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Remote Physiologic Monitoring Use Among Medicaid Population Increased, 2019-21. 2019-21 年,医疗补助人群中远程生理监测的使用有所增加。
IF 8.6 1区 医学 Q1 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-05-01 DOI: 10.1377/hlthaff.2023.00756
Nathan Pauly, Puja Nair, Jared Augenstein

Remote physiologic monitoring use increased more than 1,300 percent from 2019 to 2021, and use varied by state. This increase was driven by a small number of (predominantly internal medicine) providers. Female beneficiaries, residents of metropolitan areas, and people diagnosed with diabetes or hypertension had the highest rates of use.

从 2019 年到 2021 年,远程生理监测的使用率增长了 1,300% 以上,各州的使用情况各不相同。这一增长是由少数(主要是内科)医疗服务提供者推动的。女性受益人、大都市居民以及确诊为糖尿病或高血压患者的使用率最高。
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引用次数: 0
Licensure Policies May Help States Ensure Access To Opioid Use Disorder Medication In Specialty Addiction Treatment. 许可政策可帮助各州确保在专业戒毒治疗中获得阿片类药物使用障碍药物。
IF 8.6 1区 医学 Q1 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-05-01 DOI: 10.1377/hlthaff.2023.01306
Alene Kennedy-Hendricks, Minna Song, Alexander D McCourt, Joshua M Sharfstein, Matthew D Eisenberg, Brendan Saloner

Despite the devastating toll of the overdose crisis in the United States, many addiction treatment programs do not offer medications for opioid use disorder (MOUD). Several states have incorporated MOUD requirements into their standards for treatment program licensure. This study examined policy officials' and treatment providers' perspectives on the implementation of these policies. During 2020-22, we conducted thirty-one semistructured interviews with forty policy officials and treatment providers in nine states identified through a legal analysis. Of these states, three states required treatment organizations to offer MOUD, and two prohibited organizations from denying admission to people receiving MOUD. Qualitative findings revealed that licensure policies were part of a broader effort to transition the specialty treatment system to a model of care more consistent with medical evidence; states perceived tension between raising quality standards and maintaining adequate treatment capacity; aligning other state policies with MOUD access goals facilitated implementation of the licensure requirement; and measuring compliance was challenging. Licensure may offer states an opportunity to take a more active role in ensuring access to effective treatment.

尽管过量用药危机在美国造成了巨大的破坏,但许多戒毒计划并不提供治疗阿片类药物使用障碍 (MOUD) 的药物。一些州已将 MOUD 要求纳入其治疗项目许可标准。本研究考察了政策官员和治疗机构对这些政策实施情况的看法。2020-22 年期间,我们对通过法律分析确定的九个州的四十名政策官员和治疗机构进行了三十一次半结构式访谈。在这些州中,有三个州要求治疗机构提供 "谅解备忘录",有两个州禁止治疗机构拒绝接受 "谅解备忘录 "的患者。定性研究结果显示,许可政策是专科治疗系统向更符合医学证据的治疗模式转型的更广泛努力的一部分;各州认为在提高质量标准和保持足够的治疗能力之间存在矛盾;将其他州的政策与获得 MOUD 的目标结合起来有利于实施许可要求;衡量合规性具有挑战性。许可证制度为各州提供了一个机会,在确保获得有效治疗方面发挥更积极的作用。
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引用次数: 0
Extended Paid Maternity Leave Associated With Improved Maternal Mental Health In Hong Kong. 在香港,延长带薪产假与改善产妇心理健康有关。
IF 8.6 1区 医学 Q1 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-05-01 DOI: 10.1377/hlthaff.2023.00742
Ellie Bostwick Andres, Xinyu Du, Sharon Sze Lu Pang, Jiayi Noel Liang, Jiaxi Ye, Ming Hin Lee, Marie Tarrant, Sofie Shuk-Fei Yung, Janice M Johnston, Kris Yuet Wan Lok, Jianchao Quan

In July 2020, Hong Kong extended statutory paid maternity leave from ten weeks to fourteen weeks to align with International Labour Organization standards. We used the policy enactment as an observational natural experiment to assess the mental health implications of this policy change on probable postnatal depression (Edinburgh Postnatal Depression Scores of 10 or higher) and postpartum emotional well-being. Using an opportunistic observational study design, we recruited 1,414 survey respondents with births before (August 1-December 10, 2020) and after (December 11, 2020-July 18, 2022) policy implementation. Participants had a mean age of thirty-two, were majority primiparous, and were mostly working in skilled occupations. Our results show that the policy was associated with a 22 percent decrease in mothers experiencing postnatal depressive symptoms and a 33 percent decrease in postpartum emotional well-being interference. Even this modest change in policy, an additional four weeks of paid leave, was associated with significant mental health benefits. Policy makers should consider extending paid maternity leave to international norms to improve mental health among working mothers and to support workforce retention.

2020 年 7 月,香港将法定带薪产假从十周延长至十四周,以与国际劳工组织的标准接轨。我们将这一政策的颁布作为一个观察性自然实验,以评估这一政策变化对可能出现的产后抑郁(爱丁堡产后抑郁评分 10 分或以上)和产后情绪健康的影响。我们采用机会观察研究设计,在政策实施前(2020 年 8 月 1 日至 12 月 10 日)和政策实施后(2020 年 12 月 11 日至 2022 年 7 月 18 日)招募了 1414 名分娩的调查对象。调查对象的平均年龄为 32 岁,大多数为初产妇,大多从事技术性职业。我们的研究结果表明,政策实施后,母亲产后抑郁症状减少了 22%,产后情绪健康干扰减少了 33%。即使是这一微小的政策变化,即增加四周的带薪休假,也能带来显著的心理健康益处。政策制定者应考虑将带薪产假延长至国际标准,以改善职业母亲的心理健康并支持劳动力保留。
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引用次数: 0
Protecting Patients And Society In An Era Of Private Equity Provider Ownership: Challenges And Opportunities For Policy. 在私募股权供应商所有权时代保护患者和社会:政策的挑战与机遇。
IF 8.6 1区 医学 Q1 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-05-01 DOI: 10.1377/hlthaff.2023.00942
Christopher Cai, Zirui Song

Private equity (PE) acquisitions in health care delivery nearly tripled from 2010 to 2020. Despite concerns around clinical and economic implications, policy responses have remained limited. We discuss the US policy landscape around PE ownership, using policies in the European Union for comparison. We present four domains in which policy can be strengthened. First, to improve oversight of acquisitions, policy makers should lower reporting thresholds, review sequential acquisitions that together affect market power, automate reviews with potential denials based on market concentration effects, consider new regulatory mechanisms such as attorney general veto, and increase funding for this work. Second, policy makers should increase the longer-run transparency of PE ownership, including the health care prices garnered by acquired entities. Third, policy makers should protect patients and providers by establishing minimum staffing ratios, spending floors for direct patient care, and limits on layoffs and the sale of real estate after acquisition (forms of "asset stripping"). Finally, policy makers should mitigate risky financial behavior by limiting the amount or proportion of debt used to finance PE acquisitions in health care.

从 2010 年到 2020 年,私募股权(PE)在医疗服务领域的收购几乎增加了两倍。尽管对临床和经济影响存在担忧,但政策反应仍然有限。我们以欧盟的政策为对比,讨论了美国围绕私募股权所有权的政策环境。我们提出了可加强政策的四个领域。首先,为加强对收购的监督,政策制定者应降低申报门槛,审查会共同影响市场力量的连续收购,根据市场集中效应自动审查可能的拒绝,考虑新的监管机制(如总检察长否决权),并增加对这项工作的资金投入。其次,政策制定者应提高 PE 所有权的长期透明度,包括被收购实体获得的医疗价格。第三,政策制定者应保护患者和医疗服务提供者的利益,规定最低人员配备比例、患者直接护理支出下限、收购后裁员和出售不动产的限制("资产剥离 "的形式)。最后,政策制定者应限制医疗行业 PE 并购所使用的债务金额或比例,从而减少高风险的财务行为。
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引用次数: 0
Does Assisted Living Provide Assistance And Promote Living? 生活辅助设施是否能提供帮助并促进生活?
IF 8.6 1区 医学 Q1 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-05-01 DOI: 10.1377/hlthaff.2023.00972
Sheryl Zimmerman, Robyn Stone, Paula Carder, Kali Thomas

Assisted living has promised assistance and quality of living to older adults for more than eighty years. It is the largest residential provider of long-term care in the United States, serving more than 918,000 older adults as of 2018. As assisted living has evolved, the needs of residents have become more challenging; staffing shortages have worsened; regulations have become complex; the need for consumer support, education, and advocacy has grown; and financing and accessibility have become insufficient. Together, these factors have limited the extent to which today's assisted living adequately provides assistance and promotes living, with negative consequences for aging in place and well-being. This Commentary provides recommendations in four areas to help assisted living meet its promise: workforce; regulations and government; consumer needs and roles; and financing and accessibility. Policies that may be helpful include those that would increase staffing and boost wages and training; establish staffing standards with appropriate skill mix; promulgate state regulations that enable greater use of third-party services; encourage uniform data reporting; provide funds supporting family involvement; make community disclosure statements more accessible; and offer owners and operators incentives to facilitate access for consumers with fewer resources. Attention to these and other recommendations may help assisted living live up to its name.

八十多年来,辅助生活服务一直承诺为老年人提供帮助和高质量的生活。它是美国最大的长期护理住宅提供商,截至 2018 年,共为 91.8 万多名老年人提供服务。随着协助式生活的发展,居民的需求变得更具挑战性;人员短缺问题更加严重;法规变得更加复杂;对消费者支持、教育和宣传的需求不断增长;融资和可及性变得不足。这些因素加在一起,限制了今天的生活辅助设施充分提供援助和促进生活的程度,对居家养老和福祉造成了负面影响。本评论从四个方面提出建议,以帮助辅助生活服务实现其承诺:劳动力;法规与政府;消费者需求与角色;融资与无障碍环境。可能有帮助的政策包括:增加人员配备、提高工资和培训;制定具有适当技能组合的人员配备标准;颁布允许更多地使用第三方服务的州法规;鼓励统一的数据报告;提供支持家庭参与的资金;使社区信息披露声明更易于获取;为业主和经营者提供激励措施,以方便资源较少的消费者获得服务。关注这些建议和其他建议可帮助辅助生活名副其实。
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引用次数: 0
Physician Group Practices Accrued Large Bonuses Under Medicare's Bundled Payment Model, 2018-20. 在 2018-20 年医疗保险捆绑支付模式下,医生团体诊所获得了巨额奖金。
IF 8.6 1区 医学 Q1 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-05-01 DOI: 10.1377/hlthaff.2023.00915
Sukruth A Shashikumar, Zoey Chopra, Jason D Buxbaum, Karen E Joynt Maddox, Andrew M Ryan

The Bundled Payments for Care Improvement Advanced Model (BPCI-A), a voluntary Alternative Payment Model for Medicare, incentivizes hospitals and physician group practices to reduce spending for patient care episodes below preset target prices. The experience of physician groups in BPCI-A is not well understood. We found that physician groups earned $421 million in incentive payments during BPCI-A's first four performance periods (2018-20). Target prices were positively associated with bonuses, with a mean reconciliation payment of $139 per episode in the lowest decile of target prices and $2,775 in the highest decile. In the first year of the COVID-19 pandemic, mean bonuses increased from $815 per episode to $2,736 per episode. These findings suggest that further policy changes, such as improving target price accuracy and refining participation rules, will be important as the Centers for Medicare and Medicaid Services continues to expand BPCI-A and develop other bundled payment models.

医疗改善捆绑支付高级模式(BPCI-A)是医疗保险的一种自愿性替代支付模式,它激励医院和医生团体减少低于预设目标价格的患者护理事件支出。医生团体在 BPCI-A 中的经验尚不十分清楚。我们发现,在 BPCI-A 的前四个绩效期(2018-20 年),医生团体获得了 4.21 亿美元的奖励金。目标价格与奖金呈正相关,目标价格最低十分位数的每集平均调节付款为 139 美元,最高十分位数为 2775 美元。在 COVID-19 大流行的第一年,平均奖金从每集 815 美元增至每集 2736 美元。这些研究结果表明,随着医疗保险和医疗补助服务中心继续扩大 BPCI-A 并开发其他捆绑式支付模式,进一步的政策变化(如提高目标价格的准确性和完善参与规则)将非常重要。
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引用次数: 0
COVID-19 Vaccines: Moderna And Pfizer-BioNTech Use Varied By Urban, Rural Counties. COVID-19 疫苗:Moderna 和 Pfizer-BioNTech 在城市和农村地区的使用情况各不相同。
IF 8.6 1区 医学 Q1 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-05-01 DOI: 10.1377/hlthaff.2023.00813
Katherine Wen, Daniel A Harris, Preeti Chachlani, Kaleen N Hayes, Ellen McCarthy, Andrew R Zullo, Renae L Smith-Ray, Tanya Singh, Djeneba Audrey Djibo, Cheryl N McMahill-Walraven, Jeffrey Hiris, Rena M Conti, Jonathan Gruber, Vincent Mor

We investigated county-level variation in mRNA COVID-19 vaccine use among Medicare beneficiaries throughout the United States. There was greater use of Pfizer-BioNTech vaccines than Moderna vaccines in urban areas for first and booster doses.

我们调查了全美医疗保险受益人使用 mRNA COVID-19 疫苗的县级差异。在城市地区,辉瑞生物技术公司的疫苗比 Moderna 疫苗的首剂和加强剂量使用率更高。
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引用次数: 0
California's COVID-19 Vaccine Equity Policy: Cases, Hospitalizations, And Deaths Averted In Affected Communities. 加州 COVID-19 疫苗公平政策:受影响社区避免的病例、住院和死亡。
IF 8.6 1区 医学 Q1 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-05-01 DOI: 10.1377/hlthaff.2023.01163
Christopher M Hoover, Emily Estus, Ada Kwan, Kristal Raymond, Tanu Sreedharan, Tomás León, Seema Jain, Priya B Shete

In March 2021, California implemented a vaccine equity policy that prioritized COVID-19 vaccine allocation to communities identified as least advantaged by an area-based socioeconomic measure, the Healthy Places Index. We conducted quasi-experimental and counterfactual analyses to estimate the effect of this policy on COVID-19 vaccination, case, hospitalization, and death rates. Among prioritized communities, vaccination rates increased 28.4 percent after policy implementation. Furthermore, an estimated 160,892 COVID-19 cases, 10,248 hospitalizations, and 679 deaths in the least-advantaged communities were averted by the policy. Despite these improvements, the share of COVID-19 cases, hospitalizations, and deaths in prioritized communities remained elevated. These estimates were robust in sensitivity analyses that tested exchangeability between prioritized communities and those not prioritized by the policy; model specifications; and potential temporal confounders, including prior infections. Correcting for disparities by strategically allocating limited resources to the least-advantaged or most-affected communities can reduce the impacts of COVID-19 and other diseases but might not eliminate health disparities.

2021 年 3 月,加利福尼亚州实施了一项疫苗公平政策,将 COVID-19 疫苗优先分配给以地区为基础的社会经济衡量标准--"健康场所指数"(Healthy Places Index)确定为最不利的社区。我们进行了准实验分析和反事实分析,以估计该政策对 COVID-19 疫苗接种率、病例率、住院率和死亡率的影响。在优先社区中,政策实施后疫苗接种率提高了 28.4%。此外,在条件最差的社区,该政策估计避免了 160,892 例 COVID-19 病例、10,248 例住院治疗和 679 例死亡。尽管取得了这些进展,但优先社区的 COVID-19 病例、住院人数和死亡人数所占比例仍然较高。这些估计值在敏感性分析中是可靠的,这些分析测试了优先社区与未被政策优先考虑的社区之间的可交换性、模型规格以及潜在的时间混杂因素,包括先前的感染。通过将有限的资源战略性地分配给处境最不利或受影响最严重的社区来纠正差异,可以减少 COVID-19 和其他疾病的影响,但可能无法消除健康差异。
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引用次数: 0
'Just Get A Hysterectomy'. 切除子宫吧
IF 8.6 1区 医学 Q1 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-05-01 DOI: 10.1377/hlthaff.2023.01433
Joyvina Evans

An African American woman with uterine fibroids is advised to get a hysterectomy, despite the availability of less life-altering options.

一名患有子宫肌瘤的非裔美国妇女被建议切除子宫,尽管有一些对生命影响较小的选择。
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引用次数: 0
Benefit Design And Biosimilar Coverage In Medicare Part D: Evidence And Implications From Recent Reforms. 医疗保险 D 部分的福利设计和生物仿制药覆盖范围:近期改革的证据和影响》。
IF 8.6 1区 医学 Q1 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-05-01 DOI: 10.1377/hlthaff.2023.01297
Luca Bertuzzi, Luca Maini

There is substantial disparity between Medicare Part D and employer-sponsored health insurance plans in the coverage of biosimilars and their reference biologics. These disparities may be due to design elements of Part D plans that encourage the adoption of more expensive biologic drugs. We undertook several analyses to illustrate the dynamics of benefit design incentives over time, compare formulary coverage in Part D plans with that of employer-sponsored plans, and study how the Bipartisan Budget Act of 2018 affected Part D formulary coverage. Using these analyses of Part D reforms enacted through the Bipartisan Budget Act, we discuss the implications of elements of the Inflation Reduction Act of 2022 that will be implemented in 2025. Biosimilar coverage increased by 23 percentage points five quarters after the Bipartisan Budget Act was implemented. We predict that the Inflation Reduction Act will also have a positive effect on biosimilar coverage. Given ample evidence of a relationship between drug coverage and utilization, our results suggest that Medicare patients and the federal government could realize substantial savings if Part D formularies resembled those of employer-sponsored plans.

医疗保险 D 部分和雇主赞助的医疗保险计划在生物仿制药及其参照生物制剂的承保范围方面存在巨大差异。造成这些差异的原因可能是 D 部分计划的设计因素鼓励采用更昂贵的生物制剂药物。我们进行了多项分析,以说明福利设计激励因素随时间推移而产生的动态变化,比较 D 部分计划与雇主赞助计划的处方集覆盖范围,并研究 2018 年《两党预算法案》对 D 部分处方集覆盖范围的影响。利用这些对通过《两党预算法案》颁布的 D 部分改革的分析,我们讨论了将于 2025 年实施的《2022 年通货膨胀削减法案》内容的影响。在《两党预算法案》实施五个季度后,生物仿制药的覆盖率增加了 23 个百分点。我们预测,《通货膨胀削减法》也将对生物仿制药的覆盖率产生积极影响。鉴于有大量证据表明药品覆盖率和使用率之间存在关系,我们的研究结果表明,如果 D 部分的药品目录与雇主赞助计划的药品目录相似,那么医疗保险患者和联邦政府就可以节省大量资金。
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引用次数: 0
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