A Health Podyssey

This episode is sponsored by the Rural Health Research Gateway at the University of North Dakota.Cancer diagnosis has changed radically in the era of precision medicine. New techniques like multi-cancer early-detection screening tests can detect up to 50 types of cancer from a single blood draw.We generally think of early detection, especially of cancer, as an unambiguously good thing. Given that, you might assume and expect that insurers would readily pay for it. But it turns out the considerations regarding insurance coverage for these screening tests are quite complex.As is often the case, advances in medical technology have accelerated beyond certain policies that were put in place when cancer diagnosis and treatment were very different.Kathryn Phillips from the University of California San Francisco joins A Health Podyssey to discuss how we can gain the advantages of better cancer screening technologies as they emerge.Phillips and coauthors published a paper in the March 2022 edition of Health Affairs examining payment considerations for multi-cancer screening tests. They outline clinical and economic considerations that will have to adjust to meet the new reality.If you enjoy this interview, order the March 2022 Health Affairs issue to get research on hospitals, health equity, care delivery and more.Subscribe: RSS | Apple Podcasts | Spotify | Stitcher | Google Podcasts

Limited access to transportation is well established as a barrier to people obtaining health care services. If it's hard to get to the doctor, you're less likely to go and that means delays getting needed care, poorer management of chronic conditions, and more use of the emergency room.While health insurance typically covers emergency transportation, say for an ambulance, coverage of non-emergency transportation to get you to a doctor's visit is less common. Medicaid, which serves people with low incomes, has covered this type of transportation for decades, but it's become increasingly clear that plenty of people with incomes above the Medicaid eligibility threshold face significant transportation barriers.Thus, some insurers and health systems have begun to offer a non-emergency transportation benefit as well.Seth Berkowitz from the University of North Carolina School of Medicine joins A Health Podyssey to discuss the effect of providing a transportation benefit.Berkowitz and colleagues published a paper in the March 2022 issue of Health Affairs assessing the effects of a non-medical transportation benefit offered to members of a Medicare accountable care organization.Enrollees had very positive reactions to the program, but it was also associated with more outpatient visits per person per year and thousands of dollars more in outpatient spending.If you enjoy this interview, order the March 2022 Health Affairs issue to get research on hospitals, health equity, care delivery and more.Listen to Health Affairs Pathways.Subscribe: RSS | Apple Podcasts | Spotify | Stitcher | Google Podcasts

There's a tremendous amount of consolidation going on in the health care sector. A lot of the research about consolidation focuses on the economics. But, one of the primary arguments people make for bringing disparate parts of the health system together is that it enables clinical integration.Patients, they say, should get better care if the clinicians are talking to each other and sharing information, which is easier to do if clinicians are a part of the same health care system.It turns out that studying clinical integration is hard. How do you define it? How do you measure it or having the desired effect?Hector Rodriguez from University of California Berkeley School of Public Health joins A Health Podyssey to discuss health care consolidation.Rodriguez and colleagues published a paper in the March 2022 issue of Health Affairs examining the relationship between physician practice capabilities and service metrics, like quality, utilization, and spending.They found that physician practices with robust capabilities, as defined by technology and innovation, management, culture, and patient-centered care, spent less on Medicare fee-for-service beneficiaries than those practice locations with less robust capabilities and they delivered similar quality care.If you enjoy this interview, order the March 2022 Health Affairs issue to get research on hospitals, health equity, care delivery and more.Listen to Health Affairs Pathways.Subscribe: RSS | Apple Podcasts | Spotify | Stitcher | Google Podcasts

Out of about 5,000 community hospitals in the United States, almost 3,000 are nonprofit. More than a thousand are investor-owned, also called for-profit. The balance are owned by state or local governments.Nonprofit hospitals, like all nonprofit organizations, must have a charitable mission and for hospitals that mission is generally expressed as providing charity care and various benefits to the community.In exchange, nonprofit hospitals are exempt from various taxes, they can receive tax-deductible charitable donations and they may have access to tax-exempt bonds.There's a longstanding debate regarding whether nonprofit hospitals deserve the benefits they receive and whether nonprofit hospitals really behave all that differently from investor-owned hospitals.Jill Horwitz from the UCLA School of Law joins A Health Podyssey to discuss the similarities and differences in hospital behavior based upon ownership.Horwitz and Austin Nichols published a paper in the March issue of Health Affairs exploring the relationship between urban hospitals ownership type and which service lines they offer. They found that for-profits, nonprofits, and government-owned hospitals are all more likely to offer a service if its profitable but for-profit hospitals are overall more responsive to service profitability than nonprofits.If you enjoy this interview, order the March 2022 Health Affairs issue to get research on hospitals, health equity, care delivery and more.Listen to Health Affairs Pathways.Subscribe: RSS | Apple Podcasts | Spotify | Stitcher | Google Podcasts

Racism is a social phenomenon. Even though the medical research community has historically relied heavily on racism that treated Black bodies as property that could be experimented upon, clinical medicine has actually been pretty slow to accept racism as a legitimate topic of examination.Health services, with its ties to the social sciences, has been somewhat more accepting of the notion that racism is a topic worthy of scholarly inquiry. However, direct discourse about racism has been limited.Despite the squeamishness of mainstream institutions when it comes to talking about racism, a significant and robust body of research has arisen, demonstrating a direct link between racism and health.Ruth Enid Zambrana from the University of Maryland joins A Health Podyssey to discuss the rich intellectual history of scholarship on racism and health.Zambrana and coauthor David Williams published a paper in the February 2022 issue of Health Affairs, an issue devoted entirely to the topic of racism and health, tracing the scholarly origins of the understanding of racism as a social determinant of health.If you enjoy this interview, order the February 2022 Health Affairs Racism & Health theme issue.Listen to Health Affairs Pathways.Subscribe: RSS | Apple Podcasts | Spotify | Stitcher | Google Podcasts

There are more than 22 million people of Asian descent living in the United States. In the aggregate, Asian Americans have mostly better economic and health outcomes than other groups, including White Americans.Yet within the broad category of Asian Americans, there are dozens of subgroups often with quite different health outcomes and lived experiences. This within-group heterogeneity is often lost, buried under the so-called model minority myth, which is used to deny attention to unmet needs among Asian Americans and to denigrate the experience of other minority groups such of those of Black and Hispanic Americans.One subset of the larger Asian American population is people whose history traces to the Philippines. The relationship between the United States and the Philippines is unique and this history and present day status affect the health of Filipino Americans.Melanie Sabado-Liwag from California State University, Los Angeles joins A Health Podyssey to discuss the paper she and coauthors published in the February 2022 issue of Health Affairs, an issue devoted entirely to the topic of racism and health. They wrote about the ongoing impact of colonialism and racism on the health inequities faced by Filipino Americans.Sabado-Liwag and coauthors note that despite Filipino Americans high educational attainment and high employment rates, they still face significant health disparities. If you enjoy this interview, order the February 2022 Health Affairs Racism & Health theme issue.Listen to Health Affairs Pathways.Subscribe: RSS | Apple Podcasts | Spotify | Stitcher | Google Podcasts

In a bonus episode of A Health Podyssey, Harriet Washington discusses the history of racism in medicine and research with Vabren Watts, Health Affairs’ director of health equity, and Aletha Maybank, chief health equity officer and senior vice president of the American Medical Association. Washington is the author of several books on medical ethics, including Medical Apartheid: The Dark History of Medical Experimentation on Black Americans from Colonial Times to the Present. This featured podcast coincides with the release of "Racism & Health," the February 2022 issue of Health Affairs. Alongside the publication of this special issue, it was important for Health Affairs to provide historical context about the impact of racism on health to inform the research published in the issue.Listeners can view the video recording of this interview on our website and YouTube page. Get your copy of the Racism & Health theme issue today.Find out more on Racism & Health.Subscribe: RSS | Apple Podcasts | Spotify | Stitcher | Google Podcasts

Racism manifests in different ways for different people in different environments.For many Black women, experiences with sexual and reproductive health reveal cross-cutting themes of racism, sexism, and classism, all expressed in the context of strong social norms and prejudices regarding Black women and reproduction. Attention to poor health outcomes for Black women has grown recently in part due to stories of negative maternity experiences of prominent Black women, such as Serena Williams. Congress has gotten into the act as well and taken steps to address the crisis of high rates of maternal mortality among Black women. But what are the individual experiences behind this crisis?Monica Simpson, executive director of Sister Song, joins A Health Podyssey to discuss a paper her and coauthors published in the February 2022 issue of Health Affairs, an issue devoted entirely to the topic of racism and health. They examined the reproductive health experiences of Black women in the South.They found that Black women's experiences navigating sexual and reproductive care were informed by both structural and individual racism, often leading to poorer quality care and likely worst health outcomes.If you enjoy this interview, order the February 2022 Health Affairs Racism & Health theme issue.Listen to Health Affairs Pathways.Subscribe: RSS | Apple Podcasts | Spotify | Stitcher | Google Podcasts

Listen to this bonus episode from Health Affairs' Narrative Matters podcast, which highlights personal stories from the front lines of care.  In this episode, host Jessica Bylander interviews Wanda Irving, chair of the board of Dr. Shalon’s Maternal Action Project, before Irving reads an essay from the February 2022 issue of Health Affairs, dedicated to the theme of racism and health.This essay remembers the life and legacy of Shalon Irving, whose 2017 death brought national attention to maternal mortality among Black women in the US. Subscribe to the Narrative Matters Podcast.If you enjoy this essay, order the February 2022 Health Affairs Racism & Health theme issue.

"Members of racial and ethnic minority groups have long suffered from health inequities in the United States. These inequities result, in large part, from racial and ethnic minority populations' inequitable access to health care, which persists because of structural racism in health care policy.Racism includes a complex array of social structures, interpersonal interactions, and beliefs by which the group in power categorizes people into socially constructed 'races' and creates a racial hierarchy in which racial and ethnic minority groups are disempowered, devalued, and denied equal access to resources."These words come from the opening paragraphs of one of four overview papers in the February 2022 issue of Health Affairs, an issue devoted entirely to the topic of racism and health.Ruqaiijah Yearby from Saint Louis University joins the A Health Podyssey to discuss how structural racism is embedded in US health policy.Yearby and coauthors describe structural racism within the US health care policy today and in the past. Structural racism has created a tiered system of care with racial and ethnic minority groups experiencing poorer access and lower quality care than White Americans.If you enjoy this interview, order the February 2022 Health Affairs Racism and Health theme issue.Listen to Health Affairs Pathways.Subscribe: RSS | Apple Podcasts | Spotify | Stitcher | Google Podcasts