Competition between hospitals in a given market should provide incentives to ensure quality while also lowering costs. Over the past two decades, hospital markets have increasingly consolidated. This consolidation reduces competition and increases the comparative leverage that hospitals and associated health systems have. While there are some theoretical advantages of increased consolidation such as potential… Read More »
In January, the Medical Care Blog’s editors published a consensus statement on climate policy and health. This statement was co-signed by many of our authors, editors, and editorial board members of the Medical Care journal. As we look ahead to our focus theme for 2024, we want to begin with a look backward as well.… Read More »
California just took a significant step toward single payer health care. On Oct 7, Governor Gavin Newsom signed Senate Bill 770 (Unified Health Care Financing) into law. Introduced by Senator Scott Wiener (D-San Francisco), the law directs the Secretary of the California Health and Human Services Agency to research, develop and pursue a waiver framework… Read More »
This entry was one of the winners of our Summer 2023 student blog contest! Trends in Life Expectancy The recent decline in life expectancy in the United States is largely attributed to the well-known COVID-19 pandemic and opioid epidemic. However, these recent crises are not the sole drivers of the stagnation and subsequent drop in… Read More »
This entry was one of the winners of our Summer 2023 student blog contest! Anti-LGBTQ laws are flooding the United States. As of June, a historic 491 anti-LGBTQ bills have been introduced in 2023 – a 203% increase from the entire 2022 year. More bills were introduced in the first three months of 2023 than… Read More »
The way we’re addressing substance use and overdoses in the United States isn’t working. Let’s be perfectly clear: the “war on drugs” isn’t, and never was, really a war on drugs. It’s been a war waged on communities who are Black, Indigenous, and People of Color (BIPOC). The war on drugs started well before President… Read More »
The rapid transition from in-person to care to telemedicine visits at the start of the COVID‑19 pandemic did not adversely affect the quality of care – and even improved some aspects of care – for patients with major depression in a major integrated health system, according to a new report. The study appears as part of… Read More »
It’s that time of year again–APHA’s Annual Meeting! This year we’ll be meeting in Boston Nov. 6-9 with a digital event Nov. 14-16. I’m looking forward to seeing colleagues this year and getting to catch up with so many interesting people. Of course, I’m also excited about the excellent Medical Care Section Program. Here’s a… Read More »
As California settles into a third year of pandemic, covid-19 continues to pose a serious threat of death. But the number of people dying — and the demographics of those falling victim — has shifted notably from the first two years. Given the collective immunity people have garnered through a combination of mass vaccination and… Read More »
The Medicaid Outcomes Distributed Research Network (MODRN) was started by AcademyHealth and is a collaborative research network of state Medicaid agencies and university partners. The goal of the network is to allow analysis and learning about Medicaid by facilitating comparison across states and aggregate data with a shorter lag time than other available sources. This… Read More »
On this month’s episode of the Health Intersections Podcast, Samy Anand from the Medical Care Section recaps last month’s blog posts and previews September’s issue of the Medical Care journal. Check out these great reads. Next, Jess Williams, co-editor of the blog and podcast, interviews Dr. Cheryl Conner who is a Clinical Associate Professor at… Read More »
The pursuit of health equity requires public health and medical professionals to become adept at policy in their health advocacy work. The American Public Health Association (APHA), in fact, defines policy work as one of its 10 essential public health services. APHA says professionals should be capable of “creating, championing and implementing policies, plans and laws”.… Read More »
Almost 30 years ago I was working in the White House as part of a team working to win approval of President Bill Clinton’s proposal for universal health insurance. The effort was winding down. It was obvious it would fail. I was tired and depressed. One of my last appearances in support of the plan… Read More »
In the United States, 700 women die every year from often preventable pregnancy or childbirth complications. An additional 60,000 more experience highly preventable birth injuries. Black women are three times more likely to die from those complications than white women. According to the CDC, the maternal mortality rate in the U.S. is roughly 17.4 maternal… Read More »
While some health outcomes improve in the United States, racial and ethnic disparities in pregnancy-related outcomes persist. In the United States, Black women are three times more likely to die from a pregnancy-related complication than white women. In Kansas, Black women are more than three times as likely to die of pregnancy-related complications compared to… Read More »
The pace of progress is never fast enough for those who stand to suffer the biggest losses. Nowhere is this more apparent than in the glaring health inequities impacting Black mothers and babies in Kansas. Among the multitude of injustices Black Kansans face today, the disproportionate rates of death and devastating health complications for Black… Read More »
Nonprofit hospitals make up the majority of hospitals in the US. In exchange for their tax-exempt status, the federal government requires these hospitals to provide support in the form of community benefits. Tracking community benefit spending and its impact is important to ensure that such spending aligns with community needs. Community benefit activities can include… Read More »
How is research on patient-centered transitional care going? A supplement on this topic funded by the Patient-Centered Outcomes Research Institute (PCORI) was recently published in Medical Care. Care transitions are “ripe with hazard,” as discussed in an editorial from Amy Berman. As pointed out by Berman, figuring out what works and what doesn’t is critical to… Read More »
The pandemic has familiarized us all with the phrase “medical mistrust,” often framing those who have it as being irrational or uninformed. Oft ignored is the biomedical community’s long legacy of broken trust. Addressing cancer-related inequities will require health professionals to make concerted efforts to repair that broken trust. Cancer and Broken Trust People of… Read More »
The Biden Administration’s proposed infrastructure investments are an example of an upstream effort to address disparities related to social determinants of health (SDOH). As mentioned in our previous blog post, SDOH are the conditions or circumstances within which people live, and these differ based on the distribution of power, money, and resources. The systems and… Read More »
What is telehealth? Telehealth involves using technology to facilitate healthcare interactions but has not been used extensively in Medicare in the past. The use of telehealth may be particularly relevant where there are geographic barriers such as a lack of local providers or a public health emergency such as the coronavirus pandemic. There are a… Read More »
The World Health Organization (WHO) defines social determinants of health (SDOH) as the non-medical factors that influence health outcomes. They are the “conditions in which people are born, grow, work, live, and age.” Currently, SDOH is a hot topic as stakeholders try new ways to improve individual and population health, achieve health equity, and reduce… Read More »
Over 30% of Black, Latinx, and Indigenous populations in the US are enrolled in Medicaid programs; more than half of all Medicaid enrollees are people of color. As such, Medicaid policies disproportionately affect populations of color. As more institutions reckon with historical and current injustices due to centuries of racism and racist policies, understanding how… Read More »
In an earlier post, we showed how rural prisons and census methods create distortions in county demographic and health statistics. In this post, we add further evidence and discuss the economic, political, and research implications of these potentially misleading data. National survey methodology may contribute to inaccurate data Census policy coupled with national survey methodology… Read More »
During the past year, the COVID-19 pandemic has highlighted health inequality created by social determinants of health (SDoH) in the United States. SDoH include all aspects of the living environment, social support, safety, well-being, and resource availability, directly or indirectly influencing physical health outcomes. Consideration of SDoH is critical for successful comprehensive COVID-19 vaccine rollout.… Read More »
How could alternative pediatric payment models help to address children’s broad health, social, and developmental needs? This post delves into funding and financing challenges and potential solutions. I recently collaborated on a report on alternative payment models for child health with colleagues from the Duke Margolis Center for Health Policy and Mental Health America. The… Read More »
National Rural Health Day provides an opportunity to reflect on the quality of medical care in rural and medically underserved communities. This year has posed additional challenges to fragile healthcare systems and vulnerable populations. Faced with new barriers, rural communities are adapting and innovating through telehealth. COVID-19 caught the entire country off balance, highlighting structural… Read More »
In March, CMS and other Federal agencies announced temporary telehealth policy changes in response to the COVID-19 public health emergency. These changes promoted continued access to care while allowing for physical distancing. Virtual care encounters have increased since March. However, as the public health emergency has continued, there are questions about the future of virtual… Read More »
In this series on options for universal coverage, we explore elements of various reform proposals and evaluate their potential impact. Rather than examining complete proposals, we highlight specific policy elements that appear in one or more such proposals. The three we focus on in this series are: Eliminating Medicare Advantage (May 14, 2020) Expanding Medicare… Read More »
Note from the Editors: Last week capped two jam-packed weeks of political nominating convention activities. COVID-19 was discussed at both conventions. The Washington Post fact-checked some of the health care claims at the Democratic convention. Here, with the permission of Kaiser Health News and Politifact, we are republishing their recent fact-checking of the COVID-19 content from the Republican… 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 »
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 »
The need for a comprehensive payment approach that supports the entire maternity care experience from prenatal, labor, and delivery, to postnatal care, is critical for both maternal and child health outcomes. Aligning payment to reward better birth outcomes is becoming more widespread. A handful of states are experimenting with bundled payments to advance value-based payment… 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 »
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 »
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 »
Creating the Healthiest Nation: For science. For action. For health. The annual meeting of the American Public Health Association is just around the corner! The meeting starts this weekend, November 2nd, and runs through November 6th in Philadelphia. Special Sessions The Medical Care Section has some fantastic sessions planned for the meeting. In addition to… 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 »
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 »
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 »
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 »
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 »
Reactions to the opioid crisis are affecting patients in need of hospice and end-of-life care in the United States. Hospice providers have been largely exempt from the increasing regulation of opioid and narcotic prescriptions, as most recent laws and regulations affecting opioid prescribing specifically exempt individuals receiving cancer treatment, palliative care, or those nearing their end-of-life. However,… Read More »
During my time as a community pharmacist in Maryland, I often encountered individuals who would approach the pharmacy in search of syringes. Although they would try to disguise their intentions by stating that they needed it for someone else or for an animal, it was apparent why they were there; they were going to use… Read More »
The Centers for Medicare and Medicaid Services (CMS) has a set of “Compare” websites – Hospital Compare, Nursing Home Compare, Home Health Compare, etc.; consumers and policymakers can compare physicians, long-term care hospitals, inpatient rehabilitation facilities, hospice care, and dialysis facilities today, and other settings may follow. Together with their associated health care quality measurement… Read More »