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1.
JAMA ; 329(1): 17-18, 2023 01 03.
Artigo em Inglês | MEDLINE | ID: mdl-36484994

RESUMO

This Viewpoint details the risk to Medicaid beneficiaries if the Supreme Court supports a decision that will allow states to deny benefits to eligible recipients and deny beneficiaries' ability to hold states accountable in federal court.


Assuntos
Medicaid , Casas de Saúde , Decisões da Suprema Corte , Medicaid/legislação & jurisprudência , Casas de Saúde/legislação & jurisprudência , Governo Estadual , Estados Unidos/epidemiologia
2.
J Public Health Manag Pract ; 29(Suppl 1): S14-S21, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-36223501

RESUMO

CONTEXT: The COVID-19 pandemic and other public health challenges have increased the need for longitudinal data quantifying the changes in the state public health workforce. OBJECTIVE: To characterize the state of governmental public health workforce among state health agency (SHA) staff across the United States and provide longitudinal comparisons to 2 prior fieldings of the survey. DESIGN: State health agency leaders were invited to have their workforce to participate in PH WINS 2021. As in prior fieldings, participating agencies provided staff lists used to send e-mail invitations to employees to participate in this electronic survey. SETTING AND PARTICIPANTS: State health agency staff. MAIN OUTCOME MEASURES: PH WINS 2021 maintains the 4 primary domains from 2014 and 2017 (ie, workplace engagement, training needs assessment, emerging public health concepts, and demographics) and includes new questions related to the mental and emotional well-being; the impact of the COVID-19 pandemic on staff retention; and the workforce's awareness of and confidence in emerging public health concepts. RESULTS: The percentage of SHA staff who self-identify as Black, Indigenous, and people of color increased from 30% (95% confidence interval [CI]: 29%-32%) to 35% (95% CI: 35%-37%) between 2014 and 2021. Staff younger than 31 years accounted for 11% (95% CI: 10%-12%) of the SHA workforce in 2021 compared with 8% in 2014 (95% CI: 8%-9%). From 2014 to 2021, staff who self-identify as a woman increased from 72% (95% CI: 71%-74%) to 76% (95% CI: 75%-77%). Overall, 22% (95% CI: 21%-23%) of the SHA workforce rated their mental health as poor/fair. CONCLUSION: The 2021 PH WINS results represent unique and current perspectives on the SHA workforce and can inform future public health infrastructure investments, research, and field practice to ensure a strong public health system.


Assuntos
COVID-19 , Mão de Obra em Saúde , Feminino , Humanos , Estados Unidos , COVID-19/epidemiologia , Pandemias , Recursos Humanos , Governo Estadual , Inquéritos e Questionários , Saúde Pública/métodos
3.
J Public Health Manag Pract ; 29(1): 77-81, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-36322024

RESUMO

The Council of State and Territorial Epidemiologists (CSTE) conducted the seventh Epidemiology Capacity Assessment (ECA) from January to April 2021 in state and territorial health departments. The ECA serves to enumerate the applied epidemiology workforce and evaluate workforce capacity across the nation. The results of the ECA demonstrated a need for additional epidemiologists across jurisdictions and challenges of maintaining a trained workforce and improving public health infrastructure. The results of the ECA serve as the foundation for CSTE's workforce priorities, which focus on transforming applied epidemiology by promoting the field as a career opportunity, recruitment, and retention strategies, upskilling the workforce, and enhancing infrastructure. CSTE has outlined current and future workforce priorities, and these priorities contribute to a larger strategy to transform the field and enhance applied epidemiology capacity nationwide. This report describes the programmatic actions taken by CSTE in response to the results of the 2021 ECA.


Assuntos
Epidemiologia , Administração em Saúde Pública , Humanos , Governo Estadual , Epidemiologistas , Recursos Humanos , Saúde Pública
4.
BMC Public Health ; 22(1): 2048, 2022 11 08.
Artigo em Inglês | MEDLINE | ID: mdl-36348479

RESUMO

BACKGROUND: Consumer perceptions of legal cannabis products may drive willingness to purchase from the illegal or legal market; however, little is known on this topic. The current study examined perceptions of legal products among Canadian cannabis consumers over a 3-year period following federal legalization of non-medical cannabis in 2018. METHODS: Data were analyzed from Canadian respondents in the International Cannabis Policy Study, a repeat cross-sectional survey conducted in 2019-2021. Respondents were 15,311 past 12-month cannabis consumers of legal age to purchase cannabis. Weighted logistic regression models examined the association between perceptions of legal cannabis and province of residence, and frequency of cannabis use over time. RESULTS: In 2021, cannabis consumers perceived legal cannabis to be safer to buy (54.0%), more convenient to buy (47.8%), more expensive (47.2%), safer to use (46.8%) and higher quality (29.3%) than illegal cannabis. Except for safety of purchasing, consumers had more favourable perceptions of legal cannabis in 2021 than 2019 across all outcomes. For example, consumers had higher odds of perceiving legal cannabis as more convenient to buy in 2021 than 2019 (AOR = 3.09, 95%CI: 2.65,3.60). More frequent consumers had less favourable perceptions of legal cannabis than less frequent consumers. CONCLUSIONS: Three years since legalization, Canadian cannabis consumers generally had increasingly favourable perceptions of legal vs. illegal products - except for price - with variation across the provinces and frequency of cannabis use. To achieve public health objectives of legalization, federal and provincial governments must ensure that legal cannabis products are preferred to illegal, without appealing to non-consumers.


Assuntos
Cannabis , Humanos , Estudos Transversais , Canadá , Comportamento do Consumidor , Governo Estadual
5.
Nutrients ; 14(21)2022 Oct 22.
Artigo em Inglês | MEDLINE | ID: mdl-36364709

RESUMO

Online ordering for the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) has the potential to alleviate some of the barriers faced by WIC participants when shopping with their WIC food benefits. WIC State agencies are the leaders in planning, preparing, implementing, maintaining, and expanding WIC online ordering. Cross-sectional web-based survey research was utilized to identify barriers to implementing WIC online ordering, as well as the support needed to overcome those barriers, from a WIC State agency perspective. Web surveys were administered to 81 WIC State agencies from 31 January 2022 to 1 April 2022. Descriptive statistics, independent samples t-test, and one-way analysis of variance were used to analyze the findings. Open-ended responses were analyzed using a qualitative iterative approach. WIC State agencies noted several barriers to implementing WIC online ordering, including limited staff capacity, WIC retailer interest, and technological capabilities.


Assuntos
Assistência Alimentar , Lactente , Criança , Humanos , Feminino , Estudos Transversais , Inquéritos e Questionários , Órgãos Governamentais , Governo Estadual
7.
MD Advis ; 15(1): 27-29, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36214859
8.
PLoS One ; 17(9): e0274869, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36121814

RESUMO

CONTEXT: Recommended best practice for resource allocation decisions by governments include a stepwise process guided by economic evidence. However, the use of economic evidence in preventive health decision-making, which often impacts on multiple sectors of government, is under-researched. This study aimed to explore the resource allocation decision-making processes for preventive health interventions in the New South Wales (NSW) Government in Australia, and specifically examined the barriers and facilitators to the use of economic evidence from the perspective of multiple government departments. METHODS: This mixed methods study was conducted using semi-structured interviews with NSW Treasury representatives (n = 4), a focus group of NSW Ministry of Health representatives (n = 9), and a quantitative questionnaire of all participants. The schedule for the interviews and focus group was based on resource allocation guidance documents from Australian government agencies. Deductive content analysis was undertaken, guided by the Multiple Streams Framework. FINDINGS: NSW Treasury participants believed that decision-making processes where economic efficiency was the key guiding principle was the ideal approach. However, the NSW Ministry of Health participants identified that for preventive health decision-making, economic evidence was not used to inform their own choices but was typically only used to convince other agencies of the merits of proposed initiatives when seeking approval. The key barriers to the use of economic evidence were the lack of capacity within the NSW Ministry of Health to understand and undertake economic evaluations; a lack of collaboration between NSW Treasury and preventive health decision-makers within the NSW Ministry of Health; and deficient processes and governance mechanisms that do not facilitate or incentivise effective inter-sectoral decision-making. CONCLUSIONS: Institutional structures for resource allocation decision-making regarding preventive health result in processes that contrast with best practice recommendations. The multiple challenges to collaborative decision-making across agencies require organisational change to promote a whole-of-government approach.


Assuntos
Tomada de Decisões , Alocação de Recursos , Austrália , Humanos , Serviços Preventivos de Saúde , Governo Estadual
9.
Health Aff (Millwood) ; 41(9): 1333-1341, 2022 09.
Artigo em Inglês | MEDLINE | ID: mdl-36067426

RESUMO

Between 2008 and 2018, six states and Washington, D.C., began contracting with enrollment brokers to facilitate enrollment into Medicaid, joining the eighteen states that already had such contracts in place as of 2008. Using newly collected data covering all contracts between state Medicaid agencies and independent enrollment brokers during this period, we compared changes in Medicaid participation following the initiation of contracts with enrollment brokers with contemporaneous changes in Medicaid participation in states that never contracted with brokers. We found that contract initiation had no statistically significant effects on state-level Medicaid participation. We further found no evidence of other enrollment-related benefits, such as improved application processing times.


Assuntos
Medicaid , Humanos , Governo Estadual , Estados Unidos , Washington
10.
Artigo em Inglês | MEDLINE | ID: mdl-36078191

RESUMO

American cities and localities have historically been places of innovation and incubation when it comes to advancing equity and inclusion. Now, local governments in many states are leading the fight for stronger public health protections against COVID-19-through mask mandates, stay-at-home orders, and paid leave provisions, among other actions. However, state lawmakers have long used preemption-state laws that block, override, or limit local ordinances-to stifle local government action, often under pressure from corporate interests and political ideology. Through preemption, state lawmakers have obstructed local communities-often majority-minority communities-from responding to the expressed needs and values of their residents through policies. In this article, we first look at the context behind preemption and its disparate effects. After establishing a conceptual framework for measuring disparities, we discuss how the current COVID-19 pandemic is disproportionately harming the same communities that have been preempted from taking local action, limiting their ability to effectively combat the public health crisis. We argue that all stakeholders interested in health equity have a role to play in addressing the misuse of state preemption.


Assuntos
COVID-19 , Pandemias , COVID-19/epidemiologia , COVID-19/prevenção & controle , Humanos , Governo Local , Pandemias/prevenção & controle , Saúde Pública , Governo Estadual , Estados Unidos
11.
JAMA Health Forum ; 3(2): e214920, 2022 02.
Artigo em Inglês | MEDLINE | ID: mdl-35977273

RESUMO

Importance: Since 2014, all hospitals in Maryland have operated under an all-payer global budget system. Hospital global budgets have gained renewed attention as a strategy for constraining cost growth, improving patient outcomes, and preserving health care access in rural and underserved communities. Lessons from the implementation of the Maryland All-Payer Model (MDAPM) may have implications for policy makers, payers, and hospitals in other settings seeking to adopt global budgets or other value-based payment models. Objective: To examine perspectives on the implementation of the MDAPM among health care leaders who participated in its design and execution. Design Setting and Participants: This qualitative study with semistructured telephone interviews was conducted from November 1, 2019, to February 11, 2020. The purposive sample of Maryland health care leaders represents diverse stakeholder groups, including hospitals, state government and regulatory agencies, the federal government, and payers. Main Outcomes and Measures: Key high-level themes were extracted from interviews using qualitative content analysis, with barriers and facilitators to implementation specified within each theme. Results: A total of 20 interviews were conducted with hospital leaders (n = 6), state regulators (n = 4), federal regulators (n = 4), payer representatives (n = 3), and state leaders (n = 3). Key themes were labeled as (1) expectations (setting bold yet achievable goals), (2) autonomy (allowing hospitals to follow individual strategies within MDAPM parameters), (3) communication (encouraging early and ongoing communication between stakeholders), (4) actionable data (sharing useful hospital and patient-level data between stakeholders), (5) global budget calibration (anticipating technical challenges when negotiating budgets for individual hospitals), and (6) shared commitment to change (harnessing collective motivation for system change). Together, these themes suggest that implementing the payment model followed an evolving and collaborative process that requires stakeholder communication, data to guide decisions, and commitment to operating within the new payment system. Conclusions and Relevance: The implementation of hospital global budgets in the state of Maryland offers generalizable lessons that can inform the evolution and expansion of this approach to value-based payment in other states and settings.


Assuntos
Orçamentos , Hospitais , Acesso aos Serviços de Saúde , Humanos , Maryland , Governo Estadual
12.
J Law Med Ethics ; 50(S1): 60-63, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35902082

RESUMO

The proposed national PrEP program would serve people who are uninsured as well as those enrolled in Medicaid. In this article, the authors propose a set of recommendations for the proposed program's implementers as well as state Medicaid agencies and Medicaid managed care organizations to ensure PrEP access for people enrolled in Medicaid, addressing gaps without undermining the important role of the Medicaid program in covering and promoting PrEP.


Assuntos
Programas de Assistência Gerenciada , Medicaid , Humanos , Pessoas sem Cobertura de Seguro de Saúde , Governo Estadual , Estados Unidos
14.
Soc Sci Med ; 305: 115103, 2022 07.
Artigo em Inglês | MEDLINE | ID: mdl-35696874

RESUMO

Guns are a ubiquitous feature of contemporary US culture, driven, at least partly, by firearms' constitutional enshrinement. However, the majority of laws intended to restrict or expand firearm access and use are formulated and passed in the states, leading to 50 different firearm-related legal environments. To date, little is known about why some states pass more restrictive or permissive firearm laws than others. In this article, we identify patterns of firearm law adoption across states, by framing the problem as a bipartite network (states connected to laws and laws connected to states) that is the result of a complex, and interconnected system of unobserved forces. We employ Exponential-family Random Graph Models (ERGMs), a class of statistical network models that allow for the dispensing of the assumptions of statistical independence, to identify factors that increase or decrease the likelihood of states adopting permissive or restrictive firearms laws over the period 1979 to 2020. Results show that more progressive state governments are associated with a higher chance of enacting restrictive firearm laws, and a lower chance of enacting permissive ones. Conservative state governments are associated with the analogous reversed association. States are more likely to adopt laws if bordering states have also adopted that law. For both restrictive and permissive laws the presence of a law in a neighboring state increased the conditional likelihood of a state having that law, that is laws diffuse across state borders. High levels of homicides are associated with a state having adopted more permissive, but not more restrictive, firearm laws. In summary, these results point to a complex interplay of state internal and external factors that seem to drive different patterns of firearm law adoption Based on these results, future work using related classes of models that take into account the time evolution of the network structure may provide a means to predict the likelihood of future law adoption.


Assuntos
Armas de Fogo , Suicídio , Ferimentos por Arma de Fogo , Previsões , Homicídio , Humanos , Probabilidade , Governo Estadual , Estados Unidos
16.
Artigo em Inglês | MEDLINE | ID: mdl-35627663

RESUMO

(1) Background: The housing environment is crucial to the health of older Chinese people and is becoming an urgent policy initiative. This study explores factors that facilitate or impede the adoption of policy innovation on major housing adaptation (HA) by Chinese provincial governments using the framework of policy innovation and diffusion theory. (2) Methods: This study constructs an event history dataset on HA policy related to elevator retrofitting in existing multifamily dwellings in China; the lack of elevators constitutes an insurmountable barrier in older adults' daily lives in China. The hypotheses were tested by using a traditional event history analysis (EHA) model and a piecewise constant exponential (PCE) model, which is a modified EHA model. The dataset was summarized as "province-year" event history data on 30 Chinese provinces from 2008 to 2019. (3) Results: In addition to internal determinants (e.g., population aging level and financial dependency), diffusion mechanisms can significantly facilitate or impede the adoption of major HA policy innovation by provincial governments. Policy adoption by neighboring governments helps facilitate policy adoption by nonadopters, but policy adoption by subordinate city governments impedes provincial governments' adoption of major HA policy innovation. (4) Conclusions: This study concludes that provincial governments' adoption of major HA policy innovation should be given a higher policy priority. The central government can promote provincial governments' adoption of major HA that primarily benefits older adults by using fiscal transfer payments and enhancing the legitimacy of such policy.


Assuntos
Elevadores e Escadas Rolantes , Habitação , Idoso , China , Política de Saúde , Humanos , Governo Estadual
17.
Health Commun ; 37(12): 1552-1561, 2022 11.
Artigo em Inglês | MEDLINE | ID: mdl-35587035

RESUMO

This study analyzes differences among Americans in their trust in COVID-19 information from governmental sources and how trust is associated with personal adoption of preventative measures under the Trump administration. Based on our analysis of data from a nationally representative survey conducted in October 2020 (effective sample size after weighting = 2615), we find that Americans in general have more trust in COVID-19 information from state/local governments than from the federal government. Variables such as age, party affiliation, religiosity, and race are significantly associated with Americans' trust or lack of trust in COVID-19 information from governmental sources. During the study period, Republicans had more trust in the federal government as a COVID-19 information source than Democrats did, while Democrats had more trust in state/local governments. African Americans had the least trust in the federal and state/local governments as COVID-19 information sources, while Asian Americans had the most trust in both institutions. Trust in the state/local governments as COVID-19 information sources was positively associated with physical distancing and mask-wearing while trust in the federal government as a COVID-19 information source was negatively associated with physical distancing and mask-wearing, suggesting the distinctive roles that state/local governments and the federal government played in mobilizing Americans to adopt preventive measures.


Assuntos
COVID-19 , COVID-19/epidemiologia , COVID-19/prevenção & controle , Governo , Humanos , Distanciamento Físico , Governo Estadual , Confiança , Estados Unidos/epidemiologia
18.
Aust Health Rev ; 46(3): 316-318, 2022 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-35546421

RESUMO

The funding of medication supply in Australian public hospitals is divided between the federal government's Pharmaceutical Benefits Scheme (PBS) and thestate or territory government who pay for the remaining medications not covered under the PBS. For some high-cost medications, such as the monoclonal antibody blinatumomab, the current criteria for PBS funding in public hospitals are challenging. The strict requirement for inpatient admission, due to the risk of potentially serious adverse effects, alongside a lack of PBS reimbursement, while a hospital inpatient, may result in the state bearing the cost. A retrospective review of five patients receiving blinatumomab at our hospital found that, on average, patients remained inpatients for longer than that stipulated to meet PBS funding criteria, predominantly due to adverse effects associated with the medication. This resulted in the state government paying for the medication in full. The upcoming National Medicines Policy review should address the increasing complexity of new medications and their access and funding.


Assuntos
Custos de Medicamentos , Hospitais Públicos , Seguro de Serviços Farmacêuticos , Austrália , Governo Federal , Humanos , Seguro de Serviços Farmacêuticos/economia , Governo Estadual
19.
Eval Rev ; 46(4): 363-390, 2022 08.
Artigo em Inglês | MEDLINE | ID: mdl-35544762

RESUMO

BACKGROUND: U.S. state legislatures fill a vital role in supporting the use of evidence-based interventions (EBIs) through statutes and regulations (mandates). OBJECTIVE: The study determined the terms used by selected states to describe EBIs and how those terms are defined in mandates. RESEARCH METHODS: The mandates of eight purposely selected states were accessed and coded using the Westlaw Legal Research Database. RESULTS: Considerable variation was found in the terms used by states to describe EBIs. Although "evidence-based" was the most frequently utilized term (60% of mandates), an additional 29 alternative terms appeared with varying frequencies. Most terms were simply mentioned, with no further definition or elaboration. When terms were further defined or elaborated, the majority were defined using numerous and different types of external sources or references. Three approaches were found in the mandates defining EBIs: "single definition," "hierarchies of evidence levels," and "best available evidence"; the states differed considerably in the approaches used in their mandates. CONCLUSIONS: The variations in EBI-related terminology across states and within states, coupled with a lack of elaboration on the meaning of important terms and the predominant use of external rather than internal guidelines, may be a source of confusion for behavioral health provider agencies that seek direction about what constitutes an EBI. Prior studies indicate that many agencies may lack staff with the technical ability to adequately evaluate what constitutes an EBI. Thus, lack of clear guidance from official state government mandates may impede the implementation of EBIs within states.


Assuntos
Medicina Baseada em Evidências , Humanos , Governo Estadual , Estados Unidos
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