Health affairs scholar最新文献

Maternal morbidity and mortality in the United States is an urgent public health issue, and there are stark differences by race and ethnicity. Community-based doula care is an evidence-based strategy to improve maternal health through accompaniment, health care engagement, addressing social needs, and promoting respectful care. Yet, there is a gap in access to doula care for people who are low-income or publicly insured, due to cost and availability. New York has recently joined a growing number of states providing Medicaid coverage for doula services. There are many challenges to overcome for this benefit to succeed: limited workforce capacity, minimal integration of doulas into hospitals, and reimbursement challenges. We offer a case study for integrating doula services into hospital-based maternity care: the HOPE Program (Helping Promote Birth-Equity through Community-Based Doula Care). Through community engagement, we have co-designed a model that centers the needs and experiences of birthing people and their care-giving teams. The model illustrates strategies for hospital-community engagement, tailored doula workforce expansion, and integration of doulas into clinical spaces and teams. Investment in these components will lead to a meaningful expansion of doula services to the populations around the state and country who need it most.

Pediatric vaccination rates in the United States lag national goals. Policies that expand pharmacy-based vaccinations among children could help improve vaccination rates. Opponents argue, however, that such policies will result in delayed or missed well-child visits as most children receive routine vaccinations in primary care settings. We evaluated the likelihood of having a timely well-child visit following a routine vaccination in pharmacies and primary care settings among children aged 4-17 years. We conducted a retrospective cohort analysis with commercial claims data from 2016-2019, using conditional logistic regression models. A timely well-child visit was defined as one within 12 months after a preceding well-child visit for primary analysis and 15 months for secondary analysis. Approximately 95% of the sample consisted of children with influenza among their index vaccine(s). The odds of having a timely well-child visit were similar between children who received vaccines in pharmacies and those who received them in primary care settings. Findings suggest that guardians or parents who choose pharmacy-based pediatric vaccinations for their commercially insured children do not forgo well-child visits and may actually be more likely to obtain a timely well-child visit. Extending pharmacy-based vaccinations to patients of all ages can help improve pediatric vaccination rates.

The US health care system continues to underperform compared with other high-income countries, despite excelling on measures of care delivery and quality, also referred to as indicators of "care process." This commentary explores how the United States managed to perform well on measures of care process and how learning from this lone area of positive cross-country comparison can provide valuable lessons for improving overall health care system performance. By applying these lessons, the United States can create a more effective, efficient, and equitable health care system, ensuring better access, streamlined administration, and improved health outcomes for more Americans.

In the United States, long-term care providers, such as nursing homes and assisted living communities, are meeting consumer demand through housing and care options designed to support the growing population of people living with dementia. One approach to providing dementia care is the development of "memory care units" within existing nursing homes and assisted living communities. Memory care units provide a setting more tailored to the cognitive and functional abilities of these individuals. There is emerging evidence about the optimum strategies for memory care environments; however, little is known about the implementation, prevalence, and quality of practice-and environment-based strategies-in memory care units. This article provides insight into the prevalence of memory care unit practices using data from Ohio. The analysis points to policy and practice opportunities to address the quality of life and care for people living with dementia.

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.

In 2024, 90% of Medicare Advantage (MA) enrollees were in a plan that required prior authorization of home health care. We conducted semi-structured interviews with 44 leaders of MA plans, post-acute care (PAC) management companies, and home health agencies (HHAs) across the country to understand their experiences with prior authorization and utilization management (UM) of post-acute home health care. Our analysis of these interviews revealed that representatives of MA plans and PAC management companies report varying motives and approaches to prior authorization for post-acute home health care, resulting in varied experiences for HHAs. Both MA plan and HHA representatives view prior authorization and UM of post-acute home health as burdensome, and each have taken distinct approaches to manage the process but have conflicting views on the utility of these approaches. Home health agency representatives report that prior authorization and UM requirements impact access to care, the way that care is delivered, and ultimately patients' experiences. Our findings warrant additional research and policy attention so that MA plans' UM techniques do not unintentionally cause patient harm, particularly among vulnerable Medicare enrollees in need of post-acute home health care.