From the Editor-In-Chief Health AffairsVol. 39, No. 11: Health Spending, Medicaid & More Health Spending, Medicaid, And MoreAlan R. WeilPUBLISHED:November 2020Free Accesshttps://doi.org/10.1377/hlthaff.2020.01945AboutSectionsView PDFPermissions ShareShare onFacebookTwitterLinked InRedditEmail ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsDownload Exhibits TOPICSCosts and spendingMedicaidGlobal healthCOVID-19PandemicsCoronavirusLow incomeHigh-deductible health plansFee-for-serviceAffordable Care ActPhysician paymentMedicareMedicaid physician feesHealth disparitiesRacismEthnic disparitiesDisparities in accessHealth equityImmigrantsIn addition to the final versions of five papers originally published online, four of which relate to coronavirus disease 2019 (COVID-19), this month’s issue of Health Affairs covers a range of topics, including health spending, Medicaid policy, equity, and global health.Health SpendingFee-for-service payment is routinely blamed for excess US health spending. Michael Gusmano and coauthors analyze how physician fees are set in France, Germany, and Japan—countries that pay physicians fee-for-service. Although their approaches differ, all three countries set fees through centralized negotiation within the context of spending constraints. In the US, the authors conclude, “The absence of arrangements similar to those in the three countries we have studied leaves payers fragmented and gives providers too much control over their own prices.”Geographic variation in Medicare spending has long been viewed as evidence of health system inefficiency. With administered pricing, Medicare spending variation reflects different patterns of care that cannot be explained by population health characteristics. Analyzing fee-for-service data between 2007 and 2017, Yongkang Zhang and Jing Li report that the risk- and price-adjusted gap in spending between the highest- and lowest-decile hospital referral regions declined by 14 percent.MedicaidRebecca Myerson and coauthors explore the effects of Medicaid expansion on preconception health. Centers for Disease Control and Prevention surveillance data show important improvements in preconception health among low-income women with a recent live birth, including a 4-percentage-point increase in the share of women reporting a preconception health conversation with a provider. They also find increases in the share of women reporting daily folic acid intake in the month before pregnancy and in the use of effective contraception during the postpartum period.Providing Medicaid coverage as adults transition from incarceration to living in the community can yield significant health and social benefits. Justin Blackburn and coauthors examine how Indiana combined Medicaid expansion through a Section 1115 waiver with additional policies designed to maximize Medicaid coverage for low-income justice-involved adults. Implementation of these policies was associated with an increase in enrollment within 120 days of release from 8.8 percent to 44.9 percent. Key to the state’s success were interagency cooperation and data sharing.Oral health is an area of significant unmet need, particularly among people with low incomes. Hawazin Elani and colleagues, analyzing how the Affordable Care Act affected dental coverage for adults with incomes below 125 percent of poverty, find that it increased rates of dental coverage by almost 20 percentage points among this population in states that expanded Medicaid and that include dental care as a benefit. In states that do not offer dental coverage through Medicaid, dental coverage for this population remained below 20 percent.EquityHigh-deductible health plans (HDHPs), which are increasingly prevalent among people with private health insurance, are often paired with health savings accounts (HSAs) to improve access to care before the enrollee meets their deductible. Using survey data, Jacqueline Ellison and coauthors identify racial and ethnic, as well as socioeconomic, disparities in enrollment in HDHPs and HSAs. “The fact that HDHP enrollment is increasing over time for low-income, Hispanic, and Black adults, without similar rates of increase in HSA participation, may further contribute to…disparities,” the authors warn.Leonard Egede and colleagues examine racial and ethnic disparities in COVID-19 outcomes in Milwaukee, Wisconsin, a highly segregated “minority-majority” city. Blacks and Hispanics are 3.7 times and 3.1 times, respectively, more likely to test positive for COVID-19 than non-Hispanic Whites. Among those who test positive, members of either group are twice as likely to be hospitalized as Whites, with Hispanics twice as likely to die as Whites.Global Health PolicyAs many countries aim to implement universal health coverage, James Macinko and coauthors examine whether adults ages fifty and older are being left out. Using survey data from twenty-three high- and middle-income countries, the authors find that catastrophic health care expenditures (out-of-pocket expenses that are 25 percent or more of the household’s income) were more prevalent among rural inhabitants, those with incomes in the lowest quintile, people with a greater number of health problems, and current and former smokers.Alexander Peters and coauthors estimate the macroeconomic consequences of firearm-related fatalities in the thirty-six Organization for Economic Cooperation and Development (OECD) countries. They estimate cumulative losses of $239.0 billion in economic output from 2018 to 2030, with $152.5 billion attributable to the US alone, meaning that losses in the US exceed the combined losses of all other OECD countries. Loading Comments... Please enable JavaScript to view the comments powered by Disqus. DetailsExhibitsReferencesRelated Article Metrics History Published online 2 November 2020 Information© 2020 Project HOPE—The People-to-People Health Foundation, Inc.PDF download