The Biden Administration Killed America’s Collective Pandemic Approach

“Coronavirus case numbers are in free fall; vaccines and, to a lesser degree, viral infections have built up a wall of immunity that can blunt the virus’s impact overall. Several experts stressed that certain aspects of the CDC’s new guidelines are genuinely improving on the framework the country was using before. “The timing feels right to make some kind of change,” Whitney Robinson, an epidemiologist at Duke University, told me. But protection against SARS-CoV-2 isn’t spread equally. Millions of kids under 5 are still ineligible for shots. Vaccine effectiveness declines faster in older individuals and is patchy to begin with … Read More

The Bottom of the Health Care Rationing Iceberg

“Since February, like ethicists around the world, I have spent most of my time thinking about the tip of the health care rationing iceberg. As Covid-19 cases exploded across epidemiologic maps, I scrambled to write new guidelines for my health network for the ethical allocation of mechanical ventilators, just in case we ran out. [..] Despite that heady challenge and the urgency of the Covid-19 pandemic, I couldn’t shake the feeling that this effort was all a distraction. Here I was, trying to do a perfect job allocating a handful of mechanical ventilators for an unprecedented viral pandemic, while every … Read More

The Paradox of STEMI Regionalization: Widened Disparities Despite Some Benefits

“In this issue of JAMA Network Open, Hsia et al sought to determine whether efforts to improve access, treatment, and outcomes for patients with ST-elevation myocardial infarction (STEMI) by means of cardiac care regionalization were associated with widened or narrowed disparities between minority and nonminority communities at the zip code level across the state of California. Access was defined as admission to a hospital with percutaneous coronary intervention (PCI) capability; treatment was defined as receiving coronary angiography or PCI (as clinically indicated) the day of admission or at any time during hospitalization; and outcomes were defined as all-cause mortality at … Read More

When Actions Speak Louder Than Words — Racism and Sickle Cell Disease

“SCD [sickle cell disease] is a life-threatening, inherited blood disorder, affecting more than 100,000 Americans. Painful vaso-occlusive crises, the hallmark of SCD, result in substantial suffering and lead to associated stigma. Without adequate treatment, SCD affects all organs and is associated with decreased quality of life and a shortened life span. Among the dozens of conditions that are screened for in state newborn-screening programs, SCD is the most commonly detected condition, regardless of ethnicity. It is thus important to recognize SCD as a common and important medical condition among Americans, and not “just Black Americans.” [..] Although SCD is a … Read More

How ACOs In Rural And Underserved Areas Responded To Medicare’s ACO Investment Model

“To help establish ACOs in more areas of the country, the Centers for Medicare and Medicaid Services (CMS) developed the ACO Investment Model (AIM) to provide participating ACOs with up-front and ongoing monthly payments over 24 months to fund ACO infrastructure investments and staffing. As part of the Medicare Shared Savings Program (SSP), the payments were to be recouped through any shared savings earned by the ACOs that sufficiently decreased costs relative to a financial benchmark, as specified by SSP regulations. Forty-one new SSP ACOs, primarily located in rural and underserved health care markets, joined AIM in 2016. [..] A … Read More

Comparison of Community-Level and Patient-Level Social Risk Data in a Network of Community Health Centers

“no clear standard has emerged on how to implement social risk screening, nor how clinicians can or should use social risk information to adjust patient care or make referrals to community resources. Moreover, some have questioned the benefit of integrating social risk screening into primary care, raising concerns about the additional burden of adding more required data collection to already busy primary care practices and the limited resources available to address identified social risk factors. [..] relying solely on community-level data to understand the social context of an individual patient and/or to guide patient-level interventions poses a risk of ecological … Read More

Constructing the Modern American Midwife: White Supremacy and White Feminism Collide

“US exceptionalism in maternity care is marked by the lack of midwives as primary providers. Out of 100 births, only 10 to 12 will be attended by a midwife – and 9 out of 10 of these midwives are white. Yet globally, most childbearing women are attended to by midwives, only turning to an obstetrician if serious complications arise. According to WHO and The Lancet, midwives could help avert roughly two-thirds of all maternal and newborn deaths, while providing 87% of all essential sexual, reproductive, and maternal health services. Midwifery is one of the most ancient of traditions and professions … Read More

Special Report: U.S. jails are outsourcing medical care — and the death toll is rising

“A Reuters review of deaths in more than 500 jails found that, from 2016 to 2018, those relying on one of the five leading jail healthcare contractors had higher death rates than facilities where medical services are run by government agencies. The analysis assessed deaths from illness and medical conditions, suicide, and the acute effects of drugs and alcohol. Jails with publicly managed medical services, usually run by the sheriff’s office or local health department, had an average of 12.8 deaths per 10,000 inmates in that time. Jails with healthcare provided by one of the five companies had an additional … Read More

Reparations as a Public Health Priority — A Strategy for Ending Black–White Health Disparities

“There has not been a single year since the founding of the United States when Black people in this country have not been sicker and died younger than White people.[..] Though the racial gap in life expectancy has narrowed, Black Americans continue to die 4 years earlier, on average, than White Americans. The divides on other U.S. mortality measures are starker: Black mothers are three times as likely as White mothers to die from pregnancy-related causes; Black infants are more than twice as likely as White infants to die in their first year, according to the Centers for Disease Control … Read More

Why a Hospital Might Shun a Black Patient

“because a vast majority of programs that tie payment to cost and quality goals aren’t focused on disadvantaged populations, they create incentives for hospitals to avoid patients from these groups. For example, in the 1990s, the New York State Department of Health began grading surgeons who performed coronary bypass surgery and making their report cards available to the general public. The aim was to make outcomes more transparent and to help surgeons improve. But to this day, the initiative makes it harder for Black patients to get surgery. Why? Because statistically, outcomes are generally worse for Black patients because of … Read More