Emma E. McGinty, Sarah A. White, Matthew D Eisenberg, Nicole Palmer, C. H. Brown, Brendan K Saloner
Offering patients medications for opioid use disorder (MOUD) is the standard of care for opioid use disorder (OUD), but an estimated 75-90% of people with OUD who could benefit from MOUD do not receive medication. Payment policy, defined as public and private payers’ approaches to covering and reimbursing providers for MOUD, is one contributor to this treatment gap. We conducted a policy analysis and qualitative interviews (N=21) and surveys (N=31) with U.S. MOUD payment policy experts to characterize MOUD insurance coverage across major categories of U.S. insurers and identify opportunities for reform and innovation. Traditional Medicare, Medicare Advantage, and Medicaid all provide coverage for at least one formulation of buprenorphine, naltrexone, and methadone for OUD. Private insurance coverage varies by carrier and by plan, with methadone most likely to be excluded. The experts interviewed cautioned against rigid reimbursement models that force patients into one-size-fits-all care and endorsed future development and adoption of value-based MOUD payment models. More than 70% of experts surveyed reported that Medicare, Medicaid, and private insurers should increase payment for office- and opioid treatment program-based MOUD. Validation of MOUD performance metrics is needed to support future value-based initiatives.
{"title":"U.S. payment policy for medications to treat opioid use disorder: landscape and opportunities","authors":"Emma E. McGinty, Sarah A. White, Matthew D Eisenberg, Nicole Palmer, C. H. Brown, Brendan K Saloner","doi":"10.1093/haschl/qxae024","DOIUrl":"https://doi.org/10.1093/haschl/qxae024","url":null,"abstract":"\u0000 Offering patients medications for opioid use disorder (MOUD) is the standard of care for opioid use disorder (OUD), but an estimated 75-90% of people with OUD who could benefit from MOUD do not receive medication. Payment policy, defined as public and private payers’ approaches to covering and reimbursing providers for MOUD, is one contributor to this treatment gap. We conducted a policy analysis and qualitative interviews (N=21) and surveys (N=31) with U.S. MOUD payment policy experts to characterize MOUD insurance coverage across major categories of U.S. insurers and identify opportunities for reform and innovation. Traditional Medicare, Medicare Advantage, and Medicaid all provide coverage for at least one formulation of buprenorphine, naltrexone, and methadone for OUD. Private insurance coverage varies by carrier and by plan, with methadone most likely to be excluded. The experts interviewed cautioned against rigid reimbursement models that force patients into one-size-fits-all care and endorsed future development and adoption of value-based MOUD payment models. More than 70% of experts surveyed reported that Medicare, Medicaid, and private insurers should increase payment for office- and opioid treatment program-based MOUD. Validation of MOUD performance metrics is needed to support future value-based initiatives.","PeriodicalId":502462,"journal":{"name":"Health Affairs Scholar","volume":"59 10","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140424176","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}
General practice in the English NHS is in crisis. In response, politicians are proposing fundamental reform to the way general practice is organized. But ideas for reform are contested, and there are conflicting interpretations of the problems to be addressed. We use Barbara Starfield’s ‘4Cs’ framework for high performing primary care to provide an overall assessment of the current role and performance of general practice in England. We first assess theoretical alignment between Starfield’s framework and the role of general practice in England. We then assess actual performance using publicly available national data and targeted literature searches. We find close theoretical alignment between Starfield’s framework and the model of NHS general practice in England. But in practice, its model of universal comprehensive care risks being undermined by worsening and inequitable access, while continuity of care is declining. Underlying causes of current challenges in general practice in England appear more closely linked to under-resourcing than the fundamental design of the system. General practice in England must evolve, but wholesale re-organization is likely to damage and distract. Instead, policymakers should focus on adequately resourcing general practice while supporting general practice teams to improve the quality and coordination of local services.
{"title":"The performance of general practice in the English NHS: An analysis using Starfield’s framework for primary care","authors":"Rebecca Fisher, Hugh Alderwick","doi":"10.1093/haschl/qxae022","DOIUrl":"https://doi.org/10.1093/haschl/qxae022","url":null,"abstract":"\u0000 General practice in the English NHS is in crisis. In response, politicians are proposing fundamental reform to the way general practice is organized. But ideas for reform are contested, and there are conflicting interpretations of the problems to be addressed. We use Barbara Starfield’s ‘4Cs’ framework for high performing primary care to provide an overall assessment of the current role and performance of general practice in England. We first assess theoretical alignment between Starfield’s framework and the role of general practice in England. We then assess actual performance using publicly available national data and targeted literature searches. We find close theoretical alignment between Starfield’s framework and the model of NHS general practice in England. But in practice, its model of universal comprehensive care risks being undermined by worsening and inequitable access, while continuity of care is declining. Underlying causes of current challenges in general practice in England appear more closely linked to under-resourcing than the fundamental design of the system. General practice in England must evolve, but wholesale re-organization is likely to damage and distract. Instead, policymakers should focus on adequately resourcing general practice while supporting general practice teams to improve the quality and coordination of local services.","PeriodicalId":502462,"journal":{"name":"Health Affairs Scholar","volume":"10 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140436466","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}
This article contrasts the different approaches to COVID-19 vaccine development adopted by Oxford University, on one hand, and Texas Children’s Hospital and Baylor College of Medicine (collectively, Texas), on the other hand. Texas was praised widely in the press and academic literature for adopting an “open source” approach to vaccine development. Oxford, however, chose to license its vaccine technology to pharmaceutical manufacturer AstraZeneca and received significant public criticism as a result. Yet the Oxford vaccine reached far more individuals in developing countries than the Texas vaccine. We compare the two vaccines’ experiences, drawing attention to a constellation of interrelated elements that contribute to a successful vaccine production program, including not only IP licensing, but also timing, technology transfer, and resource mobilization, all in the context of the prevailing funding environments. This comparative analysis sheds light on how the innovation ecosystem functioned during the COVID-19 pandemic, providing useful insights for policy makers and advocates as they prepare for future pandemics and other global health challenges.
{"title":"Contrasting academic approaches to COVID-19 vaccine production and distribution: What can the Oxford and Texas experiences teach us about pandemic response?","authors":"Jorge L Contreras, Kenneth C. Shadlen","doi":"10.1093/haschl/qxae012","DOIUrl":"https://doi.org/10.1093/haschl/qxae012","url":null,"abstract":"\u0000 This article contrasts the different approaches to COVID-19 vaccine development adopted by Oxford University, on one hand, and Texas Children’s Hospital and Baylor College of Medicine (collectively, Texas), on the other hand. Texas was praised widely in the press and academic literature for adopting an “open source” approach to vaccine development. Oxford, however, chose to license its vaccine technology to pharmaceutical manufacturer AstraZeneca and received significant public criticism as a result. Yet the Oxford vaccine reached far more individuals in developing countries than the Texas vaccine. We compare the two vaccines’ experiences, drawing attention to a constellation of interrelated elements that contribute to a successful vaccine production program, including not only IP licensing, but also timing, technology transfer, and resource mobilization, all in the context of the prevailing funding environments. This comparative analysis sheds light on how the innovation ecosystem functioned during the COVID-19 pandemic, providing useful insights for policy makers and advocates as they prepare for future pandemics and other global health challenges.","PeriodicalId":502462,"journal":{"name":"Health Affairs Scholar","volume":"423 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140474333","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}
Nicole C McCann, Lorraine T Dean, Allison Bovell-Ammon, Stephanie Ettinger de Cuba, Tiffany Green, P. Shafer, J. Raifman
The COVID-19 pandemic brought increases in economic shocks due to poor health and lost employment which reduced economic well-being, especially in households with children. The American Rescue Plan Act of 2021 expanded Child Tax Credit (CTC) payments to include eligibility for the lowest income households, boosted benefit levels, and provided monthly advance payments to households with children. Using Census Household Pulse Survey (HPS) respondent data from January 2021-July 2022, we evaluated the association between these advance CTC monthly payments and food insufficiency among households with children experiencing health- or employment-related economic shocks (defined as missed work due to COVID-19/other illness, or COVID-19-related employer closure/layoff/furlough). Using a triple difference design, we found that the advance CTC was associated with greater reductions in food insufficiency among households with children experiencing economic shocks both compared with households without children and with households with children not experiencing economic shocks. Permanently expanding the advance CTC could create resilience to economic shocks during disease outbreaks, climate disasters, and recessions.
{"title":"Association between Child Tax Credit advance payments and food insufficiency in households experiencing economic shocks","authors":"Nicole C McCann, Lorraine T Dean, Allison Bovell-Ammon, Stephanie Ettinger de Cuba, Tiffany Green, P. Shafer, J. Raifman","doi":"10.1093/haschl/qxae011","DOIUrl":"https://doi.org/10.1093/haschl/qxae011","url":null,"abstract":"\u0000 The COVID-19 pandemic brought increases in economic shocks due to poor health and lost employment which reduced economic well-being, especially in households with children. The American Rescue Plan Act of 2021 expanded Child Tax Credit (CTC) payments to include eligibility for the lowest income households, boosted benefit levels, and provided monthly advance payments to households with children. Using Census Household Pulse Survey (HPS) respondent data from January 2021-July 2022, we evaluated the association between these advance CTC monthly payments and food insufficiency among households with children experiencing health- or employment-related economic shocks (defined as missed work due to COVID-19/other illness, or COVID-19-related employer closure/layoff/furlough). Using a triple difference design, we found that the advance CTC was associated with greater reductions in food insufficiency among households with children experiencing economic shocks both compared with households without children and with households with children not experiencing economic shocks. Permanently expanding the advance CTC could create resilience to economic shocks during disease outbreaks, climate disasters, and recessions.","PeriodicalId":502462,"journal":{"name":"Health Affairs Scholar","volume":"45 4","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140478698","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}
Administrative burden across state-federal benefits programs is unsustainable, and artificial intelligence (AI) and associated technologies have emerged and resulted in significant interest as possible solutions. While early in development, AI has significant potential to reduce administrative waste and increase efficiency, with many government agencies and state legislators eager to adopt the new technology. Turning to existing frameworks defining what functions are considered “inherently governmental” can help determine where more autonomous implementation could be not only appropriate, but also provide unique advantages. Such areas could include eligibility and redetermination of Medicaid eligibility as well as preventing improper Medicaid payments. However, while AI is promising, this technology may not be ready for fully autonomous implementation and instead could be deployed to augment human capabilities with robust safeguards until it has proven to be more reliable. In the meantime, the Centers for Medicare & Medicaid Services should release clear guidance around the use of AI by state Medicaid programs, and policymakers must work together to harness AI technologies in order to improve the efficiency and effectiveness of the Medicaid program.
各州-联邦福利计划的行政负担是不可持续的，人工智能（AI）和相关技术作为可能的解决方案已经出现并引起了极大的兴趣。虽然人工智能尚处于发展初期，但其在减少行政浪费和提高效率方面具有巨大潜力，许多政府机构和州立法者都迫切希望采用这项新技术。利用现有的框架来定义哪些职能被认为是 "政府固有的"，有助于确定在哪些领域更自主地实施人工智能不仅合适，而且还能提供独特的优势。这些领域可能包括医疗补助资格和重新确定医疗补助资格，以及防止不当的医疗补助支付。不过，虽然人工智能前景广阔，但这项技术可能还没有准备好完全自主实施，相反，在证明其更加可靠之前，可以部署这项技术来增强人类的能力，并采取强有力的保障措施。与此同时，美国医疗保险与医疗补助服务中心（Centers for Medicare & Medicaid Services）应围绕各州医疗补助计划对人工智能的使用发布明确的指导意见，政策制定者必须共同努力利用人工智能技术，以提高医疗补助计划的效率和有效性。
{"title":"Using Artificial Intelligence to Improve Administrative Process in Medicaid","authors":"Ted Cho, Brian J Miller","doi":"10.1093/haschl/qxae008","DOIUrl":"https://doi.org/10.1093/haschl/qxae008","url":null,"abstract":"\u0000 Administrative burden across state-federal benefits programs is unsustainable, and artificial intelligence (AI) and associated technologies have emerged and resulted in significant interest as possible solutions. While early in development, AI has significant potential to reduce administrative waste and increase efficiency, with many government agencies and state legislators eager to adopt the new technology. Turning to existing frameworks defining what functions are considered “inherently governmental” can help determine where more autonomous implementation could be not only appropriate, but also provide unique advantages. Such areas could include eligibility and redetermination of Medicaid eligibility as well as preventing improper Medicaid payments. However, while AI is promising, this technology may not be ready for fully autonomous implementation and instead could be deployed to augment human capabilities with robust safeguards until it has proven to be more reliable. In the meantime, the Centers for Medicare & Medicaid Services should release clear guidance around the use of AI by state Medicaid programs, and policymakers must work together to harness AI technologies in order to improve the efficiency and effectiveness of the Medicaid program.","PeriodicalId":502462,"journal":{"name":"Health Affairs Scholar","volume":"47 10","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140488273","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}
Child and infant mortality is a global problem. Almost half of deaths of children under age five occur in the neonatal period, the first 28 days of life, and 2.4 million neonatal deaths globally in 2020. Sub-Saharan Africa has disproportionately high numbers of neonatal deaths. Ghana’s neonatal mortality rate is 22.8 per 1,000 live births and remains behind targets set by the United Nations Sustainable Development Goals. Quality antenatal care, postnatal monitoring, breastfeeding support, and postnatal family planning are important in preventing neonatal deaths. While Ghana has made progress in making care more financially accessible, it has not been matched with the improvements in the critical infrastructure required to ensure quality healthcare. The improvements have alsonot eliminated out-of-pocket costs for care, which have hindered progress in decreasing infant mortality. Policymakers should consider investments in healthcare infrastructure, including expanding public-privatepartnerships. Policies that improve workforce development programs, transportation infrastructure, and health insurance systems improvements are needed.
{"title":"Infant Mortality in Ghana:Investing in Healthcare Infrastructure & Systems","authors":"Danielle Poulin, Gloria Nimo, Dorian Royal, Paule Valery Joseph, Tiffany Nimo, Tyra Nimo, Kofi Sarkodee, Sharon Attipoe-Dorcoo","doi":"10.1093/haschl/qxae005","DOIUrl":"https://doi.org/10.1093/haschl/qxae005","url":null,"abstract":"\u0000 Child and infant mortality is a global problem. Almost half of deaths of children under age five occur in the neonatal period, the first 28 days of life, and 2.4 million neonatal deaths globally in 2020. Sub-Saharan Africa has disproportionately high numbers of neonatal deaths. Ghana’s neonatal mortality rate is 22.8 per 1,000 live births and remains behind targets set by the United Nations Sustainable Development Goals. Quality antenatal care, postnatal monitoring, breastfeeding support, and postnatal family planning are important in preventing neonatal deaths. While Ghana has made progress in making care more financially accessible, it has not been matched with the improvements in the critical infrastructure required to ensure quality healthcare. The improvements have alsonot eliminated out-of-pocket costs for care, which have hindered progress in decreasing infant mortality. Policymakers should consider investments in healthcare infrastructure, including expanding public-privatepartnerships. Policies that improve workforce development programs, transportation infrastructure, and health insurance systems improvements are needed.","PeriodicalId":502462,"journal":{"name":"Health Affairs Scholar","volume":"68 33","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139600562","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}
{"title":"Effect of a case-capped, fee-for-service payment mechanism on accessibility and affordability of healthcare","authors":"Bernardo Cielo II, Melanie Santillan, V. de Claro","doi":"10.1093/haschl/qxae004","DOIUrl":"https://doi.org/10.1093/haschl/qxae004","url":null,"abstract":"","PeriodicalId":502462,"journal":{"name":"Health Affairs Scholar","volume":"33 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139608812","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}
Anita Charlesworth, Laurie Rachet-Jacquet, S. Rocks
A decade of low investment in the English National Health Service (NHS) resulted in strong headline productivity growth but undermined the health system's resilience and left it exposed during the COVID-19 pandemic. Projected demographic pressures, driven by the aging of the baby-boom generation and the rise in multi-morbidity levels in the population, will add pressures to already stretched health care resources. As the NHS faces the twin challenges of recovering services after the pandemic and meeting care needs from an aging population, our projections of demand for care indicate the NHS almost certainly needs significantly more beds as well as more staff. Productivity improvements in hospital care can reduce the amount of additional resources needed, but this will require significant concomitant investment in community-based health and long-term-care services.
{"title":"Short of capacity? Why the government must address the capacity constraints in the English National Health Service","authors":"Anita Charlesworth, Laurie Rachet-Jacquet, S. Rocks","doi":"10.1093/haschl/qxad091","DOIUrl":"https://doi.org/10.1093/haschl/qxad091","url":null,"abstract":"\u0000 A decade of low investment in the English National Health Service (NHS) resulted in strong headline productivity growth but undermined the health system's resilience and left it exposed during the COVID-19 pandemic. Projected demographic pressures, driven by the aging of the baby-boom generation and the rise in multi-morbidity levels in the population, will add pressures to already stretched health care resources. As the NHS faces the twin challenges of recovering services after the pandemic and meeting care needs from an aging population, our projections of demand for care indicate the NHS almost certainly needs significantly more beds as well as more staff. Productivity improvements in hospital care can reduce the amount of additional resources needed, but this will require significant concomitant investment in community-based health and long-term-care services.","PeriodicalId":502462,"journal":{"name":"Health Affairs Scholar","volume":"7 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140525633","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}
Monica D. Zuercher, Juliana F W Cohen, P. Ohri-Vachaspati, Christina A Hecht, Kenneth Hecht, Michele Polacsek, Deborah A. Olarte, Margaret Read, Anisha I Patel, Marlene B. Schwartz, Leah E Chapman, Dania Orta-Aleman, L. Ritchie, Wendi Gosliner
Parental perceptions of school meals can affect student participation and overall support for school meal policies. Little is known about parental school meal perceptions under universal free school meals (UFSM) policies. We assessed California parents' perceptions of school meals during the COVID-19 emergency response with federally funded UFSM and whether perceptions differed by race/ethnicity. Among 1110 California parents of K–12 students, most reported school meals benefit their families, saving them money (81.6%), time (79.2%), and stress (75.0%). Few reported that their child would be embarrassed to eat school meals (11.7%), but more parents of White students than Hispanic students reported this. Many parents reported that their child likes to eat lunch to be with friends (64.7%); about half felt their child has enough time to eat (54.2%). Fewer parents perceived school lunches to be of good quality (36.9%), tasty (39.6%), or healthy (44.0%). Parents of Hispanic and Asian students had less favorable perceptions of school meal quality, taste, and healthfulness than parents of White students. Parents report that school meals benefit their families, but policy efforts are needed to ensure schools have the resources needed to address cultural appropriateness. Schools should address parental perceptions of meals to optimize participation, nutrition security, and health.
{"title":"Parent perceptions of school meals and how perceptions differ by race and ethnicity","authors":"Monica D. Zuercher, Juliana F W Cohen, P. Ohri-Vachaspati, Christina A Hecht, Kenneth Hecht, Michele Polacsek, Deborah A. Olarte, Margaret Read, Anisha I Patel, Marlene B. Schwartz, Leah E Chapman, Dania Orta-Aleman, L. Ritchie, Wendi Gosliner","doi":"10.1093/haschl/qxad092","DOIUrl":"https://doi.org/10.1093/haschl/qxad092","url":null,"abstract":"\u0000 Parental perceptions of school meals can affect student participation and overall support for school meal policies. Little is known about parental school meal perceptions under universal free school meals (UFSM) policies. We assessed California parents' perceptions of school meals during the COVID-19 emergency response with federally funded UFSM and whether perceptions differed by race/ethnicity. Among 1110 California parents of K–12 students, most reported school meals benefit their families, saving them money (81.6%), time (79.2%), and stress (75.0%). Few reported that their child would be embarrassed to eat school meals (11.7%), but more parents of White students than Hispanic students reported this. Many parents reported that their child likes to eat lunch to be with friends (64.7%); about half felt their child has enough time to eat (54.2%). Fewer parents perceived school lunches to be of good quality (36.9%), tasty (39.6%), or healthy (44.0%). Parents of Hispanic and Asian students had less favorable perceptions of school meal quality, taste, and healthfulness than parents of White students. Parents report that school meals benefit their families, but policy efforts are needed to ensure schools have the resources needed to address cultural appropriateness. Schools should address parental perceptions of meals to optimize participation, nutrition security, and health.","PeriodicalId":502462,"journal":{"name":"Health Affairs Scholar","volume":"43 10","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139454855","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}
Xin Hu, Nuo Nova Nova Yang, Qinjin Fan, K. R. Yabroff, Xuesong Han
Having health insurance coverage is a strong determinant of cancer care access and survival in the United States. The expansion of Medicaid income eligibility under the Affordable Care Act has increased insurance coverage for working-age adults. Using data from the Cancer Incidence in North America (CiNA) in 2010–2019, we identified 6 432 117 incident cancer cases with known insurance status diagnosed at age 18–64 years from population-based registries of 49 states. Considerable variation in Medicaid coverage and uninsured rate exists across states, especially by Medicaid expansion status. Among expansion states, Medicaid coverage increased from 14.1% in 2010 to 19.9% in 2019, while the Medicaid coverage rate remained lower (range = 11.7% – 12.7%) in non-expansion states. The uninsured rate decreased from 4.9% to 2.1% in expansion states, while in non-expansion states, the uninsured rate decreased slightly from 9.5% to 8.1%. In 2019, 111 393 cancer cases (16.9%) had Medicaid coverage at diagnosis (range = 7.6%–37.9% across states), and 48 357 (4.4%) were uninsured (range = 0.5%–13.2%). These estimates suggest that many patients with cancer may face challenges with care access and continuity, especially following the unwinding of COVID-19 pandemic protections for Medicaid coverage. State cancer prevention and control efforts are needed to mitigate cancer care disparities among vulnerable populations.
{"title":"Health insurance coverage among incident cancer cases from population-based cancer registries in 49 US states, 2010–2019","authors":"Xin Hu, Nuo Nova Nova Yang, Qinjin Fan, K. R. Yabroff, Xuesong Han","doi":"10.1093/haschl/qxad083","DOIUrl":"https://doi.org/10.1093/haschl/qxad083","url":null,"abstract":"\u0000 Having health insurance coverage is a strong determinant of cancer care access and survival in the United States. The expansion of Medicaid income eligibility under the Affordable Care Act has increased insurance coverage for working-age adults. Using data from the Cancer Incidence in North America (CiNA) in 2010–2019, we identified 6 432 117 incident cancer cases with known insurance status diagnosed at age 18–64 years from population-based registries of 49 states. Considerable variation in Medicaid coverage and uninsured rate exists across states, especially by Medicaid expansion status. Among expansion states, Medicaid coverage increased from 14.1% in 2010 to 19.9% in 2019, while the Medicaid coverage rate remained lower (range = 11.7% – 12.7%) in non-expansion states. The uninsured rate decreased from 4.9% to 2.1% in expansion states, while in non-expansion states, the uninsured rate decreased slightly from 9.5% to 8.1%. In 2019, 111 393 cancer cases (16.9%) had Medicaid coverage at diagnosis (range = 7.6%–37.9% across states), and 48 357 (4.4%) were uninsured (range = 0.5%–13.2%). These estimates suggest that many patients with cancer may face challenges with care access and continuity, especially following the unwinding of COVID-19 pandemic protections for Medicaid coverage. State cancer prevention and control efforts are needed to mitigate cancer care disparities among vulnerable populations.","PeriodicalId":502462,"journal":{"name":"Health Affairs Scholar","volume":"28 39","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139631347","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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