ABSTRACT
This Viewpoint examines the recent decision by a federal district court that undercuts the Affordable Care Act's mandate for cost-free coverage of preventive services, including contraception, some vaccinations, many screenings, and preexposure prophylaxis for HIV, among others.
Subject(s)
Patient Protection and Affordable Care Act , Preventive Health Services , United States , Preventive Health Services/legislation & jurisprudenceSubject(s)
Child Health Services/history , Health Policy/history , Maternal Health Services/history , Preventive Health Services/history , American Medical Association/history , Child , Child Health Services/legislation & jurisprudence , Child Welfare/history , Child Welfare/legislation & jurisprudence , Female , Health Policy/legislation & jurisprudence , History, 20th Century , Humans , Infant , Maternal Health Services/legislation & jurisprudence , Preventive Health Services/legislation & jurisprudence , United StatesSubject(s)
Insurance Coverage/legislation & jurisprudence , Medically Uninsured/legislation & jurisprudence , Patient Protection and Affordable Care Act/legislation & jurisprudence , Government Employees/legislation & jurisprudence , Preventive Health Services/legislation & jurisprudence , United StatesSubject(s)
COVID-19 , Communicable Disease Control , Contact Tracing , Immunization Programs/organization & administration , Preventive Health Services , COVID-19/epidemiology , COVID-19/prevention & control , Communicable Disease Control/instrumentation , Communicable Disease Control/legislation & jurisprudence , Communicable Disease Control/methods , Communicable Disease Control/organization & administration , Contact Tracing/legislation & jurisprudence , Contact Tracing/methods , Disease Transmission, Infectious/prevention & control , Government Regulation , Hong Kong/epidemiology , Humans , Preventive Health Services/legislation & jurisprudence , Preventive Health Services/methods , SARS-CoV-2ABSTRACT
In order to combat the spread of the novel coronavirus, the Centers for Disease Control and Prevention (CDC) has developed a list of recommended preventative health behaviors for Americans to enact, including social distancing, frequent handwashing, and limiting nonessential trips from home. Drawing upon scarcity theory, the purpose of this study was to examine whether the economic stressors of perceived job insecurity and perceived financial insecurity are related to employee self-reports of enacting such behaviors. Moreover, we tested propositions regarding the impact of two state-level contextual variables that may moderate those relationships: the generosity of unemployment insurance benefits and extensiveness of statewide COVID-19-related restrictions. Using a multilevel data set of N = 745 currently employed U.S. workers nested within 43 states, we found that both job insecurity and financial insecurity were negatively related to the enactment of the CDC-recommended guidelines. However, the state-level variables acted as cross-level moderators, such that the negative relationship between job insecurity and compliance with the CDC guidelines was attenuated within states that have a more robust unemployment system. However, working in a state with more extensive COVID-19 restrictions seemed to primarily benefit more financially secure workers. When statewide policies were more restrictive, employees reporting more financial security were more likely to enact the CDC-recommended guidelines compared to their financially insecure counterparts. We discuss these findings in light of the continuing need to develop policies to address the public health crisis while also protecting employees facing economic stressors. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
Subject(s)
COVID-19/economics , COVID-19/prevention & control , Centers for Disease Control and Prevention, U.S./legislation & jurisprudence , Financial Stress/psychology , Preventive Health Services/legislation & jurisprudence , State Government , Adult , COVID-19/psychology , Centers for Disease Control and Prevention, U.S./economics , Female , Financial Stress/economics , Humans , Male , Pandemics , Preventive Health Services/economics , Preventive Health Services/methods , Unemployment/psychology , Unemployment/statistics & numerical data , United StatesSubject(s)
Contraceptive Agents/economics , Health Benefit Plans, Employee/legislation & jurisprudence , Health Care Reform/legislation & jurisprudence , Preventive Health Services/legislation & jurisprudence , Women's Health Services/legislation & jurisprudence , Adult , Female , Health Services Accessibility/legislation & jurisprudence , Humans , Insurance Coverage/legislation & jurisprudence , Patient Protection and Affordable Care Act , United StatesSubject(s)
Communicable Disease Control/legislation & jurisprudence , Coronavirus Infections/prevention & control , Pandemics/prevention & control , Pneumonia, Viral/prevention & control , Preventive Health Services/legislation & jurisprudence , Public Health/legislation & jurisprudence , Betacoronavirus/isolation & purification , COVID-19 , Communicable Disease Control/standards , Coronavirus Infections/epidemiology , Coronavirus Infections/virology , England/epidemiology , Healthcare Disparities/trends , Humans , Mass Screening , Pneumonia, Viral/epidemiology , Pneumonia, Viral/virology , Preventive Health Services/standards , Public Health/standards , SARS-CoV-2Subject(s)
Preventive Health Services/legislation & jurisprudence , Environmental Exposure/prevention & control , Food Assistance/legislation & jurisprudence , Housing/legislation & jurisprudence , Humans , Income , Nutrition Disorders/prevention & control , Substance-Related Disorders/prevention & control , United States , Wounds and Injuries/prevention & controlABSTRACT
Heart failure pandemic is rapidly approaching in Japan, requiring nationwide actions. In particular, the Japanese Circulation Society and related societies launched the Stroke and Cardiovascular Disease Control Act, which was passed by the National Diet, as the first ever legislative policy measure against stroke and cardiovascular disease. In association with this, actions against heart failure pandemic from the scientific field are also important. Because heart failure pandemic is a critical problem not only in Japan but also in many developed countries, we believe the nationwide approach, as summarized here, will greatly contribute to the development of cardiovascular medicine, particularly the management and treatment of heart failure worldwide.
Subject(s)
Delivery of Health Care, Integrated/legislation & jurisprudence , Health Policy , Heart Failure/therapy , Pandemics , Policy Making , Societies, Medical/legislation & jurisprudence , Societies, Scientific/legislation & jurisprudence , Biomedical Research/legislation & jurisprudence , Health Services Needs and Demand/legislation & jurisprudence , Heart Failure/diagnosis , Heart Failure/epidemiology , Humans , Japan/epidemiology , Needs Assessment/legislation & jurisprudence , Preventive Health Services/legislation & jurisprudence , Risk FactorsABSTRACT
BACKGROUND: Title X supports access to family planning and preventive care services. Given its focus on low-income clients, Title X clinics may have been particularly affected by the Affordable Care Act's Medicaid expansion. OBJECTIVES: To examine the impact of the Affordable Care Act's Medicaid expansion on Title X client volumes, health insurance coverage, and contraceptive method mix. RESEARCH DESIGN: A difference-in-differences design compared changes in the outcomes of interest before and after expansion, for expansion versus nonexpansion states. SUBJECTS: Administrative data from Family Planning Annual Reports that describe Title X clients who sought services. MEASURES: Female client volume was measured using a participation ratio defined as the number of female clients per 100 women aged 15-44 with incomes <250% of the federal poverty line. We also examined the share of clients by insurance type and contraceptive method type. RESULTS: We did not find evidence that expansion was related to changes in client volume. We did find a significant 9.9 percentage point increase in the share of clients with Medicaid and a significant 10.0 percentage point decrease in the share of clients without coverage. We found suggestive evidence that expansion was associated with increased use of long-acting reversible contraceptives, but those results were somewhat sensitive to model specification. CONCLUSIONS: Expansion was associated with meaningful increases in Medicaid coverage at Title X clinics and declines in uninsurance. Our results have important implications for the financial stability of Title X clinics in light of historical declines in Title X grant revenues.
Subject(s)
Contraception/economics , Family Planning Services/legislation & jurisprudence , Medicaid/legislation & jurisprudence , Patient Protection and Affordable Care Act , Preventive Health Services/legislation & jurisprudence , Adolescent , Adult , Female , Health Services Accessibility , Humans , Insurance Coverage/statistics & numerical data , Poverty , United StatesABSTRACT
This policy brief examines preventive services state legislation trends in the United States during uncertainty regarding the Affordable Care Act (ACA), which requires certain coverage of 4 evidence-based preventive services categories without additional patient costs under §2713. We used a legal mapping approach to search for and analyze state legislation related to preventive services proposed or enacted over a 25-month period of ACA uncertainty. We screened 1231 bills and coded the 76 screened-in bills. Next, we determined their characteristics and examined trends. Bills originated in 28 states, and 69.7% were not enacted. Only 3.9% contained requirements contingent on ACA modifications. About 56.6% referenced services covered by §2713, but usually not entire §2713 categories. Bills also mentioned preventive services in general (53.9%) and services outside §2713's scope (21.1%). About 55.3% applied to private insurance, and 75.0% only to one patient group. Bills generally promoted access, and 51.3% specifically prohibited cost-sharing. But 26.3% of the bills limited access to preventive services. State-level legislation targets preventive services, usually expanding, but sometimes limiting, access. Most bills single out specific services without fully incorporating evidence-based recommendations. State legislation may therefore promote access to preventive services but can favor certain services, deviate from experts' recommendations, and increase nationwide variability. State legislation can function as an important lever for access to preventive services across patient groups. This may be especially important during uncertainty about federal policy. However, the design of state-level proposals is critical for maximizing access to preventive services.
Subject(s)
Health Care Reform/legislation & jurisprudence , Health Services Accessibility , Preventive Health Services/standards , Uncertainty , Humans , Insurance Coverage/trends , Patient Protection and Affordable Care Act/legislation & jurisprudence , Preventive Health Services/legislation & jurisprudence , Preventive Health Services/statistics & numerical data , State GovernmentSubject(s)
Community Participation/legislation & jurisprudence , Mammography/economics , Medical Overuse/legislation & jurisprudence , Policy Making , Adult , Aged , Decision Making/ethics , Female , Humans , Jurisprudence , Mammography/standards , Mass Screening/methods , Middle Aged , Preventive Health Services/legislation & jurisprudence , Public Opinion , RiskABSTRACT
Hawai'i has comprehensive statewide tobacco control policies and was the first US state to raise the minimum age of sale, purchase, and possession of tobacco products to age 21 ("Tobacco 21") in a policy including not just cigarettes, but also electronic smoking devices and other tobacco products. This insights article provides strategic thinking about tobacco control advocacy planning. Specifically, we identify formative factors critical to building and sustaining our cross-sector, statewide advocacy infrastructure that has been able to address many ongoing challenges of tobacco-use prevention and control over time. This can provide new insights for other large-scale tobacco-control advocacy efforts.
Subject(s)
Consumer Advocacy , Intersectoral Collaboration , Preventive Health Services , Smoking Cessation , Tobacco Products/legislation & jurisprudence , Tobacco Use/prevention & control , Hawaii , Health Services Accessibility , Humans , Preventive Health Services/economics , Preventive Health Services/legislation & jurisprudence , Public Health , Smoking Cessation/economics , Smoking Cessation/legislation & jurisprudence , Social NormsABSTRACT
PURPOSE: Sexual and reproductive health conditions (eg, infections, cancers) represent public health concerns for American women. The present study examined how knowledge of the Patient Protection and Affordable Care Act (PPACA) relates to receipt of preventive reproductive health services among women. DESIGN: Cross-sectional online survey. SETTING: Online questionnaires were completed via Amazon Mechanical Turk, a crowdsourcing website where individuals complete web-based tasks for compensation. PARTICIPANTS: Cisgendered women aged 18 to 44 years (N = 1083) from across the United States. MEASURES: Participants completed online questionnaires assessing demographics, insurance status, preventive service use, and knowledge of PPACA provisions. ANALYSIS: Chi-squares showed that receipt of well-woman, pelvic, and breast examinations, as well as pap smears, was related to insurance coverage, with those not having coverage at all during the previous year having significantly lower rates of use. Hierarchical logistic regressions determined the independent relationship between PPACA knowledge and use of health services after controlling for demographic factors and insurance status. RESULTS: Knowledge of PPACA provisions was associated with receiving well-woman, pelvic, and breast examinations, human papillomavirus vaccination, and sexually transmitted infections testing, after controlling for these factors. Results indicate that expanding knowledge about health-care legislation may be beneficial in increasing preventive reproductive health service use among women. CONCLUSION: Current findings provide support for increasing resources for outreach and education of the general population about the provisions and benefits of health-care legislation, as well as personal health coverage plans.
Subject(s)
Health Knowledge, Attitudes, Practice , Patient Acceptance of Health Care/statistics & numerical data , Patient Protection and Affordable Care Act , Preventive Health Services/statistics & numerical data , Reproductive Health Services/statistics & numerical data , Adolescent , Adult , Cross-Sectional Studies , Female , Humans , Patient Acceptance of Health Care/psychology , Preventive Health Services/legislation & jurisprudence , Reproductive Health Services/legislation & jurisprudence , Surveys and Questionnaires , United States , Young AdultABSTRACT
Importance: Despite decades of adolescent preventive well visit and services promotion (Guidelines for Adolescent Preventive Services and Bright Futures), rates are below recommended levels and little is known of the effect of the Patient Protection and Affordable Care Act (ACA) implementation on these care rates. Objectives: To use Medical Expenditure Panel Survey data to determine (1) whether adolescent well visit rates increased from the pre-ACA period to post-ACA period, and (2) whether caregivers' reports of past-year preventive services delivery increased from the pre- to post-ACA period among adolescents with any past-year health care visit. Design, Setting, and Participants: Secondary data analysis of 2007-2009 (before ACA implementation) and 2012-2014 (after ACA implementation) Medical Expenditure Panel Survey data on the differences in well visits and preventive services. Data were collected through computer-assisted personal interviews of caregivers of a nationally representative sample of a noninstitutionalized US population (n = 25â¯695 10- to 17-year-old adolescents). Main Outcomes and Measures: For objective 1, pre- to post-ACA period differences in past-year well visits: (1) stratified bivariable logistic regressions identifying subgroup rate differences and (2) multivariable analyses controlling for demographic factors. For objective 2, pre- to post-ACA period differences in caregiver reports of preventive services receipt, including time alone with clinician: (1) bivariable (year differences) and (2) multivariable logistic regressions controlling for demographic variables. Results: A total of 6279 (50.9%) and 6730 (50.8%) participating adolescents in the pre- and post-ACA period data were male, respectively. Under objective 1, we found that well-visit rates increased from 41% to 48% post-ACA implementation (odds ratio, 1.3; 95% CI, 1.2-1.5); minority and low-income groups had the greatest increases. Under objective 2, we found that among those with any past-year visit, most preventive services rates (8 of 9) increased post-ACA implementation (range, 2%-9%, absolute), with little or no change when controlling for demographic variables. Time alone with clinicians increased 1%, significant only when covariates were controlled (adjusted odds ratio, 1.2; 95% CI, 1.0-1.3). Conclusions and Relevance: Despite modest to moderate increases, with greatest gains for underserved youth, adolescent preventive care rates remain low, highlighting the need for increased efforts to bring adolescents into well care and improve clinician delivery of preventive care within their practices.
Subject(s)
Adolescent Health Services/legislation & jurisprudence , Patient Protection and Affordable Care Act , Preventive Health Services/legislation & jurisprudence , Adolescent , Adolescent Health Services/statistics & numerical data , Child , Female , Health Care Surveys , Health Services Accessibility/statistics & numerical data , Humans , Male , Patient Acceptance of Health Care/statistics & numerical data , Preventive Health Services/statistics & numerical data , United StatesABSTRACT
The rising cost of healthcare is prompting numerous policy and advocacy discussions regarding strategies for constraining growth and creating a more efficient and effective healthcare system. Cardiovascular imaging is central to the care of patients at risk of, and living with, heart disease. Estimates are that utilization of cardiovascular imaging exceeds 20 million studies per year. The Society of Cardiovascular CT (SCCT), alongside Rush University Medical Center, and in collaboration with government agencies, regional payers, and industry healthcare experts met in November 2016 in Chicago, IL to evaluate obstacles and hurdles facing the cardiovascular imaging community and how they can contribute to efficacy while maintaining or even improving outcomes and quality. The summit incorporated inputs from payers, providers, and patients' perspectives, providing a platform for all voices to be heard, allowing for a constructive dialogue with potential solutions moving forward. This article outlines the proceedings from the summit, with a detailed review of past hurdles, current status, and potential solutions as we move forward in an ever-changing healthcare landscape.