By any measure, the United States has a level of health inequity rarely seen among developed nations. The roots of this inequity are deep and complex, and are a function of differences in income, education, race and segregation, and place. In this primer, we provide an overview of these distinctly American problems, and discuss programs and policies that might promote greater health equity in the population.
Opioid overdose deaths have been called “deaths of despair” because of their possible connection to individual and community distress. This study looks at how proximity to auto plant closures — which represent large, traumatic, and culturally significant shocks to economic opportunity — affected opioid deaths among working age adults between 1999 and 2016.
Calls for the establishment of a “public option,” which emerged during the debate on the Affordable Care Act, have reemerged in this election season. Some proposals base the public option on Medicare, while others on Medicaid. In this article, Wharton professor and LDI Senior Fellow Mark Pauly discusses the likely effects of a public option on private markets, using experience in Medicare Advantage as a guide. Will the public option become the preferred one, sweeping away the private market? Or can the public and private options peacefully coexist?
Thirteen states limit alcohol purchases to state-run stores. Washington was among these states until 2011, when voters passed Initiative 1183,
which privatized liquor sales and imposed taxes and fees on them. As a result, the number of retail sites increased dramatically, and the cost of
liquor went up. The authors compared the amount of alcohol purchased by households in Washington metropolitan areas to the amount purchased by households in 10 states that retained monopoly control of alcohol sales, before and after privatization.
Accountable Care Organizations (ACOs) are groups of physicians and hospitals that jointly contract to care for a patient population. ACO contracts incentivize coordination of care across providers. This can lead to greater consolidation of physician practices, which can in turn generate higher costs and lower quality. Given this, the study asks, as ACOs enter health care markets, do physician practices grow larger?
In this national study, Medicare beneficiaries treated by new surgeons had poorer outcomes than those treated by experienced ones in the same hospitals. However, the type of operation and the patient’s emergency status – rather than physician inexperience – explains nearly all poorer outcomes. Higher-risk cases are disproportionately treated by new surgeons.
In the United States, people who need long-term care (LTC) face a system with large gaps in care, which they must rely on friends and family to fill. Medicaid finances the majority of paid LTC, but people must exhaust their resources to qualify. Medicare and private health insurance do not cover LTC, and the private market for long-term care insurance is failing. Unpaid family and friends provide most long-term services, but the value of their services is rarely reflected in debates about LTC financing and delivery. Beyond the value of the services, this system has costs to the economy, as spouses and adult children reduce paid work to care for their loved ones. As the population ages and families are less able to shoulder the burden of LTC, the current system may be unable to meet the growing need without an alternative, sustainable financing mechanism.
Prior to the Affordable Care Act (ACA), health care safety-net programs were the primary source of care for over 44 million uninsured people. While the ACA cut the number of uninsured substantially, about 30 million people remain uninsured, and many millions more are vulnerable to out-of-pocket costs beyond their resources. The need for the safety net remains, even as the distribution and types of need have shifted. This brief reviews the effects of the ACA on the funding and operation of safety-net institutions. It highlights the challenges and opportunities that health care reform presents to safety-net programs, and how they have adapted and evolved to continue to serve our most vulnerable residents.
On January 1, 2017, Philadelphia became the second U.S. city to tax the distribution of sweetened beverages. The 1.5 cent per ounce tax applies to the distribution of sugar- and artificially sweetened beverages. Similar taxes have been passed in several other cities and are being considered at the state level. The authors examined the effect of the tax on beverage prices and sales at chain retail stores in Philadelphia.
Factors over the life course affect the mental health of urban black men with serious injuries. Childhood adversity, pre-injury physical and mental health conditions, and intentional injury (violence) are risk factors for post-injury depression and posttraumatic stress. Clinicians should expand assessment beyond the acute injury event to identify those patients at risk for poor mental health outcomes.
College affirmative action bans were associated with higher rates of smoking and drinking in underrepresented minority 11th and 12th graders, and these students continued to smoke at higher rates into young adulthood. Policymakers should consider unintended public health consequences of proposals, such as affirmative action bans, that may limit socioeconomic opportunities.
Amidst an ongoing opioid crisis that claimed 47,600 lives in 2017, increasing the availability of the rescue medication naloxone is a high priority. Naloxone reverses an opioid overdose when given intranasally or intramuscularly. But to be effective, naloxone must be available at the time of overdose. Naloxone distribution to laypeople can save a life when first responders are not immediately available, or when people witnessing overdoses are unwilling or unable to call 911. Naloxone is increasingly available through some pharmacies under a standing order; however, even when available, cost and stigma barriers persist. This Issue Brief reviews recent evidence on the outcomes and cost-effectiveness of naloxone distribution strategies in community, pharmacy, and other health care settings.
Hospital work environments that promote nurse leadership, encourage nurse participation in hospital governance and decision-making, assure adequate resources and staffing, and foster collaboration between doctors and nurses are consistently associated with better patient, quality, safety, and job outcomes. The work environment offers a powerful target for improvement efforts and warrants the resources and attention of health care administrators.