A brand new journal is being launched, Health Affairs Scholar, described on the web site as “a brand new totally open entry, peer-reviewed journal devoted to world well being coverage and rising well being companies analysis.” I want them success!
For non-researchers like me, one attention-grabbing a part of the journal is the “Commentary” part. At the beginning of the primary difficulty, the core members of the editorial group get the ball rolling with their essay, “Ten health policy challenges for the next 10 years,” by Kathryn A Phillips, Deborah A Marshall, Loren Adler, Jose Figueroa, Simon F Haeder, Rita Hamad, Inmaculada Hernandez, Corrina Moucheraud, and Sayeh Nikpay (July 2023) Like all such lists, this one is thought-provoking each for what it emphasizes, and for what it doesn’t. Let’s begin with their listing of 10 challenges: they’ve extra to say about every problem, with citations to the literature, within the essay.
Considering past the insurance coverage card: How do systemic boundaries have an effect on entry to care and what we will do about it?
Regardless of reaching an all-time low uninsurance fee in 2022, a rising realization has began to set in throughout the USA that handing out insurance coverage playing cards doesn’t function the ultimate step within the purpose of accelerating the well being of all People. Certainly, enrolling people into well being protection is barely significant if they’ll entry the medical care they want, and if they’ll accomplish that in a well timed method. …
New well being care over-the-counter merchandise: What shall be required to fulfill client wants?
The marketplace for over-the-counter (OTC) well being merchandise continues to increase dramatically. This improve is just not just for merchandise which have been available on the market for many years, equivalent to dietary dietary supplements, but in addition for brand new classes of merchandise, equivalent to on-line eye exams and prescription glasses, direct-to-consumer genetic and different sorts of screening exams equivalent to these for COVID-19 an infection, and on-line pharmacies. These developments are altering the connection between shoppers and well being care in important methods … A main instance of the benefits—and challenges—of the transfer to OTC well being merchandise is the latest US Meals and Drug Administration (FDA) approval of the advertising and marketing of OTC listening to aids. There’s a enormous unmet want for inexpensive and accessible listening to gadget merchandise as statistics present that almost all of people who would profit from listening to aids don’t use them …
Security-net packages: Why will we make it so exhausting for households to obtain social safety-net advantages?
It’s more and more acknowledged that social components like poverty and housing are key determinants of well being. But, the USA dedicates a smaller share of its Gross Home Product (GDP) to social spending on households than the typical Group for Financial Co-operation and Growth (OECD) nation (0.6% vs. 2.1% in 2019). … One other main understudied part of this drawback is that it’s difficult for economically deprived households to entry the advantages for which they’re eligible….
Guaranteeing entry to look after sufferers with restricted capability to pay: What are the unintended impacts of poorly focused assist for the well being care security internet?
All nations, no matter their particular well being fee strategy, should think about how sufferers can equitably entry care. Even nations with publicly funded techniques have gaps in entry. For instance, though the UK has the world’s largest government-run and -funded well being care system, a latest survey discovered that and one in eight adults paid for personal insurance coverage as a result of waits have been too lengthy. These points are significantly acute in the USA, with its advanced combine of personal and public insurance coverage packages. …
Are structural inequities hampering hospitals’ capability to handle social determinants of well being?
Hospitals and well being techniques have the potential to play a big position in addressing well being inequities within the communities they serve. … Rising proof, nevertheless, raises substantial concern that structural inequities could hamper the power of safety-net hospitals, which disproportionately serve low-income and racially/ethnically minoritized populations, to handle their sufferers’ and communities’ social wants. These inequities are, partly, pushed by structurally discriminant components on the core of our present hospital financing system. Our present hospital reimbursement system successfully assigns a decrease greenback quantity for the care of low-income, Black, and Latino individuals, given their disproportionate enrollment in insurance policy like Medicaid, which reimburse hospitals much less. …
With mergers of insurers and pharmacy chains and development of on-line generic retailers, can group pharmacies survive?
Pharmacies play an important position within the provision of medicines and patient-centered remedy administration companies, as demonstrated within the COVID-19 pandemic. Pharmacy accessibility is indispensable for fairness in well being care entry, as pharmacies can attain people who don’t work together with different well being care suppliers. Pharmacy entry is jeopardized by the growing development in pharmacy closures noticed up to now few years. …
The personal fairness “takeover” of well being care: What does it imply?
Personal fairness funding into well being care accelerated quickly over the past decade and exhibits no indicators of slowing down. Personal fairness corporations now play a significant position throughout the well being care trade, from hospitals and nursing houses to doctor practices and dental clinics to biotechnology, medical units, and knowledge expertise. This infusion of capital provides the potential for investments which will enhance affected person care and generate economies of scale, however personal fairness’s give attention to short-term earnings and effectivity additionally raises issues about affected person harms and better prices. Quite a few information tales have recognized examples of fraudulent exercise, overtreatment, aggressive billing practices, and widespread use of noncompete and nondisclosure agreements related to personal fairness–owned amenities and medical teams. Additionally, latest empirical proof suggests that non-public fairness acquisitions of medical practices result in greater costs and, maybe extra concerningly, that their acquisitions of nursing houses have a tendency to extend mortality charges. …
The highway forward for well being insurance policies on genomic testing and precision drugs: A lot achieved however what stays to be addressed? …
[G]enomic testing and the final discipline of “precision drugs”—which makes use of details about an individual’s genome and superior computing instruments for information aggregation to exactly goal prevention, prognosis, and remedy—have made nice advances. Genomic testing is routinely utilized in a variety of medical eventualities, together with most cancers danger screening for BRCA1/2, noninvasive prenatal testing for fetal anomalies, and genomic sequencing of tumors to focus on efficient remedies and to diagnose uncommon illnesses in newborns. But, way more well being coverage analysis is required, each on current makes use of of genomics and people which might be rising. …
“Nothing about us with out us”: How can affected person engagement contribute to significant well being coverage analysis?
A number of world initiatives have emerged to acknowledge the worth of patient-centered care. … Well being care supply and well being coverage change that doesn’t actively interact sufferers is not acceptable. With the continuing challenges dealing with well being care techniques, affected person engagement in well being coverage analysis to tell well being coverage adjustments will change into more and more essential to the supply of efficient and financially sustainable well being care to an growing old inhabitants with advanced continual care wants. …
Constructing a very world perspective: How can researchers contribute?
Latest phenomena have made obvious the interconnectedness of our world group; what occurs in a single nation touches us all, whether or not the unfold of COVID-19 an infection and of applied sciences to fight it, or crises from wars to local weather change and their humanitarian penalties. … Nonetheless, the general public well being and well being coverage literature has lengthy been dominated by authors and views from high-income nations: over 80% of the world’s inhabitants lives in low- and middle-income nations (LMICs), but authors from LMICs are underrepresented within the scientific literature, significantly in significant authorship roles. …
I particularly recognize the concreteness of this listing. It typically feels to me as if well being coverage disputes are phrased when it comes to “spend extra” or “spend much less,” with out consideration of specifics. For instance, eager about to enhance individuals’s sensible and precise entry to well being care in ways in which transcend the place to begin of medical health insurance protection, like what individuals find out about the way to get hold of info and care, or whether or not they can get to a pharmacy, appears essential to me. The difficulty of over-the-counter well being care is within the information proper now due to the FDA has for the first time approved an over-the-counter birth control pill. However there was a dramatic rise in what’s obtainable over-the-counter, and our growing old society would profit if listening to aids have been extra extensively obtainable and used.
An inventory like that is additionally an expression of encouragement to researchers. Thus, together with gadgets like genomic remedies, affected person engagement, and well being care provision in low- and middle-income nations are each essential in themselves, and likewise an indication of subjects that the journal presumably seeks to publish.
However with encouragement duly given, my very own private listing of well being coverage challenges would come with (not less than) two gadgets not listed right here. One is the set of points arising from on-line provision of well being care, which exploded in dimension throughout the pandemic, now appears to be getting scaled again. Much more sufferers are most likely getting their on-line well being care recommendation from a Google search or ChatGPT or an advocacy web site. The problems arising from dramatically expanded entry to well being care info of extremely various levels of high quality–and the way gamers within the system from well being care suppliers to for-profit corporations to authorities work together with that info–are solely rising in dimension.
The opposite set of points is value management. The listing from the editors of the brand new journal is heavy on problems with entry, systemic boundaries, structural inequality, restricted capability to pay, pharmacies closing down, Medicaid not paying sufficient, well being care wants in different nations, and so forth. However it’s only a indisputable fact that US health care spending is nearly one-fifth of the entire US economy. There have been studies for years suggesting that as much as 25% of US health care spending doesn’t provide any therapeutic benefit. The incentives to provide new well being care applied sciences that value loads and shall be coated by insurance coverage are substantial; the incentives to develop new applied sciences and practices that scale back prices by a couple of % annually, if you will get well being care suppliers to undertake the, are minimal. Discovering methods to carry down prices associated to among the greatest well being care points–like encouraging sufferers with continual circumstances to stay to their meds and weight loss plan, or addressing the opioid epidemic, or serving to the aged to age at residence the place attainable–would require insurance policies outdoors the standard well being care supply system. If the US well being care invoice was loads decrease, then increasing entry could be loads simpler. As it’s, US well being care spending is a foremost driver of the projections for federal finances deficits within the years forward.
The place the listing of 10 well being care coverage challenges mentions cost-cutting or effectivity– say, the position of personal fairness or well being care mergers–it’s skeptical of their advantages. I’m skeptical, too. However discovering some cost-cutting measures that may very well be broadly supported looks as if a worthy coverage problem.