JAMA Health Forum最新文献

Importance: Nineteen states have passed legislation requiring insurers to cover the dispensation of a 12-month supply of short-acting, hormonal contraception.

Objective: To determine whether 12-month contraceptive supply policies were associated with an increase in the receipt of 12-month or longer supply of contraception.

Design, setting, and participants: This retrospective cohort study included data from all female Medicaid enrollees aged 18 to 44 years who used short-acting hormonal contraception (ie, pill, patch, or ring) from 2016 to 2020.

Exposures: Eleven treatment states where legislation required insurers to cover a 12-month supply of contraception to continuing users and 25 comparison states without such legislation prior to December 2020.

Main outcomes and measures: Proportion of contraception months received via a single 12-month or longer fill.

Results: This study included 48 255 512 months of dispensed oral pill, patch, and ring contraception prescription supply among 4 778 264 female Medicaid enrollees. The majority of months of supplied contraception were for the contraceptive pill rather than the patch or ring. In a staggered difference-in-differences model, the 12-month supply policy was associated with an estimated 4.39-percentage point (pp) increase (95% CI, 4.38 pp-4.40 pp) in the proportion of contraception dispensed as part of a 12-month or longer supply, from a mean of 0.11% in treatment states during the first quarter of the study period. Investigating the heterogeneity in policy association across states, California stood out with a 7.17-pp increase (95% CI, 7.15 pp-7.19 pp) in the proportion of contraception dispensed as a 12-month or longer supply; in the other 10 treatment states, the policy association was less than 1 pp.

Conclusions and relevance: In this cohort study of Medicaid recipients using short-acting hormonal contraception, the passage of a 12-month contraceptive supply policy was associated with a minimal increase in the proportion of contraception dispensed through a 12-month or longer supply.

Importance: At least 10 million people in the United States have an intellectual and/or developmental disability (IDD). People with IDD experience considerably higher rates of poor overall health, chronic conditions including diabetes, mental health challenges, maternal mortality, and preventable deaths. This Special Communication proposes national goals based on a community-led consensus model that advances priority health outcomes for people with IDD and their caregivers/partners and identifies critical policy opportunities and challenges in achieving these goals. A community-led consensus agenda offers a foundation for focusing research, improving data collection and quality measurement, enhancing coverage and payment for services, and investing in a prepared clinical workforce and infrastructure in ways that align with lived experiences and perspectives of community members.

Observations: People with IDD prioritize holistic health outcomes and tailored supports and services, driven by personalized health goals, which shift over their life course. Caregivers/partners need support for their own well-being, and easy access to resources to optimize how they support loved ones with IDD. Development of an adequately prepared clinical workforce to serve people with IDD requires national and regional policy changes that incentivize and structure training and continuing education. Ensuring effective and high-value coverage, payment, and clinical decisions requires investments in new data repositories and data-sharing infrastructure, shared learning across public and private payers, and development of new technologies and tools to empower people with IDD to actively participate in their own health care.

Conclusions and relevance: Consensus health priorities identified in this project and centered on IDD community members' perspectives are generalizable to many other patient populations. Public and private payers and regulators setting standards for health information technology have an opportunity to promote clinical data collection that focuses on individuals' needs, quality measurement that emphasizes person-centered goals rather than primarily clinical guidelines, and direct involvement of community members in the design of payment policies. Clinical education leaders, accrediting bodies, and investors/entrepreneurs have an opportunity to innovate a better prepared health care workforce and shared data infrastructure to support value-based care programs.

Importance: By expanding health insurance to millions of people in the US, the Patient Protection and Affordable Care Act (ACA) may have important health, economic, and social welfare implications for people with criminal legal involvement-a population with disproportionately high morbidity and mortality rates.

Objective: To scope the literature for studies assessing the association of any provision of the ACA with 5 types of outcomes, including insurance coverage rates, access to care, health outcomes, costs of care, and social welfare outcomes among people with criminal legal involvement.

Evidence review: The literature search included results from PubMed, CINAHL Complete, APA Psycinfo, Embase, Social Science Database, and Web of Science and was conducted to include articles from January 1, 2014, through December 31, 2023. Only original empirical studies were included, but there were no restrictions on study design.

Findings: Of the 3538 studies initially identified for potential inclusion, the final sample included 19 studies. These 19 studies differed substantially in their definition of criminal legal involvement and units of analysis. The studies also varied with respect to study design, but difference-in-differences methods were used in 10 of the included studies. With respect to outcomes, 100 unique outcomes were identified across the 19 studies, with at least 1 in all 5 outcome categories determined prior to the literature search. Health insurance coverage and access to care were the most frequently studied outcomes. Results for the other 3 outcome categories were mixed, potentially due to heterogeneous definitions of populations, interventions, and outcomes and to limitations in the availability of individual-level datasets that link incarceration data with health-related data.

Conclusions and relevance: In this scoping review, the ACA was associated with an increase in insurance coverage and a decrease in recidivism rates among people with criminal legal involvement. Future research and data collection are needed to understand more fully health and nonhealth outcomes among people with criminal legal involvement related to the ACA and other health insurance policies-as well as the mechanisms underlying these relationships.