The COVID-19 pandemic has prompted patients and providers to delay or cancel a substantial share of medical care in the past year. In an article published ahead of print, Kevin Callison and Jason Ward examined the socioeconomic and demographic characteristics of patients who have been subject to these involuntary care disruptions.

Using survey data from May through October 2020, they found that, "older age, being in fair or poor health, greater education, the presence of a work-limiting disability, and having health insurance coverage were associated with greater likelihood of experiencing an involuntary disruption in accessing medical care as a result of the COVID-19 pandemic."

Kathleen Yinran Li and coauthors sought to better understand the overall costs associated with video-based, on-demand, patient-initiated telemedicine for acute respiratory infections. They evaluated direct-to-consumer telemedicine claims from a large commercial payer for 2016 to 2019 and found that 10.3 percent of these telemedicine visits led to subsequent in-person visits, compared to only 5.9 percent of in-person encounters.

Ge Bai and colleagues compared charity care in 2018 across government, nonprofit, and for-profit hospitals. They found that, among Medicare-certified general acute care hospitals, the nonprofit hospitals provided the least aggregated charity care. For every $100 of expense incurred, nonprofit hospitals spent less on charity care ($2.3) than for-profit hospitals ($3.8) or government hospitals ($4.1).

Providers are increasingly subject to payment policies based on their performance, and there is consensus that we should consider clinical factors, such as disease severity, when measuring the quality of a provider’s care. But adjusting for social risk factors, such as poverty, remains controversial.

In an April 2021 paper as part of our Policy Insight series, David Nerenz and coauthors reviewed the arguments on both sides of this debate and posed five questions that policy makers should consider when making a determination for a particular quality measure. The authors concluded that "social risk adjustment should be the default option," and that it can be an important tool for promoting health equity.

Using data from New York City on hospital readmissions, Matthew Baker and coauthors compared condition-specific models that estimate readmission rates currently used by the Centers for Medicare and Medicaid Services with multiple alternative models for the same patients, augmented with social determinants of health (SDOH) scores.

This week on Health Affairs Blog, Katie Keith provided the latest on 2021 Affordable Care Act Marketplace enrollment, navigator funding, and more. Keith also summarized the latest in litigation over an Obama-era rule implementing Section 1557, including at least two pending challenges to the Obama-era interpretation of this provision.

Finally, in celebration of National Poetry Month, we’re revisiting the three poems that won the 2019 Narrative Matters poetry contest and were featured in the April 2020 issue of Health Affairs: "The Headache," "Epidemic," and "Admission." Listen to the authors read their poems on our Narrative Matters podcast.

Request For Abstracts:
Racism And Health

Health Affairs is planning a theme issue on racism and health, with an emphasis on structural racism, to be published in February 2022. We plan to publish approximately twenty peer-reviewed articles—including original research, analyses, commentaries, and Narrative Matters—from a diverse group of researchers, scholars, and community health leaders, among others.

We’re looking for content to help shape future research and policy.

Health Affairs thanks the Robert Wood Johnson Foundation and the Episcopal Health Foundation for their generous support of this issue.

About Health Affairs

Health Affairs is the leading peer-reviewed journal at the intersection of health, health care, and policy. Published monthly by Project HOPE, the journal is available in print and online. Late-breaking content is also found through healthaffairs.org, Health Affairs Today, and Health Affairs Sunday Update.

Project HOPE is a global health and humanitarian relief organization that places power in the hands of local health care workers to save lives across the globe. Project HOPE has published Health Affairs since 1981.

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