Journal of Health Politics Policy and Law最新文献

Context: In health care, licensing is pervasive. Restrictions on applicants with criminal records may have a disparate impact on historically marginalized groups. There is bipartisan interest in evaluating whether occupational licensing requirements are too strict.

Methods: The authors analyze how 12 representative states (California, Colorado, Connecticut, Delaware, Florida, Illinois, Missouri, New York, Ohio, Pennsylvania, South Dakota, and Texas) respond when people with criminal records apply for a license for five entry-level allied health professions (dental hygienist, occupational therapy assistant, physical therapy assistant, radiologic technologist, and respiratory therapist).

Findings: With one exception for one allied health profession, all states require their licensing boards to consider past serious criminal convictions. A majority of states require the conviction to be substantially related to the scope of professional duties for it to provide a basis for disqualification. Most states make it difficult for applicants with criminal records to determine whether they may obtain a license.

Conclusions: State licensing boards have considerable discretion in handling applicants with a criminal record. The trend is toward fewer restrictions, but more could be done to increase the transparency of state licensing board guidelines, practices, and procedures-particularly in the states that still rely on a "good moral character" test.

Context: Segregation has been linked to unequal life chances. Individuals from marginalized communities experience more crime, higher levels of poverty, poorer health, and less civic engagement. In addition, segregated metropolitan regions have been found to display inequality in access to basic services. This article builds on these findings by linking segregation to infection and deaths from COVID-19.

Methods: Using census data matched to COVID infection and death statistics at the county level, this article offers a theoretical basis for the researchers' choice of segregation measures and predictions for different racial groups. It analyzes the relationship between two dimensions of segregation-racial isolation and racial unevenness-and COVID outcomes for different racial and ethnic groups.

Findings: In counties where Black and Latino residents lived in more racially isolated neighborhoods, they were much more likely to contract COVID-19. This pattern was exacerbated in counties with a high proportion of frontline workers. In addition, racial segregation increased COVID-19 death rates for Black, Latino, and white residents.

Conclusions: These findings suggest that devastating outcomes of the coronavirus pandemic were linked to a long history of racial marginalization and entrenched discrimination produced by structural inequalities embedded in our geographies. This knowledge should be used to inform public health planning.

Policy entrenchment per se is a neutral concept; both good and bad policies may become entrenched. A policy trap, however, is entrenchment's pathological form: a self-reinforcing array of policies that simultaneously creates (1) well-established, often widely recognized failures in society, and (2) high barriers to change. A familiar type of policy trap arises when the benefits of a policy are concentrated while the costs, albeit greater, are widely diffused, opaque to many who bear them, or seemingly remote. But policy traps are not necessarily permanent; they may persist only as long as reformers are unable to identify their vulnerabilities and seize moments of political opportunity. Reconstituting a domain of policy ultimately requires formulating an alternative. Without presuming to be exhaustive, this article outlines four general strategies for overcoming policy entrenchment: Schumpeterian innovation, globally oriented innovation, institutional conversion, and social creativity (the nonmarket analog to Schumpeterian change). Focusing on three areas, the article examines how policy traps have arisen and might be overcome in fossil fuels, the internet economy, and the US health care system.

Context: This study examines the extent to which political partisanship-measured as support for either the incumbent candidate for Indonesia's presidency, Joko Widodo (popularly known as Jokowi), or for Jokowi's challenger, Prabowo-affects individuals' risk perception of COVID-19 and COVID-19 vaccine hesitancy and refusal as well as beliefs about the safety and efficacy of the COVID-19 vaccine.

Methods: The authors performed multinomial logistic and ordinary least squares regression analyses on a nationally representative sample of a national survey on public trust in COVID-19 vaccines and vaccinations that was conducted in December 2020.

Findings: Individuals who voted for Prabowo in the 2019 presidential election were more likely to have a lower level of willingness and a higher level of hesitancy to get the COVID-19 vaccine than those who cast their ballot for Jokowi as the Indonesian president.

Conclusions: Political partisanship does matter in shaping individuals' hesitancy or refusal to receive the COVID-19 vaccine in Indonesia. The effect of partisanship is also significant in shaping individuals' trust in the efficacy and safety of the COVID-19 vaccine, but it is not significantly associated with individuals' risk perceptions.

State policy makers are under increasing pressure to address the prohibitive cost of health care given the lack of action at the federal level. In 2020, the United States spent more on health care than any other country in the world-$4.1 trillion, representing 19.7% of the nation's gross domestic product. States are trying to better understand their role in health care spending and to think creatively about strategies for addressing health care cost growth. One way they are doing this is through the development and use of state-based all-payer claims databases (APCDs). APCDs are health data organizations that hold transactional information from public (Medicare and Medicaid) and private health insurers (commercial plans and some self-insured employers). APCDs transform this data into useful information on health care costs and trends. This article describes states' use of APCDs and recent efforts that have provided benefits and challenges for states interested in this unique opportunity to inform health policy. Although challenges exist, there is new funding for state APCD improvements in the No Surprises Act, and potential new federal interest will help states enhance their APCD capacity so they can better understand their markets, educate consumers, and create actionable market information.

Accountable care organizations (ACOs) were envisioned as a way to address both health care cost growth and uneven quality in US health care. They emerged in the early 2000s, with the 2010 Affordable Care Act (ACA) establishing a Medicare ACO program. In the decade since their launch, ACOs have grown into one of Medicare's flagship payment reform programs, with millions of beneficiaries receiving care from hundreds of ACOs. While great expectations surrounded ACOs' introduction into Medicare, their impacts to date have been modest. ACOs have achieved some savings and improvements in measured quality, but disagreement persists over the meaning of those results: Do ACOs represent important, incremental steps forward on the path toward a more efficient, high-quality health care system? Or do their modest achievements signal a failure of large-scale progress despite the substantial investments of resources? ACOs have proven to be politically resilient, largely sidestepping the controversies and partisan polarization that have led to the demise of other ACA provisions. But the same features that have enabled ACOs to evade backlash have constrained their impacts and effectiveness. After a decade, ACOs' long-term influence on Medicare and the US health care system remains uncertain.