RESUMO
This study quantifies the effect of the 2020 state COVID economic activity reopening policies on daily mobility and mixing behavior, adding to the economic literature on individual responses to public health policy that addresses public contagion risks. We harness cellular device signal data and the timing of reopening plans to provide an assessment of the extent to which human mobility and physical proximity in the United States respond to the reversal of state closure policies. We observe substantial increases in mixing activities, 13.56% at 4 days and 48.65% at 4 weeks, following reopening events. Echoing a theme from the literature on the 2020 closures, mobility outside the home increased on average prior to these state actions. Furthermore, the largest increases in mobility occurred in states that were early adopters of closure measures and hard-hit by the pandemic, suggesting that psychological fatigue is an important barrier to implementation of closure policies extending for prolonged periods of time.
RESUMO
This study examines the rate of employment in US health care in the postpandemic period, through the end of 2022.
Assuntos
Emprego , Pessoal de Saúde , Mão de Obra em Saúde , Humanos , Atenção à Saúde/estatística & dados numéricos , Emprego/estatística & dados numéricos , Pessoal de Saúde/estatística & dados numéricos , Mão de Obra em Saúde/estatística & dados numéricos , Estados Unidos/epidemiologiaRESUMO
Buprenorphine is a treatment medication that decreases mortality risks among people with opioid use disorder (OUD). Despite its efficacy, buprenorphine is underused in the US. Insurance restrictions are commonly cited as barriers to buprenorphine prescribing. Using Medicaid, Medicare Advantage, and commercial insurance formulary files, we examined insurance-imposed utilization restrictions for buprenorphine for OUD for each year from 2017 to 2021 by insurance type. Almost all plans covered immediate-release buprenorphine in 2021, with a general trend of decreasing prior authorization requirements and quantity limits since 2017. In contrast, two payers had relatively low coverage of extended-release buprenorphine, with only 46 percent of commercial plans and only 19 percent of Medicare Advantage plans covering this formulation. Even though most Medicaid plans covered extended-release buprenorphine in 2021, 37 percent required prior authorization. Policy makers and researchers concerned with buprenorphine insurance barriers should shift their attention to extended-release buprenorphine. State lawmakers could help address these barriers by mandating that insurers include extended-release buprenorphine on their preferred drug lists.
Assuntos
Buprenorfina , Medicare Part C , Transtornos Relacionados ao Uso de Opioides , Idoso , Humanos , Estados Unidos , Buprenorfina/uso terapêutico , Transtornos Relacionados ao Uso de Opioides/tratamento farmacológico , Medicaid , Tratamento de Substituição de Opiáceos , Analgésicos Opioides/uso terapêuticoRESUMO
OBJECTIVES: To study the predictive validity of the CMS Practice Assessment Tool (PAT) among 632 primary care practices. STUDY DESIGN: Retrospective observational study. METHODS: The study included primary care physician practices recruited by the Great Lakes Practice Transformation Network (GLPTN), 1 of 29 CMS-awarded networks, and used data from 2015 to 2019. At enrollment, trained quality improvement advisers scored each of the PAT's 27 milestones by its degree of implementation based on interviews with staff, review of documents, direct observation of practice activity, and professional judgment. The GLPTN also tracked each practice's status regarding alternative payment model (APM) enrollment. Exploratory factor analysis (EFA) was used to identify summary scores; mixed-effects logistic regression was used to assess the relationship between derived scores with APM participation. RESULTS: EFA revealed that the PAT's 27 milestones could be summed into 1 overall score and 5 secondary scores. By the end of the 4-year project, 38% of practices were enrolled in an APM. A baseline overall score and 3 secondary scores were associated with increased odds of joining an APM (overall score: odds ratio [OR], 1.06; 95% CI, 0.99-1.12; P = .061; data-driven care quality score: OR, 1.11; 95% CI, 1.00-1.22; P = .040; efficient care delivery score: OR, 1.08; 95% CI, 1.03-1.13; P = .003; collaborative engagement score: OR, 0.88; 95% CI, 0.80-0.96; P = .005). CONCLUSIONS: These results demonstrate that the PAT has adequate predictive validity for APM participation.
Assuntos
Melhoria de Qualidade , Estados Unidos , Humanos , Centers for Medicare and Medicaid Services, U.S. , Estudos RetrospectivosRESUMO
We examined Medicare Part D claims from the period 2015-19 to identify state and national racial and ethnic disparities in buprenorphine receipt among Medicare disability beneficiaries with diagnosed opioid use disorder or opioid overdose. Racial and ethnic disparities in buprenorphine use remained persistently high during the study period, especially for Black beneficiaries, suggesting the need for targeted interventions and policies.
Assuntos
Buprenorfina , Medicare Part D , Transtornos Relacionados ao Uso de Opioides , Idoso , Humanos , Estados Unidos , Buprenorfina/uso terapêutico , Grupos Raciais , Transtornos Relacionados ao Uso de Opioides/tratamento farmacológico , Disparidades em Assistência à SaúdeRESUMO
BACKGROUND: The COVID-19 pandemic led several states to adopt policies permitting the delivery of substance use disorder treatment (SUDT) by telehealth. We assess the impact of state-level telehealth policies in 2020 that specifically permitted audio or audiovisual forms of telehealth offerings among SUDT facilities. PROCEDURE: Cross-sectional analysis of secondary data from between 2019 and 2022. Pre-pandemic, federal law permitted states to allow audiovisual telehealth modes for SUDT to a limited extent. 2020 laws permitted states to allow audio-only modes for the first time and strengthened ability to offer audiovisual modes. We compared national SUDT facility self-reported telehealth offerings in 2020 and beyond to 2019, in states that in 2020 had policies permitting audiovisual and audio only, compared to other states. MAIN FINDINGS: Among outpatient SUDT facilities (n = 5227) present in all four years of our data, the proportion offering telehealth increased from 18% (n = 921) in 2019-26% in 2020, 60% in 2021, and 79% in 2022. We estimate an audiovisual and audio only policy in 2020 was associated with an increase in telehealth offering rates in 2022 of +16.5% points (pp) (95% CI [+10.4,+22.6]) compared to the rates in states with no such listed policy. There was little evidence of an influence on telehealth offering in 2020 (-2.9 pp, CI [-9.0,+3.2]) and 2021 (+0.6 pp, CI [-5.5,+6.7]). CONCLUSIONS: The enactment of state-level telehealth policies that allow audio and audiovisual modalities may have increased SUDT facilities' likelihood of offering telehealth services two years after enactment.
Assuntos
Transtornos Relacionados ao Uso de Substâncias , Telemedicina , Humanos , Estados Unidos/epidemiologia , Pandemias , Estudos Transversais , Políticas , Transtornos Relacionados ao Uso de Substâncias/terapiaRESUMO
The authors evaluated fair balance in the presentation of risks and benefits in a large sample of direct-to-consumer advertising for prescription antidepressant medications appearing in magazines (1995-2006) and television (1999-2007) to assess how well they meet U.S. Food and Drug Administration guidelines. Using content analysis to capture relevant dimensions of the ads, results indicated that (a) considerably less attention is given to risks relative to benefits and (b) implicit ad content favors communication of drug benefits over risks, but that fair balance in direct-to-consumer ads has improved over time. The authors discuss policy implications and explore future research directions.
Assuntos
Publicidade/normas , Antidepressivos , Fidelidade a Diretrizes/estatística & dados numéricos , Publicações Periódicas como Assunto/normas , Medicamentos sob Prescrição , Televisão/normas , Publicidade/tendências , Fidelidade a Diretrizes/tendências , Guias como Assunto , Humanos , Publicações Periódicas como Assunto/tendências , Política Pública , Medição de Risco , Televisão/tendências , Estados Unidos , United States Food and Drug AdministrationRESUMO
School and college reopening-closure policies are considered one of the most promising non-pharmaceutical interventions for mitigating infectious diseases. Nonetheless, the effectiveness of these policies is still debated, largely due to the lack of empirical evidence on behavior during implementation. We examined U.S. college reopenings' association with changes in human mobility within campuses and in COVID-19 incidence in the counties of the campuses over a twenty-week period around college reopenings in the Fall of 2020. We used an integrative framework, with a difference-in-differences design comparing areas with a college campus, before and after reopening, to areas without a campus and a Bayesian approach to estimate the daily reproductive number (Rt). We found that college reopenings were associated with increased campus mobility, and increased COVID-19 incidence by 4.9 cases per 100,000 (95% confidence interval [CI]: 2.9-6.9), or a 37% increase relative to the pre-period mean. This reflected our estimate of increased transmission locally after reopening. A greater increase in county COVID-19 incidence resulted from campuses that drew students from counties with high COVID-19 incidence in the weeks before reopening (χ2(2) = 8.9, p = 0.012) and those with a greater share of college students, relative to population (χ2(2) = 98.83, p < 0.001). Even by Fall of 2022, large shares of populations remained unvaccinated, increasing the relevance of understanding non-pharmaceutical decisions over an extended period of a pandemic. Our study sheds light on movement and social mixing patterns during the closure-reopening of colleges during a public health threat, and offers strategic instruments for benefit-cost analyses of school reopening/closure policies.
Assuntos
COVID-19 , Teorema de Bayes , COVID-19/epidemiologia , Humanos , Incidência , Pandemias/prevenção & controle , Estados Unidos/epidemiologia , UniversidadesRESUMO
This article aimed to determine the association between the Affordable Care Act young adult mandate and suicidal behavior. From 2007 to 2013, we used the Nationwide/National Inpatient Sample and National Poison Data System to examine suicide attempt, and Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research to examine suicide. We aggregated each outcome by quarter/year and conducted a difference-in-differences linear regression to compare young adults aged 19 to 25 years with those 27 to 29 years before and after implementation. There were not statistically significant associations between the mandate and suicide attempt inpatient hospitalizations (unstandardized beta coefficient [b] = -0.72, p = .12, standard error [SE] = 0.42) and percentage of poisoning cases due to suspected suicidal intent (b = 0.23, p = .19, SE = 0.16). There was a statistically significant association when examining suicide prevalence (b = -0.03, p = .01, SE = 0.001). The results suggest that health insurance may buffer against but is unlikely to reverse the increasing suicide rate.
Assuntos
Patient Protection and Affordable Care Act , Ideação Suicida , Humanos , Seguro Saúde , Prevalência , Tentativa de Suicídio , Estados Unidos/epidemiologia , Adulto JovemRESUMO
The Institutions for Mental Diseases (IMD) exclusion prohibits use of federal Medicaid funds to treat enrollees ages 21-64 in psychiatric residential treatment facilities that have more than sixteen beds. In 2015 the federal government created a streamlined application pathway for state waivers of this rule to allow Medicaid coverage for substance use disorder (SUD) treatment in residential facilities. Nine states received IMD waivers during the period 2015-18. Using data from the 2010-18 National Survey of Substance Abuse Treatment Services, we examined changes in residential and outpatient SUD treatment facilities' acceptance of Medicaid and other types of health coverage, as well as self-pay arrangements and provision of charity care, after states' adoption of IMD waivers. Acceptance of Medicaid increased 34 percent at residential treatment facilities and 9 percent at intensive outpatient facilities two years after waiver implementation. Delivery of medications for opioid use disorder did not increase in residential facilities post waiver but did increase to some extent in outpatient facilities. Our findings suggest that IMD waivers may be an important tool for advancing access to a full continuum of SUD treatment for Medicaid enrollees.
Assuntos
Medicaid , Transtornos Relacionados ao Uso de Opioides , Adulto , Governo Federal , Humanos , Pessoa de Meia-Idade , Estados Unidos , Adulto JovemRESUMO
COVID-19 vaccination campaigns continue in the United States, with the expectation that vaccines will slow transmission of the virus, save lives, and enable a return to normal life in due course. However, the extent to which faster vaccine administration has affected COVID-19-related deaths is unknown. We assessed the association between US state-level vaccination rates and COVID-19 deaths during the first five months of vaccine availability. We estimated that by May 9, 2021, the US vaccination campaign was associated with a reduction of 139,393 COVID-19 deaths. The association varied in different states. In New York, for example, vaccinations led to an estimated 11.7 fewer COVID-19 deaths per 10,000, whereas Hawaii observed the smallest reduction, with an estimated 1.1 fewer deaths per 10,000. Overall, our analysis suggests that the early COVID-19 vaccination campaign was associated with reductions in COVID-19 deaths. As of May 9, 2021, reductions in COVID-19 deaths associated with vaccines had translated to value of statistical life benefit ranging between $625 billion and $1.4 trillion.
Assuntos
COVID-19 , Vacinas , Vacinas contra COVID-19 , Humanos , SARS-CoV-2 , Estados Unidos , VacinaçãoRESUMO
With the passage of the Affordable Care Act, states were given the option to expand their Medicaid programs. Since then, thirty-eight states and Washington, D.C., have done so. Previous work has identified the widespread effects of expansion on enrollment and the financial implications for individuals, hospitals, and the federal government, yet administrative expenditures have not been considered. Using data from all fifty states for the period 2007-17, our study estimated the effects of Medicaid expansion overall, as well as differing effects by the size and nature of the expansions. Using a quasi-experimental approach, we found no overall effect of expansion on administrative spending. However, the size of the expansion may have produced differing effects. States with small expansions experienced some increases in administrative spending, whereas states with large expansions experienced some decreases in administrative spending, including a $77 reduction in per enrollee administrative spending compared with nonexpansion states. As more states consider expanding their Medicaid programs, our findings provide evidence of potential effects.
Assuntos
Medicaid , Patient Protection and Affordable Care Act , Governo Federal , Gastos em Saúde , Humanos , Estados Unidos , WashingtonRESUMO
BACKGROUND: Youth in the justice system (YJS) are more likely than youth who have never been arrested to have mental health and substance use problems. However, a low percentage of YJS receive SUD services during their justice system involvement. The SUD care cascade can identify potential missed opportunities for treatment for YJS. Steps along the continuum of the cascade include identification of treatment need, referral to services, and treatment engagement. To address gaps in care for YJS, we will (1) implement a learning health system (LHS) to develop, or improve upon, alliances between juvenile justice (JJ) agencies and community mental health centers (CMHC) and (2) present local cascade data during continuous quality improvement cycles within the LHS alliances. METHODS/DESIGN: ADAPT is a hybrid Type II effectiveness implementation trial. We will collaborate with JJ and CMHCs in eight Indiana counties. Application of the EPIS (exploration, preparation, implementation, and sustainment) framework will guide the implementation of the LHS alliances. The study team will review local cascade data quarterly with the alliances to identify gaps along the continuum. The study will collect self-report survey measures longitudinally at each site regarding readiness for change, implementation climate, organizational leadership, and program sustainability. The study will use the Stages of Implementation Completion (SIC) tool to assess the process of implementation across interventions. Additionally, the study team will conduct focus groups and qualitative interviews with JJ and CMHC personnel across the intervention period to assess for impact. DISCUSSION: Findings have the potential to increase SUD need identification, referral to services, and treatment for YJS.
Assuntos
Comportamento Aditivo , Sistema de Aprendizagem em Saúde , Transtornos Relacionados ao Uso de Substâncias , Adolescente , Humanos , Avaliação de Programas e Projetos de Saúde , População Rural , Transtornos Relacionados ao Uso de Substâncias/terapiaRESUMO
A growing body of literature examining the effects of the Affordable Care Act (ACA) on nonelderly adults provides promising evidence of improvements in health outcomes through insurance expansions. Our review of forty-three studies that employed a quasi-experimental research design found encouraging evidence of improvements in health status, chronic disease, maternal and neonatal health, and mortality, with some findings corroborated by multiple studies. Some studies further suggested that the beneficial effects have grown over time and thus may continue to grow if the ACA insurance expansions remain in force. However, not all studies reported a significant positive relationship between ACA provisions that expanded insurance coverage and health status. We highlight the challenges facing researchers, including the importance of nonmedical factors in determining individual health and the use of outcome data predominantly drawn from self-reports. In closing, we identify opportunities to enhance researchers' understanding of the relationship between the ACA insurance expansions and health outcomes using new data sources, including electronic health records.
Assuntos
Seguro Saúde , Patient Protection and Affordable Care Act , Adulto , Acessibilidade aos Serviços de Saúde , Humanos , Recém-Nascido , Cobertura do Seguro , Medicaid , Avaliação de Resultados em Cuidados de Saúde , Estados UnidosRESUMO
BACKGROUND AND AIMS: Given the recent complete suspension of opioid-related promotional activities aimed at physicians, interest has renewed in understanding the role of promotion in the US opioid crisis. The present analysis aimed to measure associations between such interactions and opioid prescribing. DESIGN: Data on all promotions by pharmaceutical companies directly to physicians were linked to physician-level data on opioid prescriptions filled in a federal insurance program and analyzed using multivariate regression. SETTING: United States. PARTICIPANTS: A total of 865 347 US physicians, with prescriptions filled in Medicare Part D, that might receive payments from pharmaceutical promotional activities from 2014 to 2016. MEASUREMENTS: The outcome variable was days' supply dispensed by each prescriber, by year, for all opioids (collectively) and separately for the following opioid classes: hydrocodone, oxycodone, fentanyl, tapentadol, morphine and a catch-all 'other opioids'. The independent variables were receipt of any payments and dollar amounts of payments received by each prescriber by year for all opioids and separately for opioid categories. FINDINGS: Prescribers who received opioid-specific payments prescribed 8784 opioid daily doses per year more than their peers who did not receive any such payments (P < 0.001). Recipient of hydrocodone-related payments was associated with 5161 additional daily doses of hydrocodone (P < 0.001). Recipient of oxycodone-related payments was associated with 3624 additional daily doses of oxycodone (P < 0.001). Prescribers receiving any fentanyl-specific payments prescribed 1124 daily doses per year more than their peers (P < 0.001). Among recipients of opioid-specific payments (63 062 physicians), a 1% increase in amount of payments was associated with 50 daily doses of opioid prescription (P < 0.001). CONCLUSIONS: In the United States, physicians who receive direct payments from providers for opioid prescribing tend to prescribe substantially larger quantities, particularly for hydrocodone and oxycodone.
Assuntos
Analgésicos Opioides/uso terapêutico , Indústria Farmacêutica/economia , Médicos/economia , Padrões de Prática Médica/estatística & dados numéricos , Revelação , Fentanila/uso terapêutico , Humanos , Hidrocodona/uso terapêutico , Marketing/economia , Medicare Part D , Morfina/uso terapêutico , Análise Multivariada , Oxicodona/uso terapêutico , Tapentadol/uso terapêutico , Estados UnidosRESUMO
Previous research has demonstrated that older adults prefer less autonomy and seek less information when making decisions on their own relative to young adults (for a review, see M. Mather, 2006). Would older adults also prefer fewer options from which to choose? The authors tested this hypothesis in the context of different decision domains. Participants completed a choice preferences survey in which they indicated their desired number of choices across 6 domains of health care and everyday decisions. The hypothesis was confirmed across all decision domains. The authors discuss implications from these results as they relate to theories of aging and health care policy.
Assuntos
Envelhecimento/psicologia , Comportamento de Escolha , Adolescente , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Tomada de Decisões , Política de Saúde , Humanos , Pessoa de Meia-Idade , Modelos Psicológicos , Aceitação pelo Paciente de Cuidados de Saúde , Autonomia Pessoal , Inquéritos e QuestionáriosRESUMO
In 2015, Indiana expanded eligibility for Medicaid under the Affordable Care Act (ACA) through a unique waiver, Healthy Indiana Plan 2.0, which requires enrollees to make monthly contributions to an account that is similar to a health savings account to receive full benefits. Enrollees who fail to make these contributions receive less generous benefits if their income is below the federal poverty level, and if it is 100-138 percent of poverty, they are locked out of coverage for six months. We estimated the impact of this expansion on coverage rates and compared the effects to results from other states that expanded Medicaid after 2014. We found that Indiana's coverage gains (relative to pre-ACA uninsurance rates) were smaller than gains in neighboring expansion states, but larger than those in other states. These results imply that while one potential reason for Indiana's lower gains relative to neighboring states was its cost-sharing requirements, expansion led to unquestionable coverage gains in the state.
Assuntos
Custo Compartilhado de Seguro/economia , Definição da Elegibilidade/métodos , Cobertura do Seguro/estatística & dados numéricos , Medicaid/legislação & jurisprudência , Patient Protection and Affordable Care Act/legislação & jurisprudência , Adulto , Custo Compartilhado de Seguro/estatística & dados numéricos , Estudos Transversais , Bases de Dados Factuais , Feminino , Reforma dos Serviços de Saúde/legislação & jurisprudência , Humanos , Indiana , Cobertura do Seguro/legislação & jurisprudência , Masculino , Medicaid/economia , Pessoa de Meia-Idade , Avaliação de Resultados em Cuidados de Saúde , Pobreza , Análise de Regressão , Estudos Retrospectivos , Estados UnidosRESUMO
The Affordable Care Act made low-income nonelderly adults eligible for Medicaid in 2014 without requiring them to obtain disabled status through the Supplemental Security Income (SSI) program. In states that participated in the Medicaid expansion, we found that SSI participation decreased by about 3 percent after 2014.
Assuntos
Renda , Medicaid/estatística & dados numéricos , Pobreza , Previdência Social , Adulto , Definição da Elegibilidade , Humanos , Masculino , Pessoa de Meia-Idade , Patient Protection and Affordable Care Act/legislação & jurisprudência , Estados UnidosRESUMO
OBJECTIVE: To measure the change in U.S. women and children's health insurance coverage as a result of welfare reform (i.e. the creation of Temporary Assistance for Needy Families or TANF) in 1996. DATA SOURCE: 1992-1999 longitudinal data from the Survey of Income and Program Participation (SIPP) merged with data on the timing of state implementation of welfare reform after 1996. Two key advantages of the SIPP data are that they permit matching type of insurance coverage to the welfare policy environment in each state in each month, and permit controlling for individual-level fixed effects. STUDY DESIGN: We measure how much insurance coverage changed after welfare reform using a difference in differences method that eliminates the influence of time-invariant unobserved individual heterogeneity and of statewide trends in insurance coverage. Models also control for individual, state, and year fixed effects, individual-level characteristics such as education, age, and number of children, plus state-level variables such as real per capita income, real minimum wage, and Medicaid eligibility. DATA COLLECTION/EXTRACTION METHODS: We limit our analysis to the SIPP data specific to the month just completed prior to the interview; as a result, we have up to twelve observations for each individual in the SIPP. This paper uses pooled data from the 1992-1996 panels of the SIPP covering the period 1992-1999. Publicly available state identifiers permit the merger of state policies and macroeconomic variables with the SIPP. PRINCIPAL FINDINGS: TANF implementation is associated with an 8.1 percent increase in the probability that a welfare-eligible woman was uninsured. Welfare reform had less of an impact on the health insurance coverage of children. For example, TANF implementation was associated with a 3.0 percent increase in the probability that a welfare-eligible child lacked health insurance. CONCLUSIONS: An unintended consequence of welfare reform was to adversely impact the health insurance coverage of economically vulnerable women and children, and that this impact was several times larger than the previous literature implies.
Assuntos
Cobertura do Seguro/estatística & dados numéricos , Seguro Saúde/estatística & dados numéricos , Assistência Pública/legislação & jurisprudência , Política Pública , Adolescente , Adulto , Criança , Pré-Escolar , Definição da Elegibilidade , Feminino , Pesquisa sobre Serviços de Saúde , Humanos , Lactente , Recém-Nascido , Estudos Longitudinais , Medicaid/estatística & dados numéricos , Seguridade Social/legislação & jurisprudência , Estados UnidosRESUMO
Medicaid expansion undertaken through the Affordable Care Act (ACA) is already producing major changes in insurance coverage and access to care, but its potential impacts on the labor market are also important policy considerations. Economic theory suggests that receipt of Medicaid might benefit workers who would no longer be tied to specific jobs to receive health insurance (known as job lock), giving them more flexibility in their choice of employment, or might encourage low-income workers to reduce their hours or stop working if they no longer need employment-based insurance. Evidence on labor changes after previous Medicaid expansions is mixed. To view the impact of the ACA on current labor market participation, we analyzed labor-market participation among adults with incomes below 138 percent of the federal poverty level, comparing Medicaid expansion and nonexpansion states and Medicaid-eligible and -ineligible groups, for the pre-ACA period (2005-13) and the first fifteen months of the expansion (January 2014-March 2015). Medicaid expansion did not result in significant changes in employment, job switching, or full- versus part-time status. While we cannot exclude the possibility of small changes in these outcomes, our findings rule out the large change found in one influential pre-ACA study; furthermore, they suggest that the Medicaid expansion has had limited impact on labor-market outcomes thus far.