Journal of Health Politics Policy and Law最新文献

Context: Much of the existing work on the political economy of vaccine access has focused on how intellectual property rights agreements contribute to inequitable COVID-19 vaccine access between high-income and low- and middle-income countries (LMICs). The two solutions that emerged to scale up access in LMICs involved either voluntary arrangements under COVAX or a waiver of the Agreement on Trade-Related Aspects of Intellectual Property Rights (TRIPs) to allow immediate access to intellectual property. However, an additional constraint on access is weak and ineffective supply chains within LMICs that have eroded over several decades of health-sector reform.

Methods: This article reviews the literature on the political economy of supply chain strengthening in LMICs and identifies key challenges to equitable access to emergent vaccines and other medicines emanating from market and state failures in internal supply chains.

Findings: Over the past century, supply chain policies in LMICs have alternated among an emphasis on addressing market failures contributing to unaffordability of vaccines/medicines, an emphasis on state failures contributing to unavailability of vaccines/medicines, and a more recent move toward public-private hybrid arrangements to strengthen supply chains.

Conclusions: In addition to reshoring production capacity through a TRIPs waiver, the international community must address chronic weakness in internal supply chains in LMICs to ensure access to novel vaccines/medicines.

Context: The contributions from the field of public health to human society are numerous and are often taken for granted. The COVID-19 pandemic thrust the largely invisible public health workforce into the public eye. Like other career civil servants at the intersection of the citizen-state encounter, reports of uncooperative, hostile, and even violent confrontations between public health workers and those they serve are on the rise. This study explores the attitudes of public health professionals in two states in the American West.

Methods: The authors conducted an anonymous web-based survey of public health professionals in Montana and Oregon one year into the COVID-19 pandemic.

Findings: Public health workers who responded to the survey reported beliefs that the COVID-19 pandemic was politicized by actors in the government, both major political parties, the media, and the public broadly. This politicization affected workers' abilities to do their jobs, with respondents in Montana experiencing more negative impacts than those in Oregon.

Conclusions: Public health workers face growing antagonism from the public and pressure from political leaders, which poses a significant concern for the public health workforce and for communities as they prepare to address and overcome future public health challenges.

The Medicare Advantage program was created to expand beneficiary choice and to reduce spending through capitated payment to private insurers. However, many stakeholders now argue that Medicare Advantage is failing to deliver on its promise to reduce spending. Three problematic design features in Medicare Advantage payment policy have received particular scrutiny: (1) how baseline payments to insurers are determined, (2) how variation in patient risk affects insurer payment, and (3) how payments to insurers are adjusted for quality performance. The authors analyze the statute underlying these three design features and explore legislative and regulatory strategies for improving Medicare Advantage. They conclude that regulatory approaches for improving risk adjustment and for recouping overpayments from risk-score gaming have the highest potential impact and are the most feasible improvement measures to implement.

Context: During the COVID-19 pandemic, governments varied in their implementation of social distancing rules. Some governments were able to target their social distancing requirements toward specific segments of the population, whereas others had to resort to more indiscriminate applications. This article will argue that state capacity crucially affected the manner in which social distancing rules were applied.

Methods: Using data from the Oxford COVID-19 Government Response Tracker, the author performed a series of ordered logistic regressions to examine whether state capacity increased the likelihood of more targeted applications of each social distancing rule.

Findings: Given the same level of infectivity, more capable states were indeed more likely to resort to targeted applications of each social distancing restriction. Interestingly, the size of state capacity's effect varied by the type of restriction. State capacity had a stronger influence on face-covering requirements and private-gathering restrictions than it had on school closures, workplace closures, and stay-at-home orders.

Conclusions: The way in which social distancing rules are applied is endogenous to state capacity. Effective governance is a precursor to more targeted and nuanced applications of social distancing rules.

Managed care arrangements are the dominant form of insurance coverage in the United States today. These arrangements rely on a network of contracted providers to deliver services to their enrollees. After the managed care backlash, governments moved to ensure consumer access by issuing a number of requirements for carriers related to the composition and size of their networks and how this information is shared with consumers. The authors provide a comprehensive review of these state-based efforts to regulate provider network adequacy and provider directory accuracy for commercial insurance markets. In addition to common measures of adequacy, they also include requirements specifically targeted to underserved populations. Their assessment comes on the heels of recent empirical work that has raised significant questions about whether these efforts are effective, particularly considering the limited nature of enforcement. They also provide a brief overview and assessment of recent federal government efforts that replicate these state regulations with a focus on lessons learned from state regulations that may help improve their federal counterparts. Furthermore, they outline a future research agenda focused on a more comprehensive evaluation of efforts to ensure consumer access.

Context: The CDC's ability to respond to communicable disease threats has recently met significant political and legal opposition. The authors unpack the influence of political ideology on support for CDC authority, and they experimentally assess whether highlighting ideology's role in responding to health threats might bolster CDC support.

Methods: The authors fielded a demographically representative online survey experiment to 5,483 US adults. They assessed the sociopolitical correlates of CDC attitudes via multivariate regression analyses limited to a study-wide treatment group. Additionally, they tested the effectiveness of their experimental treatments via multivariate models that interact indicators of stimulus exposure with political ideology.

Findings: Although most Americans support the CDC's role in responding to health crises, self-identified conservatives are significantly less likely to do so. This effect holds when accounting for respondents' limited government and anti-expert attitudes, which the authors replicated in nationally representative data. Encouragingly, though, emphasizing the CDC's role in combating the spread of COVID-19 is associated with significantly stronger levels of support on the ideological right.

Conclusions: Efforts to communicate the CDC's importance in responding to health threats can help bridge existing ideological divides and might create an incentive for policy makers to codify the agency's regulatory powers.

During the early months of the COVID-19 pandemic, 12 states banned or restricted abortion access under elective-procedure restrictions. The rationale was preserving hospital capacity and personal protective equipment (PPE); however, abortions commonly take place in clinics and use less PPE than childbirth. This paper investigates the discursive construction of abortions, the people who get them, and the fetuses in this legislation. The authors analyzed 13 antiabortion documents using an iterative process of thematic coding and memo writing. Twenty-three percent of the legislation listed abortion as banned, whereas the remaining laws implied abortion within the terms "elective" or "nonessential." Legislation used common antiabortion tactics, such as the trivialization of abortion, risk discourses, and constructions of motherhood and fetal personhood. Discourses delegitimized abortion providers and used quasi-medical justifications for banning abortion. Finally, legislation constructed abortion clinics as sites of contagion and waste and consequently as risks to public health. The results highlight the vulnerability of abortion and the connection between abortion policy and other conservative policies, and they gesture toward a strategic attempt to ban abortion federally. These findings have several implications for a post-Roe United States and for stakeholders wishing to increase abortion access.