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John,
This month's issue of Health Affairs covers topics including patient
behavior in the face of high drug costs, access to reproductive health
services, hospital price variation, the effects of commercial
value-based payment models, and more.
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Access To Care
Examining electronic health records of Medicare Part D enrollees in
eleven
health care systems around the country, Stacie Dusetzina and coauthors
find that almost 30 percent of enrollees who were prescribed a high-cost
cancer drug did not fill the prescription within ninety days
.
Enrollees who received a low-income subsidy were nearly twice as likely
as others to fill the prescription.
Blair Darney and coauthors show that community health center clinics
that received Title X funding in the period 2016-18 provided access to
the most effective forms of contraception at about a 50 percent higher
rate
than clinics that did not receive Title X funding. These data predate
changes in the Title X program that were made by the Trump
administration and then reversed by the Biden administration.
Ushma Upadhyay and colleagues gather comprehensive data on abortion
charges and find that median patient out-of-pocket charges increased for
medication abortion
and first-trimester procedural abortion during 2017-20 by 13 percent
and 21 percent, respectively, whereas the proportion of facilities
accepting insurance declined by 9 percentage points.
Jane Zhu and coauthors analyze utilization data and conclude that the
initial disruption of in-person mental health services delivery during
the COVID-19 pandemic was quickly offset by the use of telehealth
,
although overall encounters fell for people with bipolar disorder and
schizophrenia.
Read More
Hospitals
Adding to the literature on hospital price variation, Zachary Levinson
and
colleagues find that commercial-to-Medicare price ratios have been
relatively stable
,
increasing 7 percentage points from 2012 to 2019. The overall trend
masks significant variation by hospital referral region.
Marcelo Cerullo and coauthors investigate private equity acquisition of
short-term acute care hospitals
and determine that although acquisition is associated with a $432
decrease in cost per adjusted discharge and a 1.78-percentage-point
increase in operating margin, it is also associated with "decreases in
total beds, ratio of outpatient to inpatient charges, and staffing."
Although Medicaid expansion reduced hospital closures overall, Caitlin
Carroll and coauthors find no relationship between Medicaid expansion
and
retention of obstetric units
or survival of hospitals offering obstetric services.
Read More
Social Context
Charron Long and coauthors find that older adults enrolled in Humana's
Medicare Advantage plans experience high rates of health-related social
needs.
Almost half of Black enrollees report financial strain compared with 30
percent of White enrollees, and one in five rural enrollees report
poor-quality housing compared with approximately one in six urban
enrollees.
Analyzing tenants' reports of asthma triggers in Boston,
Massachusetts, Evan Lemire and coauthors conclude that for each 10
percent increase in a neighborhood's proportion of White residents,
the incidence of reported asthma triggers decreases by 3.14 reports per
thousand residents
.
For each 10 percent increase in neighborhood median household income,
the incidence of reported asthma triggers decreases by 3.02 reports per
thousand residents.
Every state and Washington, D.C., require children from birth through
age
five to be vaccinated against certain communicable diseases to receive
child care. Alexandra Bhatti and coauthors examine vaccination laws and
find variability in their stringency and mechanics, including that 90
percent of jurisdictions permit provisional enrollment for children not
up to date with required vaccines
,
and 90 percent allow for nonmedical exemptions.
Read More
Payment And Spending
In their systematic literature review of value-based payment models in
the commercial insurance sector
,
Marina Milad and coauthors find that four out of five studies show
positive results for quality outcomes, and more than half show positive
results for spending and utilization outcomes.
José Figueroa and colleagues report that Medicare enrollees with HIV
who
are receiving antiretroviral therapy (ART) spend more than twice as much
on medical care as Medicare enrollees without HIV
.
Higher costs are largely
due to the cost of the ART drugs themselves; Medicare enrollees with HIV
have lower levels of mental health and chronic condition spending
relative to that of people without HIV.
In the Centers for Medicare and Medicaid Services annual projections of
national health expenditures, John Poisal and colleagues estimate that
national health spending growth will moderate
from 9.7 percent in 2020 to 4.2 percent in 2021 as COVID-19 impacts
wane. They expect the share of gross domestic product devoted to health
to decline from 19.7 percent in 2020 to just over 18 percent in the
2022-24 period.
April Issue
Subscribe today to Health Affairs to access our current and past issues
.
Attend These Events
Join Health Affairs for free virtual events
this month!
To go along with the new issue of the journal, we produce a variety of
events that expand on the research and bring health policy professionals
up to speed on the latest in health policy.
On April 12, Evan Lemire will discuss the article "Unequal Housing
Conditions And Code Enforcement Contribute To Asthma Disparities In
Boston, Massachusetts ."
On April 14, Katie Keith, Tim Jost, Rodney Whitlock, and Chris Fleming
will discuss the status and future of the Affordable Care Act
as part of a Lunch and
Learn event.
On April 26, Health Affairs will join with the Society of Health Policy
Young Professionals to host a Lunch and Learn event on the topic,
"Food Insecurity and Other Health-Related Social Needs Among Older
Adults ."
View Full Event Schedule
Listen to These Podcasts
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The second season of Health Affairs Pathways
debuted in March.
The latest season - titled "While We Wait" - joins Avni Kulkarni and
Sania Ali as they examine the mental health boarding crisis
,
which refers to the long-standing, nationwide problem of holding
patients for hours, days, or even weeks in emergency departments because
there are no available inpatient psychiatric beds in the hospital.
Listen
[link removed]
On A Health Podyssey, we'll speak with guests Stacie Dusetzina,
Alexandra Bhatti and Brian Powers to discuss topics including the prices
of specialty drug prescriptions, child care vaccination laws, and
health-related social needs among older adults.
Listen to the latest episode, where Seth Berkowitz discusses social
determinants of health benefit programs
,
health spending, and non-emergency medical transportation.
Listen
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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 . Â
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.
Copyright © Project HOPE: The People-to-People Health Foundation, Inc.
Health Affairs, 1220 19th Street, NW, Suite 800, Washington, DC 20036, United States
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