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Hospitals

Amid growing attention on hospitals suing their patients for unpaid bills, Zack Cooper and coauthors find that the number of lawsuits increased by 37 percent in Wisconsin from 2001 to 2018. There were 1.86 lawsuits per 1,000 Black residents compared to 1.32 per 1,000 non-Hispanic White residents, with higher rates of lawsuits by nonprofit hospitals and in less densely populated counties.

Examining the state role in antitrust enforcement, Brent Fulton and coauthors conclude that “relatively few proposed hospital mergers were challenged under antitrust laws or administrative merger review processes in the last ten years, despite over 90 percent of MSAs [metropolitan statistical areas] having a highly concentrated hospital market.”

Medicaid expansion has been found to improve hospital finances overall, but critical access hospitals face particular challenges and generally have low operating margins. Paula Chatterjee and coauthors report that these hospitals in Medicaid expansion states did not have statistically significant postexpansion increases in operating margins, staffing levels, or quality measures relative to hospitals in nonexpansion states.

Workforce

Analyzing data from over 80,000 full-time physicians, Christopher Whaley and coauthors find that male physicians earn approximately $2 million, or 25 percent, more than female physicians over the course of a simulated forty-year career. These results account for potentially confounding factors including hours worked, practice type and location, and years of experience.

In a separate paper, Whaley and coauthors explored physician compensation in the context of rapid growth in health system acquisition of physician practices. Vertical integration is associated with a 0.8 percent reduction in regression-adjusted income among physicians overall. Surgical specialists saw small increases in income, while nonsurgical specialists had small declines.

Direct care workers in long-term care, including personal care aides and nursing assistants, make up one-fifth of the US health care workforce. According to Esther Friedman and colleagues, almost all states experienced an increase in the size of their home care workforce between 2009 and 2020, and most saw a decrease in their nursing home workforce, relative to the number of people who need these services.

Equity

In the early weeks of COVID-19 vaccine availability, one-quarter of Florida’s doses were distributed through pharmacies at Publix grocery stores. Jennifer Attonito and coauthors find that these stores tend to be located in areas with an older, higher-income, and larger share White resident population. In addition: “Percentage of households at or below poverty and percentage of the population identifying as Hispanic were negatively associated with total number of vaccination sites.”

Kayte Spector-Bagdady and coauthors explore the reasons for racial and ethnic disparities in research biospecimen and data bank recruitment and enrollment at a major academic medical center, Michigan Medicine. Not only are patients eligible to enroll more likely to be older, White, and male and live in socioeconomically advantaged neighborhoods than the overall population served by the hospital, but, also, “Black or African American and Asian patients were almost twice as likely to decline enrollment compared with [non-Hispanic] White patients.”

Kevin Nguyen and coauthors examine rates of kidney failure among US adults. While kidney failure rates declined overall, disparities between low-poverty and high-poverty counties widened between 2000 and 2017. High-poverty counties—those with about one-quarter of the population living below the federal poverty level—saw an increase in kidney failure rates of 7.8 percent.

Medicare & Medicaid

Michael Chernew and coauthors find a growing gap between claims-based and survey-based measures of health status among accountable care organization (ACO) enrollees, suggesting that coding practices are behind rising risk scores.

Adam Markovitz and colleagues examine nine measures used to provide substantial financial bonuses to higher-quality Medicare Advantage (MA) plans. Comparing MA enrollees with a commercially insured population before and after the bonus program was implemented, they conclude that the program “was not associated with consistent changes in quality performance, with post-period quality performance increasing for some measures, decreasing for others, and remaining relatively flat for overall quality performance.”

Asset tests are imposed by states to limit Medicaid coverage to people who lack resources to pay for care. Noelle Cornelio and coauthors estimate how four possible changes to asset tests would affect the number of low-income seniors living in the community who would qualify for full Medicaid benefits.

Join Health Affairs for a free virtual event! In addition to the new journal edition, we produce a variety of events that relate to research published in Health Affairs and bring professionals up to speed on the latest in health policy research.

On December 9, meet author Kevin Nguyen during a special Journal Club session where he'll discuss his research article "Despite National Declines In Kidney Failure Incidence, Disparities Widened Between Low- And High-Poverty US Counties" from the December issue.

On December 15, join Health Affairs Executive Publisher Jane Hiebert-White as she leads a Professional Development session on measuring the impact of your research in academia, the media, and beyond.

Alongside the issue release, we invite authors from the issue to speak with Editor-in-Chief Alan Weil on our A Health Podyssey podcast, which features interviews with leading and up-and-coming researchers in health services and health policy.

Don't miss the latest episodes, where Ashish Jha discusses health care payment reform and Sabrina Poon breaks down the controversial two-midnight rule and its effects on hospital admissions.

A new episode with Jennifer Attonito discussing her research published in the December issue on the sociodemographic disparities in access to COVID-19 vaccines upon initial rollout in Florida will go live tomorrow morning.

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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