Health affairs scholar最新文献

Introduction: Cannabis legalization enables greater access to commercial cannabis among adults. Little is known about the extent to which demand for cannabis is met by licit or illicit markets among states with medical-only or recreational cannabis laws, or no legalization.

Methods: Annual sales values of medical and recreational tetrahydrocannabinol (THC), illicit THC, hemp-derived cannabidiol (CBD) and hemp-derived THC were estimated for 2024 in 12 US states by combining and triangulating data from national- and state-level public sources, Euromonitor's Passport database, in-store audits (n = 142), retailer interviews (n = 78), and expert interviews (n = 10) of cannabis industry stakeholders. States were classified into three types of cannabis legalization status.

Results: State-level THC market size was substantial, accounting for ≥90% of the combined cannabis market value of THC and CBD, regardless of legalization status. However, the composition of THC markets-across legal recreational, medical, illicit, and hemp-derived segments-varied considerably, even among states with the same legalization status.

Conclusions: The emergence of hemp-derived THC in both legal and non-legal markets alongside the persistence of illicit THC sales in legal markets highlight regulatory gaps and challenges in market oversight. These findings underscore the need for integrated policy approaches that align enforcement strategies with public health objectives and consumer education.

Introduction: US lockdowns and school closures implemented during the COVID-19 pandemic were intended to mitigate viral transmission and protect public health. However, the broader health effects of these interventions remain unclear.

Methods: We conducted a systematic review of peer-reviewed studies that assessed the impact of US lockdowns and school closures on health-related outcomes excluding COVID-19 transmission and mortality.

Results: A total of 132 studies met inclusion criteria, yielding 454 unique outcomes. Lockdowns and school closures were associated with detrimental health effects in the majority of outcomes analyzed, including over 90% of mental health, obesity-related, and health-related social need outcomes (child development/education, employment, access to food, and economic/financial stability). Analyses focused on vulnerable populations, such as racial and ethnic minorities, low-income groups, and individuals with disabilities, were significantly more likely to report detrimental outcomes than the general population.

Conclusion: Given how lockdowns and school closures may affect population well-being, policymakers should carefully weigh both the benefits and harms of these interventions, including how they may affect vulnerable populations. We conclude with policy recommendations to mitigate ongoing harms and inform more evidence-based decision-making.

Disability measures currently used in U.S. federal surveys fail to identify many disabled people as such. This commentary summarizes empirical evidence regarding the underperformance of the American Community Survey six questions (ACS6) and Washington Group Short Set (WGSS) questions in measuring disability status. Building trust in science is a priority issue and necessitates greater transparency and communication about the limitations of these measures, both within research communities and among the public. Considering the underperformance of the ACS6 and WGSS in measuring disability status, we provide cautionary statements that researchers can use when including these measures in studies to ensure that interpretations of results are not overgeneralized to the disabled population.

Introduction: Some state Medicaid programs place a cap on the monthly number of covered prescription fills, including medications for opioid use disorder (MOUD)-the most effective OUD treatments.

Methods: Between 2023 and 2024, we employed a quasi-systematic 3-step process (online search, survey of Medicaid experts, request-for-information) to identify contemporary Medicaid cap policy information and conducted a content analysis of cap policies.

Results: Of the 12 states with contemporary prescription cap policies, 9 operated general caps and 3 operated caps for controlled substances. Across states, caps ranged from 3-6 monthly prescriptions. All states had exemptions based on beneficiary characteristics (eg, age, health conditions) or medication type (eg, contraceptives, antipsychotics), 6 of which had cap override policies, and 5 had MOUD-specific exemptions.

Conclusion: Our search identified a dearth of publicly accessible, contemporary information on Medicaid cap policies, indicating a potential barrier to beneficiaries' understanding their prescription drug benefits. Further, although all states provided some type of policy carveout, half of the Medicaid programs operating caps did not exempt MOUD, which may negatively impact access to medically necessary medications for Medicaid beneficiaries with OUD.

Introduction: The US faces a growing mismatch between demand for inpatient psychiatric care and available capacity. Little is known about the characteristics of regions affected by inpatient psychiatric bed shortages, which hospitals have faced decreases in bed supply, and whether other psychiatric services have emerged to fill the gap.

Methods: Using data from the American Hospital Association Annual Survey, we conducted a descriptive analysis of inpatient psychiatric bed supply across hospital referral regions (HRRs) from 2012 to 2022. We examined the demographic patterns of regions affected by shortages, assessed hospital characteristics associated with reductions in psychiatric capacity, and evaluated the presence of alternative psychiatric services that may substitute for inpatient care.

Results: More than 60% of the US population consistently lived in HRRs with psychiatric bed shortages during this period, defined as fewer than 30 beds per 100 000 people. By 2022, HRRs with severe shortages, relative to those without them, were more likely to be in the West and had higher proportions of Hispanic residents, raising concerns about inequities in behavioral health care access. Hospitals most likely to reduce psychiatric capacity were general, non-profit, and system-affiliated institutions with lower total margins. Importantly, hospitals in severe shortage areas were less likely to have outpatient psychiatric services, indicating that alternative hospital-based resources may not fully offset inpatient shortfalls.

Conclusion: Addressing the nation's psychiatric bed shortage will require targeted financial support for general hospitals at risk of closing psychiatric units and investment in broader psychiatric infrastructure to ensure equitable access across regions.

The Congressional Budget Office (CBO) created a model of new drug development with the aim of informing the US Congress about the potential impact of policy changes affecting expected biopharmaceutical revenue on future innovation. While models are by their nature simplifications of reality, biopharmaceutical investment decision-making is particularly complex and poorly understood outside the investment ecosystem, raising questions about the adequacy of such models to inform policymaking. To better understand how CBO's model compares to real-world investment decision processes, we conducted semi-structured interviews with investors representing venture capital, private equity, corporate venture capital, and biopharmaceutical companies. The interviews with investors suggest that the CBO's model does not adequately reflect investment decisions for drug development. These findings highlight the risks of using models to guide policymaking and the need to improve the existing model with the help of stakeholder input before such models are adopted.

Introduction: Medical debt is widely regarded as a social problem that reflects growing out-of-pocket costs. Yet whether medical debt acts a social determinant of health by discouraging people to seek additional care may depend on one's ability to repay this debt.

Methods: We use data from the first wave of a survey of a nationally representative sample of 2090 low-wage workers in the U.S. We ran linear probability models to predict putting off filling prescriptions, receiving primary medical care, and receiving specialty medical care based on medical debt disposition.

Results: We find that workers with medical debt they cannot afford to repay are more likely to defer three types of health care and are confronted with several other financial risk factors compared with workers with medical debt they are repaying. Also, concerning putting off needed health care, there is no difference between workers who are repaying their medical debt and those with no medical debt.

Discussion: These findings suggest the need to strengthen financial assistance policies and programs and ensure access to low-cost health coverage for low-wage workers.