Preview

Telemedicine

In response to COVID-19, the Centers for Medicare and Medicaid Services significantly expanded Medicare’s telemedicine coverage. Sanuja Bose and coauthors explore the relationship between telemedicine use and the Area Deprivation Index, a composite sociodemographic measure of a neighborhood.

As telemedicine use increased, they find, the highest odds of use were seen for people living in the most disadvantaged neighborhoods.

Three Perspectives reflect on Bose and colleagues’ findings and the importance of equity as a priority in telehealth. Elaine Khoong notes that equitable access is challenging in a fee-for-service payment environment.

Jen Lau and Janine Knudsen describe the importance of using a community-based approach to address disparities in access.

Meena Seshamani adds that telehealth policy evaluation must examine equity, quality, access, and sustainability.

Disparities

The Child Tax Credit was temporarily expanded between July and December
2021.

Using survey data, Elizabeth Adams and coauthors determine that
during the expansion, rates of very low food security were cut by more than half, and there were small reductions in children’s consumption of added sugar.

Steven Martino and coauthors assess the quality of care received by American Indian/Alaska Native (AI/AN) Medicare Advantage enrollees. They fared better than their White counterparts on some measures and worse on others, with the differences occurring within the same health plans.

The authors identify “the need to address large inequities in the treatment of alcohol or other drug dependence, COPD, and diabetes—all conditions that AI/AN people suffer from at higher rates than the overall US population.”

Yuqi Zhang and coauthors analyze rates of unplanned surgery among
Medicare beneficiaries that preferably should be planned when there is adequate access to care.

Beneficiaries who live in communities with a higher Social Vulnerability Index are more likely to undergo unplanned surgery for certain access-sensitive conditions and more likely to experience worse outcomes than their less-vulnerable counterparts.

Pharmaceuticals

Despite major health policy changes, Brendan Saloner and coauthors observe few changes in substance use disorder (SUD) treatment use between 2010 and 2019.

Ultimately, they conclude, “increasing health insurance coverage may be insufficient, on its own, to boost SUD treatment use.”

C. Joseph Ross Daval and coauthors examine the 482 new drugs and biologics approved by the Food and Drug Administration (FDA) between 2010 and 2021, with a particular focus on the ten drugs approved despite a negative advisory committee vote.

They find that “the number of new approved drugs receiving advisory committee review decreased from 59 percent in 2011 to only 6 percent in 2021,” and note inconsistencies in the wording of FDA questions posed to the advisory committees.

Johanna Catherine Maclean and coauthors find that substantiated infant
maltreatment reports with the mother as the perpetrator increased by 38.4 percent after punitive prenatal substance use policies—those that criminalize prenatal substance use or consider it to be child maltreatment—were adopted by states in 2004–18.

Age-Friendly Health

Christine Ritchie and Bruce Leff describe what a care delivery system for elders focused on the home and community would look like, and they present evidence to support its importance.

They define the principles that should guide its development and discuss what it would take to create it, noting that the current facility-based system, “although convenient for clinicians, [has] turned out to be suboptimal for many patients.”

Rachael Bedard and coauthors provide a first-of-its-kind overview of the health of older adults incarcerated in New York City’s jail system. Referencing the premature aging of people who are incarcerated, the term “geriatric” is applied to people age fifty-five or older.

This group, which accounted for 8.5 percent of all detainees in 2019, is more than three times as likely as younger detainees to have a major medical or mental health diagnosis.

In an Entry Point article, Jonathan Bor describes the public health crisis of an aging prison population.

Among assisted living residents enrolled in fee-for-service Medicare who died in 2018–19, Helena Temkin-Greener and coauthors report that dual Medicare-Medicaid enrollees were significantly less likely to die at home and more likely to die in hospitals or nursing homes compared with non–
dual enrollees.

Further, “Black residents, regardless of dual enrollment status, were significantly less likely than White residents to have been enrolled in hospice at death.”

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 May 4, you are invited to attend a Professional Development event about careers in health policy with Katherine Baicker, a leading scholar in the economic analysis of health policy.

On May 17, Avital B. Ludomirsky will join the Journal Club event titled "In Medicaid Managed Care Networks, Care Is Highly Concentrated Among A Small Percentage Of Physicians."

On May 23, Nakela Cook, executive director of the Patient-Centered Outcomes Research Institute (PCORI), will be featured at the Policy Spotlight event.

On May 31, join Rachael R. Hardeman for a Professional Development event about improving the measurement of structural racism to achieve antiracist health policy.

Each week, Health Affairs Editor-in-Chief Alan Weil brings you in-depth conversations with leading researchers and influencers shaping the big ideas in health policy and the health care industry.

A Health Podyssey goes beyond the pages of Health Affairs to tell stories behind the research and share policy implications.

This month, upcoming guests will include Vilsa Curto, Caitlin Hicks, and more authors from the May issue of Health Affairs.

On a recent episode, Stacie Dusetzina chats with Health Affairs Editor-in-Chief Alan Weil about the complex world of drug pricing.

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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