Trends in Nasal Spray Prescribing Patterns by Otolaryngologists in the US Medicare Population

Objectives: To quantify national and state-level prescribing and cost trends for the 3 most prescribed nasal sprays by otolaryngologists in the Medicare population. Methods: Through the Centers for Medicare and Medicaid Services (CMS) database and the Kaiser Family Foundation, we retrieved data on Medicare enrollment and on claims and costs of fluticasone propionate, azelastine HCl, and ipratropium bromide prescribed by otolaryngologists from January 1, 2013 to December 31, 2017. Results: From 2013 to 2017, CMS reimbursed $128.8 million for 5.2 million claims of fluticasone propionate, azelastine HCl, and ipratropium bromide prescribed by otolaryngologists. The national claim rate for fluticasone propionate increased 6.5% per year from 2013 to 2015 and then decreased 4.3% per year from 2015 to 2017 while azelastine HCl and ipratropium bromide consistently increased annually (19.0% and 12.2% respectively) from 2013 to 2017. The cost for fluticasone propionate decreased 33.0% a year from 2013 to 2015 and then increased 5.4% annually to $13.60 per claim in 2017. Azelastine HCl decreased 14.8% annually from $91.30 to $50.23 per claim and ipratropium bromide increased 5.2% annually to $34.78 in 2017. Variations in the claim rate and cost for all 3 nasal sprays were observed in some states. Conclusions: Otolaryngologists are prescribing azelastine HCl and ipratropium at an increasingly higher rate in the Medicare population, while the rate for fluticasone propionate has been decreasing nationally. Utilization and costs of nasal sprays also vary geographically across the United States.

Identifying Racial Differences in Vocational Rehabilitation Services

The literature on racial differences in vocational rehabilitation (VR) services has not been updated for over a decade. Using the 2017 individual-level national RSA-911 data, supplemented with the 2017 American Community Survey and publicly available information from Kaiser Family Foundation, we investigate racial differences at each step of the VR process—application, eligibility, service provision, and employment outcomes at closure. At the first step, application, White individuals with disabilities are less likely to apply than their African American, American Indian/Alaska Native, and Hispanic counterparts, and more likely to apply than their Asian counterparts. For the remaining three steps, the results are inverted: the White subgroup has higher eligibility rates, service rates, and employment rates than the African American, American Indian/Alaska Native, and Hispanic subgroups, and lower rates than the Asian subgroup. These findings suggest that racial and ethnic differences continue to exist in the VR process despite several legislative acts and policy efforts. Within each racial and ethnic minority group, we also find large variation in application rates and employment rates across states, which indicates a need for developing performance measures and standardized guidelines for state VR agencies to better serve individuals with disabilities from racial and ethnic minorities.

Do patients benefit from legislation regulating step therapy?

Step therapy, also termed fail-first policy, describes a practice of insurance and pharmacy benefit management companies denying reimbursement for a specific treatment until after other treatments have first been found ineffective (i.e. failed). Laws to limit step therapy have been passed in 29 states of the United States. Using extrapolated data on fully insured employees, we find that except for New York and New Mexico, enacted State laws don't apply to even one-third of a state's population. Using the more robust Kaiser Family Foundation (KFF) data, which do not include fully insured employees, we find that only 2–10% of a state's population is covered. Advocating for these laws has been an expensive and time-consuming process, likely to become more so for the 21 states without such laws. The laws that have been enacted can be near impossible, to enforce, and loopholes exist. As a result, using KFF data, more than 90% of people in the United States with health insurance may still be unable to access the treatment chosen as most appropriate for them with their physician. Based on these data, we conclude federal step-therapy legislation is needed.

Employer-Mandated Vaccination for COVID-19

When the US Food and Drug Administration (FDA) decided to grant emergency use authorization (EUA) for the first two vaccines for COVID-19, the United States’ response to the pandemic entered a new phase. Initially, the greatest challenge is having enough doses of vaccine and administering them to all who want it. Yet even while many wait expectantly for their turn to be vaccinated, a significant minority of Americans are hesitant. Lack of information or misinformation about the vaccine, a long-standing and well-entrenched antivaccination movement, distrust of public health officials, and political polarization have left many people ambivalent or opposed to vaccination. According to a poll by the Kaiser Family Foundation taken in late November and early December 2020, 27% of respondents surveyed stated that they would “probably” or “definitely” not be willing to be vaccinated.1 Reflecting the sharp partisan divide that has characterized views about the pandemic, Democrats (86%) were far more likely than Republicans (56%) to be vaccinated. (Am J Public Health. Published online ahead of print February 4, 2021: e1–e4. https://doi.org/10.2105/AJPH.2020.306166 )

Semantic Expressions of Mental Health During Covid-19 Pandemic: the Environment Impact

Covid-19 is becoming a pandemic of such magnitude that it has caused a global danger to mental health. This study aims to describe the impact of the Covid-19 pandemic on mental health. The study uses a semantic method which is used to uncover the meaning of linguistic expressions. The semantic expressions were reviewed to identify the mental health problem as the result of Covid-19 and the supporting factors for psychological symptoms. The data collection process uses note-taking techniques related to mental health as the effect of Covid-19. The result shows that a number of phrases refer to mental symptoms with people who lose their job leading to depression or social distancing and staying at home, having an influence on people because they become more likely to have mental symptoms. Based on observations from various news and articles from Kaiser Family Foundation (KFF) that refer to mental symptoms for students, workers, and women with children as the result of the Covid-19 pandemic, the researchers draw a conclusion that three mental symptoms that often occur i.e. anxiety, depressive disorder, and suicidal thoughts. Semantically, the expressions referring to the symptoms have the same meaning.

COVID-19 Exposes Urgent Inequities: A Call to Action for Healthcare Reform

The COVID-19 pandemic has exposed undeniable health inequities among marginalized communities (MC), including black, indigenous, and other people of color (BIPOC) in the United States (Forno and Celedón 2012, Kaiser Family Foundation 2017, US National Center for Health Statistics 2019, Glasgow 2020). The lack of centralized support for local health responses has jeopardized many MC/BIPOC (Baah, Teitelman, and Riegel 2019). We propose the Department of Health and Human Services (HHS) implement the following policy steps: 1. Centrally collect patient data on social determinants of health and equity and post-COVID-19 health outcomes (Paradies et al. 2015, Jones et al. 2009, Magnan 2017). Real-time data collection allows for real-time quality improvement and implementation of policies to mitigate inequities in the short-term. 2. Expand and implement Centers for Medicare and Medicaid (CMS) value-based care models (VBCM) to address inequities in the long-term. VBCMs institutionalize data collection initiated in Step 1 while concurrently implementing interventions. 3. Temporarily expand Medicaid coverage for individuals needing subsidized insurance. This provides a safety net for those suffering employment instability during the crisis, alleviating some root causes of health inequities. These steps will centralize resources, empowering local health systems to control and contain outbreaks disproportionately occurring among MC/BIPOC. HHS is positioned to implement these policies and mitigate further damage from COVID-19. HHS agencies such as the Food and Drug Administration (FDA) and Centers for Disease Control and Prevention (CDC) have successfully implemented centralization responses, such as the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) in response to the HIV/AIDS epidemic, effectively targeting disparities (Valdiserri and Holtgrave 2020). These previous successful responses by the HHS should compel intervention in the present crisis.

Racial disparities in knowledge, attitudes and practices related to COVID-19 in the USA

Background Recent reports indicate racial disparities in the rates of infection and mortality from the 2019 novel coronavirus (coronavirus disease 2019 [COVID-19]). The aim of this study was to determine whether disparities exist in the levels of knowledge, attitudes and practices (KAPs) related to COVID-19. Methods We analyzed data from 1216 adults in the March 2020 Kaiser Family Foundation ‘Coronavirus Poll’, to determine levels of KAPs across different groups. Univariate and multivariate regression analysis was used to identify predictors of KAPs. Results In contrast to White respondents, Non-White respondents were more likely to have low knowledge (58% versus 30%; P < 0.001) and low attitude scores (52% versus 27%; P < 0.001), but high practice scores (81% versus 59%; P < 0.001). By multivariate regression, White race (odds ratio [OR] 3.06; 95% confidence interval [CI]: 1.70–5.50), higher level of education (OR 1.80; 95% CI: 1.46–2.23) and higher income (OR 2.06; 95% CI: 1.58–2.70) were associated with high knowledge of COVID-19. Race, sex, education, income, health insurance status and political views were all associated with KAPs. Conclusions Racial and socioeconomic disparity exists in the levels of KAPs related to COVID-19. More work is needed to identify educational tools that tailor to specific racial and socioeconomic groups.

The Immigrant Experience in Hurricane Season

This chapter assesses how the effects of Hurricane Harvey in August of 2017 were especially painful for immigrant families, many of whom feared that reporting property damage and losses caused by the storm would draw negative attention from governmental authorities. The Kaiser Family Foundation published survey findings on the impact of Harvey on immigrants living along the Texas Gulf Coast. The findings show that immigrants with homes hit by Harvey reported feeling more worried about seeking help for storm-related damages than their native-born counterparts. About 34% of immigrants responded that they were very worried that reaching out for help would highlight their own or a family member’s status. Immigrants were also less likely to have flood or home insurance, or to apply for governmental disaster assistance. Notably, the Federal Emergency Management Agency’s policies do not guarantee Disaster Unemployment Assistance to undocumented individuals. For these reasons, fear of disclosing immigration status may act as a barrier to immigrants seeking help and to broader efforts to ameliorate storm damage and safeguard health in the wake of natural disasters.

Misperceptions and Reality in the Policy Process

What does the public know about taxes? Not all that much. For example, according to a comprehensive survey done a while back by National Public Radio, Kaiser Family Foundation, and the Kennedy School of Government, only 40 percent of respondents knew that the federal...

Employee Choice and the Demand for Health Insurance Coverage: Evidence from Random Coefficients Models

This study examines the effects of deductibles, employee premium contributions, and the availability of tax-sheltered health savings accounts on employee selection into health insurance plans after passage of the Affordable Care Act, and particularly after implementation of the individual mandate. In doing so, a utility-based structural demand model is applied to market-level macro data from the Kaiser Family Foundation and the Health Research Educational Trust. Results from random coefficients models indicate that for an average consumer, price sensitivity for employer-sponsored health insurance plans varies by age, wage, health condition and gender. Employees who are older, obese, or female are less sensitive to deductibles and premiums than younger and healthier employees, or male employees. These findings suggest that high deductible health plans that combine a tax-sheltered account with higher deductibles will negatively impact the utility of older employees and females as compared to younger employees and males.