A Health Podyssey

In the February 2021 edition, Health Affairs presented a collection of papers from the National Academy of Medicine (NAM) for their Vital Directions for Health and Health Care project.While originally established in 2016, NAM reassessed its priorities and found a vastly different health care landscape in 2020. Not only had the COVID-19 pandemic ripped through the health care ecosystem nationwide, but issues regarding maternal health, mental health, and elder care surfaced as pressing concerns. And, as always, health costs and financing was flagged for appraisal.But, as Dr. Victor Dzau, president of the National Academy of Medicine, and colleagues note in their opening commentary, health equity was present throughout every priority.The collection of commentaries from NAM sets forth health and health care priorities for 2021 and the new Biden administration. Vital Directions for Health and Health Care: Priorities For 2021 identifies the overarching theme of this series as the clear and urgent obligation for the US to turn its full attention to the growing problem of health inequities and to the structural racism that perpetuates health disparities.On this episode of A Health Podyssey, listen to Health Affairs Editor-in-Chief Alan Weil interview Dr. Victor Dzau on the new Vital Directions publication, why health equity is fundamental for shaping health system reform, and how converging science disciplines will shape the field of health and medicine.Subscribe: RSS | Apple Podcasts | Google Podcasts | Spotify | Castro | Stitcher

The opioid epidemic has ravaged American life.It has claimed more than 750,000 lives as a result of a drug overdose since 1999. In 2018 alone, more than 2 million people had an opioid use disorder and more than 800,000 people used heroin.To alleviate these deaths of despair and get people the treatment they need, many individuals are looking to short-term residential facilities for substance use treatment programs, commonly referred to as rehabilitation, or rehab.But, as a paper in the 2021 February issue of Health Affairs notes, recruitment practices and cost of care at these facilities can raise concerns. The authors found most programs required up-front payments, with for-profit programs charging more than twice as much as nonprofits.Listen to Alan Weil interview Tamara Beetham, a PhD student in health policy and management at the Yale School of Medicine and lead author of the paper. Subscribe: RSS | Apple Podcasts | Google Podcasts | Spotify | Castro | Stitcher

Have health economists been underestimating supply-side constraints when making predictions regarding cost and utilization for universal health coverage programs, such as Medicare For All? That's certainly what Dr. Adam Gaffney, a pulmonary specialist from Cambridge Health Alliance and Harvard Medical School, and colleagues posit in a new policy paper published in the January 2021 issue of Health Affairs.As Gaffney and co-authors note in their paper, "focusing only on the impact of health care reform on government expenditures is short-sighted." On the supply side, there's a natural limit to doctor and nurses' time as well as the number of hospital beds in a given facility.Their analysis suggest that while first-dollar universal coverage expansion would increase ambulatory visits by about 7-10% and hospital use by about 0-3%, modest administrative savings could offset the costs of these increases.On this episode of A Health Podyssey, Alan Weil and Adam Gaffney take listeners through health reform economics 101 before sharing the implications of the paper, ultimately questioning whether health reform is too focused on a demand-side framework.Subscribe: RSS | Apple Podcasts | Google Podcasts | Spotify | Castro | Stitcher

More than 500,000 individuals in the U.S. experience homeless at any given time, and many of those individuals qualify for Medicaid in states that expanded the program under the Affordable Care Act.Medicaid expansion can be helpful for individuals unable to afford private health insurance. Medicaid expansion has been found to slow rates of health decline for some low-income adults, for example. But to date, little is known about the relationship between those experiencing homelessness gaining coverage through Medicaid expansion and health care service use.With homelessness on the rise in the United States, it is important to study such trends and what implications they may have for both those experiencing homelessness and health care providers.On today's episode of A Health Podyssey, Alan Weil interviews Dr. Jeral Self, a researcher at Mathematica and an adjunct faculty member at the Tulane School of Public Health and Tropical Medicine, on how Medicaid expansion affected health care utilization for adults experiencing homelessness in Arkansas. Listen to what this new data reveal about the health care needs of those experiencing homelessness. Subscribe: RSS | Apple Podcasts | Google Podcasts | Spotify | Castro | Stitcher

For better or worse, online platforms and social media have enabled individuals to publicly post their opinions of businesses online. As a result, business are at the mercy of public feedback, which can have an impact on their success. Hospitals and physicians are not immune to this trend. The Centers for Medicare and Medicaid Services has pushed the idea of consumerization through price transparency policies and the Five-Star Quality Rating System so that patients can rate their providers, for example.But what is the actual value of a star rating? On this episode of A Health Podyssey, Alan Weil interviews Dr. Adam Schwartz, associate professor of orthopedic surgery at the Mayo Clinic College of Medicine and Science, who wrote a research paper with colleagues in the January 2021 issue of Health Affairs on the monetary value of an additional hospital or physician star rating when choosing a provider for total joint replacement.While patients' interpretation of star ratings has been poorly understood historically, Schwartz and his colleagues put forward data to help spur further research to understand the value and trust patients place in publicly reported quality ratings.Listen to Alan Weill and Adam Schwartz discuss public reporting, quality ratings, and their implications on hospital and physician businesses.Subscribe: RSS | Apple Podcasts | Google Podcasts | Spotify | Castro | Stitcher

Every year, Health Affairs publishes a retrospective look at national healthcare spending. In 2020, Anne Martin and colleagues from the CMS Office of the Actuary found that U.S. healthcare spending increased 4.6% to $3.8 trillion in 2019. The rate of health spending declined slightly from 2018, which noted a growth rate of 4.7%. Hospital care, physician and clinical services, and retail purchase of prescription drugs, which accounted for 61% of total national health spending, saw faster growth rates in spending in 2019.These figures predate the coronavirus, which has led to major changes in healthcare delivery and spending. In this week’s episode of A Health Podyssey, Alan Weil invites Sherry Glied, dean of the Robert F. Wagner Graduate School of Public Service at New York University, to the program. They take a step back from the main findings from the paper and discuss the relationship between administrative costs and the high costs of healthcare prices. Listen to Sherry Glied share why she thinks value-based care won’t be transformational and how public health is a desirable field to choose a career in now.Subscribe: RSS | Apple Podcasts | Google Podcasts | Spotify | Castro | Stitcher

As we close the books on the year 2020, we turn the tables on Health Affairs Editor-in-Chief Alan Weil wherein the interviewer becomes the interviewee.Alan shares a bit about his educational background, what it actually means to be the editor for the leading health policy journal, and how empirical research has changed since the COVID-19 pandemic.Looking back at the year's event, he elaborates on his blog post from June explaining his skepticism that the healthcare system can actually address social determinants of health. Looking forward to 2021, he predicts that administrative moves may continue to dominate the health policy landscape as a result of the 2020 election.Listen to Alan Weil talk about these topics and more on a special episode of A Health Podyssey.Subscribe: RSS | Apple Podcasts | Google Podcasts | Spotify | Castro | Stitcher

From severe weather such as the destructive wildfires in California to air pollution nationwide, there's a growing body of knowledge linking climate change to human health.On this episode of A Health Podyssey, host Alan Weil interviews Dr. Kristie Ebi, a professor in the Department of Global Health at the University of Washington, to discuss this complex relationship.Ebi served as the theme advisor for the December edition of Health Affairs, which is fully dedicated to exploring that link between climate and health. She published two papers in the issue. One notes that the people most harmed by climate change are those who have so far contributed the least to greenhouse gas emissions. The second connects how detection and attribution studies could quantify how climate change is affecting health.They note that while emissions have fallen during the COVID-19 pandemic, it's not enough to make a long-term impact. With the healthcare industry responsible for about 4.5% of the worldwide greenhouse gas emissions, hospitals and health systems can take the moment to re-evaluate their relationship to climate change.Listen to hear why Dr. Ebi believes individuals shouldn't feel hopeless in the face of climate change.Subscribe: RSS | Apple Podcasts | Google Podcasts | Spotify | Castro | Stitcher

Does America have a healthy relationship with food?In addition to the direct health effects of diet, food production and distribution affects environmental factors, which then trickles down to our health statuses. For example, an estimated one quarter of global greenhouse gas emissions relate to food production.In a new paper published in the climate-centric December edition of Health Affairs, Mary Kathryn Poole, a PhD student in population health sciences at the Harvard T.H. Chan School of Public Health, and colleagues explored the relationship between The National School Lunch Program, one of the largest federal food programs, and its impacts on the environment.In this week’s episode of A Health Podyssey, Alan Weil interviews Mary Kathryn Poole to discuss her paper, the EAT-Lancet Commission’s reference diet, strategies to reduce red meat consumption, and how they relate to planetary health diets.Subscribe: RSS | Apple Podcasts | Google Podcasts | Spotify | Castro | Stitcher

How are Indigenous communities responding to climate change?It’s an important but often under-looked question. As a new paper published in the climate-centric December edition of Health Affairs posits, Indigenous communities are uniquely vulnerable as climate-related events can impact their day-to-day lives, self-determination, and physical and emotional health.In 2016, the Pala Band of Mission Indians tribe, who are located in southern California, conducted a vulnerability assessment regarding the effects of climate change. High temperatures, wildfires, storm flooding and drought were all identified as major concerns.And yet, the assessment revealed few participants were aware of many of the potential health consequences at the individual and community levels as a result of these threats.Indigenous communities have a history of adapting to their environment but some impacts from climate change for these communities are unexpected.In this week’s episode of A Health Podyssey, Alan Weil interviews Shasta Gaughen, director of the Pala Environmental Department for the Pala Band of Mission Indians, to discuss her recent paper and these unintended consequences of climate change as it relates to physical, mental, and cultural health for Indigenous communities.Subscribe: RSS | Apple Podcasts | Google Podcasts | Spotify | Castro | Stitcher