HEALTH REFORM DEVELOPMENTS
The health domain consists of key aspects involving health professions education, patient care, and clinical research. As noted in a paper published on March 21, 2024 in the journal JAMA Oncology, minority and socioeconomically disadvantaged population subgroups are underrepresented in clinical trials. That fact may reduce the generalizability of trial results and propagate health disparities, which leads to the necessity of focusing on social determinants of health (SDoH) as a means of making needed improvements. Examples of SDoH are low levels of education, lack of employment opportunities, and unsafe neighborhoods.
The March 2024 issue of The Milbank Quarterly contains an article that highlights the negative influence played by the lack of adequate transportation as a SDoH. The authors propose applying a more holistic transportation justice framework to systemic problems in health care. They suggest ways to advance the impact of transportation interventions and highlight the limitations of how health services researchers and practitioners currently conceptualize and use transportation. Incorporating a transportation justice framework offers an opportunity to address transportation and mobility needs more comprehensively and equitably within health care research, delivery, and policy.
Limiting The Availability Of Junk Health Insurance Plans
Since the Patient Protection And Affordable Care Act (ACA) became law in March 2010, efforts have been made to provide coverage for the uninsured and to make health care more affordable. A concern is that some beneficiaries are purchasing lower quality insurance, or “junk insurance plans” that discriminate based on pre-existing conditions and provide little or no coverage. On March 28 of this year, the Departments of Health and Human Services, Labor, and the Treasury (collectively, the Departments) released the Short-Term, Limited-Duration Insurance and Independent, Noncoordinated Excepted Benefits Coverage, or Junk Insurance Final Rules. Short-term, limited-duration insurance (STLDI) is a type of health insurance that typically is designed to fill temporary gaps in coverage when an individual is transitioning from one source of coverage to another. Unlike most health insurance plans, STLDI plans are not subject to the ACA’s critical consumer protections, including guaranteeing coverage for individuals with pre-existing conditions and prohibiting discrimination based on health status, age, or gender. These final rules will limit “short-term” plans to truly short-time periods, no more than four months instead of three years.
Primary Care In The U.S. And Nine Other Nations
An Issue Brief released by The Commonwealth Fund in March 2024 posits that despite the importance of primary care, health systems around the world are facing challenges at the patient and provider level. Many nations struggle to ensure access to care, or first contact; continuity of care; comprehensiveness of care; and coordination of care. These four core components of high-quality primary care are essential to achieve better overall health outcomes. Factors, such as workforce shortages and growing administrative burdens, pose significant barriers to care. The Brief compares the state of primary care in the United States with nine other high-income nations. It updates an earlier Commonwealth Fund study comparing primary care performance in the U.S. with nine peer countries: Australia, Canada, France, Germany, the Netherlands, New Zealand, Sweden, Switzerland, and the United Kingdom.
The findings reveal that although 86% or more of respondents in all 10 countries reported having a regular doctor or place to go for care, adults in the U.S., Sweden, and Canada had the lowest rates, and U.S. adults were the least likely to have a longstanding relationship with a primary care provider. Less than a third of U.S. primary care providers reported making home visits compared to more than two-thirds in all other surveyed countries. Physicians in the U.S. and Germany were most likely to screen their patients for social needs, such as housing and food insecurity. Fewer than four in 10 physicians in the U.S., Sweden, the Netherlands, and Germany reported adequate coordination with specialists and hospitals regarding changes to their patients’ care. A conclusion is that the U.S. trails its peers, particularly in access to and continuity of care. Patients in the U.S. are among the least likely to have access to primary care outside of regular business hours or a longstanding relationship with their primary care physician.