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Dear John,
The December 2022 issue of Health Affairs
includes research funded through the Robert Wood Johnson Foundation’s Equity-Focused Policy Research program. In an introductory analysis, Daniel Finkelstein and colleagues describe the relationship between income and health.
Although various government programs provide a financial safety net, the authors point out that "there is inequitable access to these programs, which can exacerbate health disparities."
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Equitable Social Supports
The Earned Income Tax Credit (EITC) is associated with improved health outcomes, but about one in five eligible families do not receive the benefit.
In interviews with EITC-eligible Californians, Rita Hamad and coauthors find gaps in awareness of the program, confusion about complex eligibility requirements, and language barriers to obtaining needed information.
Dana Thomson and coauthors examine EITC receipt among eligible Hispanic families. They find "lower odds of EITC receipt among income-eligible families with a self-employed parent, families with a parent who had lower English language proficiency, and families living with relatives."
Enrollees in Temporary Assistance for Needy Families (TANF) face sanctions if
they do not comply with various program requirements.
Quantitative analysis of Illinois data conducted by Kathryn Kaplan and coauthors shows that "Black and multiracial families enrolled in TANF were more
likely to be sanctioned compared with families of other races."
Qualitative interviews highlight the role of child support cooperation requirements, which the authors refer to as "an outdated and institutionally racist operating model that takes away money from families that are already struggling to achieve economic stability."
Donna Ginther and Michelle Johnson-Motoyama examine the association between state TANF policies and child welfare.
As economic resources are correlated with child maltreatment, the authors find that state TANF policies that restrict access to benefits yield "statistically significant increases in neglect victims, total foster care placements, and foster care placements for reasons of neglect."
Policy makers worry that benefits "cliffs," where a small increase in income can reduce or eliminate eligibility, serve as disincentives to work or advancement.
In interviews with low-income parents in Pittsburgh, Pennsylvania, Kess Ballentine and coauthors find little evidence of this response.
Rather, they report, "In the context of a limited social welfare system and a labor market rife with jobs with low pay, meager fringe benefits, and little flexibility, parents focused on securing the
right balance of resources, including money, time, energy, and in-kind resources, to promote family well-being."
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Community Health
In a Policy Insight, Anthony Iton and coauthors argue that population health interventions intended to promote equity and reduce disparities must shift from a "technocratic" approach with a "focus on individuals’ behaviors, genes, or access to health care" to one based on communities exercising power.
The work of health equity, the authors state, "requires enhancing the quality of democracy to change the status quo power balance in communities throughout the US."
Stephen Trinidad and coauthors analyze fifteen indices of area-based socioeconomic deprivation, identified through a systematic scoping review, and find variation in the data used to define deprivation, the geographic boundaries used to define each area, and whether or not the indices rank areas.
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Access To Care
The Colorado Family Planning Initiative expanded access to contraceptives in 2009 by allowing all clients of Title X clinics to choose any contraceptive method approved by the Food and Drug Administration at low or no cost to the client.
Sara Yeatman and coauthors find that the initiative led to a 6–12 percent increase in on-time college completion among women.
Drawing upon Germany’s reference pricing for anti-inflammatory biosimilars, James Robinson
explains that it is "administratively feasible, clinically acceptable to patients, and financially beneficial to purchasers" to group biologics and biosimilars into a single category for payment, as advocated by the Medicare Payment Advisory Commission.
Using national data from the period 2011–15, Paula Chatterjee and coauthors find that up to 31.6 percent of Medicaid disproportionate share hospital payments, which subsidize hospitals serving low-income patients and providing uncompensated care, have gone to hospitals that "demonstrated low orientation toward caring for low-income populations."
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Acknowledgments
Health Affairs thanks the Robert Wood Johnson Foundation for its financial support of the equitable social supports articles. As the year comes to a close, I express my deep gratitude to Sarah Kolk and Ndidi Anekwe for preparing excellent drafts of the article summaries that appear in each month’s From The Editor-In-Chief.
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Health Affairs Branded
Post:
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This month, we'll feature authors from the
December issue discussing topics like expanded contraceptive access and the use of area-based socioeconomic deprivation indices.
Recently, Health Affairs Editor-in-Chief Alan Weil interviewed Abdinasir Ali from the University of Iowa College of Public Health to discuss the effects of state eviction
moratoriums on mental health.
Check out our podcasts, and subscribe on Spotify, Apple, or wherever you prefer to 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.
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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