Health Affairs ForefrontOnce In A Weil
Health Affairs In 2017: Editor’s Picks
When I released my “Editor’s Picks for 2016,” I said “2017 promises to be an eventful year in health policy.” That turned out to be an understatement. As Health Affairs Editor-in-Chief, I have the pleasure of reading hundreds of articles each year—more, I’m sure, than most of our readers. In selecting my “top ten” for 2017, I look for something different than “most-read” or “most-shared.” My list of articles, in alphabetical order, covers a broad range of topics. Many of these articles analyze the effects of a specific policy; others raise the profile of issues that deserve more attention. Some articles had unexpected findings. Their shared attribute is that the authors chose to focus on interesting and important questions. These are my picks for the year—whether they are yours or not, I hope you find them interesting, enjoy reading them, and learn something from them. And, dare I say, 2018 promises to be another eventful year in health policy.
‘Go Back To California’: When Providers Fail Transgender Patients
Laura Arrowsmith | September 2017
A transgender doctor shares her experience of being mistreated by a health care provider. She discusses how medical education and the health care system need to change to be able to care for transgender patients.
Iowa’s Medicaid Expansion Promoted Healthy Behaviors But Was Challenging To Implement And Attracted Few Participants
Natoshia M. Askelson, Brad Wright, Suzanne Bentler, Elizabeth T. Momany, and Peter Damiano | May 2017
States adopting Medicaid expansions in more conservative political environments are including features designed to promote healthy behaviors among enrollees. Natoshia Askelson and colleagues evaluate the approach taken in Iowa. They find low compliance with program requirements and significant gaps in knowledge among enrollees and providers. Their results raise questions about the viability of efforts to reform Medicaid by shifting responsibility for healthy behaviors onto enrollees.
Los Angeles Safety-Net Program eConsult System Was Rapidly Adopted And Decreased Wait Times To See Specialists
Michael L. Barnett, Hal F. Yee, Jr., Ateev Mehrotra, and Paul Giboney | March 2017
Access to specialty care has long been identified as a challenge for low-income and otherwise vulnerable people. The Los Angeles County Department of Health Services developed the eConsult system, which connects primary care providers electronically to specialists. The system has produced dramatic results: three to four years after implementation, one-quarter of inquiries were being resolved without the patient having to visit a specialist, and wait times when appointments were needed had fallen by eleven days.
Lower-Income Countries That Face The Most Rapid Shift In Noncommunicable Disease Burden Are Also The Least Prepared
Thomas J. Bollyky, Tara Templin, Matthew Cohen, and Jospeh L. Dieleman | November 2017
As health systems make progress tackling communicable diseases and life expectancy has increased, countries face a rising burden of noncommunicable diseases such as diabetes, cancer, and cardiovascular disease. Thomas Bollyky and colleagues map the growth of these diseases against each country’s health system functioning, finding that countries that are projected to have the greatest increase in their noncommunicable disease burden as a share of health burden are also the least prepared.
Women In The United States Experience High Rates Of Coverage ‘Churn’ In Months Before And After Childbirth
Jamie R. Daw, Laura A. Hatfield, Katherine Swartz, and Benjamin D. Sommers | April 2017
Stable health insurance coverage could be particularly important for pregnant women, since timely and regular prenatal care is known to improve birth outcomes. Jamie Daw and colleagues examine women’s insurance patterns before and after childbirth, finding that that 58 percent of pregnant women change insurance status at least once during pregnancy, and 62 percent spend at least one month without any insurance at all.
Impact Of Ambulance Diversion: Black Patients With Acute Myocardial Infarction Had Higher Mortality Than Whites
Renee Y. Hsia, Nandita Shakar, and Yu-Chu Shen | June 2017
Renee Hsia and colleagues document the consequences of disparities in mortality after a heart attack for blacks and whites in California. They find that when hospitals were on ambulance diversion—reflecting overcrowded conditions—blacks experienced mortality rates as much as 19 percent higher than whites.
Substantial Physician Turnover And Beneficiary ‘Churn’ In A Large Medicare Pioneer ACO
John Hsu, Christine Vogeli, Mary Price, Richard Brand, Michael E. Chernew, Namita Mohta, Sreekanth K. Chaguturu, Eric Weil, and Timothy G. Ferris | April 2017
Medicare and private payers are increasingly promoting the use of accountable care organizations (ACOs) to improve care delivery. John Hsu and colleagues analyze data from Partners HealthCare, one of the largest Pioneer ACOs in the country. The data reveal high levels of physician and enrollee turnover within the ACO and a modest number of enrollees assigned to each physician.
Only One In Twenty Justice-Referred Adults In Specialty Treatment For Opioid Use Receive Methadone Or Buprenorphine
Noa Krawczyk, Caroline E. Picher, Kenneth A. Feder, and Brendan Saloner | December 2017
When people with substance use disorders enter the criminal justice system, there is an opportunity to direct them to treatment. Noa Krawczyk and colleagues find that fewer than 5 percent of people referred to opioid use disorder treatment through the criminal justice system are receiving agonist therapies, indicating a missed opportunity in connecting people to evidence-based treatment.
A National Profile Of End-Of-Life Caregiving In The United States
Katherine Ornstein, Amy S. Kelley, Evan Bollens-Lund, and Jennifer L. Wolff | July 2017
Katherine Ornstein and colleagues profile the 2.3 million people in the United States who provide care to people ages sixty-five and older in their final year of life, with a focus on the almost 90 percent of caregivers who are unpaid. About half of the caregivers report that they are exhausted when they go to bed and have no time for themselves, and that the caregiving is emotionally difficult, highlighting the need to support this growing population.
Market Share Matters: Evidence Of Insurer And Provider Bargaining Over Prices
Eric T. Roberts, Michael E. Chernew, and J. Michael McWilliams | January 2017
Proposed mergers among large US health insurers and growing consolidation among providers have renewed concerns about the effects of market concentration on commercial health care prices. The authors estimate that insurers with larger market shares negotiated prices for office visits that were lower than those by insurers with small market shares. They also find that insurers require greater market shares to negotiate lower prices from large provider groups than they do when negotiating with smaller provider groups.