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4.
Med J Aust ; 211(11): 490-491.e21, 2019 12.
Artículo en Inglés | MEDLINE | ID: mdl-31722443

RESUMEN

The MJA-Lancet Countdown on health and climate change was established in 2017 and produced its first Australian national assessment in 2018. It examined 41 indicators across five broad domains: climate change impacts, exposures and vulnerability; adaptation, planning and resilience for health; mitigation actions and health co-benefits; economics and finance; and public and political engagement. It found that, overall, Australia is vulnerable to the impacts of climate change on health, and that policy inaction in this regard threatens Australian lives. In this report we present the 2019 update. We track progress on health and climate change in Australia across the same five broad domains and many of the same indicators as in 2018. A number of new indicators are introduced this year, including one focused on wildfire exposure, and another on engagement in health and climate change in the corporate sector. Several of the previously reported indicators are not included this year, either due to their discontinuation by the parent project, the Lancet Countdown, or because insufficient new data were available for us to meaningfully provide an update to the indicator. In a year marked by an Australian federal election in which climate change featured prominently, we find mixed progress on health and climate change in this country. There has been progress in renewable energy generation, including substantial employment increases in this sector. There has also been some progress at state and local government level. However, there continues to be no engagement on health and climate change in the Australian federal Parliament, and Australia performs poorly across many of the indicators in comparison to other developed countries; for example, it is one of the world's largest net exporters of coal and its electricity generation from low carbon sources is low. We also find significantly increasing exposure of Australians to heatwaves and, in most states and territories, continuing elevated suicide rates at higher temperatures. We conclude that Australia remains at significant risk of declines in health due to climate change, and that substantial and sustained national action is urgently required in order to prevent this.


Asunto(s)
Cambio Climático , Política Ambiental , Planificación en Salud , Política de Salud , Salud , Australia , Economía , Exposición a Riesgos Ambientales , Gobierno Federal , Financiación de la Atención de la Salud , Humanos , Gobierno Local , Mosquitos Vectores , Política , Energía Renovable , Gobierno Estatal , Incendios Forestales
5.
Am J Law Med ; 45(2-3): 130-170, 2019 May.
Artículo en Inglés | MEDLINE | ID: mdl-31722626

RESUMEN

In many areas of innovation, the United States is a leader, but this characterization does not apply to the United States' position in assisted reproductive technology innovation and clinical use. This article uses a political science concept, the idea of the "democratic deficit" to examine the lack of American public discourse on innovations in ART. In doing so, the article focuses on America's missing public consultation in health care innovation. This missing discourse is significant, as political and ethical considerations may impact regulatory decisions. Thus, to the extent that these considerations are influencing the decisions of federal agency employees, namely those who work within the U.S. Food and Drug Administration, the public is unable to participate in the decision-making process. This lack of a public discourse undermines the goals of the administrative state, which include democratic participation, transparency, and accountability. The United Kingdom, on the other hand, has had a markedly divergent experience with assisted reproductive technology innovation. Instead of ignoring the various ethical, social, and legal issues surrounding assisted reproductive technology innovation, the United Kingdom engaged in a five-strand public consultation on the topic of mitochondrial transfer, a form of assisted reproductive technology that uses genetic modification in order to prevent disease transmission. This article argues that after a multi-decade standstill in terms of the public discourse related to ethical issues associated with assisted reproductive technology and germline modification, it is time for the United States to institute a more democratic inquiry into the scientific, ethical, and social implications of new forms of assisted reproductive technology and ultimately, forthcoming medical innovations that involve genetic modification.


Asunto(s)
Democracia , Invenciones/legislación & jurisprudencia , Formulación de Políticas , Técnicas Reproductivas Asistidas/legislación & jurisprudencia , Participación de la Comunidad , Gobierno Federal , Fertilización In Vitro/ética , Fertilización In Vitro/legislación & jurisprudencia , Política de Salud/legislación & jurisprudencia , Humanos , Invenciones/ética , Técnicas Reproductivas Asistidas/ética , Responsabilidad Social , Participación de los Interesados , Gobierno Estatal , Encuestas y Cuestionarios , Reino Unido , Estados Unidos , United States Food and Drug Administration/legislación & jurisprudencia
7.
Am J Law Med ; 45(2-3): 106-129, 2019 May.
Artículo en Inglés | MEDLINE | ID: mdl-31722633

RESUMEN

Beginning on inauguration day, President Trump has attempted an executive repeal of the Affordable Care Act. In doing so, he has tested the limits of presidential power. He has challenged the force of institutional and non-institutional constraints. And, ironically, he has helped boost public support for the ACA's central features. The first two sections of this article respectively consider the use of the President's tools to advance and to subvert health reform. The final two sections consider the forces constraining the administration's attempted executive repeal. I argue that the most important institutional constraint, thus far, is found in multifaceted actions by states - and not only blue states. I also highlight the force of public voices. Personal stories, public opinion, and 2018 election results - bolstered by presidential messaging - reflect growing support for government-grounded options and statutory coverage protections. Indeed, in a polarized time, "refine and revise" seems poised to supplant "repeal and replace" as the conservative focus countering liberal pressure for a common option grounded in Medicare.


Asunto(s)
Personal Administrativo , Reforma de la Atención de Salud/legislación & jurisprudencia , Patient Protection and Affordable Care Act/legislación & jurisprudencia , Política , Gobierno Federal , Financiación Gubernamental/legislación & jurisprudencia , Financiación Gubernamental/organización & administración , Regulación Gubernamental , Reforma de la Atención de Salud/historia , Historia del Siglo XX , Historia del Siglo XXI , Humanos , Reembolso de Seguro de Salud/legislación & jurisprudencia , Jurisprudencia , Medicaid/legislación & jurisprudencia , Medicaid/organización & administración , Medicare/legislación & jurisprudencia , Medicare/organización & administración , Patient Protection and Affordable Care Act/organización & administración , Cobertura de Afecciones Preexistentes , Opinión Pública , Gobierno Estatal , Estados Unidos
9.
West J Emerg Med ; 20(6): 885-892, 2019 Oct 14.
Artículo en Inglés | MEDLINE | ID: mdl-31738715

RESUMEN

INTRODUCTION: On January 1, 2014, the State of Maryland implemented the Global Budget Revenue (GBR) program. We investigate the impact of GBR on length of stay (LOS) for inpatients in emergency departments (ED) in Maryland. METHODS: We used the Hospital Compare data reports from the Centers for Medicare and Medicaid Services (CMS) and CMS Cost Reports Hospital Form 2552-10 from January 1, 2012-March 31, 2016, with GBR hospitals from Maryland and hospitals from West Virginia (WV), Delaware (DE), and Rhode Island (RI). We implemented difference-in-differences analysis and investigated the impact of GBR implementation on the LOS or ED1b scores of Maryland hospitals using a mixed-effects model with a state-level fixed effect, a hospital-level random effect, and state-level heterogeneity. RESULTS: The GBR impact estimator was 9.47 (95% confidence interval [CI], 7.06 to 11.87, p-value<0.001) for Maryland GBR hospitals, which implies, on average, that GBR implementation added 9.47 minutes per year to the time that hospital inpatients spent in the ED in the first two years after GBR implementation. The effect of the total number of hospital beds was 0.21 (95% CI, 0.089 to 0.330, p-value = 0 .001), which suggests that the bigger the hospital, the longer the ED1b score. The state-level fixed effects for WV were -106.96 (95% CI, -175.06 to -38.86, p-value = 0.002), for DE it was 6.51 (95% CI, -8.80 to 21.82, p-value=0.405), and for RI it was -54.48 (95% CI, -82.85 to -26.10, p-value<0.001). CONCLUSION: Our results indicate that GBR implementation has had a statistically significant negative impact on the efficiency measure ED1b of Maryland hospital EDs from January 2014 to April 2016. We also found that the significant state-level fixed effect implies that the same inpatient might experience different ED processing times in each of the four states that we studied.


Asunto(s)
Presupuestos/organización & administración , Eficiencia Organizacional/economía , Servicio de Urgencia en Hospital/organización & administración , Tiempo de Internación/economía , Gobierno Estatal , Control de Costos , Servicio de Urgencia en Hospital/estadística & datos numéricos , Reforma de la Atención de Salud , Costos de Hospital , Humanos , Tiempo de Internación/estadística & datos numéricos , Maryland , Medicaid/organización & administración , Modelos Estadísticos , Estados Unidos
12.
Health Serv Res ; 54(6): 1233-1245, 2019 12.
Artículo en Inglés | MEDLINE | ID: mdl-31576563

RESUMEN

OBJECTIVE: To examine between-state differences in the socioeconomic and health characteristics of Medicare beneficiaries dually enrolled in Medicaid, focusing on characteristics not observable to or used by policy makers for risk adjustment. DATA SOURCE: 2010-2013 Medicare Current Beneficiary Survey. STUDY DESIGN: Retrospective analyses of survey-reported health and socioeconomic status (SES) measures among low-income Medicare beneficiaries and low-income dual enrollees. We used hierarchical linear regression models with state random effects to estimate the between-state variation in respondent characteristics and linear models to compare the characteristics of dual enrollees by state Medicaid policies. PRINCIPAL FINDINGS: Between-state differences in health and socioeconomic risk among low-income Medicare beneficiaries, as measured by the coefficient of variation, ranged from 17.5 percent for an index of socioeconomic risk to 20.3 percent for an index of health risk. Between-state differences were comparable among the subset of low-income beneficiaries dually enrolled in Medicare and Medicaid. Dual enrollees with incomes below the Federal Poverty Level were in better health and had higher SES in states that offered Medicaid to individuals with relatively higher incomes. Duals' average incomes were higher in states with Medically Needy programs. CONCLUSIONS: Characteristics of dual enrollees differ substantially across states, reflecting differences in states' low-income Medicare populations and Medicaid policies. Risk-adjustment methods using dual enrollment to proxy for poor health and low SES should account for this state-level heterogeneity.


Asunto(s)
Doble Elegibilidad para MEDICAID y MEDICARE , Determinación de la Elegibilidad/normas , Medicaid/estadística & datos numéricos , Medicaid/normas , Medicare/estadística & datos numéricos , Medicare/normas , Ajuste de Riesgo/métodos , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Factores Socioeconómicos , Gobierno Estatal , Estados Unidos
16.
Health Serv Res ; 54(6): 1263-1272, 2019 12.
Artículo en Inglés | MEDLINE | ID: mdl-31602631

RESUMEN

OBJECTIVE: To measure discordance between aggregate estimates of means-tested coverage from the American Community Survey (ACS) and administrative counts and examine the association of discordance with ACA Medicaid expansion. DATA SOURCES: 2010-2016 ACS and counts of Medicaid and Children's Health Insurance Program enrollment from the Centers for Medicare & Medicaid Services. STUDY DESIGN: State-by-year counts of means-tested coverage from the ACS were compared to administrative counts using percentage differences. Discordance was compared for states that did and did not adopt expansion using difference-in-differences. We then contrasted the effect of expansion on means-tested coverage estimated from the ACS with results from administrative data. DATA COLLECTION/EXTRACTION: Survey and administrative data. PRINCIPAL FINDINGS: One year before expansion there was a 0.8 and 4 percent overcount in expansion and nonexpansion states, respectively. By 2016, there was a 10.64 percent undercount in expansion states vs a 0.02 percent undercount in nonexpansion states. The ACS suggests that expansion increased means-tested coverage in the full population by three percentage points, relative to five percentage points suggested by administrative records. CONCLUSIONS: Discordance between the ACS and administrative records has increased over time. The ACS underestimates the impact of Medicaid expansion, relative to administrative counts.


Asunto(s)
Programa de Seguro de Salud Infantil/estadística & datos numéricos , Exactitud de los Datos , Cobertura del Seguro/estadística & datos numéricos , Seguro de Salud/estadística & datos numéricos , Medicaid/estadística & datos numéricos , Pacientes no Asegurados/estadística & datos numéricos , Encuestas y Cuestionarios/estadística & datos numéricos , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Gobierno Estatal , Estados Unidos
19.
J Leg Med ; 39(2): 121-136, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31503528

RESUMEN

Empowered to play a larger role in the delivery and administration of health care, a number of states are attempting to solve the pharmaceutical pricing crisis in creative and varied ways. This essay summarizes three particular states' more activist approaches, including states that have sought to empower their Medicaid programs to limit coverage of certain drugs based on price, attempted to use leverage to impose cost-efficiency requirements, and, in the most dramatic example, relied on new usage of "gouging" laws to bring down the costs of prescription drugs. Although all three approaches have met substantial resistance, they illustrate a new era of state experimentation in an effort to bring down the cost of prescription drugs.


Asunto(s)
Control de Costos , Costos de los Medicamentos/legislación & jurisprudencia , Honorarios Farmacéuticos/legislación & jurisprudencia , Medicamentos bajo Prescripción/economía , Gobierno Estatal , Costos y Análisis de Costo/legislación & jurisprudencia , Política de Salud/economía , Política de Salud/legislación & jurisprudencia , Legislación como Asunto , Maryland , Massachusetts , Medicaid/legislación & jurisprudencia , New York , Activismo Político , Estados Unidos
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