Jodi L Liu, Lawrence Baker, Annie Yu-An Chen, Jue (Jessie) Wang
Dementia specialists – neurologists, geriatricians, and geriatric psychiatrists – serve a critical clinical function in diagnosing early-stage Alzheimer’s disease and determining eligibility for treatment with disease-modifying therapies. However, the availability of dementia specialists is limited and varies across the U.S. Using data from the Area Health Resources Files, we found that the median density of dementia specialists across hospital referral regions in U.S. is 29.7 per 100,000 population aged 65 and older (interquartile range 20.7 to 44.0). We derived thresholds of 33 to 45 dementia specialists per 100,000 population aged 65 and older as the provider density necessary to care for older adults with mild cognitive impairment and dementia. Based on these thresholds, we estimated that 34% to 60% of the population aged 65 and older resided in areas with potential dementia specialist shortfalls. The extent of potential shortfalls varied by state and rurality. A better understanding of potential gaps in the availability of dementia specialists will inform policies and practices to ensure access to services for people with cognitive impairment and dementia.
{"title":"Geographic Variation in Shortfalls of Dementia Specialists in the U.S.","authors":"Jodi L Liu, Lawrence Baker, Annie Yu-An Chen, Jue (Jessie) Wang","doi":"10.1093/haschl/qxae088","DOIUrl":"https://doi.org/10.1093/haschl/qxae088","url":null,"abstract":"\u0000 Dementia specialists – neurologists, geriatricians, and geriatric psychiatrists – serve a critical clinical function in diagnosing early-stage Alzheimer’s disease and determining eligibility for treatment with disease-modifying therapies. However, the availability of dementia specialists is limited and varies across the U.S. Using data from the Area Health Resources Files, we found that the median density of dementia specialists across hospital referral regions in U.S. is 29.7 per 100,000 population aged 65 and older (interquartile range 20.7 to 44.0). We derived thresholds of 33 to 45 dementia specialists per 100,000 population aged 65 and older as the provider density necessary to care for older adults with mild cognitive impairment and dementia. Based on these thresholds, we estimated that 34% to 60% of the population aged 65 and older resided in areas with potential dementia specialist shortfalls. The extent of potential shortfalls varied by state and rurality. A better understanding of potential gaps in the availability of dementia specialists will inform policies and practices to ensure access to services for people with cognitive impairment and dementia.","PeriodicalId":502462,"journal":{"name":"Health Affairs Scholar","volume":"38 10","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141639864","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
F. LaMountain, Molly T Beinfeld, William Wong, Eunice Kim, James D Chambers
Biosimilars offer the potential for cost savings and expanded access to biologic products, however, there are concerns regarding the rate of biosimilar uptake. We assessed the relationship between biosimilar and originator pricing, coverage, and market share by describing four case studies that fall into two categories: (1) sole preferred coverage strategy (i.e., aim is to have originator product preferred; biosimilar(s) non-preferred), defined as steep ASP reductions for originator products (decline in net prices by at least 50% following the introduction of biosimilar competition by 2022) and (2) non-sole preferred coverage strategy (i.e., aim is to have originator product preferred alongside biosimilar products), defined as moderate ASP reductions for originator products with (net prices did not decline by at least 50% of its pre-biosimilar competition value). We found that originators with sole preferred coverage strategies maintained formulary preference and market share relative to originators with non-sole preferred coverage strategies. Regardless of strategy, the market-weighted ASP for all four product families (originator and biosimilars) declined significantly in the years following the introduction of biosimilars, suggesting that biosimilar uptake alone may not be a complete measure of whether the biosimilar market is facilitating competition and lowering prices.
生物仿制药具有节约成本和扩大生物制品使用范围的潜力，但人们对生物仿制药的吸收率存在担忧。我们评估了生物仿制药与原研药定价、覆盖范围和市场份额之间的关系，并将四个案例研究分为两类：(1) 唯一优先覆盖战略（即目标是原研药产品优先；生物仿制药非优先），定义为原研药产品的 ASP 锐减（到 2022 年引入生物仿制药竞争后，净价格下降至少 50%）；(2) 非唯一优先覆盖战略（即目标是原研药产品与生物仿制药同时优先），定义为原研药产品的 ASP 锐减（到 2022 年引入生物仿制药竞争后，净价格下降至少 50%）、(2) 非独家优先覆盖战略（即，旨在使原研产品与生物类似药产品同时获得优先覆盖），定义为原研产品的 ASP 降幅适中（净价格至少没有下降到生物类似药竞争前价值的 50%）。我们发现，与采用非独家优先覆盖策略的原研药相比，采用独家优先覆盖策略的原研药能保持处方集优先权和市场份额。无论采用哪种策略，所有四个产品系列（原研药和生物仿制药）的市场加权平均售价在生物仿制药推出后的几年中都出现了显著下降，这表明仅凭生物仿制药的吸收量可能无法全面衡量生物仿制药市场是否促进了竞争并降低了价格。
{"title":"Biosimilar underutilization alone does not foretell a broken biologics market","authors":"F. LaMountain, Molly T Beinfeld, William Wong, Eunice Kim, James D Chambers","doi":"10.1093/haschl/qxae090","DOIUrl":"https://doi.org/10.1093/haschl/qxae090","url":null,"abstract":"\u0000 Biosimilars offer the potential for cost savings and expanded access to biologic products, however, there are concerns regarding the rate of biosimilar uptake. We assessed the relationship between biosimilar and originator pricing, coverage, and market share by describing four case studies that fall into two categories: (1) sole preferred coverage strategy (i.e., aim is to have originator product preferred; biosimilar(s) non-preferred), defined as steep ASP reductions for originator products (decline in net prices by at least 50% following the introduction of biosimilar competition by 2022) and (2) non-sole preferred coverage strategy (i.e., aim is to have originator product preferred alongside biosimilar products), defined as moderate ASP reductions for originator products with (net prices did not decline by at least 50% of its pre-biosimilar competition value). We found that originators with sole preferred coverage strategies maintained formulary preference and market share relative to originators with non-sole preferred coverage strategies. Regardless of strategy, the market-weighted ASP for all four product families (originator and biosimilars) declined significantly in the years following the introduction of biosimilars, suggesting that biosimilar uptake alone may not be a complete measure of whether the biosimilar market is facilitating competition and lowering prices.","PeriodicalId":502462,"journal":{"name":"Health Affairs Scholar","volume":"28 10","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141640144","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
D. Luo, M. Ouayogodé, John Mullahy, Ying (Jessica) Cao
Regional variation in healthcare use threatens efficient and equitable resource allocation. Within the Medicare program, variation in care delivery may differ between centrally administered traditional Medicare (TM) and privately managed Medicare Advantage (MA) plans which rely on different strategies to control care utilization. As MA enrollment grows, it is particularly important for program design and long-term healthcare equity to understand regional variation between TM and MA plans. This study examined regional variation in length of stay (LOS) for stroke inpatient rehabilitation between TM and MA plans in 2019 and how that changed in 2020, the first year of the COVID-19 pandemic. Results showed that MA plans had larger across-region variations than TM (standard deviation (SD)=0.26 vs. 0.24 days, 11% relative difference). In 2020, across-region variation for MA further enlarged but the trend for TM stayed relatively stable. Market competition among all inpatient rehabilitation facilities (IRFs) within a region was associated with a moderate increase in within-region variation of LOS (elasticity=0.46). Policies reducing administrative variation across MA plans or increasing regional market competition among IRFs can mitigate regional variation in healthcare use.
{"title":"Regional Variation in Length of Stay for Stroke Inpatient Rehabilitation in Traditional Medicare and Medicare Advantage","authors":"D. Luo, M. Ouayogodé, John Mullahy, Ying (Jessica) Cao","doi":"10.1093/haschl/qxae089","DOIUrl":"https://doi.org/10.1093/haschl/qxae089","url":null,"abstract":"\u0000 Regional variation in healthcare use threatens efficient and equitable resource allocation. Within the Medicare program, variation in care delivery may differ between centrally administered traditional Medicare (TM) and privately managed Medicare Advantage (MA) plans which rely on different strategies to control care utilization. As MA enrollment grows, it is particularly important for program design and long-term healthcare equity to understand regional variation between TM and MA plans. This study examined regional variation in length of stay (LOS) for stroke inpatient rehabilitation between TM and MA plans in 2019 and how that changed in 2020, the first year of the COVID-19 pandemic. Results showed that MA plans had larger across-region variations than TM (standard deviation (SD)=0.26 vs. 0.24 days, 11% relative difference). In 2020, across-region variation for MA further enlarged but the trend for TM stayed relatively stable. Market competition among all inpatient rehabilitation facilities (IRFs) within a region was associated with a moderate increase in within-region variation of LOS (elasticity=0.46). Policies reducing administrative variation across MA plans or increasing regional market competition among IRFs can mitigate regional variation in healthcare use.","PeriodicalId":502462,"journal":{"name":"Health Affairs Scholar","volume":"3 10","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141642558","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Debra R Winberg, Matthew C Baker, Xiaochu Hu, Keith A Horvath
Value-Based Care (VBC) payment models are becoming increasingly prevalent as alternatives to the traditional fee-for-service paradigm. This research quantifies the relationship between physician characteristics and participation in VBC payment models using the Association of American Medical Colleges’ 2022 National Sample Survey of Physicians. We specified logistic regressions using physician-level variables to assess associations with current and new participation in Accountable Care Organizations, Primary Care First (PCF) model, capitation, and bundled payments. Our results indicate that most respondents engaged in at least one VBC. Participation varied based on several characteristics, and physician specialty was highly predictive of overall participation. Compared to primary care physicians (PCPs), hospital-based physicians (OR=0.6, p<0.001), medical specialists (OR=0.5, p<0.001), psychiatrists (OR=0.4, p<0.001), and surgeons (OR=0.5, p<0.001) were less likely to participate in VBC models. Medical specialists and surgeons were less likely to participate in commercial capitation than PCPs while medical specialists and obstetricians/gynecologists were more likely to participate in certain bundles than PCPs. We suggest several policies to close the cross-specialty participation gap by including specialists and appealing to providers and patients.
{"title":"Who Participates in Value-Based Care Models? Physician Characteristics and Implications for Value-based Care","authors":"Debra R Winberg, Matthew C Baker, Xiaochu Hu, Keith A Horvath","doi":"10.1093/haschl/qxae087","DOIUrl":"https://doi.org/10.1093/haschl/qxae087","url":null,"abstract":"\u0000 Value-Based Care (VBC) payment models are becoming increasingly prevalent as alternatives to the traditional fee-for-service paradigm. This research quantifies the relationship between physician characteristics and participation in VBC payment models using the Association of American Medical Colleges’ 2022 National Sample Survey of Physicians. We specified logistic regressions using physician-level variables to assess associations with current and new participation in Accountable Care Organizations, Primary Care First (PCF) model, capitation, and bundled payments. Our results indicate that most respondents engaged in at least one VBC. Participation varied based on several characteristics, and physician specialty was highly predictive of overall participation. Compared to primary care physicians (PCPs), hospital-based physicians (OR=0.6, p<0.001), medical specialists (OR=0.5, p<0.001), psychiatrists (OR=0.4, p<0.001), and surgeons (OR=0.5, p<0.001) were less likely to participate in VBC models. Medical specialists and surgeons were less likely to participate in commercial capitation than PCPs while medical specialists and obstetricians/gynecologists were more likely to participate in certain bundles than PCPs. We suggest several policies to close the cross-specialty participation gap by including specialists and appealing to providers and patients.","PeriodicalId":502462,"journal":{"name":"Health Affairs Scholar","volume":"63 19","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141643533","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Daeho Kim, David J Meyers, L. Keohane, Hiren Varma, Emma M Achola, Amal N Trivedi
Enrollment in Medicare Advantage (MA) has been rapidly growing. We examine whether MA enrollment affects the outcomes of post-acute nursing home care among patients with Alzheimer’s Disease and Related Dementias (ADRD). We exploit year-to-year changes in MA penetration rates within counties from 2012 through 2019. After adjusting for patient-level characteristics and county fixed effects, we find that MA enrollment was not associated with days spent at home, nursing home days, likelihood of becoming a long-stay resident, hospital days, hospital readmission, or 1-year mortality. There was a modest increase in successful discharge to community by 0.73 percentage points (relative increase of 2.4%) associated with a 10-percentage point increase in MA enrollment. The results are consistent among racial/ethnic subgroups and dual-eligible patients. These findings suggest an imperative need to monitor and improve quality of managed care among enrollees with ADRD.
{"title":"Medicare Advantage Enrollment and Outcomes of Post-Acute Nursing Home Care Among Patients with Dementia","authors":"Daeho Kim, David J Meyers, L. Keohane, Hiren Varma, Emma M Achola, Amal N Trivedi","doi":"10.1093/haschl/qxae084","DOIUrl":"https://doi.org/10.1093/haschl/qxae084","url":null,"abstract":"\u0000 Enrollment in Medicare Advantage (MA) has been rapidly growing. We examine whether MA enrollment affects the outcomes of post-acute nursing home care among patients with Alzheimer’s Disease and Related Dementias (ADRD). We exploit year-to-year changes in MA penetration rates within counties from 2012 through 2019. After adjusting for patient-level characteristics and county fixed effects, we find that MA enrollment was not associated with days spent at home, nursing home days, likelihood of becoming a long-stay resident, hospital days, hospital readmission, or 1-year mortality. There was a modest increase in successful discharge to community by 0.73 percentage points (relative increase of 2.4%) associated with a 10-percentage point increase in MA enrollment. The results are consistent among racial/ethnic subgroups and dual-eligible patients. These findings suggest an imperative need to monitor and improve quality of managed care among enrollees with ADRD.","PeriodicalId":502462,"journal":{"name":"Health Affairs Scholar","volume":"38 7","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141347219","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
M. Bicket, Elizabeth M Stone, Kayla N. Tormohlen, Reekarl Pierre, Emma E. McGinty
Changes chronic noncancer pain treatment have led to decreases in prescribing of opioids and increases in the availability of medical cannabis, despite its federal prohibition. Patients may face barriers to establishing new care with a physician based on use of these treatments. We compared physician willingness to accept patients based on prescription opioid, cannabis, or other pain treatment use. This study of 36 states and DC with active medical cannabis programs surveyed physicians who treat patients with chronic noncancer pain between July 13 and August 4, 2023. Of 1,000 physician respondents (34.5% female, 63.2% white, 78.1% primary care), 852 reported accepting new patients with chronic pain. Among those accepting new patients with chronic pain, more physicians reported that they would not accept new patients taking prescription opioids (20.0%) or cannabis (12.7%) than non-opioid prescription analgesics (0.1%). In contrast, 68.1% reported willingness to accept new patients using prescribed opioids on a daily basis. For cannabis, physicians were more likely to accept new patients accessing cannabis through medical programs (81.6%) than from other sources (60.2%). Access to care for persons with chronic noncancer pain appears the most restricted among those taking prescription opioids, though patients taking cannabis may also encounter reduced access.
{"title":"Access to Care for Patients with Chronic Pain Receiving Prescription Opioids, Cannabis, or Other Treatments","authors":"M. Bicket, Elizabeth M Stone, Kayla N. Tormohlen, Reekarl Pierre, Emma E. McGinty","doi":"10.1093/haschl/qxae086","DOIUrl":"https://doi.org/10.1093/haschl/qxae086","url":null,"abstract":"\u0000 Changes chronic noncancer pain treatment have led to decreases in prescribing of opioids and increases in the availability of medical cannabis, despite its federal prohibition. Patients may face barriers to establishing new care with a physician based on use of these treatments. We compared physician willingness to accept patients based on prescription opioid, cannabis, or other pain treatment use. This study of 36 states and DC with active medical cannabis programs surveyed physicians who treat patients with chronic noncancer pain between July 13 and August 4, 2023. Of 1,000 physician respondents (34.5% female, 63.2% white, 78.1% primary care), 852 reported accepting new patients with chronic pain. Among those accepting new patients with chronic pain, more physicians reported that they would not accept new patients taking prescription opioids (20.0%) or cannabis (12.7%) than non-opioid prescription analgesics (0.1%). In contrast, 68.1% reported willingness to accept new patients using prescribed opioids on a daily basis. For cannabis, physicians were more likely to accept new patients accessing cannabis through medical programs (81.6%) than from other sources (60.2%). Access to care for persons with chronic noncancer pain appears the most restricted among those taking prescription opioids, though patients taking cannabis may also encounter reduced access.","PeriodicalId":502462,"journal":{"name":"Health Affairs Scholar","volume":"119 37","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141351955","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Xiaoxi Zhao, Michael R Richards, C. Damberg, Christopher M Whaley
Insurer-provider integration is a new form of vertical integration, with increasing prominence in health care markets. While there are potential benefits from tighter alignment between providers and payers, risks of perverse impacts on health care markets loom large. Yet, little is known about this new wave of consolidation, which limits options for policy or regulatory responses. We focus on a dominant insurer’s acquisitions of Ambulatory Surgery Centers (ASCs) to document the growth and geographic spread of these ownership events. We find that a diverse swathe of the US has experienced an insurer-led ASC takeover. The acquisitions are also more frequently in areas where the insurer holds a higher enrollee market share at baseline; though, a linear prediction of the likelihood of ASC acquisition shows a more nuanced picture.
{"title":"Market Landscape and Insurer-Provider Integration: The Case of Ambulatory Surgery Centers","authors":"Xiaoxi Zhao, Michael R Richards, C. Damberg, Christopher M Whaley","doi":"10.1093/haschl/qxae081","DOIUrl":"https://doi.org/10.1093/haschl/qxae081","url":null,"abstract":"\u0000 Insurer-provider integration is a new form of vertical integration, with increasing prominence in health care markets. While there are potential benefits from tighter alignment between providers and payers, risks of perverse impacts on health care markets loom large. Yet, little is known about this new wave of consolidation, which limits options for policy or regulatory responses. We focus on a dominant insurer’s acquisitions of Ambulatory Surgery Centers (ASCs) to document the growth and geographic spread of these ownership events. We find that a diverse swathe of the US has experienced an insurer-led ASC takeover. The acquisitions are also more frequently in areas where the insurer holds a higher enrollee market share at baseline; though, a linear prediction of the likelihood of ASC acquisition shows a more nuanced picture.","PeriodicalId":502462,"journal":{"name":"Health Affairs Scholar","volume":"36 19","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141357138","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Ruijie Liu, Tamara Beetham, Helen Newton, Susan H Busch
Since January 2020, Medicare has covered opioid use disorder (OUD) treatment services at opioid treatment programs (OTPs), the only outpatient settings allowed to dispense methadone for treating OUD. This study examined policy-associated changes in Medicare acceptance and the availability of four OUD treatment services (ongoing buprenorphine, HIV/AIDS education, employment services, and comprehensive mental health assessment), by for-profit status, and county-level changes in Medicare-accepting-OTPs access, by sociodemographic characteristics (racial composition, poverty rate, and rurality). Using data from the 2019-2022 National Directory of Drug and Alcohol Abuse Treatment Facilities, we found Medicare acceptance increased from 21.31% in 2018 to 80.76% in 2021. The availability of the four treatment services increased but no increases were significantly associated with Medicare coverage. While county-level OTP access significantly improved, counties with higher rates of nonwhite residents experienced an additional average increase of 0.86 Medicare-accepting-OTPs (95% CI: [0.05, 1.67]) compared to those without higher rates of nonwhite populations. Overall, Medicare coverage was associated with improved OTP access, not ancillary services.
{"title":"Access to Treatment Before and After Medicare Coverage of Opioid Treatment Programs","authors":"Ruijie Liu, Tamara Beetham, Helen Newton, Susan H Busch","doi":"10.1093/haschl/qxae076","DOIUrl":"https://doi.org/10.1093/haschl/qxae076","url":null,"abstract":"\u0000 Since January 2020, Medicare has covered opioid use disorder (OUD) treatment services at opioid treatment programs (OTPs), the only outpatient settings allowed to dispense methadone for treating OUD. This study examined policy-associated changes in Medicare acceptance and the availability of four OUD treatment services (ongoing buprenorphine, HIV/AIDS education, employment services, and comprehensive mental health assessment), by for-profit status, and county-level changes in Medicare-accepting-OTPs access, by sociodemographic characteristics (racial composition, poverty rate, and rurality). Using data from the 2019-2022 National Directory of Drug and Alcohol Abuse Treatment Facilities, we found Medicare acceptance increased from 21.31% in 2018 to 80.76% in 2021. The availability of the four treatment services increased but no increases were significantly associated with Medicare coverage. While county-level OTP access significantly improved, counties with higher rates of nonwhite residents experienced an additional average increase of 0.86 Medicare-accepting-OTPs (95% CI: [0.05, 1.67]) compared to those without higher rates of nonwhite populations. Overall, Medicare coverage was associated with improved OTP access, not ancillary services.","PeriodicalId":502462,"journal":{"name":"Health Affairs Scholar","volume":"1 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141380316","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
H. Robertson, E. Graeden, Justin Kerr, Michael Van Maele, Rebecca Katz
Global financing for health security was dramatically impacted by COVID-19. Here, we provide an empirical analysis of how that funding changed. Using data from Global Health Security (GHS) Tracking (ghscosting.tracking.org), we analyzed disbursements of direct financial assistance for global health security from 2016 to 2022 to compare pre-pandemic funding (2016-2019) to post-pandemic (2020-2022) funding for preparedness and response during each of the seven World Health Organization (WHO)-declared public health emergencies of international concern (PHEICs) from 2009 to 2022. Over $165B was disbursed for capacity-building and preparedness activities between January 2016 and December 2022, and over $76B was provided for PHEIC response. Preparedness funding remained evenly distributed since 2016 across regions, with the African region receiving about 70% of total preparedness funding. Indeed, how capacity-building and preparedness funding is distributed has changed remarkably little since 2016, despite unprecedented changes to the funding environment – including markedly increased spending – in response to COVID-19. This suggests we now have a unique opportunity to restructure how funds are tracked for accountability and assessing return on investment moving forward.
{"title":"Follow the Money: A Global Analysis of Funding Dynamics for Global Health Security","authors":"H. Robertson, E. Graeden, Justin Kerr, Michael Van Maele, Rebecca Katz","doi":"10.1093/haschl/qxae083","DOIUrl":"https://doi.org/10.1093/haschl/qxae083","url":null,"abstract":"\u0000 Global financing for health security was dramatically impacted by COVID-19. Here, we provide an empirical analysis of how that funding changed. Using data from Global Health Security (GHS) Tracking (ghscosting.tracking.org), we analyzed disbursements of direct financial assistance for global health security from 2016 to 2022 to compare pre-pandemic funding (2016-2019) to post-pandemic (2020-2022) funding for preparedness and response during each of the seven World Health Organization (WHO)-declared public health emergencies of international concern (PHEICs) from 2009 to 2022. Over $165B was disbursed for capacity-building and preparedness activities between January 2016 and December 2022, and over $76B was provided for PHEIC response. Preparedness funding remained evenly distributed since 2016 across regions, with the African region receiving about 70% of total preparedness funding. Indeed, how capacity-building and preparedness funding is distributed has changed remarkably little since 2016, despite unprecedented changes to the funding environment – including markedly increased spending – in response to COVID-19. This suggests we now have a unique opportunity to restructure how funds are tracked for accountability and assessing return on investment moving forward.","PeriodicalId":502462,"journal":{"name":"Health Affairs Scholar","volume":"29 48","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141379560","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Katrina E Hauschildt, David P Bui, D. Govier, Tammy L Eaton, E. Viglianti, Catherine K. Ettman, H. McCready, Valerie A Smith, A. O’Hare, Thomas F. Osborne, Edward J. Boyko, George N Ioannou, Matthew L. Maciejewski, A. Bohnert, Denise M. Hynes, Theodore J. Iwashyna
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 Census region. We found Veterans in the South, compared to 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.
{"title":"Regional Variation in Financial Hardship Among US Veterans During the COVID-19 Pandemic","authors":"Katrina E Hauschildt, David P Bui, D. Govier, Tammy L Eaton, E. Viglianti, Catherine K. Ettman, H. McCready, Valerie A Smith, A. O’Hare, Thomas F. Osborne, Edward J. Boyko, George N Ioannou, Matthew L. Maciejewski, A. Bohnert, Denise M. Hynes, Theodore J. Iwashyna","doi":"10.1093/haschl/qxae075","DOIUrl":"https://doi.org/10.1093/haschl/qxae075","url":null,"abstract":"\u0000 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 Census region. We found Veterans in the South, compared to 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.","PeriodicalId":502462,"journal":{"name":"Health Affairs Scholar","volume":"341 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141386113","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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