Pub Date : 2025-12-05DOI: 10.1001/jamahealthforum.2025.5635
Anita A Vashi, Tracy Urech, Siqi Wu, Steven Asch
{"title":"Fragmented Financing in Emergency Department Use Among US Veterans.","authors":"Anita A Vashi, Tracy Urech, Siqi Wu, Steven Asch","doi":"10.1001/jamahealthforum.2025.5635","DOIUrl":"10.1001/jamahealthforum.2025.5635","url":null,"abstract":"","PeriodicalId":53180,"journal":{"name":"JAMA Health Forum","volume":"6 12","pages":"e255635"},"PeriodicalIF":11.3,"publicationDate":"2025-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12701505/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145745717","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
<p><strong>Importance: </strong>Population aging and rising cancer burden in low- and middle-income countries have intensified reliance on family caregivers, yet evidence on socioeconomic disparities in caregiving burden remains scarce.</p><p><strong>Objective: </strong>To quantify multidimensional caregiving burden, psychological distress, and economic burden, as well as identify risk factors, with a focus on the impact of socioeconomic disparities among family caregivers of older patients with cancer in China.</p><p><strong>Design, setting, and participants: </strong>This multicenter cross-sectional study recruited 6786 patient-caregiver dyads from 22 hospitals across 14 Chinese provinces between August 2022 and August 2023. Patients were 60 years or older with cancer; caregivers were family members or cohabiting partners 18 years or older who provided 50% or more daily care for 30 or more days. Data collection included sociodemographics, health assessments, caregiving details, expenditures, and clinical records.</p><p><strong>Exposures: </strong>Socioeconomic status (SES), categorized into 4 levels based on education and household income.</p><p><strong>Main outcomes and measures: </strong>Caregiving burden (measured by the Caregiver Reaction Assessment across 5 domains), psychological distress (measured by the Patient Health Questionnaire 9 and Generalized Anxiety Disorder 7 scales), and economic burden (direct caregiving expenditure and income loss).</p><p><strong>Results: </strong>Of the 6786 patient-caregiver dyads enrolled, the mean (SD) age of patients was 69.2 (6.1) years and 4128 (60.8%) were male, while the mean (SD) age of family caregivers was 53.8 (12.6) years and 3040 (44.8%) were male. Caregivers reported the following mean (SD) scores on a 5-point scale of Caregiver Reaction Assessment: health burden, 2.02 (0.69); scheduling burden, 2.64 (0.72); financial pressure, 3.03 (0.74); lack of family support, 2.09 (0.56); and self-esteem, 2.39 (0.42). Lower SES was independently associated with elevated burden across domains of health problems (β coefficient, -0.07; 95% CI, -0.10 to -0.04; P < .001), self-esteem (β coefficient, -0.15; -0.18 to -0.12; P < .001), disrupted schedule (β coefficient, -0.07; 95% CI, -0.11 to -0.03; P < .001), financial pressure (β coefficient, -0.14; 95% CI, -0.17 to -0.11; P < .001), and lack of family support (β coefficient, -0.14; 95% CI, -0.17 to -0.11; P < .001). Caregivers with health problems, insufficient sleep, longer care periods, lack of cocaregivers, limited nursing skills, and being employed experienced higher burden. Caregivers with the lowest level of SES faced elevated risks of anxiety (odds ratio, 1.37; 95% CI, 1.15-1.62) and depression (odds ratio, 1.71; 95% CI, 1.41-2.05) compared to caregivers with the highest level of SES. Subgroup analyses revealed that spouses reported higher health and financial burden, while higher-educated adult child caregivers were at greater risks for psychological
{"title":"Socioeconomic Disparities in Caregiver Burden Among Families of Older Patients With Cancer.","authors":"Wen Ju, Hao Jiang, Shanrui Ma, Bingfeng Han, Siwei Zhang, Minghua Cong, Wenqiang Wei","doi":"10.1001/jamahealthforum.2025.5614","DOIUrl":"10.1001/jamahealthforum.2025.5614","url":null,"abstract":"<p><strong>Importance: </strong>Population aging and rising cancer burden in low- and middle-income countries have intensified reliance on family caregivers, yet evidence on socioeconomic disparities in caregiving burden remains scarce.</p><p><strong>Objective: </strong>To quantify multidimensional caregiving burden, psychological distress, and economic burden, as well as identify risk factors, with a focus on the impact of socioeconomic disparities among family caregivers of older patients with cancer in China.</p><p><strong>Design, setting, and participants: </strong>This multicenter cross-sectional study recruited 6786 patient-caregiver dyads from 22 hospitals across 14 Chinese provinces between August 2022 and August 2023. Patients were 60 years or older with cancer; caregivers were family members or cohabiting partners 18 years or older who provided 50% or more daily care for 30 or more days. Data collection included sociodemographics, health assessments, caregiving details, expenditures, and clinical records.</p><p><strong>Exposures: </strong>Socioeconomic status (SES), categorized into 4 levels based on education and household income.</p><p><strong>Main outcomes and measures: </strong>Caregiving burden (measured by the Caregiver Reaction Assessment across 5 domains), psychological distress (measured by the Patient Health Questionnaire 9 and Generalized Anxiety Disorder 7 scales), and economic burden (direct caregiving expenditure and income loss).</p><p><strong>Results: </strong>Of the 6786 patient-caregiver dyads enrolled, the mean (SD) age of patients was 69.2 (6.1) years and 4128 (60.8%) were male, while the mean (SD) age of family caregivers was 53.8 (12.6) years and 3040 (44.8%) were male. Caregivers reported the following mean (SD) scores on a 5-point scale of Caregiver Reaction Assessment: health burden, 2.02 (0.69); scheduling burden, 2.64 (0.72); financial pressure, 3.03 (0.74); lack of family support, 2.09 (0.56); and self-esteem, 2.39 (0.42). Lower SES was independently associated with elevated burden across domains of health problems (β coefficient, -0.07; 95% CI, -0.10 to -0.04; P < .001), self-esteem (β coefficient, -0.15; -0.18 to -0.12; P < .001), disrupted schedule (β coefficient, -0.07; 95% CI, -0.11 to -0.03; P < .001), financial pressure (β coefficient, -0.14; 95% CI, -0.17 to -0.11; P < .001), and lack of family support (β coefficient, -0.14; 95% CI, -0.17 to -0.11; P < .001). Caregivers with health problems, insufficient sleep, longer care periods, lack of cocaregivers, limited nursing skills, and being employed experienced higher burden. Caregivers with the lowest level of SES faced elevated risks of anxiety (odds ratio, 1.37; 95% CI, 1.15-1.62) and depression (odds ratio, 1.71; 95% CI, 1.41-2.05) compared to caregivers with the highest level of SES. Subgroup analyses revealed that spouses reported higher health and financial burden, while higher-educated adult child caregivers were at greater risks for psychological","PeriodicalId":53180,"journal":{"name":"JAMA Health Forum","volume":"6 12","pages":"e255614"},"PeriodicalIF":11.3,"publicationDate":"2025-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12743282/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146115044","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-05DOI: 10.1001/jamahealthforum.2025.5470
Daniel J Morgan, Deborah Korenstein
{"title":"Public Health for the Post-COVID-19 Public.","authors":"Daniel J Morgan, Deborah Korenstein","doi":"10.1001/jamahealthforum.2025.5470","DOIUrl":"https://doi.org/10.1001/jamahealthforum.2025.5470","url":null,"abstract":"","PeriodicalId":53180,"journal":{"name":"JAMA Health Forum","volume":"6 12","pages":"e255470"},"PeriodicalIF":11.3,"publicationDate":"2025-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145679425","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}
Pub Date : 2025-12-05DOI: 10.1001/jamahealthforum.2025.5334
Sunita M Desai, Prianca Padmanabhan, Sherry Glied, Eric T Roberts
<p><strong>Importance: </strong>Despite increasing consolidation in the US hospital market, little is known about how these mergers influence labor and delivery admissions and obstetric outcomes for patients with Medicaid.</p><p><strong>Objective: </strong>To assess whether hospital mergers are associated with changes in patient flows to hospitals and care quality for pregnant Medicaid enrollees.</p><p><strong>Design, setting, and participants: </strong>This cross-sectional study used a stacked difference-in-differences design to examine mergers occurring between 2004 and 2011. Changes in outcomes were examined in the 3 years before vs 3 years after a merger. Estimates were compared by urban vs rural settings and for Medicaid patients relative to privately insured patients. Labor and delivery admissions in 9 US states accounted for approximately 25% of all Medicaid-covered births nationwide during the study period. Medicaid-enrolled patients admitted for labor and delivery residing in counties that experienced a single hospital merger (intervention) or matched comparison counties without a merger during the same period were included. The analysis took place between December 2023 and April 2025.</p><p><strong>Exposure: </strong>Residing in a county that experienced a hospital merger.</p><p><strong>Outcomes: </strong>Outcomes included patient travel distance for delivery, admissions to safety net hospitals, and admissions to hospitals with a neonatal intensive care unit (NICU), indicating advanced obstetric capabilities. Obstetric quality outcomes included obstetric trauma for instrument-assisted and non-instrument-assisted admissions and in-hospital mortality.</p><p><strong>Results: </strong>The analysis included 527 499 Medicaid labor and delivery admissions across 30 merger and 28 nonmerger counties. The mean (SD) age across Medicaid labor and delivery admissions was 25.8 (5.9) years, and all were female individuals. In addition, 15.4% were Black, 19.9% were Hispanic, and 20.5% were White individuals. County-level exposure to a merger was associated with an adjusted 0.5-mile (95% CI, 0.1-1.0) increase in travel distance (an 8% increase from the 6.3-mile premerger baseline), a 9.2-percentage point (95% CI, 2.3-16.1) increase in admissions to safety net hospitals, and a 7.9-percentage point (95% CI, -11.2 to -4.6) decrease in admissions to NICU-equipped hospitals. One obstetric trauma measure (among non-instrument-assisted deliveries) increased slightly (0.4 percentage points; 95% CI, 0.2-0.6), whereas in-hospital mortality was unchanged. Urban counties experienced a decrease in admissions to NICU-equipped hospitals, whereas rural counties experienced increases. Compared with privately insured patients, Medicaid enrollees had larger increases in travel distance (0.6; 95% CI, 0.0-1.1) and safety net admissions (6.8; 95% CI, 1-12.6), but similar changes in NICU-equipped hospital admissions (-0.1; 95% CI, -2.4 to 2.3).</p><p><strong>Conclusions and r
{"title":"Hospital Mergers, Hospital Choice, and Care Quality for Pregnant Enrollees in Medicaid.","authors":"Sunita M Desai, Prianca Padmanabhan, Sherry Glied, Eric T Roberts","doi":"10.1001/jamahealthforum.2025.5334","DOIUrl":"10.1001/jamahealthforum.2025.5334","url":null,"abstract":"<p><strong>Importance: </strong>Despite increasing consolidation in the US hospital market, little is known about how these mergers influence labor and delivery admissions and obstetric outcomes for patients with Medicaid.</p><p><strong>Objective: </strong>To assess whether hospital mergers are associated with changes in patient flows to hospitals and care quality for pregnant Medicaid enrollees.</p><p><strong>Design, setting, and participants: </strong>This cross-sectional study used a stacked difference-in-differences design to examine mergers occurring between 2004 and 2011. Changes in outcomes were examined in the 3 years before vs 3 years after a merger. Estimates were compared by urban vs rural settings and for Medicaid patients relative to privately insured patients. Labor and delivery admissions in 9 US states accounted for approximately 25% of all Medicaid-covered births nationwide during the study period. Medicaid-enrolled patients admitted for labor and delivery residing in counties that experienced a single hospital merger (intervention) or matched comparison counties without a merger during the same period were included. The analysis took place between December 2023 and April 2025.</p><p><strong>Exposure: </strong>Residing in a county that experienced a hospital merger.</p><p><strong>Outcomes: </strong>Outcomes included patient travel distance for delivery, admissions to safety net hospitals, and admissions to hospitals with a neonatal intensive care unit (NICU), indicating advanced obstetric capabilities. Obstetric quality outcomes included obstetric trauma for instrument-assisted and non-instrument-assisted admissions and in-hospital mortality.</p><p><strong>Results: </strong>The analysis included 527 499 Medicaid labor and delivery admissions across 30 merger and 28 nonmerger counties. The mean (SD) age across Medicaid labor and delivery admissions was 25.8 (5.9) years, and all were female individuals. In addition, 15.4% were Black, 19.9% were Hispanic, and 20.5% were White individuals. County-level exposure to a merger was associated with an adjusted 0.5-mile (95% CI, 0.1-1.0) increase in travel distance (an 8% increase from the 6.3-mile premerger baseline), a 9.2-percentage point (95% CI, 2.3-16.1) increase in admissions to safety net hospitals, and a 7.9-percentage point (95% CI, -11.2 to -4.6) decrease in admissions to NICU-equipped hospitals. One obstetric trauma measure (among non-instrument-assisted deliveries) increased slightly (0.4 percentage points; 95% CI, 0.2-0.6), whereas in-hospital mortality was unchanged. Urban counties experienced a decrease in admissions to NICU-equipped hospitals, whereas rural counties experienced increases. Compared with privately insured patients, Medicaid enrollees had larger increases in travel distance (0.6; 95% CI, 0.0-1.1) and safety net admissions (6.8; 95% CI, 1-12.6), but similar changes in NICU-equipped hospital admissions (-0.1; 95% CI, -2.4 to 2.3).</p><p><strong>Conclusions and r","PeriodicalId":53180,"journal":{"name":"JAMA Health Forum","volume":"6 12","pages":"e255334"},"PeriodicalIF":11.3,"publicationDate":"2025-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12681039/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145679396","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-05DOI: 10.1001/jamahealthforum.2025.5620
Hridika Shah, Emma Prus, Brian Castrucci, Sandro Galea, Catherine K Ettman
{"title":"Poor Mental Health and the Use of Buy Now, Pay Later Loans.","authors":"Hridika Shah, Emma Prus, Brian Castrucci, Sandro Galea, Catherine K Ettman","doi":"10.1001/jamahealthforum.2025.5620","DOIUrl":"10.1001/jamahealthforum.2025.5620","url":null,"abstract":"","PeriodicalId":53180,"journal":{"name":"JAMA Health Forum","volume":"6 12","pages":"e255620"},"PeriodicalIF":11.3,"publicationDate":"2025-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12701504/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145745661","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-05DOI: 10.1001/jamahealthforum.2025.6539
Benjamin D Sommers, Patricia Mae G Santos
{"title":"Rhetoric vs Reality on Immigrants' Health Care Spending.","authors":"Benjamin D Sommers, Patricia Mae G Santos","doi":"10.1001/jamahealthforum.2025.6539","DOIUrl":"https://doi.org/10.1001/jamahealthforum.2025.6539","url":null,"abstract":"","PeriodicalId":53180,"journal":{"name":"JAMA Health Forum","volume":"6 12","pages":"e256539"},"PeriodicalIF":11.3,"publicationDate":"2025-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145670903","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}
Pub Date : 2025-12-05DOI: 10.1001/jamahealthforum.2025.5120
Sandro Galea, Zirui Song
{"title":"Back to the Future of Primary Care.","authors":"Sandro Galea, Zirui Song","doi":"10.1001/jamahealthforum.2025.5120","DOIUrl":"https://doi.org/10.1001/jamahealthforum.2025.5120","url":null,"abstract":"","PeriodicalId":53180,"journal":{"name":"JAMA Health Forum","volume":"6 12","pages":"e255120"},"PeriodicalIF":11.3,"publicationDate":"2025-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145745745","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}
Pub Date : 2025-12-05DOI: 10.1001/jamahealthforum.2025.5653
Amal N Trivedi, Lan Jiang, David J Meyers, Aaron L Schwartz, Kenneth W Kizer, Jean Yoon
{"title":"Spending by the Veterans Affairs Health Care System for Medicare Advantage Enrollees.","authors":"Amal N Trivedi, Lan Jiang, David J Meyers, Aaron L Schwartz, Kenneth W Kizer, Jean Yoon","doi":"10.1001/jamahealthforum.2025.5653","DOIUrl":"10.1001/jamahealthforum.2025.5653","url":null,"abstract":"","PeriodicalId":53180,"journal":{"name":"JAMA Health Forum","volume":"6 12","pages":"e255653"},"PeriodicalIF":11.3,"publicationDate":"2025-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12717610/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146115061","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-05DOI: 10.1001/jamahealthforum.2025.5878
{"title":"Error in Figure 1.","authors":"","doi":"10.1001/jamahealthforum.2025.5878","DOIUrl":"10.1001/jamahealthforum.2025.5878","url":null,"abstract":"","PeriodicalId":53180,"journal":{"name":"JAMA Health Forum","volume":"6 12","pages":"e255878"},"PeriodicalIF":11.3,"publicationDate":"2025-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12681030/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145679436","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-05DOI: 10.1001/jamahealthforum.2024.4970
{"title":"JAMA Health Forum.","authors":"","doi":"10.1001/jamahealthforum.2024.4970","DOIUrl":"https://doi.org/10.1001/jamahealthforum.2024.4970","url":null,"abstract":"","PeriodicalId":53180,"journal":{"name":"JAMA Health Forum","volume":"6 12","pages":"e244970"},"PeriodicalIF":11.3,"publicationDate":"2025-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145679404","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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