Why is syndemic theory becoming more prominent in US healthcare policy and practice? A qualitative analysis of the timeline and future of syndemics in HIV-related healthcare

Introduction to the CLER National Report of Findings 2022: The COVID-19 Pandemic and Its Impact on the Clinical Learning Environment.

In this book, Phelps and Parente explore the US health care system and set out the case for its reform. They trace the foundations of today's system, and show how distortions in the incentives facing participants in the health care market could be corrected in order to achieve lower costs, a higher quality of care, a higher level of patient safety, and a more efficient allocation of health care resources. Phelps and Parente propose novel yet economically robust changes to US tax law affecting health insurance coverage and related issues. They also discuss a series of specific improvements to Medicare and Medicaid, and assess potential innovations that affect all of health care, including chronic disease management, fraud and abuse detection, information technology, and other key issues. The Economics of US Health Care Policy will be illuminating reading for anyone with an interest in health policy, and will be a valuable supplementary text for courses in health economics and health policy, including for students without advanced training in economics.

On January 7, a federal appeals court rejected six Georgia primary care physicians’ (PCPs) challenge to the Centers for Medicare and Medicaid Services’ (CMS) 20-year, sole-source relationship with the secretive, specialist-dominated federal advisory committee that determines the relative value of medical services. The American Medical Association’s (AMA) Relative Value Scale Update Committee (RUC) is, in the court’s view, not subject to the public interest rules that govern other federal advisory groups. Like the district court ruling before it, the decision dismissed the plaintiffs’ claims out of hand and on procedural grounds, with almost no discussion of content or merit. Thus ends the latest attempt to dislodge what is perhaps the most blatantly corrosive mechanism of US health care finance, a star-chamber of powerful interests that, complicit with federal regulators, spins Medicare reimbursement to the industry’s advantage and facilitates payment levels that are followed by much of health care’s commercial sector. Most important, this new legal opinion affirms that the health industry’s grip on US health care policy and practice is all but unshakable and unaccountable, and it appears to have co-opted the reach of law.

Consilience of healthcare legislation, complexity science & computational analysis

The COVID-19 pandemic has illuminated and amplified the harsh reality of health inequities experienced by racial and ethnic minority groups in the United States. Members of these groups have disproportionately been infected and died from COVID-19, yet they still lack equitable access to treatment and vaccines. Lack of equitable access to high-quality health care is in large part a result of structural racism in US health care policy, which structures the health care system to advantage the White population and disadvantage racial and ethnic minority populations. This article provides historical context and a detailed account of modern structural racism in health care policy, highlighting its role in health care coverage, financing, and quality.

Health Systems Need to Transform Data Collection to Advance Health Equity.

Remedy and reaction: the peculiar American struggle over health care reform

The enactment of the Affordable Care Act (ACA) in 2010 was the most monumental change in US health care policy since the passage of Medicaid and Medicare in 1965.1,2 Despite a bill that was more than 900 pages, the primary goals of the legislation were clear: increase the number of individuals with health insurance; improve the quality of care; and tame the seemingly inexorable increases in the cost of care.

Over the past decade, multiple federal, state and local government mission statements have employed syndemic theory in proposed policies and practices. We interviewed 20 key informants from academia, non-governmental organisations and local government public health officials on range of topics relating to how syndemic theory is shaping healthcare policy and practice. Informants highlighted the role of syndemic theory in providing person-centred services. They also provided examples of HIV-related care services and organisational change that have been influenced or shaped by syndemic theory. However, informants also indicated that they are just beginning to understand how to employ syndemics and noted that there are many barriers to putting syndemic theory into practice. In particular, they described how governance structures and funding are siloed and therefore at odds with the holistic and integrated framework that is core to syndemic theory. Nevertheless, they felt the central messages of syndemic theory are well supported among colleagues and remained committed to finding ways to put syndemic theory in practice. We argue that that governmental and non-governmental institutions and departments will need to substantially invest in braided funding streams and associated healthcare administrative structures.

Good policy requires a strategic focus, the antithesis of conventional wisdom—if it ain't broke, don't fix it. US health care system can never be accused of taking a strategic, systems view of its health problems. Dr Fox opens his analysis of health policy by noting immediately, The contemporary disarray in health affairs in the United States is a result of history. It is the cumulative result of inattention to the burden of chronic disabling illness. I would add that it is also the result of political characteristics (pluralism, individualism, divided government powers), social ethos (volunteerism, lack of consensus), and economic perspective (capitalism, uncritical reliance on the mythic market). central theme is that combating infection and other acute disease has been the main force distorting every aspect of US health care policy, even though chronic disease was recognized by the 1920s as the major health issue. However, Dr Fox

Child Poverty and Health in the United States: Introduction and Executive Summary.

The 2010 Patient Protection and Affordable Care Act was a major legislative achievement of the 111th Congress. This law structurally reforms the US health care system by encouraging universal health care coverage through regulated competition among private insurance companies. When looking at the process for reform, what strikes an observer of US health care policy in the first place is that the Democratic majority was able to enact something in a political field characterized by strong resistance to change. This article builds on that observation. Arguments concentrate on the legislative process of the reform and support the idea that it may be partly explained by considering an evolution of US legislative institutions, mostly in the sense of a more centralized legislative process. Based on approximately one hundred semidirected interviews, I argue that the Democratic majority, building on lessons from both President Bill Clinton's health care reform attempt and the Republicans' strategy of using strong congressional leadership to pass social reforms, was able to overcome institutional constraints that have long prevented comprehensive change. A more centralized legislative process, which has been described as "unorthodox lawmaking," enabled the Democratic leadership to overcome multiple institutional and political veto players.

Supreme Court asked to decide future of US health care

Initial immunotherapy outcomes with toripalimab suggest a potential paradigm shift in the treatment of advanced triple-negative breast cancer (TNBC), promising extended survival for patients. However, its cost-effectiveness in the treatment of TNBC within the US health care context remains to be determined. A 5-year Markov model was developed using data from the TORCHLIGHT study to evaluate the cost-effectiveness of toripalimab plus nab-paclitaxel as a first-line therapy for metastatic or recurrent TNBC in the US. The model incorporated efficacy and safety data, literature-derived costs and utilities, and calculated ICERs. Sensitivity analyses were conducted to assess the impact of variable uncertainties on the outcomes. Toripalimab combined with nab-P chemotherapy for TNBC patients resulted in an additional 2.68 life years (LYs) and 1.72 quality-adjusted life years (QALYs), with an ICER of $593,750 per QALY. Sensitivity analyses indicated that the cost and survival utility of toripalimab significantly influence patient outcomes. At a $100,000/QALY WTP threshold, combination therapy was not cost-effective compared with nab-P alone. Our analysis suggests that, from a US health care system perspective, toripalimab in combination with chemotherapy does not demonstrate a significant cost-effective advantage over nab-P chemotherapy as a first-line treatment for patients with TNBC at a WTP threshold of $100,000/QALY and has a limited impact on US health care policy and clinical practice.

A New Healthcare Alliance: Consumer Engagement in the New Healthcare Economy