We just wrapped up #SexEdForAll month in May, yet most people still believe sex education is just about sex. But it’s so much more than that! That’s why I created the Sexuality Education Legislation and Policy: A State-by-State Comparison of Health Indicators story map, in conjunction with the Robert Graham Center for Policy Studies in… Read More »
Every night at 8pm, my neighborhood in Los Angeles, like many, cheers for the front-line health care providers who care for our communities. My family joins in the nightly raucous thanks. But a few nights ago, we paused. Where were the cheers for the public health professionals? Medical professionals have been in the spotlight, doing the… Read More »
We are in the midst of two global public health catastrophes: the rapid spread of COVID-19 and the more insidious, chronic effects of climate change. The swift spread of COVID-19 has devastated many countries and their economies. But global changes in environmental conditions have been harming communities for decades. The World Health Organization estimates that… Read More »
With the 2020 US presidential election drawing near, debate about the options for universal coverage will ramp up. At the heart of this debate is the estimated 45% of US adults who are either uninsured or under-insured. They are at risk of experiencing financial hardship or going without needed care in a time when access to… Read More »
COVID-19 has revealed many vulnerabilities in our societal structure. One particular vulnerability is the risk inherent in our use of congregate institutions to house and treat people. This includes the risks of inpatient psychiatric facilities. Inadvertently, the pandemic has surfaced critical questions that we should seek to answer even when the virus is under control: What is the right… Read More »
As of April 17, 2020, the novel coronavirus has infected more than 2.4 million people globally and led to 170,000 deaths. The global response to the COVID-19 pandemic largely emphasizes social distancing and shelter-in-place ordinances. These policies impact everyone, also upending the lives of those not directly affected by the virus COVID-19 pandemic. Like other… Read More »
The current requirements for social distancing affect support groups for people with substance use disorders, but online support groups may provide the perfect solution. This post is the first in a series of planned posts on telehealth for addiction. COVID-19, the disease caused by the novel coronavirus called SARS-CoV2, is putting tremendous strain on all… Read More »
The first reports of COVID-19, the name now used to describe the disease caused by a novel coronavirus, first emerged around New Year’s day of 2020. Since then, the conversation has shifted from containment efforts in Wuhan, China to social distancing and mandatory closures across the U.S., including in New York, California, Illinois [pdf], Massachusetts,… Read More »
The rapid emergence of COVID-19 reminds us of the importance of the public health system. Local health departments (LHDs) play a central role in emergency preparedness and response. Effective epidemic response rests on the performance of the essential public health activities— assessment, policy development, and assurance—by LHDs. Evidence suggests that LHDs can improve population health… Read More »
This post summarizes what we know right now about the SARS-CoV-2 virus and the disease it causes, COVID-19. The information contained in this post may change as the situation changes, or may become obsolete. We will attempt to update if any of this changes substantively. News and social media outlets have fallen short of useful… Read More »
Yesterday, the Centers for Medicare and Medicaid Services (CMS) unveiled new guidance about using telehealth during this public health emergency due to the coronavirus outbreak. This guidance will help increase access to telehealth services. In addition, this will help people receive care who may not be able to visit their providers in person. While the… Read More »
COVID-19, the disease caused by the novel coronavirus, is spreading across the US and around the world. Can providers use telehealth to help identify and manage the novel coronavirus while helping organizations manage capacity and prevent the spread of COVID-19? Read on to find out more. Because of its airborne person-to-person transmission, coronavirus and related… Read More »
What role might the myth of “female hysteria” play in women’s health disparities? For thousands of years, women’s health complaints were often diagnosed as “female hysteria” – a catch-all term that basically implied “it’s all in her head.” The condition was sometimes believed to be caused by a wandering uterus and/or sexual frustration. Doctors treated… Read More »
With the current focus on social risk factors (SRFs) affecting health care, it is not surprising that methods for comparing hospital performance might do well to account for such factors in their assessment. If up to 70 percent of health outcomes are driven by factors beyond medical care, and measures used to compare hospitals focus… Read More »
Patients are sometimes referred to as “frequent flyers” when they visit an emergency department multiple times for the same issue. Often this is because discharged patients miss necessary follow-up care. This results in further worsening health, and may contribute to the frequent flying. To address this cycle, patients may be referred to a community health… Read More »
Health care is on everyone’s mind. Here’s what presidential candidates say about healthcare: the 2020 edition. We are two weeks into the 2020 presidential primary season. On the Democratic side, muddled results in Iowa and very close results in New Hampshire have sprung some surprises. Currently at the top of the Democratic field are Pete… Read More »
As of late, rural health has been a hot topic and buzzword in the public health and health policy spheres. Health Affairs recently published an entire issue related to topics on rural health. The American Journal of Public Health recently issued a call for manuscripts for a special issue dedicated entirely to rural health. Rural… Read More »
The current healthcare system is not built for individuals with serious illnesses. These individuals can benefit from palliative care, which focuses on quality of life and symptom relief. Alternative payment models that incorporate palliative care are in development. Yet, the challenges of expanding these models of care are substantial. Betsy recently died after a sixteen-year… Read More »
Over the past eight years, the US health care system has seen the widespread implementation of Accountable Care Organizations (ACOs) as a way to move from volume to value. What are ACOs? ACOs are groups of providers that are collectively accountable for the cost and quality of care for a defined patient population. Examples include… Read More »
Research shows that decriminalization of drug possession, combined with other harm reduction efforts and treatment services, is an important component of efforts to improve public health and health equity. It was early in medical school when I encountered the first of many patients who had spent years in jail or prison for drug possession. On… Read More »
Although telehealth has been in use for quite some time, uptake has been low. In particular, an inconsistent policy landscape presents a number of obstacles, such as site restrictions on where telehealth can be delivered, provider restrictions on who can deliver services, and reimbursement restrictions around payment for services. However, some recently developed policies aim… Read More »
Homelessness is both a public health issue and a deeply troubling sign of policy failures in a rich country such as the US. Yet what are the right ways to respond, both in the moment and on a larger scale? In early November, the American Public Health Association (APHA) gathered for our annual meeting at… Read More »
Do you recall the last time you did not have your morning cup of coffee or tea? Without it, you might be moody throughout the day and not get done what you intended. How about the last time you skipped lunch? Were you able to focus on your work with a rumbling stomach? Now imagine… Read More »
This year, teachers striking across the country have found common ground on a priority outside of typical debates around salaries or pensions. Educators in three major cities–Los Angeles, Oakland, and Chicago–among others, have been calling for more school counselors, librarians, nurses, psychologists, and social workers to support their students’ development beyond academic benchmarks. These public… Read More »
It is impossible to bring up a discussion of school sports without mentioning the great bogeyman of sports-related injuries: concussions. The number of concussions has been on the decline in recent years. But a recent estimate suggests that there are still about 4 concussions per 10,000 athletic exposures in high schools. An athletic exposure is… Read More »
This month, the website www.ACEsAware.org is set to launch. It will train healthcare workers to screen for Adverse Childhood Experiences (known as ACEs) in primary care clinics, but is that scope too narrow? Should school workers be included too? The website is part of the work of Dr. Nadine Burke Harris in her new role… Read More »
This month, The Medical Care Blog is hosting a series of posts about the importance of school health. Following up on our 2016 series on the childhood roots of inequity (read the first in the series here), we are dedicating our Thursdays this month to posts that reflect on the health challenges that confront schools.… Read More »
Inappropriate antipsychotic medication use among older adults with dementia is associated with increased risk [pdf] of hospitalization and death. In 2017, the rate of potentially inappropriate use was 16%, having fallen from 24% in 2011. While this decline has been substantial, further decreasing the rate is an important goal to protect the health and wellbeing… Read More »
When was the last time you recall seeing your health information recorded on paper? Probably not recently. As stressed in an earlier blog post, electronic health record (EHR) adoption is becoming commonplace for a majority of healthcare providers. Your personal information that was once stored on stagnant paper records is now being captured in dynamic… Read More »
Many issues affect the delivery of care to patients who are most in need. Particularly, those who live in rural areas or those who need specialized care may not have access to the care they need. Patients whose care transitions across acute care and long-term/post-acute care (LTPAC) settings may have additional challenges in receiving coordinated… Read More »
VBID and alternative payment models comprise two approaches to reform with different incentives that influence underlying motives. The underlying principle of Value-Based Insurance Design (VBID) is to align patient out-of-pocket costs, or cost-sharing (deductibles, co-pays, etc.), with clinical value of services. Decreasing cost-sharing for high-value services and increasing cost-sharing for low-value services is the goal of… Read More »
As a sexual health educator at public high schools in Tennessee, teachers would consistently jump in as I approached the topic of contraception. Required by law, these teachers would “emphatically promote sexual risk avoidance through abstinence.” After this abrupt interruption, I would then proceed to talk about all forms of contraception, including abstinence. Students would… Read More »
Two recent commentaries about politics and health–one in Medical Care by Dr. Ranit Mishori, and one in The New York Times by Dr. Paul Krugman–made me think about how my pre-academia work experiences might be able to help me have the greatest impact with my research as a new public health faculty member. I decided… Read More »
The codes of the International Classification of Diseases (ICD) serve as the backbone for billing, payment, and surveillance programs across the entire healthcare system – nationally and globally. Recent research published in Medical Care by Alexander Mainor and colleagues from the Dartmouth Institute for Health Policy & Clinical Practice has shown that the transition of… Read More »
A 14-year-old girl came to my primary care clinic with abdominal pain, similar to abdominal pain she’s had intermittently for years. As with all women of reproductive age, I checked a urine pregnancy test, and it was positive. I returned to the patient’s room to talk with her about the result, and her first question… Read More »
Homelessness and housing are issues of public health significance. This month, we published a Special Commentary about homelessness in Medical Care, informed by the 2017 policy statement we co-authored for the American Public Health Association (APHA) about homelessness and how federal, state, and local authorities can use evidence-based solutions to help bring an end to… Read More »
Access to care facilitates better health, and much of the work in Medical Care analyzes policy changes that affect insurance coverage both for the population as a whole and for disadvantaged groups (see examples, here, here, and here). Unfortunately, even as governments and researchers work on existing problems, technology is enabling new barriers. Wellness programs… Read More »
For months, I’ve been keenly interested in trying to explore where the field of primary care research stands. It’s daunting to pull your head up from your own research, take stock of what your colleagues (both known and unknown) are doing and try to assess where the field is advancing. Doing this every now and… Read More »
“One foot in the grave,” he said. “Is that how you feel?” I asked. “No, it’s how I live.” Unsheltered for 38 years, he had lived primarily behind a dumpster floating in and out of the medical, social and judicial system. In the month before the new Keck School of Medicine of the University of… Read More »
The economic burden of the U.S. opioid epidemic likely exceeds $78.5 billion per year when considering its impact on healthcare, substance abuse treatment, the criminal justice system, and productivity costs. Although medication assisted treatment for opioid abuse (covered previously at our blog) may help to reduce these costs [pdf], the epidemic is likely to continue to negatively impact… Read More »
“A book lying idle on the shelf is wasted ammunition.” – Henry Miller, The Books in My Life (1952) The Medical Care Blog is home to many strong opinions. In the last year, contributors have written provocatively about the political determinants of health, highlighted the per-mile cost of President Trump’s wall in numbers of children who… Read More »
Although the term health equity is widely used, a common understanding of this term is lacking. Viewing health equity through the lenses of allostatic load and intersectionality could help. This blog post considers three case scenarios, all of which are composites of actual cases that have occurred within the United States, to explore ideas of… Read More »
Individuals experiencing homelessness are among the most medically, socially, economically, and politically vulnerable in our society. Because of this, patterns of service use by these individuals can often serve as indicators of the safety net capacity and overall wellness of the systems of care we have in place – like “canaries in the coal mine.”… Read More »
It’s a new season. The federal government re-opened this week after a record-breaking shut-down. Democrats gained control of the U.S. House of Representatives, feeling newly emboldened after the dispute about a border wall. A gaggle of 2020 presidential hopefuls has revealed themselves in recent weeks, lining up to be, arguably, the most liberal class of… Read More »
President Trump wants $5 billion right now for his border wall, and another $7 billion (or maybe $13 billion) later on to finish the project. What else could we do with that kind of money? Here’s an idea: with $12 billion we could cover ALL 3.9 million uninsured children in the US today, and still have a… Read More »
There are approximately 61 million women of reproductive age (15-44 years) in the United States, and at any given time, 70% of them are at risk of unintended pregnancy—that is, they are sexually active but do not want to become pregnant. About 72% of women who currently use contraception use non-permanent methods, such as the… Read More »
Going to the hospital is more than a drag. For patients, it can be a frightening experience, dangerous to one’s health, a burden on family and caregivers, and very expensive. Policies to reduce preventable return visits to the hospital are good for patients – and good for Medicare’s bottom line. Medicare’s Hospital Readmission Reduction Program… Read More »
A relatively undiscussed and unconsidered form of discrimination continues to plague our health care institutions. It’s about time we talk about it. Insurance-based discrimination is the prejudicial treatment of a patient based on his/her insurance status. This type of discrimination mostly affects the 28.9 million Americans who have no health insurance coverage, although there is… Read More »
A few weeks ago, a headline in the Chicago Tribune grabbed my attention: “Millennials are trading primary care doctors for faster, cheaper alternatives.” This headline fits the rather unfortunate stereotype of millennials as impatient, job-hopping, financially-struggling, digital natives. But if this is true, then millennials are bound to “swipe left” to health care delivered in a… Read More »
The concept that health comes with significant social determinants is everywhere we turn. This idea – that health and health inequities are driven by “the conditions in which people are born, grow, live, work and age [and are] shaped by the distribution of money, power and resources” – is increasingly the focus of articles, research… Read More »