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JAMA Network Open Aug 2023Understanding how social policies shape health is a national priority, especially in the context of the COVID-19 pandemic.
IMPORTANCE
Understanding how social policies shape health is a national priority, especially in the context of the COVID-19 pandemic.
OBJECTIVE
To understand the association between politically motivated changes to Nebraska's Supplemental Nutrition Assistance Program (SNAP) policy and public health measures during the COVID-19 pandemic.
DESIGN, SETTING, AND PARTICIPANTS
This cross-sectional study used synthetic control methods to estimate the association of Nebraska's decision to reject emergency allotments for the SNAP with food security and hospital capacity indicators. A counterfactual for Nebraska was created by weighting data from the rest of the US. State-level changes in Nebraska between March 2020 and March 2021 were included. Data were acquired from the Census Bureau's Household Pulse Survey on individual food security and mental health indicators and from the US Centers for Disease Control and Prevention on hospital-level capacity indicators. Data analysis occurred between October 2022 and June 2023.
INTERVENTION
The rejection of additional SNAP funds for low-income households in Nebraska from August to November 2020.
MAIN OUTCOMES AND MEASURES
Food insecurity and inpatient bed use indicators (ie, inpatient beds filled, inpatient beds filled by patients with COVID-19, and inpatients with COVID-19).
RESULTS
The survey data of 1 591 006 respondents from May 2020 to November 2020 was analyzed, and 24 869 (1.56%) lived in Nebraska. Nebraska's population was composed of proportionally more White individuals (mean [SD], 88.70% [0.29%] vs 78.28% [0.26%]; P < .001), fewer individuals who made more than $200 000 in 2019 (4.20% [0.45%] vs 5.22% [0.12%]; P < .001), and more households sized 1 to 3 (63.41% [2.29%] vs 61.13% [1.10%); P = .03) compared with other states. Nebraska's rejection of additional funding for SNAP recipients was associated with increases in food insecurity (raw mean [SD] difference 1.61% [1.30%]; relative difference, 19.63%; P = .02), percentage of inpatient beds filled by patients with COVID-19 (raw mean [SD] difference, 0.19% [1.55%]; relative difference, 3.90%; P = .02), and percentage of inpatient beds filled (raw mean [SD] difference, 2.35% [1.82%]; relative difference, 4.10%; P = .02).
CONCLUSIONS AND RELEVANCE
In this cross-sectional study, the association between social policy, food security, health, and public health resources was examined, and the rejection of emergency allotments in Nebraska was associated with increased food insecurity. Additionally, this intervention was associated with an increased rate of hospitalizations for COVID-19 and non-COVID-19 causes.
Topics: Humans; Food Assistance; Cross-Sectional Studies; Pandemics; COVID-19; Hospitalization; Hospitals; Food Security
PubMed: 37556142
DOI: 10.1001/jamanetworkopen.2023.26332 -
British Journal of Hospital Medicine... Dec 2023As medical assistance in dying seemingly gains traction, this editorial discusses the arguments for and against it, looking at the balance of patient autonomy and...
As medical assistance in dying seemingly gains traction, this editorial discusses the arguments for and against it, looking at the balance of patient autonomy and alleviation of suffering vs the potentially far-reaching and unintended consequences. The authors hope that this provides a platform for further debate and education around assisted dying.
Topics: Humans; Suicide, Assisted; Dissent and Disputes; Medical Assistance
PubMed: 38153012
DOI: 10.12968/hmed.2023.0262 -
The Journal of Allergy and Clinical... Nov 2023The COVID-19 pandemic had a profound impact on society in general and allergists' practices in particular. The adverse effects included a loss of practice productivity...
The COVID-19 pandemic had a profound impact on society in general and allergists' practices in particular. The adverse effects included a loss of practice productivity and income, staffing, and in-office procedures due to concerns about the spread of infection and the need for social/physical distancing as well as isolation. Allergy training programs and research activities also suffered. Federal financial assistance, rapid adoption of telehealth with Medicare waivers, and adaptation of practice sites, training programs, and research activities allowed for some return to normal, although still with significant restrictions in staffing and in-office procedures. There were positive aspects to the pandemic in the form of telehealth initiatives, pathways for rapid development and approval of tests and treatments, opportunities for new collaborations, and expertise in vaccines. Preparation for the next pandemic needs to be considered now to avoid the mistakes and missteps that occurred with the COVID-19 pandemic. On a national level, a strategy to overcome the societal divisions, misinformation/disinformation, and distrust of science needs to be developed based on better communication, as well as advocacy for continued improvement in our public health system. Practices and training programs as well as research centers need to institutionalize changes made during the pandemic so they can quickly be reinitiated when necessary.
Topics: Aged; Humans; United States; Pandemics; Allergists; Medicare; COVID-19; Telemedicine
PubMed: 37541618
DOI: 10.1016/j.jaip.2023.07.037 -
JAMA Psychiatry Dec 2023The reported prevalence of autism in children has consistently risen over the past 20 years. The concurrent implications for the adult Medicaid system, which insures...
IMPORTANCE
The reported prevalence of autism in children has consistently risen over the past 20 years. The concurrent implications for the adult Medicaid system, which insures autistic adults due to low income or disability, have not been studied.
OBJECTIVE
To estimate the prevalence of adults identified as autistic in Medicaid claims data and to examine the prevalence by year, age, and race and ethnicity to understand enrollment patterns.
DESIGN, SETTING, AND PARTICIPANTS
This cohort study used data from a longitudinal Medicaid claims cohort of enrollees aged 18 years or older with a claim for autism at any point from January 1, 2011, to December 31, 2019, and an approximately 1% random sample of all adult Medicaid enrollees. The data were analyzed between February 22 and June 22, 2023.
EXPOSURE
Adults enrolled in Medicaid with a claim for autism.
MAIN OUTCOME AND MEASURES
Prevalence of autism per 1000 Medicaid enrollees for each year was calculated using denominator data from the Centers for Medicare & Medicaid Services weighted to nondisabled population demographic characteristics. Prevalence by race and ethnicity were calculated for study year 2019.
RESULTS
Across 9 years, 403 028 unique adults had autism claims in their Medicaid records (25.7% female, 74.2% male, 3.3% Asian, 16.8% Black, 12.2% Hispanic, 0.8% Native American, 0.8% Pacific Islander, 74.3% White, and 4.2% of multiple races). Across all ages, autism prevalence increased from 4.2 per 1000 enrollees in 2011 to 9.5 per 1000 enrollees in 2019. The largest increase over the 9 years was in the 25- to 34-year age group (195%), and the smallest increase was in the 55- to 64-year age group (45%). The prevalence of White enrollees was at least 2 times that of the prevalence of every other racial group in all age categories.
CONCLUSIONS AND RELEVANCE
The study findings suggest that despite difficulties in identifying autism in adults, there is a considerable and growing population of autistic adults enrolled in Medicaid. As children on the autism spectrum become autistic adults, Medicaid is an important insurance provider for an increasing number of autistic adults and can be a valuable resource for understanding the health of the autistic population.
Topics: Child; Adult; Humans; Male; Aged; United States; Female; Medicaid; Autistic Disorder; Cohort Studies; Prevalence; Medicare
PubMed: 37792361
DOI: 10.1001/jamapsychiatry.2023.3708 -
Palliative & Supportive Care Oct 2023To examine the impact of the Canadian MAiD program and analyze its safeguards. (Review)
Review
OBJECTIVES
To examine the impact of the Canadian MAiD program and analyze its safeguards.
METHODS
A working group of physicians from diverse practice backgrounds and a legal expert, several with bioethics expertise, reviewed Canadian MAiD data and case reports. Grey literature was also considered, including fact-checked and reliable Canadian mainstream newspapers and parliamentary committee hearings considering the expansion of MAiD.
RESULTS
Several scientific studies and reviews, provincial and correctional system authorities have identified issues with MAiD practice. As well, there is a growing accumulation of narrative accounts detailing people getting MAiD due to suffering associated with a lack of access to medical, disability, and social support.
SIGNIFICANCE OF RESULTS
The Canadian MAiD regime is lacking the safeguards, data collection, and oversight necessary to protect Canadians against premature death. The authors have identified these policy gaps and used MAiD cases to illustrate these findings.
Topics: Humans; Canada; Suicide, Assisted; Physicians; Medical Assistance
PubMed: 37462416
DOI: 10.1017/S1478951523001025 -
JCO Oncology Practice May 2024Medicaid Privatization: Has the Invisible Hand Led Us Astray? presents timely questions regarding our nation's healthcare safety-net: (1) What are the consequences when...
Medicaid Privatization: Has the Invisible Hand Led Us Astray? presents timely questions regarding our nation's healthcare safety-net: (1) What are the consequences when states outsource the administration of Medicaid to private organizations with a profit motive?; (2) Can returning administrative responsibility back to state governments restore any losses to quality and equity experienced by previously privatized public programs?; and (3) Is it time to abandon Medicaid managed care altogether for state-operated fee-for-service or other alternative administrative arrangements?
Topics: United States; Privatization; Medicaid; Humans
PubMed: 38364195
DOI: 10.1200/OP.23.00820 -
Prehospital and Disaster Medicine Dec 2023The Russian invasion of Ukraine in 2022 has affected more people and destroyed a local public health facility. When some territories in Ukraine were de-occupied,...
INTRODUCTION
The Russian invasion of Ukraine in 2022 has affected more people and destroyed a local public health facility. When some territories in Ukraine were de-occupied, national and international mobile clinics (MCs) were involved for medical assistance to local inhabitants. Knowledge about population health, medical, and humanitarian needs after they have been de-occupied has to improve planning for health system response.
OBJECTIVE
The aim of this study was to summarized the MC experience at the first month after the area was de-occupied, as well as to show out-patient visits and to identify a need for medicines and medical equipment in the MC.
METHODS
The information related to the missions was obtained by direct observation and estimation on empirical data gathering in the field during a twelve-day mission in April-May 2022. All patients were divided by age, sex, and diseases according to the International Classification of Diseases-10 (ICD-10). During the twelve-day MC mission, medical assistance was provided for 478 out-patients. Descriptive statistical methods were undertaken using Microsoft Office 2019, Excel with data analysis.
INTERVENTIONS
All out-patients were evaluated clinically. Personal medical cards were completed for each patient. Glucose testing as well as tests for coronavirus disease 2019/COVID-19 had been done, if it was necessary. All sick persons were treated for their disease.
RESULTS
The priority needs for emergency and primary medical care, medicines, and hygienic and sanitation supplies after the area was de-occupied were fixed. The most frequent reasons for visiting the МС were: hypertension (27.6%), musculoskeletal-related (arthritis) diseases (26.9%), heart and peripheral vascular diseases (12.1%), upper gastrointestinal disorder (5.4%), upper respiratory infection (5.0%), and diabetes Type-2 (3.7%). Other diagnoses such as lower respiratory tract infection, diagnoses of the digestive system (hemorrhoids and perianal venous thrombosis), chronic obstructive pulmonary disease/COPD or asthma, eye diseases, gynecology-related condition, menstrual condition, and urinary tract disorder were distributed almost equally (0.21%-2.51%) among the patient population.
CONCLUSIONS
In the de-occupied territories, a health responder could be ready for medical assistance to patients with noncommunicable diseases (NCDs) as well as to support a person with psychological reactions who asked for sedatives and sleep-inducing medicines. These data clearly demonstrate that MCs must be equipped by blood pressure (BP) monitor, stethoscope, pulse oximeter, and diabetes testing kit glucose with essential medicines. This study improves health response planning for local civilian populations in de-occupied territory.
Topics: Humans; Medical Assistance; Diabetes Mellitus; Glucose
PubMed: 37770387
DOI: 10.1017/S1049023X23006398 -
Journal of the American Medical... Oct 2023To examine the impact of COVID-19 on clinical health outcomes and health-related social needs among Medicaid-Medicare dual-eligible beneficiaries. (Review)
Review
OBJECTIVES
To examine the impact of COVID-19 on clinical health outcomes and health-related social needs among Medicaid-Medicare dual-eligible beneficiaries.
DESIGN
Scoping review.
SETTING AND PARTICIPANTS
Dual eligibles during COVID-19.
METHODS
We performed a comprehensive scoping review including observational studies, clinical trials, and original empirical research studies of PubMed and CINAHL. We generated a list of terms related to programs that both serve dual eligibles and address our desired outcomes. With the assistance of a medical librarian, we identified relevant abstracts published during COVID-19 meeting our inclusion criteria. We performed full-text reviews of relevant abstracts and selected the final studies. We extracted the study population, design, and major findings, then conducted thematic analysis.
RESULTS
1100 articles were identified, with 439 deemed relevant. On full text-review, 15 articles met inclusion criteria representing more than 86 million Medicare beneficiaries. No studies were specific only to dual eligibles. Topic areas included in this review include COVID-19 case counts (2 articles), mortality (8 articles), hospitalizations (7 articles), food insecurity (1 article), self-reported mental health (1 article), and social connectedness (2 articles). Dual eligibles had disparate COVID-19-related outcomes from Medicare-only enrollees in 12 of 15 studies. Studies show higher mortality for dual eligibles overall, but this was not true for dual eligibles in nursing homes and assisted living communities. Dual eligibles were more likely to experience food insecurity. More favorably, dual eligibles reported greater social connectedness.
CONCLUSIONS AND IMPLICATIONS
Dual eligibles had different outcomes from Medicare-only recipients in multiple health outcomes and health-related social needs during COVID-19, but studies are limited, particularly in terms of health-related social needs. Future work focusing on outcomes only among dual-eligible beneficiaries, integrated care programs, and fiscal alignment between Medicare and Medicaid plans may help stakeholders address health needs specific to dual eligibles.
Topics: Aged; Humans; COVID-19; Eligibility Determination; Hospitalization; Medicaid; Medicare; United States; Observational Studies as Topic; Clinical Trials as Topic
PubMed: 37696498
DOI: 10.1016/j.jamda.2023.08.007 -
Journal of General Internal Medicine Nov 2023On July 1, 2021, North Carolina's Medicaid Transformation mandatorily switched 1.6 million Medicaid beneficiaries from fee-for-service to managed care plans. We examined...
INTRODUCTION
On July 1, 2021, North Carolina's Medicaid Transformation mandatorily switched 1.6 million Medicaid beneficiaries from fee-for-service to managed care plans. We examined the early enrollee experience in terms of engagement in plan selection, provider continuity, use of primary care visits, and assistance with social needs.
METHODS
Using electronic health records (EHR) covering pre- and post-transition periods (1/1/2019-5/31/2022) from the largest provider network in western North Carolina, we identified all children and adults under age 65 with continuous Medicaid or private coverage. We conducted primary surveys of a random sample of Medicaid-covered enrollees and obtained self-reported rates of engagement in plan selection, continuity of provider access, and receipt of social need assistance. We used comparative interrupted time series models to estimate the relative change in primary care visits associated with the transition.
RESULTS
Our EHR-based study cohorts included 4859 Medicaid and 5137 privately insured enrollees, with 398 Medicaid enrollees in the primary surveys. We found that 77.3% of survey participants reported that the managed care plan they were on was not chosen but automatically assigned to them, 13.1% reported insufficient information about the transition, and 19.2% reported lacking assistance with plan choice. We found that 5.9% were assigned to a different primary care provider. Over 29% reported not receiving any additional social need assistance. The transition was associated with a 7.1% reduction (95% CI, -11.5 to -2.7%) in the volume of primary care visits among Medicaid enrollees relative to privately insured enrollees.
CONCLUSIONS
Medicaid enrollees in North Carolina may have had limited awareness and engagement in the transition process and experienced a reduction in primary care visits. As the state's transition process gains a foothold, future policy needs to improve enrollee engagement and develop evidence on healthcare utilization and patient outcomes.
Topics: Child; Adult; United States; Humans; Aged; Medicaid; North Carolina; Managed Care Programs; Fee-for-Service Plans; Surveys and Questionnaires
PubMed: 37488369
DOI: 10.1007/s11606-023-08319-9 -
PloS One 2023Multisectoral actions (MSAs) on health are key to implementation of primary health care (PHC) and achieving the targets of the Sustainable Development Goal 3. However,... (Review)
Review
BACKGROUND
Multisectoral actions (MSAs) on health are key to implementation of primary health care (PHC) and achieving the targets of the Sustainable Development Goal 3. However, there is limited understanding and interpretation of how MSAs on health articulate and mediate health outcomes. This realist review explored how MSAs influence on implementing PHC towards universal health coverage (UHC) in the context of multilevel health systems.
METHODS
We reviewed published evidence that reported the MSAs, PHC and UHC. The keywords used in the search strategy were built on these three key concepts. We employed Pawson and Tilley's realist review approach to synthesize data following Realist and Meta-narrative Evidence Syntheses: Evolving Standards publication standards for realist synthesis. We explained findings using a multilevel lens: MSAs at the strategic level (macro-level), coordination and partnerships at the operational level (meso-level) and MSAs employing to modify behaviours and provide services at the local level (micro-level).
RESULTS
A total of 40 studies were included in the final review. The analysis identified six themes of MSAs contributing to the implementation of PHC towards UHC. At the macro-level, themes included influence on the policy rules and regulations for governance, and health in all policies for collaborative decision makings. The meso-level themes were spillover effects of the non-health sector, and the role of community health organizations on health. Finally, the micro-level themes were community engagement for health services/activities of health promotion and addressing individuals' social determinants of health.
CONCLUSION
Multisectoral actions enable policy and actions of other sectors in health involving multiple stakeholders and processes. Multisectoral actions at the macro-level provide strategic policy directions; and operationalise non-health sector policies to mitigate their spillover effects on health at the meso-level. At micro-level, MSAs support service provision and utilisation, and lifestyle and behaviour modification of people leading to equity and universality of health outcomes. Proper functional institutional mechanisms are warranted at all levels of health systems to implement MSAs on health.
Topics: Humans; Health Services; Government Programs; Medical Assistance; Sustainable Development; Primary Health Care
PubMed: 37561811
DOI: 10.1371/journal.pone.0289816