In a recent Health Affairs blog post, Universal Health Coverage? Why?, Walter McClure, Alain Enthoven, and Tim McDonald make a convincing case for expanding health insurance coverage in the United States. They argue that universal coverage is a “wise public investment” that “expands the workforce and makes it more productive,” similar to universal public education.… Read More: Universal Health Coverage? A Response »
Annual routine check-ups, flu shots, and mammograms are among the basic preventive services for which the Patient Protection and Affordable Care Act of 2010 established a mandate for insurance plans: full coverage, with no out-of-pocket costs. In making it a little easier for some parts of the US population to access basic services, did the… Read More: Getting recommended preventive care: costs aren’t the only barrier »
One of the challenges in delivering efficient medical care is identifying people who are at risk of a negative outcome, so we can focus our efforts on screening and treating those at elevated risk. We do this in individual face-to-face encounters through clinical, diagnostic processes: taking a patient’s history, performing a physical examination, recording signs… Read More: New methods in risk modeling: does adding EHR data improve… »
Cancer is a dreaded disease – and in the US, a typical response to a cancer diagnosis is to try every treatment available in hopes that something might work. Understandable! But cancer overtreatment is a serious problem that drives up costs, causes avoidable morbidity and mortality, and reduces the quality of care. What is overtreatment?… Read More: Cancer care: sometimes less is more »
Recently, I sat down to talk with Arlene Ash, PhD about risk adjustment. Dr. Ash is Professor and Chief of the Division of Biostatistics and Health Services Research, Department of Quantitative Health Sciences at the University of Massachusetts Medical School. As a methods expert on risk adjustment in health services research, she has pioneered tools… Read More: The Past, Present, and Future of Risk Adjustment: An Interview… »
The burden of contraception falls primarily on women. In the United States, women need prescriptions for the majority of contraceptive methods, and so are vulnerable to changes in the healthcare system affecting access to care. Recently, President Trump has issued executive orders on religious liberty and related subjects that have paved the way for a rule… Read More: POLICY UPDATE: Contraception Coverage »
This post is the final one in our 4-part series focusing on presentations that were delivered at a special panel session at APHA16 on the childhood roots of health inequity [part 1, part 2, part 3]. Our fourth presenter, Dr. Jennifer Manly, is Associate Professor of Neuropsychology in Neurology at the Gertrude H. Sergievsky Center and the… Read More: The Childhood Roots of Health Inequity: Part 4 – Dr.… »
This post is the third in our series focusing on presentations that were delivered at a special panel session at APHA16 on the childhood roots of health inequity [part 1, part 2]. Our third presenter, Kerith Conron, ScD, MPH, is currently the Blachford-Cooper Distinguished Scholar and Research Director at The Williams Institute of UCLA’s School… Read More: The childhood roots of health inequity: Part 3 – Dr.… »
Ten years ago, Medicare began publicly financing and subsidizing the prescription drug program for seniors known as Part D. Individuals over age 65 with incomes below poverty are dually eligible for both Medicaid and Medicare, and full-benefit dual enrollees are automatically enrolled in a subsidized prescription drug plan with minimal co-payments. Turns out, this policy intervention may have played… Read More: How did Part D affect mortality among women with breast… »
High-quality evidence supports the use of medical marijuana for chronic pain, neuropathic pain, and other conditions. Yet, patients who live in some states can’t legally use it — and are threatened with loss of access to their prescribed pain medications if they do. I know this because a close family member of mine has chronic pain.… Read More: Chronic pain, opioids, and medical marijuana »
Exposure to toxic stress in childhood is associated with adult health inequities. Last fall, the Medical Care Health Equity Committee organized a special panel presentation on the topic at the 2016 APHA Annual Meeting. This post is the second of a series of posts.
Children who grow up in stressful environments, without adequate adult support, are at much greater risk of developing heart disease, cancer, and many other diseases as adults. This is partly because of the coping behaviors that people use to deal with stress, but also because of the cumulative effects of toxic stress. Thus, many of… Read More: The childhood roots of health inequity: Part 1 – Dr.… »
After a whirlwind APHA 2016 in Denver, we are back with a quick summary of the meeting and Medical Care Section events. There were about 11,600 conference registrants overall. We were impressed with the great turnout for Medical Care Section events. We had standing room only for the Special Invited Panel Session: The Childhood Roots of Health Inequity, a… Read More: APHA 2016 – Editors’ Wrap-up »
In just a few days, thousands of public health practitioners, students, scholars, and activists will descend on Denver, Colorado for APHA 2016. This year, your faithful co-editors will be there, live-tweeting about sessions! So be sure to follow @MedCareBloggers for real-time updates. Here are just a few of the sessions we’re looking forward to this year:… Read More: APHA16 Preview »
President Obama’s Affordable Care Act (ACA) included provisions to gradually reduce the Medicare part D “doughnut hole” – a much-maligned gap in coverage that was an economizing feature of President Bush’s legislation. So, how have these changes affected drug use and spending by seniors? A new article in Medical Care provides insights. Under the standard part D benefit… Read More: The ACA vs. the doughnut hole: Medicare part D utilization… »
Diversity in clinical trials is critically important. Each new treatment needs to be tested in a broad, diverse population, because men and women of different ancestries have different responses to both diseases and treatments. If only certain groups of people participate in clinical trials, it can increase disparities and worsen outcomes for people underrepresented in the clinical trial data. Until… Read More: Broadening participation in clinical trials »
Medical Care has recently published two papers on the topic of pressure ulcers — costly, painful, largely preventable infections associated with poorer quality care. In the first, from researchers at the University of Manitoba, York University, and the University of British Columbia, lead author Malcolm Doupe, PhD and colleagues focus on the risk of developing stage… Read More: Pressure ulcers: risk factors and the power of policy »
Quality in healthcare can be a slippery concept. But in general, our medical system treats mortality as the ultimate adverse event. Higher mortality is thought to indicate poorer quality care. But what if death were the appropriate and preferred outcome for an individual? Consider the hypothetical case of an 87-year-old man named Philip. Philip has a living… Read More: Death is not always an adverse event »
If you had to find a nursing home for a loved one, would you pick an independent, non-profit facility over a facility that was affiliated with a large, for-profit chain? If you said yes, your instincts are good. Independent and non-profit nursing homes are rated higher by patients and their families on the experience of their care. Kai… Read More: Families rate independent and nonprofit nursing homes higher on patient… »
“Breaking The Fee-For-Service Addiction: Let’s Move To A Comprehensive Primary Care Payment Model,” a recent Health Affairs blog post by Rushika Fernandopulle of Iora Health, argues for replacing FFS payment with risk-adjusted comprehensive payments for primary care. We agree. However, the post portrays sponsors’ continuing to require submission of “dummy claims” as an unproductive addiction… Read More: Breaking the Fee-for-Service Addiction: Don’t Throw the Baby Out with… »
Support for patient-centered medical homes (PCMH) has been growing in recent years. A typical PCMH model includes a primary care physician supported by a multidisciplinary team, coordinated care, measurements of quality and safety, and enhanced access to same-day appointments. Preliminary program evaluations have shown that PCMHs can improve access and quality, but to date, there… Read More: Evaluating the ability of patient-centered medical homes to improve clinical… »
Emergency department (ED) use has been increasing in the US for several decades, and some estimate that about half of all outpatient ED visits are potentially avoidable (also referred to as primary-care sensitive, or PCS). ED visits are expensive and may signify issues with access to, and quality of, care. Thus, reducing ED use is… Read More: Emergency Department Use in Massachusetts for Low-Income Adults with Subsidized… »