JAMA Health Forum最新文献

Importance: Adult dental coverage under Medicaid varies widely across states and delivery systems. Most adult beneficiaries are now enrolled in managed care, yet little is known about how these benefits are structured and implemented within Medicaid managed care organizations (MCOs).

Objective: To examine trends in the generosity, delivery models, and enrollment patterns of adult dental benefits delivered through Medicaid MCOs and assess coverage alignment with Medicaid fee-for-service (FFS) coverage.

Design, setting, and participants: This cross-sectional analysis included adult Medicaid beneficiaries aged 19 years or older who had state Medicaid MCO or FFS coverage across all 50 states and Washington, DC. This analysis used a novel linked national dataset combining multiple Centers for Medicare & Medicaid Services administrative sources from 2016 to 2022. The analysis was conducted from April 8, 2025, to October 8, 2025.

Exposures: State-level Medicaid MCO or FFS program with adult comprehensive dental coverage, emergency-only dental coverage, or no dental coverage.

Main outcomes and measures: The generosity of dental benefits; the degree of alignment in benefit generosity between Medicaid MCO and Medicaid FFS programs; and enrollment of adults in dental MCO or FFS programs by benefit (coverage) type.

Results: The number of states offering comprehensive adult dental benefits through Medicaid MCOs increased from 33 (64.7%) in 2016 to 36 (70.6%) in 2022. Carve-out models, typically using stand-alone prepaid health plans for dental coverage, increased from 4 states (7.8%) in 2016 to 8 states (15.7%) in 2022. In 2016, 51.0% of states had mismatched benefit levels between MCO and FFS programs compared with 35.3% in 2022. The number of MCO enrollees with comprehensive dental coverage increased from 14.2 million (58.7%) in 2016 to 25.3 million (59.8%) in 2022, reflecting substantial managed care penetration.

Conclusions and relevance: This study found that although the generosity and scope of MCO dental benefits expanded over time, alignment with FFS programs remained inconsistent. As new legislation cuts federal funding to states, understanding how dental benefits are designed and delivered is critical to inform future coverage decisions and ensure equitable access.

Importance: Physician emigration from low- and middle-income countries to high-income countries is a major driver of inequitable distribution of health care and health outcomes across the world. World Health Organization (WHO) signatory countries unanimously signed the voluntary Global Code of Practice on the International Recruitment of Health Personnel (WHO Code) in 2010. The goal was to reduce health care workforce emigration by discouraging active recruitment of physicians from WHO-designated shortage countries and by promoting investment in the physician workforce in those countries. This study adds to the literature by providing evidence about whether the goal has been achieved 10 years after worldwide implementation of the WHO Code.

Objective: To evaluate whether the WHO Code was associated with changes in physician emigration and physician density in WHO-designated shortage countries after 2010.

Design, setting, and participants: A difference-in-differences design was used to examine trends in physician supply before and after 2010. The data (from 2000 through 2021) were collected by the Organization for Economic Co-operation and Development (OECD) and were used to examine physician outflow from 56 WHO-designated shortage countries vs 116 nonshortage countries. The data analysis took place October 2024 to September 2025.

Exposures: Worldwide adoption of the 2010 WHO Code.

Main outcomes and measures: The primary outcome was annual physician migration to OECD countries and the secondary outcome was physician density by country and year (per 1000 population using World Bank data) in the origin countries.

Results: A total of 135 888 physicians emigrated from WHO-designated shortage countries during 2000 to 2021 and 516 030 physicians emigrated from nonshortage countries. Compared with nonshortage countries, there was a decrease in physician outflow by 47.03 physicians (95% CI, -92.29 to -1.76 physicians) per country per year after 2010 in WHO-designated shortage countries and the WHO Code was associated with a reduction of nearly 30% in the average annual outflow of physicians from these countries. However, there was a slight decrease in physician density in the WHO-designated shortage countries after 2010 (-0.22 [95% CI, -0.33 to -0.11] physicians per 1000 population) compared with the nonshortage countries.

Conclusions and relevance: This study found that voluntary implementation of the WHO Code was associated with lower physician outflow from WHO-designated shortage countries without improvement in physician density in those countries.

Importance: Poor nutrition remains the leading modifiable risk factor for cardiovascular disease and its major risk actors, contributing to substantial morbidity, early disability, mortality, economic burdens, and health disparities in the US. Food is Medicine (FIM) is a growing movement that integrates food-based nutrition interventions into health care delivery to prevent, manage, and treat diet-related chronic diseases. Early research has indicated that FIM interventions including produce prescriptions, medically tailored groceries, and medically tailored meal are promising as cost-effective approaches to improve cardiovascular disease and associated health outcomes. Delivered in coordination with health care systems, FIM interventions are increasingly supported by federal and state legislative efforts, the latter via Medicaid Section 1115 waivers and in lieu of service pathways, as well as some private payers.

Observations: Although coverage and policy pathways for FIM remain fragmented, cardiovascular specialists and other clinicians have an opportunity to play pivotal roles in operationalizing FIM in health systems through systematic screening for nutrition insecurity, risk stratification, closed-loop referral workflows, quality improvement through outcome measurement and monitoring, and patient education, as supported by electronic health record integration and multidisciplinary teams. Implementation science can assist clinicians in optimizing FIM delivery and scalability by standardizing eligibility criteria, intervention dose, duration of benefits, culturally tailored patient education, and clinician awareness. Clinician-initiated research, policy engagement, and health system leadership will also help to advance FIM, especially as a foundational component of value-based care delivery and health equity.

Conclusions and relevance: FIM policies and clinical integration potentially offer an opportunity to address the root causes of cardiometabolic disease, better manage health care costs, and promote health equity. Continued research, policy reform, and clinician engagement are needed to realize the full potential of FIM in 21st century medical practice.