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Síndrome da Imunodeficiência Adquirida , Humanos , Síndrome da Imunodeficiência Adquirida/tratamento farmacológico , Síndrome da Imunodeficiência Adquirida/prevenção & controle , Infecções por HIV/tratamento farmacológico , Infecções por HIV/prevenção & controle , Cooperação Internacional , Estados Unidos , Programas Governamentais/legislação & jurisprudência , Governo Federal , Regulamento Sanitário InternacionalRESUMO
This Viewpoint summarizes inefficiencies in the 340B program and provides suggestions for equitable reform that will potentially benefit patients.
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Custos de Medicamentos , Programas Governamentais , Medicamentos sob Prescrição , Custos de Medicamentos/legislação & jurisprudência , Estados Unidos , Programas Governamentais/economia , Programas Governamentais/legislação & jurisprudência , Governo FederalAssuntos
Programas Governamentais , Pandemias/prevenção & controle , Administração em Saúde Pública , Desenvolvimento de Vacinas , Vacinas Virais , Animais , Surtos de Doenças , Programas Governamentais/economia , Programas Governamentais/legislação & jurisprudência , Programas Governamentais/organização & administração , Humanos , Pandemias/economia , Saúde Pública , Estados Unidos , Zoonoses/epidemiologiaRESUMO
BACKGROUND: The Community Eligibility Provision (CEP) allows high-poverty schools participating in US Department of Agriculture meal programs to offer universal free school meals. Emerging evidence suggests benefits of CEP for student meal participation, behavior, and academic performance. Although CEP became available nationwide in 2014, in school year 2019-2020, one third of eligible schools were not participating. OBJECTIVE: This study evaluates which school, district, and state factors are associated with CEP participation. DESIGN: Cross-sectional study comparing CEP-participating with eligible nonparticipating schools to assess the relationship between CEP participation and school, district, and state factors. PARTICIPANTS: US public schools eligible for CEP in school year 2017-2018 (n = 42,813). MAIN OUTCOME MEASURES: CEP participation. STATISTICAL ANALYSES PERFORMED: Penalized regression variable selection methods to determine which factors contribute information to the model. Generalized logistic regression to predict odds of CEP participation unadjusted and adjusted for each factor in the full sample and in stratified analyses by whether a state was part of the CEP phase-in period (early vs late implementing states). RESULTS: In the full sample, adjusted odds of CEP participation were greater in states where CEP had been available longer (odds ratio [OR], 1.50; 95% confidence interval [CI], 1.34, 1.67). In late implementing states, adjusted odds of CEP participation were higher in schools with more students directly certified for free meals (OR in schools with 80%-89% vs 30%-39% directly certified: 19.32; 95% CI, 12.98, 28.76), Title I schools (OR, 1.85; 95% CI, 1.55, 2.21), and urban schools (OR suburban vs urban, 0.46; 95% CI, 0.36, 0.59). Differences by school level, enrollment, district size, student race/ethnicity, and geographic region also existed. CONCLUSIONS: Findings may help advocates, state agencies, and policymakers understand potential barriers to adoption and guide research exploring effective strategies to promote uptake. Future research should use qualitative and longitudinal designs to explore barriers to adoption, including cost and state and local policies.
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Assistência Alimentar/legislação & jurisprudência , Serviços de Alimentação , Programas Governamentais/legislação & jurisprudência , Refeições , Instituições Acadêmicas , Participação da Comunidade , Estudos Transversais , Humanos , Estados Unidos , United States Department of AgricultureRESUMO
OBJECTIVES: The Balancing Incentive Program (BIP) was an optional program for states within the Patient Protection and Affordable Care Act to promote Medicaid-funded home and community-based services (HCBS) for older adults and persons with disabilities. Twenty-one states opted to participate in BIP, including several states steadfastly opposed to the health insurance provisions of the Affordable Care Act. This study focused on identifying what factors were associated with states' participation in this program. METHODS: Event history analysis was used to model state adoption of BIP from 2011 to 2014. A range of potential factors was considered representing states' economic, political, and programmatic conditions. RESULTS: The results indicate that states with a higher percentage of Democrats in the state legislature, fewer state employees per capita, and more nursing facility beds were more likely to adopt BIP. In addition, states with fewer home health agencies per capita, that devoted smaller proportions of Medicaid long-term care spending to HCBS, and that had more Money Follows the Person transitions were also more likely to pursue BIP. DISCUSSION: The findings highlight the role of partisanship, administrative capacity, and program history in state BIP adoption decisions. The inclusion of BIP in the Affordable Care Act may have deterred some states from participating in the program due to partisan opposition to the legislation. To encourage the adoption of optional HCBS programs, federal policymakers should consider the role of financial incentives, especially for states with limited bureaucratic capacity and that have made less progress rebalancing Medicaid long-term services and supports.
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Serviços de Saúde Comunitária , Pessoas com Deficiência , Programas Governamentais , Serviços de Assistência Domiciliar , Medicaid , Casas de Saúde , Patient Protection and Affordable Care Act , Política , Governo Estadual , Serviços de Saúde Comunitária/economia , Serviços de Saúde Comunitária/legislação & jurisprudência , Pessoas com Deficiência/legislação & jurisprudência , Programas Governamentais/economia , Programas Governamentais/legislação & jurisprudência , Serviços de Assistência Domiciliar/economia , Serviços de Assistência Domiciliar/legislação & jurisprudência , Humanos , Assistência de Longa Duração/economia , Assistência de Longa Duração/legislação & jurisprudência , Medicaid/economia , Medicaid/legislação & jurisprudência , Casas de Saúde/economia , Casas de Saúde/legislação & jurisprudência , Patient Protection and Affordable Care Act/economia , Patient Protection and Affordable Care Act/legislação & jurisprudência , Estados UnidosRESUMO
Due to increasing demand and scarce financial resources for healthcare, health system efficiency has become a major topic in political and scientific debates. While previous studies investigating determinants of health system efficiency focused primarily on economic and social influence factors, the role of the political regime has been neglected. In addition, there is a lack of formal theoretical work on this specific topic, which ensures transparency and logical consistency of arguments and implications. Using a public choice approach, this paper provides a rigorous theoretical and empirical investigation of the relationships between health system efficiency and political institutions. We develop a simple principal-agent model describing the behavior of a government with respect to investments in population health under different political regimes. The main implication of the theoretical model is that governments under more democratic regimes put more effort in reducing embezzlement of health expenditure than non-democratic regimes. Accordingly, democratic countries are predicted to have more efficient health systems than non-democratic countries. We test this hypothesis based on a broad dataset including 158 countries over the period 1995-2015. The empirical results clearly support the implications of the theoretical model and withstand several robustness checks, including the use of alternative indicators for population health and democracy and estimations accounting for endogeneity. The empirical results also indicate that the effect of democracy on health system efficiency is more pronounced in countries with higher income levels. From a policy perspective, we discuss the implications of our findings in the context of health development assistance.
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Democracia , Política de Saúde/legislação & jurisprudência , Sistemas Políticos , Política , Programas Governamentais/economia , Programas Governamentais/legislação & jurisprudência , Política de Saúde/economia , Humanos , Saúde da PopulaçãoAssuntos
COVID-19/prevenção & controle , Controle de Doenças Transmissíveis/organização & administração , Programas Governamentais/organização & administração , Pandemias/prevenção & controle , COVID-19/epidemiologia , Controle de Doenças Transmissíveis/legislação & jurisprudência , Programas Governamentais/legislação & jurisprudência , Humanos , Liderança , Pandemias/estatística & dados numéricos , Reino Unido/epidemiologiaAssuntos
Custo Compartilhado de Seguro/legislação & jurisprudência , Programas Governamentais/tendências , Cobertura Universal do Seguro de Saúde/normas , Cobertura Universal do Seguro de Saúde/tendências , Canadá , Custo Compartilhado de Seguro/história , Custo Compartilhado de Seguro/métodos , Programas Governamentais/legislação & jurisprudência , História do Século XX , História do Século XXI , HumanosRESUMO
The Korean government's strategy to combat coronavirus disease 2019 (COVID-19) has focused on non-pharmaceutical interventions, such as social distancing and wearing masks, along with testing, tracing, and treatment; overall, its performance has been relatively good compared to that of many other countries heavily affected by COVID-19. However, little attention has been paid to health equity in measures to control the COVID-19 pandemic. The study aimed to examine the unequal impacts of COVID-19 across socioeconomic groups and to suggest potential solutions to tackle these inequalities. The pathways linking social determinants and health could be entry points to tackle the unequal consequences of this public health emergency. It is crucial for infectious disease policy to consider social determinants of health including poor housing, precarious working conditions, disrupted healthcare services, and suspension of social services. Moreover, the high levels of uncertainty and complexity inherent in this public health emergency, as well as the health and socioeconomic inequalities caused by the pandemic, underscore the need for good governance other than top-down measures by the government. We emphasize that a people-centered perspective is a key approach during the pandemic era. Mutual trust between the state and civil society, strong accountability of the government, and civic participation are essential components of cooperative disaster governance.
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COVID-19/prevenção & controle , Equidade em Saúde/normas , Política de Saúde , Infectologia/legislação & jurisprudência , COVID-19/fisiopatologia , Programas Governamentais/legislação & jurisprudência , Programas Governamentais/métodos , Equidade em Saúde/estatística & dados numéricos , Humanos , Infectologia/métodos , Infectologia/tendências , Pandemias/prevenção & controle , Pandemias/estatística & dados numéricos , Saúde Pública/legislação & jurisprudência , Saúde Pública/métodos , Saúde Pública/tendências , República da CoreiaRESUMO
BACKGROUND: Southeast Asian countries host signficant numbers of forcibly displaced people. This study was conducted to examine how health systems in Southeast Asia have responded to the health system challenges of forced migration and refugee-related health including the health needs of populations affected by forced displacement; the health systems-level barriers and facilitators in addressing these needs; and the implications of existing health policies relating to forcibly displaced and refugee populations. This study aims to fill in the gap in knowledge by analysing how health systems are organised in Southeast Asia to address the health needs of forcibly displaced people. METHODS AND FINDINGS: We conducted 30 semistructured interviews with health policy-makers, health service providers, and other experts working in the United Nations (n = 6), ministries and public health (n = 5), international (n = 9) and national civil society (n = 7), and academia (n = 3) based in Indonesia (n = 6), Malaysia (n = 10), Myanmar (n = 6), and Thailand (n = 8). Data were analysed thematically using deductive and inductive coding. Interviewees described the cumulative nature of health risks at each migratory phase. Perceived barriers to addressing migrants' cumulative health needs were primarily financial, juridico-political, and sociocultural, whereas key facilitators were many health workers' humanitarian stance and positive national commitment to pursuing universal health coverage (UHC). Across all countries, financial constraints were identified as the main challenges in addressing the comprehensive health needs of refugees and asylum seekers. Participants recommended regional and multisectoral approaches led by national governments, recognising refugee and asylum-seeker contributions, and promoting inclusion and livelihoods. Main study limitations included that we were not able to include migrant voices or those professionals not already interested in migrants. CONCLUSIONS: To our knowledge, this is one of the first qualitative studies to investigate the health concerns and barriers to access among migrants experiencing forced displacement, particularly refugees and asylum seekers, in Southeast Asia. Findings provide practical new insights with implications for informing policy and practice. Overall, sociopolitical inclusion of forcibly displaced populations remains difficult in these four countries despite their significant contributions to host-country economies.
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Programas Governamentais , Pessoal de Saúde , Acessibilidade aos Serviços de Saúde , Migrantes , Sudeste Asiático , Programas Governamentais/legislação & jurisprudência , Pessoal de Saúde/estatística & dados numéricos , Acessibilidade aos Serviços de Saúde/estatística & dados numéricos , Humanos , Indonésia , Malásia , Assistência Médica , Mianmar , Dinâmica Populacional , Pesquisa Qualitativa , Refugiados , Tailândia , Migrantes/estatística & dados numéricosRESUMO
The US government maintains that local sanctuary policies prevent deportations of violent criminals and increase crime. This report tests those claims by combining Immigration and Customs Enforcement (ICE) deportation data and Federal Bureau of Investigation (FBI) crime data with data on the implementation dates of sanctuary policies between 2010 and 2015. Sanctuary policies reduced deportations of people who were fingerprinted by states or counties by about one-third. Those policies also changed the composition of deportations, reducing deportations of people with no criminal convictions by half-without affecting deportations of people with violent convictions. Sanctuary policies also had no detectable effect on crime rates. These findings suggest that sanctuary policies, although effective at reducing deportations, do not threaten public safety.
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Emigração e Imigração/legislação & jurisprudência , Programas Governamentais/tendências , Política Pública/legislação & jurisprudência , Adulto , Agressão , Crime , Criminosos , Deportação , Emigração e Imigração/tendências , Feminino , Programas Governamentais/legislação & jurisprudência , Humanos , Masculino , Políticas , Fatores de Risco , Estados Unidos , ViolênciaRESUMO
Five new challenges were brought to the federal management of SUS from the establishment of the Primary Health Care Secretariat (SAPS) in May 2019, as follows: a) to expand people's access to health facilities; b) to define a new financing model from health outcomes and efficiency; c) to define a new model of provision and training of family and community doctors for remote areas; d) to strengthen clinic and multi-professional teamwork; e) to expand computerization of health facilities and use of electronic medical records. This essay discusses these elements in light of a new evaluation model that also guides a new process of financing the Brazilian Primary Health Care (PHC). It builds on the correction of distributive distortions, and also seeks to guide greater effectiveness and efficiency in public investment and quality of service provided to the population. The proposal for a new PHC evaluation and financing model was elaborated through studies of the best international examples and discussion with representatives of the National Council of State Health Secretaries (CONASS) and the National Council of Municipal Health Secretaries (CONASEMS), and with technical support from the World Bank.
A partir da criação de uma Secretaria de Atenção Primária à Saúde (SAPS) no Ministério da Saúde em maio de 2019, cinco novos desafios foram trazidos para a gestão federal do SUS: a) ampliação do acesso da população às unidades de saúde da família, b) definição de um novo modelo de financiamento baseado em resultados em saúde e eficiência, c) definição de um novo modelo de provimento e formação de médicos de família e comunidade para áreas remotas, d) fortalecimento da clínica e do trabalho em equipe multiprofissional, e) ampliação da informatização das unidades de saúde e uso de prontuário eletrônico. Esse ensaio discute esses elementos à luz de um novo modelo avaliativo que, ao mesmo tempo, seja capaz de orientar o novo processo de financiamento da Atenção Primária à Saúde (APS) no Brasil. Este baseia-se na correção de distorções distributivas e também busca orientar maior efetividade e eficiência no investimento público e qualidade do serviço prestado à população. Através de estudos dos melhores exemplos internacionais e discussão com os representantes do Conselho Nacional de Secretários Estaduais de Saúde (CONASS) e do Conselho Nacional dos Secretários Municipais de Saúde (CONASEMS) e com apoio técnico do Banco Mundial, foi elaborada a proposta de novo modelo avaliativo e de financiamento da APS.
Assuntos
Programas Governamentais , Implementação de Plano de Saúde , Acessibilidade aos Serviços de Saúde , Atenção Primária à Saúde , Brasil , Programas Governamentais/economia , Programas Governamentais/legislação & jurisprudência , Implementação de Plano de Saúde/economia , Implementação de Plano de Saúde/legislação & jurisprudência , Acessibilidade aos Serviços de Saúde/economia , Acessibilidade aos Serviços de Saúde/legislação & jurisprudência , Acessibilidade aos Serviços de Saúde/organização & administração , Humanos , Atenção Primária à Saúde/economia , Atenção Primária à Saúde/legislação & jurisprudência , Atenção Primária à Saúde/organização & administração , Reembolso de Incentivo , Cobertura Universal do Seguro de SaúdeRESUMO
Resumo A partir da criação de uma Secretaria de Atenção Primária à Saúde (SAPS) no Ministério da Saúde em maio de 2019, cinco novos desafios foram trazidos para a gestão federal do SUS: a) ampliação do acesso da população às unidades de saúde da família, b) definição de um novo modelo de financiamento baseado em resultados em saúde e eficiência, c) definição de um novo modelo de provimento e formação de médicos de família e comunidade para áreas remotas, d) fortalecimento da clínica e do trabalho em equipe multiprofissional, e) ampliação da informatização das unidades de saúde e uso de prontuário eletrônico. Esse ensaio discute esses elementos à luz de um novo modelo avaliativo que, ao mesmo tempo, seja capaz de orientar o novo processo de financiamento da Atenção Primária à Saúde (APS) no Brasil. Este baseia-se na correção de distorções distributivas e também busca orientar maior efetividade e eficiência no investimento público e qualidade do serviço prestado à população. Através de estudos dos melhores exemplos internacionais e discussão com os representantes do Conselho Nacional de Secretários Estaduais de Saúde (CONASS) e do Conselho Nacional dos Secretários Municipais de Saúde (CONASEMS) e com apoio técnico do Banco Mundial, foi elaborada a proposta de novo modelo avaliativo e de financiamento da APS.
Abstract Five new challenges were brought to the federal management of SUS from the establishment of the Primary Health Care Secretariat (SAPS) in May 2019, as follows: a) to expand people's access to health facilities; b) to define a new financing model from health outcomes and efficiency; c) to define a new model of provision and training of family and community doctors for remote areas; d) to strengthen clinic and multi-professional teamwork; e) to expand computerization of health facilities and use of electronic medical records. This essay discusses these elements in light of a new evaluation model that also guides a new process of financing the Brazilian Primary Health Care (PHC). It builds on the correction of distributive distortions, and also seeks to guide greater effectiveness and efficiency in public investment and quality of service provided to the population. The proposal for a new PHC evaluation and financing model was elaborated through studies of the best international examples and discussion with representatives of the National Council of State Health Secretaries (CONASS) and the National Council of Municipal Health Secretaries (CONASEMS), and with technical support from the World Bank.
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Humanos , Atenção Primária à Saúde/economia , Atenção Primária à Saúde/legislação & jurisprudência , Atenção Primária à Saúde/organização & administração , Programas Governamentais/economia , Programas Governamentais/legislação & jurisprudência , Implementação de Plano de Saúde/economia , Implementação de Plano de Saúde/legislação & jurisprudência , Acessibilidade aos Serviços de Saúde/economia , Acessibilidade aos Serviços de Saúde/legislação & jurisprudência , Acessibilidade aos Serviços de Saúde/organização & administração , Reembolso de Incentivo , Brasil , Cobertura Universal do Seguro de SaúdeAssuntos
Controle de Doenças Transmissíveis/métodos , Infecções por Coronavirus/prevenção & controle , Programas Governamentais/legislação & jurisprudência , Pessoas Mal Alojadas , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Populações Vulneráveis , Betacoronavirus , COVID-19 , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/terapia , Programas Governamentais/economia , Acessibilidade aos Serviços de Saúde , Humanos , Pneumonia Viral/diagnóstico , Pneumonia Viral/terapia , Saúde Pública/economia , Saúde Pública/legislação & jurisprudência , Fatores de Risco , SARS-CoV-2 , Reino UnidoRESUMO
Governments' attempts to manage immigration increasingly restrict immigrants' eligibility to healthcare, education, and welfare benefits. This article examines the operation of these restrictions in the United Kingdom. It draws on qualitative research with civil servants and NGO expert advisors, and applies sociological theories on bureaucracy as a lens to interpret these data. Conceptually, the paper employs a generative synthesis of Ritzer's notion of "irrational rationality" and Foucault's perspective on "governmentality" to explain observed outcomes. Findings show that public service workers struggle with complex and opaque regulations, which grant different entitlements to different categories of migrants. The confusion results in mistakes, arbitrary decisions, and hypercorrection, but also a system-wide indifference to irrational outcomes, supported by human factors in contexts of austerity. I consider this a form of governmentality-effected neglect, where power operates as much through inaction as well as through intention, but which results in exclusions of legal migrants that are harsher in practice than in law.
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Emigrantes e Imigrantes/legislação & jurisprudência , Emigração e Imigração/legislação & jurisprudência , Serviço Social/legislação & jurisprudência , Empregados do Governo/psicologia , Programas Governamentais/legislação & jurisprudência , Humanos , Entrevistas como Assunto , Pesquisa Qualitativa , Racionalização , Reino UnidoRESUMO
Opioid misuse is a national health crisis that requires sustained treatment, prevention, and recovery efforts. This study evaluates the innovative treatment approaches that two states - Kentucky and Missouri - implemented in their states using State Targeted Response to the Opioid Crisis Grant (Opioid STR) program funds from the Substance Abuse Mental Health and Services Administration (SAMHSA), as well as preliminary findings from the Opioid STR national, cross-site evaluation that is funded and managed by SAMHSA. The Kentucky approach discusses the Emergency Department (ED) bridge model, which links patients discharged from EDs to appropriate professional treatment and recovery services. Missouri implemented the Medication First (MedFirst) model, an evidence-based treatment for individuals with opioid use disorder (OUD). These states highlight novel approaches likely being implemented throughout the country to combat the opioid epidemic. Findings from the case studies and supported by the national evaluation indicate that key factors to successful program implementation - supportive state policies, partnerships and collaborations, and sustainability - facilitated the implementation of planned interventions. The novel approaches discussed combined with care across the continuum (prevention, treatment and recovery) and continued federal support is likely to have an impact on reducing opioid misuse across the U.S.
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Buprenorfina/uso terapêutico , Programas Governamentais/economia , Epidemia de Opioides , Transtornos Relacionados ao Uso de Opioides/tratamento farmacológico , Avaliação de Programas e Projetos de Saúde , Governo Estadual , Medicina Baseada em Evidências , Programas Governamentais/legislação & jurisprudência , Humanos , Kentucky , Missouri , Tratamento de Substituição de Opiáceos , Estudos de Casos Organizacionais , Estados UnidosRESUMO
BACKGROUND: Leaders of Missouri's State Targeted Response to the opioid crisis (STR) grant have prioritized increasing access to treatment medications for opioid use disorder (MOUD) through a "Medication First" approach. This conceptual framework prioritizes rapid, sustained, low-barrier access to MOUD for optimal impact on decreased illicit drug use and mortality. Medication First principles and practices were facilitated through state-level structural changes and disseminated to participating community treatment programs via a multi-pronged, multi-disciplinary approach. In the first nine months of STR, 14 state-contracted treatment agencies operating 38 sites used STR funding to implement the Medication First model. METHODS: We utilized state billing and service data to make comparisons before and during STR on the following outcomes: MOUD utilization, timely access to MOUD, amount of psychosocial services delivered, treatment retention at 1, 3, and 6â¯months, and monthly price of treatment. We conducted follow-up analyses examining differences across MOUD types (no medication, methadone, buprenorphine, oral naltrexone, mixed antagonist + agonist, and extended release naltrexone). RESULTS: During STR, MOUD utilization increased (44.8% to 85.3%), timeliness of MOUD receipt improved (Median of 8â¯days vs. 0â¯days), there were fewer psychosocial services delivered, treatment retention improved at one, three, and six month timeframes, and the median cost per month was 21% lower than in the year prior to STR. All differences were driven by increased utilization of buprenorphine. CONCLUSIONS: Findings suggest Medication First implementation through STR was successful in all targeted domains. Though much more work is needed to further reduce logistical, financial, and cultural barriers to improved access to maintenance MOUD, the steps taken through Missouri's STR grant show significant promise at making swift and drastic transformations to a system of care in response to a growing public health emergency.
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Analgésicos Opioides/administração & dosagem , Buprenorfina/administração & dosagem , Programas Governamentais/economia , Implementação de Plano de Saúde , Acessibilidade aos Serviços de Saúde/organização & administração , Transtornos Relacionados ao Uso de Opioides/tratamento farmacológico , Avaliação de Programas e Projetos de Saúde , Analgésicos Opioides/uso terapêutico , Feminino , Programas Governamentais/legislação & jurisprudência , Humanos , Masculino , Missouri , Tratamento de Substituição de Opiáceos , Governo EstadualRESUMO
INTRODUCTION: The federal Opioid State Targeted Response (Opioid STR) grants provided funding to each state to ramp up the range of responses to reverse the ongoing opioid crisis in the U.S. Washington State used these funds to develop and implement an integrated care model to expand access to medication treatment and reduce unmet need for people with opioid use disorders (OUD), regardless of how they enter the treatment system. This paper examines the design, early implementation and results of the Washington State Hub and Spoke Model. METHODS: Descriptive data were gathered from key informants, document review, and aggregate data reported by hubs and spokes to Washington State's Opioid STR team. RESULTS: The Washington State Hub and Spoke Model reflects a flexible approach that incorporates primary care and substance use treatment programs, as well as outreach, referral and social service organizations, and a nurse care manager. Hubs could be any type of program that had the required expertise and capacity to lead their network in medication treatment for OUD, including all three FDA-approved medications. Six hub-spoke networks were funded, with 8 unique agencies on average, and multiple sites. About 150 prescribers are in these networks (25 on average). In the first 18â¯months, nearly 5000 people were inducted onto OUD medication treatment: 73% on buprenorphine, 19% on methadone, and 9% on naltrexone. CONCLUSIONS: The Washington State Hub and Spoke Model built on prior approaches to improve the delivery system for OUD medication treatment and support services, by increasing integration of care, ensuring "no wrong door," engaging with community agencies, and supporting providers who are offering medication treatment. It used essential elements from existing integrated care OUD treatment models, but allowed for organic restructuring to meet the population needs within a community. To date, there have been challenges and successes, but with this approach, Washington State has provided medication treatment for OUD to nearly 5000 people. Sustainability efforts are underway. In the face of the ongoing opioid crisis, it remains essential to develop, implement and evaluate novel models, such as Washington's Hub and Spoke approach, to improve treatment access and increase capacity.