no case favored complex systems. Greater financial integration was generally not associated with better quality.

Shelter-In-Place Orders Reduced COVID-19 Mortality And Reduced The Rate Of Growth In Hospitalizations

Most states enacted shelter-in-place orders when mitigating the coronavirus disease 2019 (COVID-19) pandemic. Emerging evidence indicates that these orders have reduced COVID-19 cases. Using data starting at different dates in March and going through May 15, 2020, we examined the effects of shelter-in-place orders on daily growth rates of both COVID-19 deaths and hospitalizations, using event study models. We found that shelter-in-place orders reduced both the daily mortality growth rate nearly three weeks after their enactment and the daily growth rate of hospitalizations two weeks after their enactment. After forty-two days from enactment, the daily mortality growth rate declined by up to 6.1 percentage points. Projections suggest that as many as 250,000-370,000 deaths were possibly averted by May 15 in the forty-two states plus Washington, D.C., that had statewide shelter-in-place orders. The daily hospitalization growth rate examined in nineteen states with shelter-in-place orders and three states without them that had data on hospitalizations declined by up to 8.4 percentage points after forty-two days. This evidence suggests that shelter-in-place orders have been effective in reducing the daily growth rates of COVID-19 deaths and hospitalizations.

Iowa's Medicaid Healthy Behaviors Program Associated With Reduced Hospital-Based Care But Higher Spending, 2012-17

Health behavior incentive programs are increasingly common in Medicaid programs nationwide. Iowa's Healthy Behaviors Program (HBP) requires Medicaid expansion enrollees to complete an annual wellness exam and health risk assessment or pay monthly premiums to avoid disenrollment. The extent to which the program reduces the use of hospital-based care and lowers health care spending is unknown. Using data for 2012-17 from Medicaid and for 2014-17 from HBP, we evaluated changes in use and spending associated with HBP participation. Compared to nonparticipants, HBP participants were less likely to have an emergency department visit or be hospitalized (by 9.6 percentage points and 2.8 percentage points, respectively) but had higher total health care spending ($1,594). Meanwhile, Iowa's Medicaid expansion was associated with increased use and spending independent of HBP participation-that is, applying to both participants and nonparticipants. Overall, our findings suggest that the HBP was associated with substantial reductions in hospital-based care but increased health care spending.

Thousands Of Lives Could Be Saved In The US During The COVID-19 Pandemic If States Exchanged Ventilators

It is thought that there are not enough mechanical ventilators in the United States for every patient who may need one during the novel coronavirus disease (COVID-19) pandemic. However, there has been no analysis that measures the potential magnitude of the problem or proposes a solution. In this article I combine the pandemic forecasting model used by the federal government with estimates of ventilator availability from the literature to assess the expected shortage under various scenarios. I then propose that the federal government organize a national effort for ventilators to be exchanged between states to take advantage of the intertemporal differences in demand peaks. I evaluate versions of this proposal, including use of the national stockpile, to estimate the potentially substantial number of lives that could be saved. In the absence of other viable solutions, the government should begin this effort in earnest, or else make preparations for such coordination should the country face another pandemic in the future.

Guns In Political Advertising Over Four US Election Cycles, 2012-18

Gun-related deaths are on the rise in the US, and following recent mass shootings, gun policy has emerged as an issue in the 2020 election cycle. Political advertising is an increasingly important tool for candidates seeking office to communicate their policy priorities. Over $6 billion was spent on political ads in the 2016 election cycle, and spending in the 2020 cycle is expected to be even higher. Tracking gun-related political advertising over time can offer critical insights into how candidates view the salience of gun policy in the context of the 2020 election and beyond. We analyzed the coverage of guns in over fourteen million candidate-related television ad airings for presidential, congressional, gubernatorial, and state legislative races over four election cycles: 2012, 2014, 2016, and 2018. The share of candidate-related ad airings that referred to guns increased from 1 percent in the 2012 cycle to over 8 percent in the 2018 cycle. Pro-gun rights content dominated but dropped from 86 percent of airings mentioning guns in the 2012 cycle to 45 percent in the 2018 cycle. Advertising in favor of gun regulation and against the National Rifle Association increased over time. These shifts offer insights into how gun issues are being framed in the 2020 election cycle.

Legacies And Lessons: A Final Conversation With Fitzhugh Mullan

The late academic, physician, policy maker, and writer discusses his career achievements, lessons for the future, and cancer.