The relationship between community social risk factors and regional hospital-reported cash, negotiated, and chargemaster prices for 14 common services.

BACKGROUND: Social risk factors are key drivers of the geographic variation in spending in the United States but little is known how community-level social risk factors are associated with hospital prices. Our objective was to describe the relationship between regional hospital-reported prices and social risk factors by price type (chargemaster, cash, commercial, Medicare, and Medicaid). METHODS: This cross-sectional analysis used newly available hospital-reported prices from acute general hospitals in 2022. The prices were for 14 common services. Prices were winsorized at 98%, wage index-adjusted, standardized by service, and aggregated to hospital service areas (HSAs). For social risk, we used 23 measures across 5 domains of social risk (socioeconomic position; race, ethnicity, and culture; gender; social relationships; and residential and community context). Spearman's correlation was used to estimate associations between median prices and social risk by price type. RESULTS: Prices were reported from 2,386 acute general hospitals in 45% (1,502 of 3,436) HSAs. Correlations between regional prices and other social risk factors varied by price type (range: -0.19 to 0.31). Chargemaster and cash prices were significantly correlated with the most community characteristics (10 of 23, 43%) followed by commercial prices (8, 35%). Medicare and Medicaid prices were only significantly correlated with 1 measure (all p < 0.01). All price types were significantly correlated with the percentage of uninsured (all p < 0.01). Chargemaster, cash, and commercial prices were positively correlated with percentage of Hispanic residents, residents with limited English proficiency, and non-citizens (all p < 0.05). CONCLUSIONS: While regional correlations between prices and social risk factors were weak across all prices, chargemaster, cash, and commercial prices were more like closely aligned with community-level social risk factors than the two public payers (Medicare and Medicaid). Chargemaster, cash, and commercial hospital prices appeared to be higher in socially disadvantaged communities. Further research is needed to clarify the relationship between prices and community social risk factors.

A Qualitative Comparative Analysis of Combined State Health Policies Related to Human Papillomavirus Vaccine Uptake in the United States.

OBJECTIVES: To examine how combinations of state policies, rather than single policies, are related to uptake of human papillomavirus (HPV) vaccine. METHODS: Using publicly available records and the literature, we characterized policies for each US state and Washington, DC, in 2015 (n = 51), including (1) Medicaid expansion, (2) policies permitting HPV vaccination in pharmacies, (3) school-entry requirements, (4) classroom sex education mandates, and (5) parental education mandates. Using qualitative comparative analysis, we identified which existing combinations of these policies were necessary and sufficient for high HPV vaccine initiation among adolescents, with National Immunization Survey-Teen data. RESULTS: No single policy was necessary or sufficient for high HPV vaccine uptake; however, 1 set of policies had consistently high HPV vaccine uptake: adoption of all policies except parental education mandates (girls: consistency = 1.00, coverage = 0.07; boys: consistency = 0.99, coverage = 0.08). CONCLUSIONS: We identified a set of polices related to high HPV vaccine uptake. Future studies should examine how these policies and others, individually and in combination, are associated with HPV vaccine uptake. Public Health Implications. This study provides insight into what sets of policies are consistently related to high HPV vaccine uptake.

Emergency department visits attributable to asthma in North Carolina, 2008.

BACKGROUND: Asthma is a prevalent, morbid, and costly chronic condition that may result in preventable exacerbations requiring emergency department (ED) care. In North Carolina we have limited information about the frequency and characteristics of asthma-related ED visits. METHODS: We estimated statewide population-based asthma-related ED visit rates in North Carolina, both overall and by age, sex, geography, insurance, and season. RESULTS: There were 86,700 asthma-related ED visits in North Carolina in 2008, representing 2.1% of all ED visits in the state. Substantial geographic variation existed, with rates ranging from 1.3 visits per 1,000 population in Ashe County to 21.0 visits per 1,000 population in Pasquotank County. Rates by age, sex, and month were consistent with the findings of other studies. Of asthma ED visits, 4.8% were preceded by another asthma visit to the same ED within 14 days. The proportion of patients who made at least 1 additional asthma visit to the same ED within 365 days was 23.5%; 11.6% of asthma ED patients met at least 1 criterion for being at high risk of hospitalization or death. LIMITATIONS: We lacked data on ED visits for asthma outside North Carolina, information about the accuracy of asthma diagnosis in the ED, patient identifiers that would allow linking across EDs, data on race or ethnicity, and data on urgent care utilization. CONCLUSIONS: We have characterized the burden of asthma in EDs across North Carolina, by county and among key subpopulations. These data can be used to target and evaluate local and statewide asthma-control policy efforts.