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.
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.
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.”
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.
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.
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 enrolleeswith 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.
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.
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.
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.
Health Affairs is the leading peer-reviewedjournalat 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.
