State Health Policy Research Articles

Sugar, A Morally Ambiguous Substance: Responsibility, Social Class and Pleasure in Scotland’s State Primary Schools

Children’s sugar consumption has been marked out as an important area of public health policymaking in the UK, due to connections between sugar consumption, obesity, type 2 diabetes and dental decay. Yet unlike other regulated substances (alcohol, tobacco, e-cigarettes), ‘moderate’ or ‘responsible’ sugar consumption, rather than abstinence, is the desired policy outcome. Based on ethnographic fieldwork in Edinburgh in 2018–19 in two demographically mixed Scottish state primary schools, I examine how school staff navigate this space of lenience written into state health policy—whereby some sugar can be consumed, sometimes. The public health dangers of sugar consumption, coupled with its relational pleasures (through associations with kinship, nurture and celebration) help illuminate how schools—as responsible agents—attempt to care for and govern children. It is sugar’s ambiguity, I argue, that enables it to become a crucial tool for children’s socialisation. Where and how sugar can be consumed responsibly, and which pleasures are deemed permissible or excessive, vary contextually: they are shaped through social class, and depend on the school policy being enacted. Beyond being an object to regulate, children’s pleasures in sugar are central to affective, social and class-informed practices of creating morally responsible persons.

Impact Of State Expenditures On The Increase In Life Expectancy In Brazil

This study analyses the impact of state public health expenditure on life expectancy in Brazil between 1990 and 2021, focusing on how investments in the health sector influence the population's longevity. The research uses a panel data model to explore the correlation between health spending and life expectancy, considering per capita income as a secondary variable. The results show a significant positive relationship between increased health spending and improvements in life expectancy across Brazilian states. However, another relevant finding indicates that health spending has become insufficient to significantly boost life expectancy, possibly due to rising healthcare costs driven by an ageing population. This ageing has generated increasing pressure for more health resources, requiring expanded expenditure in this sector. This study aims to contribute to the debate on the effectiveness of state health policies and encourages future investigations into optimising public health investments to maximise benefits for the population

The determinants of nonprofit hospital CEO compensation.

Hospital CEO salaries have grown quickly over the past two decades. We investigate correlates of rising nonprofit hospital CEO pay between 2012 and 2019 by merging compensation data from Candid's IRS 990 forms with hospital data from the National Academy for State Health Policy Hospital Cost Tool. Almost half of the measured increase in CEO compensation (44.5%) accrued to a "base case" CEO, who was leading a non-teaching hospital system or independent hospital with fewer than 100 beds that earned 0 profits and provided no charity care. Another 28.5% of the measured salary increase resulted from changes in the generosity with which observable metrics were rewarded, particularly the reward for heading a system with 500 or more beds. The remaining 27% resulted mostly from hospital systems or single hospitals that increased their profits or bed size over time. The increase in CEO compensation associated with leading larger healthcare systems and earning greater profits may explain the increase in healthcare system consolidation which has occurred over the last several years.

Medicaid coverage for gender-affirming surgery: A state-by-state review.

To systematically review Medicaid policies state-by-state for gender-affirming surgery coverage. Primary data were collected for each US state utilizing the LexisNexis legal database, state legislature publications, and Medicaid manuals. A cross-sectional study evaluating Medicaid coverage for numerous gender-affirming surgeries. We previously reported on state health policies that protect gender-affirming care under Medicaid coverage. Building upon our prior work, we systematically assessed the 27 states with protective policies to determine coverage for each type of gender-affirming surgery. We analyzed Medicaid coverage for gender-affirming surgeries in four domains: chest, genital, craniofacial and neck reconstruction, and miscellaneous procedures. Medicaid coverage for each type of surgery was categorized as explicitly covered, explicitly noncovered, or not described. Among the 27 states with protective Medicaid policies, 17 states (63.0%) provided explicit coverage for at least one gender-affirming chest procedure and at least one gender-affirming genital procedure, while only eight states (29.6%) provided explicit coverage for at least one craniofacial and neck procedure (p = 0.04). Coverage for specific surgical procedures within these three anatomical domains varied. The most common explicitly covered procedures were breast reduction/mastectomy and hysterectomy (n = 17, 63.0%). The most common explicitly noncovered surgery was reversal surgery (n = 12, 44.4%). Several states did not describe the specific surgical procedures covered; thus, final coverage rates are indeterminate. In 2022, 52.9% of states had health policies that protected gender-affirming care under Medicaid; however, coverage for various gender-affirming surgical procedures remains both variable and occasionally unspecified. When specified, craniofacial and neck reconstruction is the least covered anatomical area compared with chest and genital reconstruction.

Why does the cost of employer-sponsored coverage keep rising?

Over the past 25 years, the gap between the increase in health insurance costs and workers' wages has significantly expanded. This trend has led to significant concerns about healthcare affordability, with surveys revealing conflicting opinions regarding whether hospitals or health insurance companies bear the blame for escalating costs. To better understand these dynamics, we examined consumer price indices for health insurance, hospital services, and professional services from 2006 to 2023 using Bureau of Labor Statistics data. Our analysis shows that the hospital price index rose steadily between 2006 and 2023, faster than insurance premiums or professional services. To examine whether differences in underlying costs are driving higher hospital price increases, we evaluated the profit margins of hospitals and health insurance companies using the National Academy for State Health Policy''s Hospital Cost Tool and National Association of Insurance Commissioners Industry Reports. Our findings reveal that hospitals (for-profit and nonprofit) have consistently maintained higher profit margins than insurance companies. As health insurance costs continue to weigh heavily on working Americans, our analysis suggests that high hospital prices drive insurance premiums.

The Intersection of Successful Aging and Family Caregiving.

For the millions of older adults who rely on the support of a family caregiver, successful aging is not an individual achievement but a cooperative process between a care receiver and a caregiver. Yet, family caregivers are rarely incorporated into theoretical models of successful aging. Family caregivers also play an essential role in recent healthcare delivery movements that seek to better align care delivery with successful aging. Greater reliance on family caregivers by the US healthcare system is occurring as an increasingly vocal constituency is tasking policymakers with developing and implementing federal and state health policies that would help build the national infrastructure needed to support them. This paper provides a critical discussion of how family caregivers actualize successful aging for older adults. We highlight the key role of family caregivers in healthcare delivery innovations aimed at facilitating successful aging and discuss policies that support family caregivers. As successful aging continues to evolve as a dominating framework in the literature, we conclude with key recommendations for how research, policy, and practice efforts in successful aging can be more inclusive and supportive of family caregivers.

Malnutrition and Anemia Among Particularly Vulnerable Tribal Groups of Odisha, India: Needs for Context-Specific Intervention.

As undernutrition and anemia persist to be prevalent in India, the socioeconomically disadvantaged groups continue to take the greater brunt. Odisha is home to the largest number of particularly vulnerable tribal groups (PVTGs) in India. The study aimed to provide a comprehensive report on the undernutrition and anemia status of all the PVTGs of Odisha. A community-based cross-sectional study was conducted among (N = 1461, 683 males and 779 females) 13 PVTGs spread across 12 districts of Odisha from August 2018 to February 2019. Among the under-five children, the prevalence of underweight was observed in 75.26%, stunting in 55.42%, and wasting in 60.00% and all forms of undernutrition were higher among girls. Among children and adolescents belonging to the age group of 5 to 19 years, the prevalence of thinness was 46.7%. In individuals above the age of 20, the prevalence of underweight among males was 37.7% and females was 44.3% and severe anemia was present in 36.5% of females and 35.8% of males. Women in the reproductive age have a higher prevalence of anemia. The study shows that undernutrition and anemia remain high in the PVTGs, especially among the under-five children and women in the reproductive age. As the country heads toward fulfilling Sustainable Development Goals (SDG) by 2030, national and state health policies need to be designed and implemented, giving special focus to these vulnerable groups.

Patterns of immunotherapy utilization for non-small cell lung cancer in Texas pre- and post-regulatory approval.

Immunotherapy has shown remarkable benefits for non-small cell lung cancer (NSCLC) since approved by the US Food and Drug Administration (FDA). Texas, however, ranks below the national average in access to treatment for NSCLC. This retrospective cohort study assessed first-line immunotherapy treatment patterns and associated factors pre- and post-FDA approval in Texas. Patients ≥18years diagnosed with NSCLC from the Texas Cancer Registry database (2011-2018) and were stratified into pre- and post-FDA approval era. The rates of immunotherapy utilization were examined, and the average annual percent change (AAPC) in immunotherapy utilization across patient subgroups was compared. Multivariable logistic regression was used to identify associations of patient characteristics with immunotherapy utilization for patients with metastatic- and all-stage NSCLC. A total of 13,501 and 9509 patients with NSCLC were identified in pre-post-approval periods, respectively. Post-approval, immunotherapy utilization increased from 1.7 to 13.0%, and AAPC from 54.8 to 82.7%. Pre-approval, patients living in a county with ≥20% of households below the poverty level were less likely to receive immunotherapy (OR=0.73, 95% CI=0.61-0.94) while patients with private insurance were more likely to receive immunotherapy (OR=1.56, 95% CI=1.10-2.23). Post-approval, socioeconomic disparities were more prominent (10-19.9 and ≥20% of households below the poverty level: OR=0.77, 95% CI=0.66-0.90 and OR=0.71, 95% CI=0.60-0.86, respectively). Patients with metastatic NSCLC showed similar patterns of socioeconomic disparities pre- and post-approval. Our findings suggest that patients' socioeconomic status hinders immunotherapy utilization for NSCLC in Texas. This emphasizes the need for state health policy reforms such as Medicaid expansion and tailored cancer care strategies.

Well-being and subjectively experienced Stress among Doctors of the oncology Institute

Health, life satisfaction and subjective well-being are key concepts that directly define the complex of a person’s quality of life, and at the same time they support it and are the most significant determinants. These determinants directly express “how people perceive their place in life, in the context of the culture and value systems in which they live and in relation to their goals, expectations, standards and interests” (WHO, 1996, p. 5). In addition to health, satisfaction and economic well-being, work also appears in the ranking of human priorities. The author Uháľ (2006, p. 29) refers to it as the constant, rational and free activity of a person that is based on a sense of creative necessity and the necessity of maintaining life. He adds that it is connected with joy and effort, “which aims to create individual and social good and values of both material and spiritual nature”. According to the author Árpová (2018), the general effort to preserve and improve human health is such a serious task that issues related to it are not only the subject of interest of important national and international institutions and the topic of several international documents, it is also of interest for individual countries and is a priority of their governments. We are talking about the state health policy, which, according to WHO (1999), directly determines the goals, strategies and priorities of the state in the field of healthcare, its support and development, as well as protection and restoration. Several contemporary experts such as Musil (2004) and Géringová (2011) define helping professions as professions based on providing professional assistance to people in difficult life situations. Thus, these professions are significantly different from other professions.

Early Childhood in Marginalized Roma Communities: Health Risks and Health Outcomes.

This study aims to compare selected early childhood health risks and health outcomes of children from marginalized Roma communities (MRCs) in Slovakia with those of the majority. We obtained cross-sectional data from mother-child dyads from the majority (N = 109) and MRCs (N = 143) via questionnaires and from medical records. Socioeconomic status, health risks and health outcomes were compared using chi-square and Mann-Whitney U tests in SPSS. Mothers from MRCs reported significantly worse socioeconomic status. Air quality in the households in MRCs was significantly worse, affected by heating with stoves, burning fresh wood and indoor smoking. The diet composition of children from MRCs was characterized by shorter breastfeeding and unhealthy diet composition less fresh fruits and vegetables, more processed meat products, and sweet and salty snacks. Children from MRCs more often suffered from respiratory and diarrheal diseases, used antibiotics and were hospitalized. The health and healthy development of children living in MRCs is endangered by various poverty-related factors. Persistent differences in exposures and health in early childhood should be a priority goal of the state's social and health policies.

Will the United States pass on telemedicine progress?

During the COVID-19 pandemic, federal and state health policies allowed temporary flexibilities for Medicare and Medicaid beneficiaries, leading to a sharp increase in telemedicine use. However, many of the flexibilities that enabled innovation and growth in telemedicine continue temporarily since the federal emergency declaration ended in May 2023, and the United States has not made permanent decisions about telemedicine policy. Analysts have raised concerns about increased spending, program integrity, safety, and equity, and recommend strengthening oversight. Here, we argue that we must continue the flexibilities to better understand telemedicine's quality, safety, and outcomes, and until the United States can develop an evidence-based digital health strategy. A premature regression to pre-pandemic telemedicine policies risks unintended consequences. We must continue the current policy flexibilities, safeguard against fraud and abuse, and immediately prioritize research and evaluation of telemedicine's quality, safety, and outcomes, to avoid unintended consequences and support more permanent policy decision-making.

Obowiązki państwa dotyczące ochrony życia i zdrowia pacjentów w świetle Europejskiej Konwencji Praw Człowieka

The purpose of the article is analyze the comparative of national regulations with the norms of the European Convention on Human Rights regarding the protection of patients' life and health and assessment of government activities and strategies in state health policy. The European Convention on Human Rights introduces the obligations of states in the field of protection of life and health of patients. In the event of a violation of patient rights, the Convention allows to submit complaints to the European Court of Human Rights. Protection of life and health of citizens and counteracting its threats is one of the key duties of the country. Security of health is above all an invaluable social value. The task of the state is to take care of health of society by creating an appropriate organizational and legal system, infrastructure and ensuring financial resources to design and effectively implement measures to protect the life and health of citizens. As part of this task, the state should provide high quality of medical services and protect patients from harmful medical practices.

Teaching Grassroots Health Law, Policy and Advocacy: Service and Collaborative Learning.

This column describes the history, mission, and work of Saint Louis University School of Law's service-learning course Health Law, Policy and Advocacy: Grassroots Advocacy. Grassroots Advocacy allows law students to work with advocacy organizations on state and federal health policy initiatives, engaging in legislative and administrative advocacy and public education. The course uses community collaboration, community-led advocacy, and collaborative learning to train the next generation of health policy advocates for Missouri and the nation.

Baseline Study on the Discriminatory Laws, Attitudes and Societal Practices Hindering Diverse Sex Workers’ Access to Sexual and Reproductive Health and Rights Services in Selected Senatorial Local Governments in Rivers State, Nigeria

Achieving comprehensive access to Sexual and Reproductive Health and Rights (SRHR) services remains a pressing global health challenge, particularly for marginalized populations such as sex workers, who face the highest unmet needs. This study exposes the baseline issues related to discriminatory laws, attitudes, and societal practices that hinder diverse sex workers’ access to comprehensive SRHR services in Rivers State, Nigeria. Specifically, the study identified key barriers affecting sex workers’ access to SRHR services, evaluated their satisfaction with these service deliveries, examined the effects of societal inequalities and discriminatory legal practices on their health outcomes, and proposed sensitivity and rights-based approaches for improving service delivery. The study adopted stratified sampling methodology and collated both quantitative and qualitative data through desk reviews and analysis of existing state health policies, in-depth focus group discussions with 300 diverse sex workers, and analysis of 2000 feedbacks collected through questionnaires embedded in the Kobo Collect app. Key study findings revealed that significant majority (91.1%) of sex workers have experienced discrimination when accessing SRHR services in formal healthcare facilities, with primary sources of these discriminations perpetuated by healthcare workers (77.4%), brothel owners (47.1%), and family members (43.9%). Consequently, 89.9% of respondents have avoided formal healthcare facilities, opting instead for local pharmacies (66%), traditional medical specialists (56.8%), and self-medication (48.4%), despite its adverse effects such as recurrent Sexual Transmitted Infections (STIs) (57.5%), worsening STIs to Sexual Transmitted Diseases (STDs) (58.3%), unwanted pregnancies (18%), post-abortion complications (27.1%), adverse drug reactions (49.1%), and drug abuse/overdose (48.4%). In addition, there was notable dissatisfaction among respondents regarding SRHR services as 61.4% of engaged sex workers rated “Poor to Very Poor” for service affordability, a mixed opinions for availability and accessibility as respondents rated “Fair to Poor” (57.4% for availability and 68% for accessibility) and 75% of the respondents criticized the accountability system to be “Poor to Very Poor”. Qualitative analyses of existing laws and policies in the State revealed an institutional neglect and exclusion of sex workers from health service protections as some state laws and policies, such as Rivers State Reproductive Law, Rivers State Contributory Health Protection Programme, Rivers State Strategic Health Development Plan, and the Rivers State HIV/AIDS Anti-Discrimination Law, were non-inclusive and perpetuate discriminatory practices against sex workers in SRHR service provision. To close-in the gaps, the study recommended implementing non-discrimination policies, reducing waiting times, ensuring strict privacy and confidentiality measures, reforming laws to ensure inclusive service delivery, providing non-clinical training on gender identity and sexual orientation for healthcare providers, appointing focal persons for key populations, and enforcing accountability systems across healthcare facilities as a right based model for enhancing SRHR outcomes for diverse sex workers in Rivers State.

THE NATIONAL STRATEGY TO SUPPORT FAMILY CAREGIVERS: A STATE-LEVEL PERSPECTIVE ON IMPLEMENTATION

Abstract The 2022 National Strategy to Support Family Caregivers includes action steps that a wide range of non-federal organizations, including states, can take to support family caregivers. States have a variety of ways that they can approach supporting family caregiver policy via action steps, including but not limited to strengthening access to services, collaborating among agencies and organizations to coordinate activities, and tracking caregiver data to help ensure services are meeting caregiver needs. Several states are taking the lead in promoting use of caregiver assessment tools. States can monitor whether initiatives and activities are achieving their goals of supporting caregivers and care recipients through tracking the implementation of the state’s actions to support family caregivers. Drawing on the National Academy for State Health Policy’s role in supporting states through its Resource and Dissemination Center, this presentation will highlight ranges of action steps in the National Strategy that states can take to support family caregivers; note frameworks that states can consider using to track implementation of action steps; and highlight states’ initiatives aligning with action steps.

POLICY SERIES: ARE WE THERE YET? MEASURING PROGRESS IN ACHIEVING POLICY GOALS FOR FAMILY CAREGIVERS

Abstract The RAISE Family Caregiving Advisory Council, created under the Recognize, Assist, Include, Support, and Engage (RAISE) Family Caregivers Act (2018) has been tasked to support the Secretary of Health and Human Services in developing a national family caregiving strategy, published in 2022 as its National Strategy to Support Family Caregivers. One key concern identified by advocates and others is the accountability question: how can we hold policymakers at all levels of government accountable for achieving the policy goals articulated in the National Strategy? This symposium discusses that issue by first providing an overview of a key mechanism for state accountability, AARP’s State Scorecard on Long-Term Services and Supports, which identifies support for family caregivers as one of its four dimensions. Susan Reinhard, PhD, Senior Vice President at AARP and Director of its Public Policy Institute, will describe the history, goals, and future of the Scorecard’s family caregiver component. Salom Teshale, PhD, from the National Academy for State Health Policy will describe how states are focusing their energies in current actions supporting family caregivers, while Mike Wittke, MPA, of the National Alliance for Caregiving will discuss how federal actions might be tracked and assessed. Drawing on research supporting the RAISE Advisory Council, Eileen J. Tell, MPH will suggest additional dimensions that could be integrated into the assessment of progress. Rani Snyder, MPA, of the John A. Hartford Foundation will act as discussant.

Legal determinants of control and supervision in the health system in Poland

The crisis triggered by the SARS-CoV-2 virus epidemic has demonstrated how much of a challenge it is for each Member State of the European Union to ensure the implementation of its health policy in accordance with the pro-visions of Article 168 of the Treaty on the Functioning of the European Unionand in a spirit of European solidarity. The aim of this article is to present the legal determinants of supervision and control of the implementation of health policy in Poland in terms of its subjective and objective scopes, and their analysis in terms of effectiveness and efficiency. The subject of this article includes the systematisation in legal terms of the competencies and tasks of the entitiesresponsible for the implementation of the state health policy, an indication of the criteria for supervision and control in health protection, and the presentation of the principles and techniques of control carried out in this area of thestate activity. The result of the analysis is the conclusion that the provisions of law ensure the proper functioning of the system of control and supervision system in the area of health protection.

An Analysis of Studies Pertaining to Masks in Morbidity and Mortality Weekly Report: Characteristics and Quality of Studies through 2023

BackgroundThe purpose of this study was to describe and evaluate the nature and methodology of reports and appropriateness of conclusions in The Morbidity and Mortality Weekly Report (MMWR) pertaining to masks. Because MMWR has substantial influence on United States health policy and is not externally peer-reviewed, it is critical to understand the scientific process within the journal. Mask policies have been highly influenced by data published in the MMWR. MethodsRetrospective cross-sectional study of MMWR publications pertaining to masks through 2023. Outcomes included study design, whether the study was able to assess mask effectiveness, if results were statistically significant, if masks were concluded to be effective, if randomized evidence or conflicting data were mentioned or cited, and appropriateness of causal statements. ResultsThere were 77 studies, all published after 2019, that met our inclusion criteria. The most common study design was observational without a comparator group: 22/77 (28.6%); 0/77 were randomized; 23/77 (29.9%) assessed mask effectiveness; 11/77 (14.3%) were statistically significant, but 58/77 (75.3%) stated that masks were effective. Of these, 41/58 (70.7%) used causal language. One mannequin study used causal language appropriately (1.3%). None cited randomized data; 1/77 (1.3%) cited conflicting evidence. ConclusionsMMWR publications pertaining to masks drew positive conclusions about mask effectiveness >75% of the time despite only 30% testing masks and <15% having statistically significant results. No studies were randomized, yet over half drew causal conclusions. The level of evidence generated was low and the conclusions were most often unsupported by the data. Our findings raise concern about the reliability of the journal for informing health policy.

Even one voice: Teaching legislative advocacy as a core competency in family medicine.

Credentialing bodies increasingly focus on advocacy as a competency to be developed by physicians during residency. The skills of advocacy are especially important with the increased attention on social determinants of health, as restrictive state and federal health policy decisions gain widespread attention in the national news media. This movement is reflected in the ACGME's recently revised statement on the training mission of family medicine residencies with the most recent update of milestones, which identifies advocacy as a core competency. Additionally, the major family medicine organizations and governing bodies all similarly identify advocacy as an important professional responsibility for family physicians. Advocacy is a broad term that can be applied across a range of settings and scenarios. For the purposes of this paper we focus primarily on legislative advocacy as a specific area for growing curricular emphasis in family medicine residency programs.

Nonprofit Hospitals: Profits And Cash Reserves Grow, Charity Care Does Not.

Using the National Academy of State Health Policy Hospital Cost Tool, we compared changes in hospital profits with changes in hospitals' charity care and cash reserves between 2012 and 2019. We estimated substantial growth in nonprofit hospital operating profits and cash reserves in this period but no corresponding increase in charity care.