Health affairs scholar最新文献

Regulatory actors, particularly market authorization agencies, health technology assessment agencies, and health care procurement agencies, exert a powerful influence on the adoption and use of health technologies (eg, medicines and medical devices). With health care being responsible, directly and indirectly, for an estimated 4.6% of global greenhouse gas emissions, alongside other environmental harms, these actors have recognized the need to address the environmental impacts of health technologies. In this commentary, we utilize concepts of regulatory stringency and lifecycle thinking, considering scope, prescriptiveness, and performance requirements, to analyze recent efforts to incorporate environmental sustainability into the regulation of medicines and medical devices. While we acknowledge recent progress, we argue that there is significant, untapped potential for developing more fulsome and effective regulatory mechanisms to improve the environmental sustainability of health technologies.

Scientific, technical, and medical (STM) publishers follow 3 basic tenets: (1) no compensation for peer reviewers; (2) manuscript submission only to one journal; and (3) no dissemination of manuscripts while under review. An antitrust lawsuit was filed in federal district court against STM publishers challenging these tenets. The lawsuit will have important implications for how STM research is published and will also affect authors and editors. Academic researchers (plaintiffs) who have served as authors and reviewers allege that the 6 largest STM publishers (defendants) have conspired to require authors to abide by the 3 basic tenets. The plaintiffs argue that the publishers have substantial market power, pursue anticompetitive policies, and violate Section 1 of the Sherman Antitrust Act. This article focuses principally on the second tenet, that research manuscripts may be submitted to only one journal. This requirement, which the plaintiffs believe is an antitrust violation, is not a feature of law journals, where multiple simultaneous submissions of manuscripts are a central part of the publishing process. This article will explain how the court may approach the legal analysis in this lawsuit and the important implications of the outcome of this litigation for the scholarly publishing ecosystem.

Understanding disparities in hospital finances is essential for ensuring equitable systems of care. One understudied element is total assets, which include both financial and capital resources that hospitals acquire. We evaluated changes and drivers of variation in US hospital assets from 2000 through 2019 using data from the Centers for Medicare and Medicaid Services and American Hospital Association Annual Survey. We decomposed overall variation in total assets to determine the level (hospital, health system, or health care market) that contributed most to variation, and examined the extent to which asset growth was associated with changes in common inputs to hospital wealth vs changing relationships with these inputs or other unmeasured factors. Total assets held by US hospitals increased from $750 billion in 2000 to $1.6 trillion in 2019. Most variation occurred between hospitals, such that high-asset hospitals tended to remain high-asset and low-asset hospitals remained low-asset. Most of the increase in assets was due to unmeasured factors (ie, not patient revenue). We conclude that hospital wealth in the form of assets has grown substantially over time and accrued primarily to wealthy hospitals. Policymakers should consider broader measures of hospital wealth when targeting financial resources and efforts to strengthen data on hospital financing.

Artificial intelligence (AI) holds transformative potential for global health, particularly in underdeveloped regions like Africa. However, the integration of AI into healthcare systems raises significant concerns regarding equity and fairness. This debate paper explores the challenges and risks associated with implementing AI in healthcare in Africa, focusing on the lack of infrastructure, data quality issues, and inadequate governance frameworks. It also explores the geopolitical and economic dynamics that exacerbate these disparities, including the impact of global competition and weakened international institutions. While highlighting the risks, the paper acknowledges the potential benefits of AI, including improved healthcare access, standardization of care, and enhanced health communication. To ensure equitable outcomes, it advocates for targeted policy measures, including infrastructure investment, capacity building, regulatory frameworks, and international collaboration. This comprehensive approach is essential to mitigate risks, harness the benefits of AI, and promote social justice in global health.

Extending pregnancy-related Medicaid eligibility from 60 days to 12 months postpartum represents an important opportunity to reduce maternal mortality and racial inequities in maternal health outcomes. However, patterns of health care service use after 60 days postpartum among Medicaid enrollees are not well understood. We use Medicaid claims data representing Medicaid-covered live births in 46 states in 2018 to examine outpatient visits during the postpartum year. We find that more than three-quarters of enrollees with full-year Medicaid coverage have at least one outpatient visit between 61 days and 12 months postpartum. The share of enrollees with visits varies from 51.5% to 88.0% across states and is higher among enrollees with diagnosed physical or mental/behavioral health conditions or pregnancy/delivery complications. We also find that visits including mental/behavioral health care are more common for non-Hispanic white enrollees than non-Hispanic Black and Hispanic enrollees and for rural enrollees than urban enrollees during the postpartum year, controlling for other characteristics. These findings suggest that many Medicaid enrollees who maintain Medicaid coverage beyond 60 days postpartum will receive outpatient care but also suggest that there may be inequities in receipt of postpartum health care across and within states.

Many neighborhoods with concentrated racial and ethnic minority older adult populations experience high neighborhood disadvantage. Yet, to date, no studies have analyzed how neighborhood disadvantage affects the relationship between race and hospitalization among older adults. To fill this gap, we examined if neighborhood disadvantage moderates the relationship between race and hospitalization among older adults in the United States. Medicare claims data from 2018 on 530 962 beneficiary hospitalizations were merged with neighborhood data, and regression models assessed if the Area Deprivation Index (ADI) moderated the association between race and hospitalization. At the highest ADI score, the odds ratio (OR) for hospitalization for Black compared with White beneficiaries was the lowest (OR: 0.96; 95% CI: 0.89-1.04). At the lowest ADI score, the OR for hospitalization for Black compared with White beneficiaries was the highest (OR: 1.19; 95% CI: 1.09-1.29). When Black and White beneficiaries reside in severely deprived areas, the disparity in their outcomes is narrower. However, when they reside in areas with more advantages, White beneficiaries experience better outcomes than Black beneficiaries. Our findings have implications for practice and policy to invest resources in communities to assure health equity.

Although pandemic-era telemedicine flexibilities may have preserved access to care, concerns remain that telemedicine may have been inequitably distributed among older adults, especially those with mild cognitive impairment or dementia (MCID). As telemedicine flexibilities are set to fully expire on December 31, 2024, we aimed to examine pandemic-era and future-intended telemedicine use among older Americans to help inform post-pandemic telemedicine policy design. We hypothesized that telemedicine would be disproportionately underutilized among older adults with MCID or with racial and ethnic minority status. We used nationally representative survey data from the Health and Retirement Study and analyzed pandemic-era and future-intended telemedicine use among 10 075 Medicare beneficiaries aged >50 years during 2020-2022 by cognition across beneficiaries-level characteristics such as age, gender, insurance status, education, and multimorbidity. Results were adjusted by survey weights and nonresponse rates for national representativeness. Contrary to our hypothesis, compared with White Medicare beneficiaries, Hispanic and Black beneficiaries with normal cognition reported 44% and 57% greater pandemic-era and future-intended telemedicine use, respectively, while Black beneficiaries with MCID reported 57% greater pandemic-era telemedicine use. Our findings suggest that pandemic-era telemedicine utilization was especially common among racial and ethnic minority groups and those with MCID.

Long-acting injectable antiretroviral therapy (LAI-ART) is expected to improve health outcomes among persons with HIV. Yet, uptake has been slow and data on potential barriers to access are sparse. We used medication formulary data from state Medicaid and AIDS Drug Assistance Programs (ADAPs) to examine state-level variation in access to LAI-ART among uninsured and low-income persons with HIV. We identified substantial coverage gaps: cabotegravir/rilpivirine was not covered without prior authorization by 26 state Medicaid programs and not covered at all by 15 state ADAPs; lenacapavir was not covered without prior authorization by 32 Medicaid programs and not covered at all by 18 ADAPs. As a result of these gaps, many US persons with HIV are currently unable to access LAI-ART. Policies that increase access are needed to ensure the equitable distribution of LAI-ART. As states work to reduce supply and payment chain barriers, the US Department of Health and Human Services, notably its Centers for Medicare & Medicaid Services and the Health Resources and Services Administration, should provide increased federal assistance, guidance, and oversight to improve LAI-ART access among people with HIV.

To combat antimicrobial resistance (AMR), advocates have called for passage of the Pioneering Antimicrobial Subscriptions To End Upsurging Resistance (PASTEUR) Act in the United States, which would appropriate $6 billion in new taxpayer-funded subsidies for antibiotic development. However, the number of antibiotics in clinical development, and US Food and Drug Administration approvals of new antibiotics, have already markedly increased in the last 15 years. Thus, instead of focusing on more economic subsidies, we recommend reducing selective pressure driving AMR by (1) establishing pay-for-performance mechanisms that disincentivize overprescribing of antibiotics, (2) focusing existing research and development funding on strategies that decrease reliance on antibiotics, and (3) changing regulation or law to require specialized training in antibiotic stewardship for a clinician to be able to prescribe new antibiotics that target unmet AMR need. To stabilize the antibiotic market, we recommend (1) establishment of an advisory board of clinical practitioners to more accurately target existing antibiotic incentives and (2) endowment of nonprofit companies that sustainably self-fund antibiotic discovery, creating a bench of molecules that can be partnered with industry at later stages of development.