Table of Contents
Overview
Definition of Health Policy
Health policy can be defined as the "decisions, plans, and actions that are undertaken to achieve specific healthcare goals within a society" according to the World Health Organization (WHO).[1.1] This definition emphasizes the importance of health policy in shaping the future of healthcare by outlining priorities and the expected roles of various stakeholders, thereby building consensus and informing the public.[1.1] In addition to defining health policy, it is essential to consider how health itself is defined and treated. Health is often viewed in terms of its public aspect, which underscores the responsibility of governments and other agencies to meet public health objectives.[3.1] The WHO categorizes health policy into several domains, including public health, mental health, and health care insurance, highlighting its extensive nature and the impact it has on virtually every individual within a community.[4.1]Importance of Health Policy
Health policy plays a crucial role in shaping the health outcomes of populations, particularly among vulnerable and disadvantaged groups. One of the primary functions of health policy is to assess the potential health effects of proposed initiatives through mechanisms such as Health Impact Assessments (HIA). HIAs aim to maximize positive health effects while minimizing negative ones by providing recommendations to decision-makers and stakeholders.[5.1] The process of conducting HIAs involves several steps, including screening, scoping, assessment, and the formulation of recommendations, which collectively help identify health risks and benefits associated with specific policies or programs.[6.1] Moreover, understanding the performance of health systems is essential for policymakers to enhance health outcomes. Health System Performance Assessment (HSPA) serves as a systematic approach to monitor and evaluate how well health systems meet their objectives and support overarching health goals.[7.1] This evaluation process is vital for informing future health policy decisions and ensuring that interventions are effective. Evaluating the effectiveness of health policies is further supported by various metrics and tools. For instance, outcome metrics are employed to measure the effectiveness of interventions and programs, establishing baselines and tracking improvements in health outcomes.[8.1] The Centers for Disease Control and Prevention (CDC) utilizes a program evaluation framework that includes both outcome and impact evaluations to assess how well policies achieve their intended results and to compare these outcomes against what would have occurred in their absence.[9.1] Economic evaluations are essential in the formulation and assessment of health policies, particularly through methods such as cost-effectiveness and cost-utility analyses. These evaluations provide a comprehensive introduction to the principles underlying these economic methods, which are crucial for informing resource allocation decisions in global health.[11.1] Cost-utility analysis, a specific type of cost-effectiveness analysis, evaluates policy alternatives based on their relative costs and health outcomes, using measures such as quality-adjusted life-years (QALYs) and disability-adjusted life-years (DALYs) to express these outcomes.[11.1] Furthermore, economic theories, particularly the concepts of supply and demand, significantly influence healthcare pricing and access. For instance, higher demand in the United States compared to Europe can lead to increased healthcare prices, illustrating how demand dynamics can affect health policy outcomes.[12.1] Understanding these economic principles is vital, as they not only inform policy decisions but also highlight the importance of equity in healthcare systems worldwide.[14.1]History
Early Developments in Health Policy
The early developments in health policy were significantly influenced by pioneering figures in clinical research and vaccination. James Lind's clinical trial in 1756, which tested various dietary treatments for British sailors suffering from scurvy, established foundational standards for clinical research that continue to have modern-day applications, particularly in the fields of nutrition and public health.[40.1] Similarly, Edward Jenner's experiments with cowpox vaccination in 1796 demonstrated the efficacy of vaccination against smallpox, thereby laying the groundwork for modern vaccine development.[39.1] These early clinical trials not only advanced the science of immunization but also contributed to the establishment of ethical standards in clinical testing, which are essential for fostering public trust in health interventions.[38.1] The principles established by Lind and Jenner have shaped the ethical framework of clinical research, influencing contemporary health policy and practices.[38.1] The evolution of health policy is intricately linked to the development of epidemiology, which has its historical roots in the writings of Hippocrates from the third and fourth centuries B.C..[57.1] The modern field of epidemiology emerged as a response to the transmission of infectious diseases during periods of industrialization and colonial expansion, highlighting the importance of understanding disease dynamics in shaping health policies.[57.1] Epidemiology plays a crucial role in scientific decision-making within healthcare and public health, providing a foundation for effective disease control and prevention strategies.[55.1] For example, the recognition that smoking initiation predominantly occurs among youth has informed targeted anti-tobacco policies, demonstrating how epidemiological insights can guide public health interventions.[56.1] These developments illustrate the significant impact of early epidemiological studies on contemporary health policy, particularly in addressing infectious diseases and promoting preventive care.[55.1] The historical precursors of epidemiology can be traced back to Hippocrates, but the modern field emerged significantly during periods of industrialization, which facilitated both domestic and international transmission of infectious diseases, as well as the economic growth of certain nations and the military expansion of colonial powers.[57.1] Important historical research has documented how epidemics and infectious diseases were controlled, contributing to the escape from premature death and the remarkable long-term improvements in life expectancy observed over the last two centuries.[59.1] This body of work, particularly from the Cambridge Group for the History of Population and Social Structure, has provided secure knowledge of mortality and life expectancy trends in England over nearly five centuries, offering insights that are crucial for informing contemporary health policy strategies aimed at addressing infectious diseases and promoting preventive care.[59.1]Key Milestones in U.S. Health Policy
Key milestones in U.S. health policy have played a crucial role in shaping healthcare access and equity. One significant legislative effort was the Kerr-Mills Act of 1960, which provided federal funds to assist states in offering medical care to the poor and elderly, serving as a precursor to Medicaid.[33.1] This act aimed to support seniors who were not on public assistance but required help with their medical bills.[44.1] Following this, the White House Conference on Aging in 1961 recommended health insurance for the elderly under Social Security, further influencing the development of health policy.[45.1] Subsequently, Medicare was established to cover Americans aged 65 and older, while Medicaid was designed to provide coverage for low-income individuals, significantly impacting healthcare access for vulnerable populations.[44.1] The 1961 White House Conference on Aging further influenced health policy by recommending health insurance for the elderly under Social Security, highlighting the growing recognition of the need for comprehensive health coverage for vulnerable populations.[33.1] The civil rights movement of the early 1960s also played a crucial role in advancing health policy, as major civil rights groups endorsed Medicare as part of President Johnson's War on Poverty, emphasizing the intersection of health and social justice.[43.1] In 1996, the Health Insurance Portability and Accountability Act (HIPAA) was enacted, which restricted the use of pre-existing conditions in health insurance coverage determinations and established standards for the privacy of medical records.[41.1] This legislation marked a significant shift towards protecting patients' rights and ensuring equitable access to healthcare services. Additionally, the establishment of the Children's Health Insurance Program (CHIP) in 1997 expanded health coverage to millions of low-income children, further solidifying the role of government in providing healthcare access.[42.1] Over time, Medicaid and CHIP have become vital sources of funding for hospitals, community health centers, and nursing homes, demonstrating the ongoing impact of these early policies on the current healthcare system.[42.1] These key milestones reflect a historical trajectory characterized by evolving societal needs and political advocacy, which continue to influence contemporary health policy discussions and reforms in the United States.In this section:
Recent Advancements
Impact of the Affordable Care Act
The Patient Protection and Affordable Care Act (ACA) has significantly expanded access to health insurance in the United States, resulting in an estimated 20 million previously uninsured individuals gaining coverage. This expansion is supported by various state-level initiatives that served as models for the ACA. For instance, Massachusetts implemented health reforms in 2006 that laid the groundwork for the ACA, while the Oregon Health Insurance Experiment (OHIE) in 2008 expanded Medicaid eligibility to a random sample of low-income individuals, providing valuable insights into the effects of such policies on population health outcomes. Additionally, California's Low-Income Health Program (LIHP), which operated from 2011 to 2013, offered expanded coverage to low-income adults prior to their eligibility for Medicaid expansion in 2014, further illustrating the ACA's impact on health insurance accessibility.[81.1] The role of data analytics has become increasingly vital in assessing the long-term impacts of the ACA and Medicaid expansion on population health outcomes. Evidence-based methods, including predictive models and big data analytics (BDA), have been employed to develop and evaluate public health policies. These methodologies enable real-time decision-making and enhance the accuracy of public health policy development.[82.1] The vast amounts of clinical data generated from the healthcare sector, such as Electronic Health Records (EHR), prescriptions, and laboratory reports, present significant opportunities for analysis using advanced technologies. The integration of big data analytics in healthcare has become more critical, especially with the rise of social media platforms and smartphone applications that monitor personal health parameters.[83.1] This evolution in data analytics not only supports evidence-based public health policy decision-making but also facilitates a deeper understanding of the ACA's effects on population health.Innovations in Health Policy and Technology
Recent advancements in health policy have increasingly focused on integrating technology to enhance healthcare delivery and patient outcomes. Telemedicine has emerged as a transformative tool, providing remote healthcare services that significantly improve access to care, especially during crises such as the COVID-19 pandemic. Studies indicate that telemedicine interventions lead to substantial improvements in patient health outcomes and cost savings, particularly in managing chronic diseases like diabetes, hypertension, and heart disease.[79.1] Over the past two decades, the use of telemedicine has increased significantly, aiming to improve access to care and address barriers in traditional settings, thereby promoting better adherence to treatment.[78.1][80.1] Systematic reviews confirm that telemedicine has led to significant improvements in patient outcomes and cost savings, particularly during crises like the COVID-19 pandemic.[79.1][78.1] In conclusion, telemedicine plays a crucial role in revolutionizing healthcare by enhancing patient satisfaction and adherence, ultimately leading to better management of chronic diseases and reduced healthcare costs.[79.1] Moreover, policy initiatives such as the Affordable Care Act’s Medicaid expansion have been crucial in improving access to care through insurance coverage, linked to better health outcomes and reduced mortality rates.[90.1] While accountable care organizations (ACOs) and bundled payment programs have shown mixed results in directly improving patient outcomes, they emphasize prevention and population health, essential for advancing quality in healthcare delivery.[90.1] The evolving landscape of health policy reflects a shift towards patient-centered care, prioritizing patient experiences and needs. This approach is evident in the growing emphasis on co-designing healthcare services with patients and families, fostering partnerships that enhance the overall healthcare experience.[84.1] As health policies continue to adapt and incorporate technological innovations, the focus remains on improving access, quality, and outcomes in healthcare.Global Health Policy
Role of International Organizations
International organizations are pivotal in formulating and implementing global health policies, addressing worldwide health challenges through collaboration and standard-setting. The World Health Organization (WHO) leads these efforts by establishing global health standards and working with United Nations agencies and partners to improve health outcomes. This involves collecting and disseminating evidence on effective health interventions to governments, health workers, and the public, thereby enhancing global health practices [110.1]. A notable initiative is the Epidemic Intelligence from Open Sources (EIOS) by WHO, which promotes international cooperation in data-sharing and public health response [103.1]. Collaborative efforts like those of the Joint United Nations Programme on HIV/AIDS (UNAIDS) and the Global Fund to Fight AIDS, Tuberculosis, and Malaria demonstrate the success of targeted health crisis interventions [104.1]. Despite these initiatives, international organizations face significant challenges. The COVID-19 pandemic highlighted the need for robust Global Health Security (GHS) and resilient public health systems, particularly in low- and middle-income countries (LMICs) [105.1]. The WHO has recognized the importance of strengthening health systems and improving preparedness to manage such emergencies [113.1]. However, the pandemic exposed critical weaknesses in global health systems, threatening to reverse decades of progress [112.1]. Furthermore, these organizations must address health equity and ensure universal access to quality healthcare. The WHO emphasizes combating misinformation, strengthening primary care, and addressing disparities in health equity, especially in maternal and child health, nutrition, and mental health [113.2]. The rise of social media has further complicated these efforts by eroding public trust in healthcare institutions, challenging the effective implementation of health policies [114.1].Comparative Health Policies Across Countries
Comparative health policies across countries reveal significant variations in approaches to global health challenges, influenced by differing national priorities, economic conditions, and social determinants. In the United States, global health policy is integrated into broader national strategies encompassing economic globalization, security, and international relations. This integration promotes international collaborations to address complex health issues through mechanisms such as federal funding, development aid, and scientific research.[93.1] Key actors in this landscape include not only well-known agencies like the US Agency for International Development and the Centers for Disease Control and Prevention but also various executive branch agencies, highlighting the multifaceted nature of global health governance.[94.1] In contrast, Canada has adopted a more participatory approach to health policy, exemplified by the establishment of the Patient-Centered Outcomes Research Institute (PCORI) and the Strategy for Patient-Oriented Research. These initiatives emphasize public engagement in health policy development, aiming to bridge the gap between research and practical application.[115.1] The United Kingdom also showcases a long-standing commitment to patient engagement through the National Institute for Health and Clinical Excellence (NICE), which incorporates public participation in decision-making processes related to health care standards.[115.1] The evolution of global health principles has been significantly shaped by recent crises, such as the COVID-19 pandemic, which underscored the need for health policies that address social and economic determinants of health. Kumanan Rasanathan and colleagues argue that governments must leverage current global crises to foster healthy societies that promote equity and sustainability.[95.1] This perspective aligns with the United Nations Sustainable Development Goals (SDGs), which advocate for universal health coverage and global health security as essential components of health policy.[96.1] Despite these advancements, disparities in health policy implementation persist, particularly in low- and middle-income countries (LMICs) facing financial constraints and reduced aid from major donors.[97.1] To address these disparities, global health organizations must focus on high-impact areas during public health emergencies, such as community engagement, effective communication, and strengthening health infrastructure.[116.1] By prioritizing these areas, countries can better align their health policies with the diverse needs of their populations, ultimately enhancing global health outcomes.In this section:
Global Health ChallengesGlobalizationInternational RelationsDevelopment AidInternational Development
Health Equity
Policies Addressing Health Inequities
Policies aimed at addressing health inequities have increasingly focused on improving access to care and the social determinants of health. The Affordable Care Act’s Medicaid expansion is a notable example, as it has been associated with better health outcomes and reduced mortality rates among low-income populations.[126.1] However, while initiatives such as accountable care organizations (ACOs) and bundled payment programs have not significantly improved patient outcomes, they have emphasized the importance of prevention and population health, positioning them as vital mechanisms for advancing quality and health outcomes.[126.1] Health inequities are perpetuated by a combination of systemic factors both within and outside the healthcare system. Access to high-quality, comprehensive, and culturally appropriate healthcare is essential for a healthy population.[127.1] Historical and contemporary laws have disadvantaged minoritized groups, contributing to racial and ethnic health inequities through various social, economic, and psychological mechanisms.[128.1] The lack of adequate representation of these groups in national health surveys further limits the ability to address their specific health needs effectively.[128.1] To promote health equity, strategies must include cross-sector collaborations among practitioners, researchers, and educators, as well as leadership development and equity training.[129.1] These approaches aim to reduce health disparities and improve overall health and quality of life for all individuals, regardless of their social circumstances.[130.1] The National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP) emphasizes the importance of addressing social determinants of health (SDOH) through policy initiatives that protect all groups from health risks, such as tobacco use.[131.1] Interventions targeting social determinants can significantly impact health equity. These include improving housing standards, reducing food and economic insecurity, and enhancing educational opportunities.[132.1] Furthermore, addressing the social context in which individuals live—encompassing economic conditions, housing, nutrition, and education—has been shown to be a stronger predictor of health outcomes than medical care alone.[134.1] Community engagement is also critical in health policy-making, as co-created public health actions can reduce health inequities and promote social change.[135.1] Ethical decision-making processes in public health must consider the rights and well-being of diverse communities, ensuring that the voices of underserved populations are prioritized.[136.1] By integrating these strategies, health policies can more effectively address the root causes of health disparities and promote equity across the healthcare system.In this section:
Public Health Policies
Tobacco Control Policies
Tobacco control policies have emerged as a significant area of public health intervention, driven by the need to reduce health disparities and improve community health outcomes. Effective tobacco control measures often involve community engagement, which has been shown to enhance the relevance and sustainability of such initiatives. For instance, Contra Costa Health Services (CCHS) successfully engaged local communities and medical professionals to enact the nation’s first uniform, countywide legislation restricting tobacco use in public areas across all 19 cities in Contra Costa County over 20 years ago.[172.1] This collaborative approach not only fostered trust but also ensured that local concerns were incorporated into the policy-making process. The formulation of tobacco control policies is influenced by various social, economic, and political factors, necessitating a comprehensive understanding of the community dynamics involved.[180.1] The integration of community perspectives is crucial for identifying issues and crafting viable solutions, particularly in addressing newer challenges such as bioterrorism planning, where community ownership of the agenda has proven critical.[172.1] Tobacco control policies play a crucial role in addressing public health concerns, and prioritizing health issues is essential for their effectiveness. This prioritization should be based on factors such as magnitude, morbidity, mortality, impact on quality of life, and the burden posed on the public health system.[181.1] The next step involves defining the goals, objectives, indicators, and targets of the program, followed by the formulation of an appropriate action plan to achieve these within predefined time limits.[181.1] Successful implementation of these policies requires the involvement of trained personnel to systematically organize manpower, materials, and logistics at the necessary locations.[181.1] Prior to the actual launch of the program, conducting a pilot run is vital to identify and rectify any potential defects.[181.1] Furthermore, the program should be supported by periodic monitoring and supervision from trained personnel to effectively guide grassroots workers.[181.1] Finally, a thorough evaluation of the program is necessary to assess its overall impact and effectiveness.[181.1] In the broader context of public health in the United States, tobacco control policies exemplify the collaborative efforts required across federal, state, and local levels of government. The “patchwork” nature of public health responsibilities underscores the necessity for coordinated action among diverse stakeholders, including both public and private entities, to effectively implement and sustain tobacco control measures.[182.1]In this section:
Future Challenges In Health Policy
Emerging Health Issues
Emerging health issues are increasingly shaping the landscape of health policy, driven by a combination of demographic changes, technological advancements, and evolving societal needs. One significant challenge is the rising healthcare costs associated with an aging population, which necessitates more medical attention for chronic illnesses and specialized care. This trend is compounded by the growing demand for mental health services, where healthcare systems are struggling to meet needs due to long wait times, limited access to specialized care, and insufficient resources.[188.1] Moreover, chronic diseases are a major concern, as they account for a substantial portion of illness, disability, and healthcare expenditures in the United States. For instance, obesity affects a significant percentage of both children and adults, leading to increased risks of chronic conditions such as type 2 diabetes and heart disease, which collectively impose a financial burden of nearly $173 billion annually on the healthcare system.[194.1] In response to these challenges, innovative approaches are being explored to enhance healthcare delivery. Digital health technologies, precision medicine, and integrated care models are at the forefront of this transformation. These innovations emphasize prevention, effective governance, and cross-sector collaborations, aiming to create resilient health systems capable of addressing contemporary public health challenges.[189.1] The integration of precision medicine, which tailors healthcare based on individual variability in genetics, environment, and lifestyle, is expected to continue evolving. This approach, alongside advancements in artificial intelligence (AI), holds the potential to personalize care and improve health outcomes.[196.1] However, ensuring equitable access to these innovations remains a critical challenge, particularly for marginalized and underrepresented populations. Efforts to address health equity must focus on the design, development, and deployment of digital health tools to mitigate disparities in access and outcomes.[199.1] As policymakers navigate these emerging health issues, they must also consider the implications of changes in insurance coverage and the role of state and federal regulations in shaping the healthcare landscape. The expiration of continuous coverage during the pandemic has highlighted the need for careful monitoring of insurance eligibility and access to care, particularly as alternative options gain traction.[191.1]Anticipated Policy Changes and Reforms
Anticipated policy changes in health care are expected to address the growing economic burden of chronic illnesses and improve access to care, particularly for marginalized communities. Research indicates that reducing chronic disease risk factors and enhancing management of chronic conditions can significantly protect individuals from severe illness, such as that caused by COVID-19, while also alleviating health and economic costs associated with these conditions.[192.1] Community Health Centers (CHCs) play a crucial role in this context, having saved Medicaid an estimated $38.6 billion in 2023 by maintaining patient health and preventing costly emergency room visits and hospitalizations.[193.1] With further investment, CHCs could effectively address gaps in primary care and combat the chronic disease and mental health crises prevalent in underserved communities.[193.1] The expansion of Medicaid under the Affordable Care Act has significantly contributed to addressing racial and ethnic inequities in access to affordable healthcare, resulting in increased insurance coverage and improved health outcomes for marginalized communities.[216.1] Despite these advancements, disparities in access to healthcare persist, influenced by factors such as race, socioeconomic status, and geographic location.[217.1] Residents of rural counties, particularly those with a high proportion of American Indian or Alaska Native populations, are more likely to depend on Medicaid for their healthcare needs across all age groups.[218.1] Therefore, it is crucial to implement reforms in Medicaid eligibility to ensure that these vulnerable populations continue to receive the necessary support, especially in light of potential reductions in federal funding that could jeopardize their access to care.[218.1] Additionally, community involvement in health systems strengthening is increasingly recognized as vital for improving health outcomes. Evidence suggests that engaging local communities in health policy development can enhance program effectiveness and ensure that health interventions are more responsive to the needs of those they serve.[202.1] Therefore, future policy changes should prioritize community engagement and the integration of anti-racist practices within healthcare systems to mitigate existing disparities and promote health equity.[220.1]Research And Evidence In Health Policy
Importance of Evidence-Based Policies
Evidence-based policy-making plays a crucial role in health policy by ensuring that decisions regarding projects and programs are informed by the best available research evidence. This approach emphasizes the systematic and transparent access to, and appraisal of, evidence as an integral part of the policymaking process, rather than merely targeting the objectives of the policy itself.[226.1] The integration of economic evaluations, such as cost-effectiveness analyses (CEAs), into health policy decisions is essential for addressing the value of healthcare interventions. These evaluations help to determine the health outcomes achieved per dollar spent, thereby guiding both individual physician decision-making and broader societal resource allocation.[223.1] Furthermore, the ethical dimensions of public health actions, particularly in the context of prioritizing interventions, highlight the need to balance economic evidence with ethical considerations. For instance, during the COVID-19 pandemic, debates arose regarding whether healthcare workers should receive priority for medical care due to their increased risk of infection.[225.1] Community engagement is another vital aspect of evidence-based policymaking. Effective collaboration with communities can help address health disparities by tailoring public health policies to meet the unique needs of specific populations. This involves engaging community members in the research process and the implementation of interventions, thereby ensuring that the evidence used in policymaking is relevant and accessible.[229.1] Moreover, health outcomes are influenced by a variety of determinants beyond the traditional health system, including policies related to transportation, living wages, and zoning. These factors can significantly impact health outcomes, particularly for vulnerable communities facing socioeconomic barriers.[233.1] For example, policies aimed at improving access to care, such as the Medicaid expansion under the Affordable Care Act, have been associated with better health outcomes and reduced mortality rates.[234.1]Current Research Trends in Health Policy
Stakeholder engagement plays a crucial role in the translation of research findings into health policy. It involves the active participation of various groups who may have an interest in the research, including patients, payers, policymakers, and members of the public, among others.[230.1] This engagement can take several forms, categorized into four levels: communication, consultation, collaboration, and coproduction. At the communication level, stakeholders receive information without contributing, while consultation allows them to provide feedback without a commitment from developers to act on it. Collaboration engages stakeholders in influencing guideline production, and coproduction involves them as equal members of the development team, significantly impacting decision-making.[230.1] The importance of stakeholder engagement is underscored by its ability to incorporate diverse perspectives into the research process. Researchers often grapple with questions regarding the nature of stakeholder engagement, its significance, and the appropriate timing and methods for involvement.[232.1] Frameworks have been developed to systematically identify stakeholders and synthesize their views, which can enhance the relevance and applicability of research findings.[232.1] Engaging stakeholders at various stages of research, such as prioritizing questions before a study begins or developing dissemination plans post-study, can lead to more effective health policy outcomes.[232.1]References
[1] Health policy - Wikipedia — Health policy can be defined as the "decisions, plans, and actions that are undertaken to achieve specific healthcare goals within a society". According to the World Health Organization, an explicit health policy can achieve several things: it defines a vision for the future; it outlines priorities and the expected roles of different groups; and it builds consensus and informs people.
[3] Health Policy - an overview | ScienceDirect Topics — Health. It is crucial to define policy but also to give a brief account of how health is being defined and treated. Doing the latter first, health is defined, in the spirit of this Encyclopedia, in terms of its public aspect: The health of the public and therefore the responsibility and role of government and other agencies to meet public objectives for the public health.
[4] Health Policy - Health Policy - Health Policy - Academic Guides at ... — Health policy is defined by the World Health Organization as the decisions, plans, and actions that are undertaken to achieve specific healthcare goals within a society. There are many categories of health policy, such as: Public health . Mental health. Health care insurance . Due to the extensive nature of health policy, it is one area of law that affects virtually everyone in a given community.
[5] Health impact assessment (HIA) methods - World Health Organization (WHO) — Health Impact Assessment (HIA) is a practical approach used to judge the potential health effects of a proposed policy, programme or project on a population, particularly on vulnerable or disadvantaged groups. Recommendations are produced for decision-makers and stakeholders, with the aim of maximizing the proposal's positive health effects and minimizing its negative health effects.
[6] Health Impact Assessment | Healthy Places | CDC — How HIAs are conducted. The six steps of HIAs are as follows: Screening: Identify the plan, policy, project, or program decisions for which an HIA would be useful.. Scoping: Plan the HIA and identify which health risks and benefits to consider.. Assessment: Identify affected populations and quantify the decision's health effects.. Recommendations: Suggest practical actions to promote positive
[7] Introduction - Assessing health system performance - NCBI Bookshelf — Policy-makers need to have an in-depth understanding of how their health system is working in order to improve it. Health system performance assessment (HSPA) gives them the details they need. It is a process of monitoring, evaluating, communicating, and reviewing the extent to which aspects of a health system meet their key objectives and support overarching health system goals, as measured
[8] PDF — Health in All Policies Evaluation Tool for ... • Outcome Metrics - measure the effectiveness of a given intervention or program's objectives on the population or area of focus. Outcome evaluations use research methods to establish a baseline and measure improvements for the individuals, groups, or
[9] CDC Approach to Program Evaluation — CDC Approach to Program Evaluation About CDC Approach to Program Evaluation CDC Program Evaluation Framework About CDC Approach to Program Evaluation CDC Program Evaluation Framework View All Program Evaluation CDC Approach to Program Evaluation CDC uses program evaluation to answer important questions about public health programs through methodical and intentional engagement with interest holders. Outcome evaluation measures how well a program, policy, or organization has achieved its intended outcomes. Impact evaluation compares the outcomes of a program, policy, or organization to estimates of what the outcomes would have been without it. About CDC Approach to Program Evaluation; About Office of Policy, Performance, and Evaluation CDC Program Evaluation Framework. Program Evaluation About CDC Approach to Program Evaluation CDC Program Evaluation Framework
[11] An Introduction to the Main Types of Economic Evaluations Used for ... — Specifically, we provide an up-to-date comprehensive introduction to the main principles underlining the most common economic evaluation methods used in the context of informing resource allocation decisions in global health [namely cost-effectiveness/cost-utility analyses and cost-benefit analyses (6)] (Table 1), outlining their key features, differences, advantages and limitations. | Cost-utility analysis | Cost-utility analysis (a specific type of cost-effectiveness analysis) is a form of comparative economic analysis that evaluates two or more policy alternatives in terms of their relative costs and outcomes, where the outcomes are expressed by a generic measure of health status that considers both the effect on mortality and morbidity (e.g., quality-adjusted life-years (QALYs) and disability-adjusted life-years (DALYs)).
[12] 15.1 Supply and Demand in Health-Care Markets - GitHub Pages — The prices can be high because demand is high. For example, if the demand curve is further to the right in the United States compared to Europe (part [a] of Figure 15.3 "Two Explanations for Why Health Care in the United States Is More Expensive Than in Europe"), this implies—all else being equal—higher prices in the United States. The
[14] Principles of health economics including: the notions of scarcity ... — They cannot be calculated separately and added together, for example. 1.2 Markets, Demand and Supply. 1.2.1 Markets. Economics is a social science, ... Equity is an important policy objective in almost every health care system in the world. Economists have created some very useful ways of measuring equity, but apart from that economic analysis
[33] A (Brief) History of Health Policy in the United States - PMC — The Kerr-Mills Act was passed, which used federal funds to support state programs providing medical care to the poor and elderly (a precursor to Medicaid).6 In 1961, the White House Conference on Aging was held, in which the task force recommended health insurance for the elderly under Social Security. The Health Insurance Portability and Accountability Act (HIPAA) was passed in 1996, restricting the use of pre-existing conditions in health insurance coverage determinations, setting standards for the privacy of medical records, and favorably taxed long-term care insurance.8 In that same year, the Personal Responsibility and Work Opportunity Act removed the link between Medicaid and cash assistance eligibility, and allowed states to cover parents and children at higher rates.
[38] History of Clinical Research - Academia.edu — The history of clinical research stretches from ancient practices, such as the dual diet trial in the Book of Daniel, to modern therapeutic advances driven by structured clinical trials. Pioneers like James Lind and Edward Jenner established foundational principles that have shaped ethical standards in clinical testing.
[39] History of Clinical Trials: Why They Were Created & Why They Matter ... — A Look Back: The Early History of Clinical Trials. ... Dr. Edward Jenner's experiments with smallpox vaccinations in the late 18th century helped establish the practice of inoculation. By observing the effects of cowpox exposure on immunity to smallpox, Jenner pioneered a form of clinical trial that laid the foundation for modern vaccine
[40] Founders of epidemiology and thier contributions | PDF - SlideShare — Hippocrates was the first to examine relationships between disease and environmental factors, rejecting supernatural causes. James Lind conducted experiments on scurvy prevention that established clinical research standards. Edward Jenner developed the smallpox vaccine through observation of immunity from cowpox.
[41] A (Brief) History of Health Policy in the United States - PMC — The Kerr-Mills Act was passed, which used federal funds to support state programs providing medical care to the poor and elderly (a precursor to Medicaid).6 In 1961, the White House Conference on Aging was held, in which the task force recommended health insurance for the elderly under Social Security. The Health Insurance Portability and Accountability Act (HIPAA) was passed in 1996, restricting the use of pre-existing conditions in health insurance coverage determinations, setting standards for the privacy of medical records, and favorably taxed long-term care insurance.8 In that same year, the Personal Responsibility and Work Opportunity Act removed the link between Medicaid and cash assistance eligibility, and allowed states to cover parents and children at higher rates.
[42] How History Has Shaped Racial and Ethnic Health Disparities - KFF — Today, Medicaid, along with the Children’s Health Insurance Program, which was established in 1997, provide health and long-term care coverage to millions of low-income individuals in the U.S. and are a key source of funding for hospitals, community health centers, physicians, and nursing homes. It allows states to receive federal funds for providing Medicaid and CHIP coverage to lawfully residing immigrant children and pregnant people without the five-year waiting period established by the Personal Responsibility and Work Opportunity and Reconciliation Act. Over time, a growing number of states have adopted the ICHIA option for children and pregnant individuals.
[43] Health Care Reform and Social Movements in the United States — The outpouring of civil rights activity in the early 1960s spurred politicians to support Medicare as part of Johnson’s War on Poverty, and major civil rights groups all endorsed the legislation.13 Organized labor was again a strong supporter of health reform, not just to ensure care for the uninsurable but also “to eliminate the increasingly costly problem of negotiating health benefits for [union] retirees.” The AFL-CIO created the National Council of Senior Citizens, made up of retired union members, to publicly campaign for Medicare. Although most campaigns push for a single-payer system, some, including UHCAN and the Maryland Citizens’ Health Initiative, argue that universal coverage could be achieved by other financing methods.44 Whatever their differences, state and national reform groups all agree that a movement for universal health care must rely on grassroots mobilization and the support and participation of local activists.
[44] 2.1. Historical background - eurohealthobservatory.who.int — In another, the Kerr-Mills Act of 1960 provided assistance to states to help seniors who were not on public assistance, but who required help with their medical bills (US Department of Health and Human Services, 2000). Medicare covered Americans aged 65 and older, and Medicaid covered about half of those with low incomes.
[45] A (Brief) History of Health Policy in the United States — The Kerr-Mills Act was passed, which used federal funds to support state programs providing medical care to the poor and elderly (a precursor to Medicaid).6 In 1961, the White House Conference on Aging was held, in which the task force recommended health insurance for the elderly under Social Security. The Health Insurance Portability and Accountability Act (HIPAA) was passed in 1996, restricting the use of pre-existing conditions in health insurance coverage determinations, setting standards for the privacy of medical records, and favorably taxed long-term care insurance.8 In that same year, the Personal Responsibility and Work Opportunity Act removed the link between Medicaid and cash assistance eligibility, and allowed states to cover parents and children at higher rates.
[55] 12.7 The Role of Epidemiology in Scientific Decision-Making and Policy ... — 12.7 The Role of Epidemiology in Scientific Decision-Making and Policy Development - Population Health for Nurses | OpenStax Population Health for Nurses12.7 The Role of Epidemiology in Scientific Decision-Making and Policy Development 3.3 Public/Community Health Nursing Practice 12 Epidemiology for Informing Population/Community Health Decisions Epidemiology is at the foundation of scientific decision-making in health care and public health. Health care clients, professionals, and public health practitioners, including nurses, base their health care decision-making and health education on sound epidemiological studies. This chapter has highlighted the important role epidemiology plays in public health, particularly in disease control and prevention. Section URL: https://openstax.org/books/population-health/pages/12-7-the-role-of-epidemiology-in-scientific-decision-making-and-policy-development
[56] The Role of Epidemiology in Evidence-based Policy Making: A Case Study ... — The following sections use tobacco control among youth to illustrate how epidemiology and the related sciences have helped us understand the problem, assess the effectiveness of interventions, inform policy and programmatic decisions, and evaluate progress (Table 1). Epidemiology has been central to our recognition that smoking largely begins among youth, preventing smoking initiation is critical to controlling tobacco use, and policies are the most effective interventions. The MTCP is an anti-tobacco program that is run by the Massachusetts Department of Public Health, with four primary goals: 1) to prevent smoking in youth, 2) increase cessation rates among current smokers, 3) prevent exposure to second hand smoke, and 4) eliminate tobacco related disparities.
[57] Lessons From the Political History of Epidemiology for ... - PubMed — Historical precursors of the field we now call epidemiology date back to Hippocrates. Modern epidemiological science, however, developed as domestic and international infectious disease transmission accompanied industrialization, some nations' economic growth, and colonial powers' military expansion …
[59] An introduction to the history of infectious diseases, epidemics and ... — Much important historical work on how epidemics and infectious disease were brought under control, the escape from premature death, and the sources of the spectacular long‐term improvements in life expectancy over the last two centuries has been published or reviewed in the Economic History Review, an academic journal published since 1927 by the Economic History Society. As a result of work over several decades at the Cambridge Group for the History of Population and Social Structure by Tony Wrigley, the late Roger Schofield, Jim Oeppen and the late Ros Davies, we have secure knowledge of the long run trends in mortality and life expectancy in England (but not Wales or Scotland) over nearly five centuries – far longer than for any other country on the planet.
[78] Revolutionizing Healthcare: How Telemedicine Is Improving Patient ... — Revolutionizing Healthcare: How Telemedicine Is Improving Patient Outcomes and Expanding Access to Care - PubMed eCollection 2024 Jul. Revolutionizing Healthcare: How Telemedicine Is Improving Patient Outcomes and Expanding Access to Care Revolutionizing Healthcare: How Telemedicine Is Improving Patient Outcomes and Expanding Access to Care Telemedicine uses digital technologies to provide healthcare services remotely, greatly improving patient access, especially during crises like the COVID-19 pandemic. This systematic review investigates telemedicine's effects on patient outcomes, access to care, and its role in the evolving healthcare landscape. Significant improvements in patient health outcomes and cost savings were reported with telemedicine interventions. In conclusion, telemedicine significantly improves patient outcomes, access, and satisfaction in chronic disease management, especially diabetes care.
[79] PDF — Traditional Care Barriers to Adherence in Traditional Care Telemedicine's Role in Overcoming Barriers Impact on Chronic Disease Management Diabetes Management Hypertension Management Heart Disease Management Economic Impact Regulatory and Reimbursement Challenges Future Directions Cost-Effectiveness of Telemedicine in Managing Chronic Diseases Reduction in Healthcare Costs Cost Savings in Diabetes Management Economic Impact of Telemedicine During the COVID-19 Pandemic Cost-Effectiveness in Hypertension Management Impact on Healthcare Infrastructure Costs Cost-Effectiveness in Heart Disease Management Barriers to Cost-Effectiveness Overcoming Barriers to Enhance Cost-Effectiveness Future Directions In conclusion, the implementation of telemedicine for the management of chronic diseases such as diabetes, hypertension, and heart disease has shown significant potential in improving patient outcomes, adherence to treatment, and reducing healthcare costs. In summary, telemedicine has the potential to significantly improve adherence to treatment in chronic disease management, leading to better patient outcomes and reduced healthcare costs.
[80] Improving Access to Care: Telemedicine Across Medical Domains — Over the past 20 years, the use of telemedicine has increased exponentially. Its fundamental aim is to improve access to care. In this review, we assess the extent to which telemedicine has fulfilled this promise across medical domains. Additionally, we assess whether telemedicine has improved related health outcomes.
[81] The Affordable Care Act's Impacts on Access to Insurance and Health ... — The Patient Protection and Affordable Care Act (ACA) expands access to health insurance in the United States, and, to date, an estimated 20 million previously uninsured individuals have gained coverage. In particular, we discuss evidence from (a) Massachusetts, which implemented reforms in 2006 that served as the blueprint for the ACA; (b) the Oregon Health Insurance Experiment (OHIE), which expanded Medicaid eligibility to a random sample of a low-income eligible population in 2008; and (c) California’s Low-Income Health Program (LIHP), a Medicaid Section 1115 waiver demonstration project that provided expanded coverage in county programs to low-income adults from 2011 to 2013 prior to their becoming eligible for the state’s Medicaid expansion in 2014.
[82] Big data-driven public health policy making: Potential for the ... — Several previous studies used evidence-based methods and verified their results, such as predictive models, in big data analytics (BDA) for developing public health policy. In public health policy decision-making, big data analytics (BDA) may be useful for making real-time accurate decision. Evidence-based public health policy models development and evaluation using big data analytics and Web technologies. 33.Dritsakis G., Kikidis D., Koloutsou N., Murdin L., Bibas A., Ploumidou K., Laplante-Lévesque A., Pontoppidan N.H., Bamiou D.E. Clinical validation of a public health policy-making platform for hearing loss (EVOTION): protocol for a big data study. 80.Saunders G.H., Christensen J.H., Gutenberg J., Pontoppidan N.H., Smith A., Spanoudakis G., Bamiou D.E. Application of big data to support evidence-based public health policy decision-making for hearing.
[83] The role of data science in healthcare advancements: applications ... — Due to the voluminous amounts of clinical data generated from the health care sector like the Electronic Health Records (EHR) of patients, prescriptions, clinical reports, information about the purchase of medicines, medical insurance-related data, investigations, and laboratory reports, there lies an immense opportunity to analyze and study these using recent technologies . Big data and its utility in healthcare and medical sciences have become more critical with the dawn of the social media era (platforms such as Facebook and Twitter) and smartphone apps that can monitor personal health parameters using sensors and analyzers . This review article provides an insight into the advantages and methodologies of big data usage in health care systems.
[84] Patient-Centered Healthcare: From Patient Experience to Human ... — Despite significant variations in patient-centeredness reported globally by various reports, healthcare organizations across the globe have been actively working on various person-centeredness strategies in the pursuit to provide high-quality health outcomes. Patient and family-centered care encompasses “an approach to the planning, delivering, and evaluating health care grounded in mutually beneficial partnerships among healthcare providers, patients, and families.” The primary outcome related to patient-centeredness and patient and family-centered care is patient experience, which is “the sum of all interactions, shaped by an organization’s culture, that influence patient perceptions across the continuum of care.” Future operational patient-centered healthcare models aim to achieve a state of excellence in human experience in healthcare “that is grounded in the experiences of patients & families, members of the healthcare workforce and the communities they serve.” To achieve this optimistic goal, healthcare systems are increasingly moving toward new models of care with co-design and coproduced healthcare services that are shifting the conversation from “What’s the matter with you?” to “What matters to you?” The patient and family engagement across all the levels of a healthcare system, from coproduced shared decision-making at the point of care to co-designed organizational process and national healthcare policy framework, is crucial for improving patient-centeredness across the continuum of the healthcare journey.
[90] The Role of Health Policy in Improving Health Outcomes and Health ... — Policy focused on improving access to care through insurance coverage, such as the Affordable Care Act’s Medicaid expansion, has led to better health and reduced mortality. Here, the evidence is somewhat more mixed; accountable care organizations (ACOs) and bundled payment programs have failed to have much effect on patient outcomes (48-55), but they have improved emphasis on prevention and population health and are broadly considered to be an important mechanism by which to advance further goals related to quality and outcomes. [DOI] [PubMed] [[Google Scholar](https://scholar.google.com/scholar_lookup?journal=Health%20Affairs%20(Millwood&title=At%20federally%20funded%20health%20centers,%20Medicaid%20expansion%20was%20associated%20with%20improved%20quality%20of%20care&author=MB%20Cole&author=O%20Galarraga&author=IB%20Wilson&author=B%20Wright&author=AN%20Trivedi&volume=36&issue=1&publication_year=2017&pages=40-8&pmid=28069845&doi=10.1377/hlthaff.2016.0804&)] [DOI] [PMC free article] [PubMed] [[Google Scholar](https://scholar.google.com/scholar_lookup?journal=Health%20Affairs%20(Millwood&title=Medicaid%20expansion%20and%20outpatient%20cardiovascular%20care%20use%20among%20low-income%20nonelderly%20adults,%202012%E2%80%9315&author=SAM%20Khatana&author=L%20Yang&author=LA%20Eberly&volume=42&issue=11&publication_year=2023&pages=1586-94&pmid=37931196&doi=10.1377/hlthaff.2023.00512&)] [DOI] [PubMed] [[Google Scholar](https://scholar.google.com/scholar_lookup?journal=Health%20Affairs%20(Millwood&title=The%20ACA%20Medicaid%20expansion%20and%20perinatal%20insurance,%20health%20care%20use,%20and%20health%20outcomes:%20a%20systematic%20review&author=M%20Bellerose&author=L%20Collin&author=JR%20Daw&volume=41&issue=1&publication_year=2022&pages=60-8&pmid=34982621&doi=10.1377/hlthaff.2021.01150&)] [DOI] [PubMed] [[Google Scholar](https://scholar.google.com/scholar_lookup?journal=Health%20Affairs%20(Millwood&title=Lack%20of%20access%20to%20specialists%20associated%20with%20mortality%20and%20preventable%20hospitalizations%20of%20rural%20Medicare%20beneficiaries&author=KJ%20Johnston&author=H%20Wen&author=KE%20Joynt%20Maddox&volume=38&issue=12&publication_year=2019&pages=1993-2002&pmid=31794307&doi=10.1377/hlthaff.2019.00838&)]
[93] What is global health? Key concepts and clarification of misperceptions ... — As a key part of the national strategy in economic globalization, security and international policies, global health in the United States has promoted collaborations across countries to deal with challenging medical and health issues through federal funding, development aids, capacity building, education, scientific research, policymaking and implementation. A research study on a medical or health problem among rural-to-urban migrants in China can be considered as global if the researchers frame the study with a global perspective and include an objective to inform other countries in the world to deal with the same or similar issues. The purpose of this article is to promote global health through research and publication. Articles from Global Health Research and Policy are provided here courtesy of BMC
[94] Global Health: Governance and Policy Development - PMC — In addition to well-known actors, such as the US Agency for International Development and the US Centers for Disease Control and Prevention, executive branch agencies with a significant involvement in global health include the departments of state, defense, agriculture, homeland security, labor, and commerce, as well as the National Institutes of Health, the Food and Drug Administration, the Environmental Protection Agency, the Peace Corps, and the Health Resources and Services Administration. Reflecting the emergence of the new era in global health governance, in 1998 the Rockefeller Foundation established an initiative to create innovative new public-private partnerships, including the Medicines for Malaria Venture, the Global Alliance for TB Drug Development, and the International Partnership on Microbicides.38
[95] Can current interlinked crises stimulate the structural and policy ... — Kumanan Rasanathan and colleagues argue that governments and other societal actors, including the health sector, must ensure current global crises lead to choices and action to build healthy societies that enhance social, economic, and environmental equity and sustainability The world faces multiple interlinked crises, with severe and long lasting impacts on health and health equity1: covid-19
[96] Normative convergence between global health security and universal ... — Background The UN Sustainable Development Goals (SDGs) and WHO Thirteenth General Programme of Work underscored the importance of mitigating health emergencies while ensuring accessible and affordable health services. Central to these efforts are global health security (GHS) and universal health coverage (UHC), which act both as standalone goals and as cross-cutting approaches to health policy
[97] 26 Countries Are Most Vulnerable to US Global Health Aid Cuts. Can ... — These actions are also particularly concerning because other major global health donors, namely European governments, are slashing aid budgets and low- and middle-income countries (LMICs) are facing mounting debt pressures. Which countries are exposed to US global health aid cuts and fiscally constrained? To assess the magnitude of the funding shock, we compare the total amount of US bilateral global health funding that a country received to domestic government expenditure on health in 2022. We drill down on countries that are “highly exposed” to funding cuts, defined as those where US bilateral global health assistance is equivalent to 10 percent or more of government health expenditure.
[103] Global Health Partnerships | Deloitte Insights — Collaboration among nations and international organizations can close some of these gaps, particularly in data-sharing. 6 WHO's Epidemic Intelligence from Open Sources (EIOS) initiative, formalized in 2017, is building a global community of public health stakeholders from nations and international organizations to share ideas, expertise, and
[104] International Collaboration for Global Public Health — Also significant were widespread efforts to address the HIV/AIDS epidemic through such mechanisms as the Joint United Nations Programme on HIV/AIDS (UNAIDS)3 and the more recently established Global Fund to Fight AIDS, Tuberculosis and Malaria.4
[105] The role of international support programmes in global health ... - PLOS — Large scale public health emergencies such as COVID-19 demonstrate the importance of Global Health Security (GHS) and highlight the necessity of resilient public health systems capable of preparing for, detecting, managing, and recovering from such emergencies. Many international programmes support low- and middle-income countries (LMICs) to strengthen public health capabilities for compliance
[110] The role of United Nations and their partners in health — It is the role of the World Health Organization (WHO) to set global standards for health; WHO works with other United Nations agencies and a lot of partners to improve health, including to: Gather evidence on new ways to improve people's health; Share information and ideas on health, such as with governments, health workers and the public
[112] 10 global health issues to track in 2021 - World Health Organization (WHO) — A previously unknown virus raced around the world, rapidly emerging as one of its top killers, laying bare the inadequacies of health systems. Today, health services in all regions are struggling to both tackle COVID-19, and provide people with vital care. In another blow, the pandemic threatens to set back hard-won global health progress achieved over the past two decades - in fighting infectious diseases, for example, and improving maternal and child health. So in 2021, countries around the world will need to continue battle COVID-19 (albeit with the knowledge that effective tools are evolving).
[113] The 13 biggest threats to global health, according to WHO - Advisory — WHO noted that it is "working with countries and partners to strengthen health systems, improve preparedness, and expand the availability of long-term contingency financing for complex health emergencies." However, the group said "political solutions" are need "to resolve protracted conflicts, stop neglecting the weakest health systems, and protect health care workers and facilities from attacks." WHO said it is working to address disparities in health equity by improving "child and maternal care, nutrition, gender equality, mental health, and access to adequate water and sanitation" and providing guidance on how countries can work to improve health care equity. In order to bolster public trust in health care workers and systems, WHO said it is working to help countries "strengthen primary care" and to combat misinformation on social media platforms.
[114] These Are the 13 Most Pressing Global Health Issues This Decade — 3. Making health care accessible to everyone With the overall increase of cancer, diabetes, and other noncommunicable diseases worldwide, access to quality health care for all is essential in reducing health inequality. Whether it is a new vaccine-resistant strain of influenza or the continued spread of various mosquito-transmitted diseases like malaria, it is important for countries to focus on preparedness and preventative measures by investing in health care and infrastructure. To keep global health care systems afloat, the world requires an additional 18 million health care workers by the end of 2030. Groups like the anti-vaccination movement, for instance, use social media to spread misinformation, eroding public trust in health care institutions on a global scale.
[115] Ten health policy challenges for the next 10 years - PMC — For example, over a decade ago, the US Congress created the Patient-Centered Outcomes Research Institute (PCORI) to “conduct research to provide information about the best available evidence to help patients and their health care providers make more informed decisions.”52 In Canada, provincial governments have adopted health legislation based on a broad public consultation process, “Putting People First,”53 which established principles in the law that expanded efforts to engage the public in health policy, and the Strategy for Patient-Oriented Research was launched nationally by the Canadian Institutes of Health Research to address the gap in research getting “knowledge into action.”54 In the United Kingdom, with a long history of patient engagement, the National Institute for Health and Clinical Excellence (NICE) has invited patient and public participation to consider issues related to social value judgments in assessments and the development of guidance and quality standards on social care based partly on patient preferences.55
[116] Equity in epidemic response: an action-oriented framework for guiding ... — The framework covers six high-impact areas that should be addressed during an infectious disease public health emergency: community partnerships and engagement; communication; social and economic conditions; data systems and methods; health infrastructure and supply chains for preventives, therapeutics, and diagnostics; and accessibility of outbreak resources and essential health services. Drawing from our review of the strengths and limitations of existing epidemic/pandemic frameworks and the social, behavioral, and equity literature, we identified six high-impact areas for the EER framework: community partnerships and engagement; communication; social and economic conditions; data systems and methods; health infrastructure and supply chains for preventives, therapeutics, and diagnostics; and accessibility of outbreak resources and essential health services.
[126] The Role of Health Policy in Improving Health Outcomes and Health Equity — Policy focused on improving access to care through insurance coverage, such as the Affordable Care Act’s Medicaid expansion, has led to better health and reduced mortality. Here, the evidence is somewhat more mixed; accountable care organizations (ACOs) and bundled payment programs have failed to have much effect on patient outcomes (48-55), but they have improved emphasis on prevention and population health and are broadly considered to be an important mechanism by which to advance further goals related to quality and outcomes. [DOI] [PubMed] [[Google Scholar](https://scholar.google.com/scholar_lookup?journal=Health%20Affairs%20(Millwood&title=At%20federally%20funded%20health%20centers,%20Medicaid%20expansion%20was%20associated%20with%20improved%20quality%20of%20care&author=MB%20Cole&author=O%20Galarraga&author=IB%20Wilson&author=B%20Wright&author=AN%20Trivedi&volume=36&issue=1&publication_year=2017&pages=40-8&pmid=28069845&doi=10.1377/hlthaff.2016.0804&)] [DOI] [PMC free article] [PubMed] [[Google Scholar](https://scholar.google.com/scholar_lookup?journal=Health%20Affairs%20(Millwood&title=Medicaid%20expansion%20and%20outpatient%20cardiovascular%20care%20use%20among%20low-income%20nonelderly%20adults,%202012%E2%80%9315&author=SAM%20Khatana&author=L%20Yang&author=LA%20Eberly&volume=42&issue=11&publication_year=2023&pages=1586-94&pmid=37931196&doi=10.1377/hlthaff.2023.00512&)] [DOI] [PubMed] [[Google Scholar](https://scholar.google.com/scholar_lookup?journal=Health%20Affairs%20(Millwood&title=The%20ACA%20Medicaid%20expansion%20and%20perinatal%20insurance,%20health%20care%20use,%20and%20health%20outcomes:%20a%20systematic%20review&author=M%20Bellerose&author=L%20Collin&author=JR%20Daw&volume=41&issue=1&publication_year=2022&pages=60-8&pmid=34982621&doi=10.1377/hlthaff.2021.01150&)] [DOI] [PubMed] [[Google Scholar](https://scholar.google.com/scholar_lookup?journal=Health%20Affairs%20(Millwood&title=Lack%20of%20access%20to%20specialists%20associated%20with%20mortality%20and%20preventable%20hospitalizations%20of%20rural%20Medicare%20beneficiaries&author=KJ%20Johnston&author=H%20Wen&author=KE%20Joynt%20Maddox&volume=38&issue=12&publication_year=2019&pages=1993-2002&pmid=31794307&doi=10.1377/hlthaff.2019.00838&)]
[127] Federal Policy to Advance Racial, Ethnic, and Tribal Health Equity. — As described throughout this report, racial, ethnic, and tribal health inequities are created and sustained by factors both inside and outside of the health care system. However, health is strongly tied to the health care system—a healthy population requires access to high-quality, comprehensive, affordable, timely, respectful, and culturally appropriate health care. The health care system
[128] Connection Between Health Equity and History, Federal Policy, and Data ... — Theory and empirical research suggest that these historical and contemporary federal and state laws disadvantage people from minoritized groups shape racial and ethnic health inequities through various social, economic, physical, and psychological mechanisms into low-quality neighborhoods, schools, and jobs and other circumstances, including chronic and acute psychosocial stressors (Bailey et al., 2017; Gee and Ford, 2011; Komro et al., 2012; Williams, 1999; Williams and Collins, 2001; Williams et al., 1997, 2016, 2019). Conclusion 2-1: The lack of oversampling of underrepresented racial, ethnic, and tribal populations in national health surveys and other relevant federal data collection efforts—for example, the Office of Management and Budget categories of American Indian or Alaska Native and Native Hawaiian or Pacific Islander—limits the availability of reliable data, and therefore meaningful action, by federal programs, researchers, and advocates to advance health equity for these communities.
[129] Progress on Major Public Health Challenges: The Importance of Equity — We discuss how cross-sectoral work; collaborations among practitioners, researchers, and educators; leadership development; education and training; and policy translation can improve public health efforts to achieve equity. Strategies such as cross-sector partnerships; collaborations among practitioners, researchers, and educators; leadership development; equity training; and equity-informed policy translation should enable the reduction of current health disparities and achievement of better health and quality of life for all people in the United States, regardless of their socially determined circumstances.
[130] 1 The Need to Promote Health Equity - National Center for Biotechnology ... — In this report promoting health equity means creating the conditions where individuals and communities have what they need to enjoy full, healthy lives. Health equity requires focused and sustained societal efforts to confront historical and contemporary injustices and eliminate health disparities (Brennan Ramirez et al., 2008; HHS, n.d.).
[131] Addressing Social Determinants of Health and Chronic Diseases — Addressing Social Determinants of Health and Chronic Diseases | Advancing Health Equity in Chronic Disease | CDC NCCDPHP's Approach Our Work in Action Programs Communications Social Determinants of Health Tools for Partners Rural Health View All Addressing Social Determinants of Health and Chronic Diseases The National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP) works to achieve health equity by addressing SDOH. State and local policies can ensure that all groups are equally protected from the harms of tobacco—for example by limiting access to tobacco products, creating smokefree public spaces, and requiring health insurance coverage of quit-smoking treatments. Social Determinants of Health at CDC NCCDPHP's Programs to Equitably Address Social Determinants of Health The National Center for Chronic Disease Prevention and Health Promotion advances healthy equity through six areas of action.
[132] Addressing Health Equity and Social Determinants of Health Through ... — Interventions to promote good health in individuals and communities can include improving housing standards, reducing food insecurity, reducing economic insecurity and unemployment, increasing levels of educational attainment, and reducing stress from discriminatory practices.38 The Healthy People Web site offers evidence-based resources on addressing social determinants of health within 5 domains: (1) Economic Stability, (2) Education, (3) Health and Health Care, (4) Neighborhood and Built Environment, and (5) Social and Community Context.39 Resources that inform effective interventions for social determinants of health include the PhenX (phenotypes and exposures) Toolkit released by the National Institutes of Health and the National Institute of Minority Health and Disparities.41 In addition, Healthy People 2030 identifies objectives that are relevant to the COVID-19 pandemic response (Table 4; see Supplemental Digital Content SDC2, available at http://links.lww.com/JPHMP/A746).
[134] Addressing Social Determinants of Health in Federal Programs — Although high-quality, affordable health care is essential to addressing medical conditions when they arise, the strongest predictor of health outcomes in the US is not medical care but rather the broader social context in which people live and work. These social determinants of health, such as economic conditions, housing, nutrition, the environment, transportation, and education, are
[135] Addressing Health Disparities through Community Participation: A ... — Addressing Health Disparities through Community Participation: A Scoping Review of Co-Creation in Public Health - PMC Conclusions: Co-created public health actions offer the opportunity to reduce health inequity and promote social change; yet, further effort is needed to involve communities in the entire cycle of decision making. The scoping review was carried out to answer the research question: “What methods have been used in co-created public health actions that incorporate the principle of equity, how does community or citizen participation tend to be articulated, and what effects on health and equity have been observed?”. Participatory methodology, equity focus, and community participation in 31 co-created public health actions reviewed. 24.Israel B.A., Schulz A.J., Parker E.A., Becker A.B. Review of Community-Based Research: Assessing Partnership Approaches to Improve Public Health.
[136] Ethical Public Health: Community Engagement and Decision-Making — Ethical decision-making in public health policymaking is a structured process for resolving the moral dilemmas surrounding public health research and programs. Public health officials examine the relevant facts and ethical considerations of a given decision and then analyze how different options affect the rights and well-being of specific groups, individuals and communities. 5 This process is
[172] PDF — Reducing the health disparities of the 21st century will require even greater community participation to harness the diverse skills, resources and perspectives needed to identify and defi ne issues and to craft viable solutions.9 10 11 Even when addressing newer issues such as bioterrorism planning, where the health department is the lead, sharing ownership of the agenda with communities has been shown to be critical to developing trust and creating plans that incorporate local concerns.12 Contra Costa’s Experience Contra Costa Health Services (CCHS) has a long history of developing strategies for engaging communities to promote the public’s health.13 14 15 16 More than 20 years ago, CCHS formed a coalition of heart, lung and cancer agencies and engaged the local medical community to enact the nation’s fi rst uniform, countywide legislation restricting tobacco use in public areas in the work place in all 19 cities in Contra Costa County.
[180] 25 Public Health Policy Examples - Helpful Professor — Examples of Public Health Policy. ... Formulation of effective and evidence-based public health policies is a complex practice and is influenced by a variety of social, economic, scientific, and political forces. The effectiveness of such policies can be seen in cases such as tobacco control, vaccine programs, seatbelt laws, workplace exposure
[181] Formulating Evidence-based Public Health Policies: A Guide to Policy ... — magnitude/morbidity/mortality/impact on quality of life/burden posed on the public health system), cost-effectiveness of proposed interventions, and availability of resources, the health concerns should be prioritized. The next step is to define the goal, objectives, indicators, and targets of the program and then formulate an appropriate action plan to accomplish the proposed goal and targets within the predefined time-limits. However, this essentially requires the involvement of trained personnel to systematically organize the manpower, material, and other logistics at the required places. Before the actual launch of the program, it is of crucial importance to undertake a pilot-run to rectify any defects that are observed. The entire program should be supplemented with periodic monitoring and supervision by trained personnel to guide the grass-root level of workers in the field. Finally, the program should be evaluated (viz.
[182] U.S. Public Health - KFF — Public health powers and responsibilities derive from the U.S. Constitution and are shared across federal, state, and local levels of government – each of which has unique roles in such efforts that can vary state by state and even community by community. While many of public health efforts are funded and implemented through public (i.e. governmental) programs, private actors are also involved in funding and delivering public health services in the U.S. Given the many actors involved and the variations across federal, state and local roles and approaches, public health in the U.S. has often been referred to as a “patchwork” system. In the U.S., public health powers and responsibilities are shared across federal, state, and local levels of government.
[188] Healthcare Challenges 2025: Key Issues & Future Insights — Healthcare Challenges in 2025: Key Issues Shaping the Future of Global Health Home>Blog>Healthcare Challenges in 2025: Key Issues Shaping the Future of Global Health As per the data from National Health Expenditures (Source), in the U.S. alone, healthcare spending has increased over the years: ➢ Rising Healthcare Costs: Older people require more medical attention, leading to increased expenses for chronic illness management, specialized care, and related needs. Healthcare systems are struggling to cope with the rising demand for mental health services, facing obstacles such as long wait times for therapy, limited access to specialized care, and insufficient resources. To sum it up, there are many challenges in healthcare today — ranging from rising costs and growing mental health concerns to data security issues and the complexities of an aging population.
[189] Public Health in the 21st Century: Challenges, Innovations & Future — This article explores innovative approaches like digital health technologies, precision medicine, and integrated care models that are transforming healthcare delivery. Emphasising prevention, effective governance, and cross-sectorial collaborations, it highlights successful case studies and the role of sustainability, health literacy, and global solidarity in shaping resilient health systems. By embracing innovation and fostering collaboration, public health can address these challenges and create a healthier, equitable future for populations worldwide. This article explores the contemporary challenges in public health, innovative approaches to address them, and a vision for the future. Community involvement is a cornerstone of successful public health interventions. While challenges such as pandemics, health inequities, and climate change persist, innovations in technology, policy, and community engagement offer transformative solutions.
[191] Five Issues to Watch in Healthcare in 2025 — When the pandemic and the public health emergency declaration expired, continuous coverage was rescinded and state Medicaid programs were required to undergo a process over the course of several months to redetermine people’s eligibility for Medicaid. But between fewer incentives for Medicaid expansion, the loss of subsidies for purchasing plans on insurance exchanges, and alternative options like ICHRA gaining traction, policymakers may want to pay closer attention to shifts in the number of people with insurance coverage and their sources of insurance as changes are likely in the next couple years. Historically, state policymakers have not always played a large role in the life sciences because much of it is regulated by federal agencies like the Food and Drug Administration (FDA) or funded by federal agencies like the National Institutes of Health (NIH).
[192] Health and Economic Benefits of Chronic Disease Interventions — Special topic: COVID-19 and chronic conditions. Reducing chronic disease risk factors and improving management of chronic conditions can help protect people from serious illness from COVID-19. These efforts can reduce health and economic costs of chronic conditions and COVID-19 and better prepare communities for future public health emergencies.
[193] PDF — Research estimates that in 2023, primary care at CHCs saved Medicaid an estimated $38.6 billion by keeping patients healthy, preventing ER visits and hospitalizations, and reducing use of costly specialty services.5 With additional investment, CHCs can address gaps in primary care and reverse the nation’s chronic disease and mental health crises, in communities who need it the most. CHCs are the health care home for many of America’s medically underserved communities, including: 20 million people with low incomes (at or below 200% FPL)7 10 million rural patients (1 in 5 of all rural residents)8 9.4 million children 3.8 million seniors 419 thousand veterans CHCs are the largest provider of primary care in the U.S., serving 32.5 million 6 patients in 2023 Horizon Health, South Dakota National Association of Community Health Centers, 2025 For more information, please contact federalaffairs@nachc.org 2 CHCs provide integrated mental health and substance use disorder treatment.
[194] Fast Facts: Health and Economic Costs of Chronic Conditions — Fast Facts: Health and Economic Costs of Chronic Conditions | Chronic Disease | CDC Chronic diseases account for most illness, disability, and death in the United States and are the leading drivers of health care costs. Obesity affects 20% of children and 42% of adults, putting them at risk of chronic diseases such as type 2 diabetes, heart disease, and some cancers.10 Just over 1 in 3 young adults aged 17 to 24 are too heavy to join the U.S. military.11 Obesity costs the U.S. health care system nearly $173 billion a year.12 It can lead to heart disease, type 2 diabetes, some cancers, and obesity.23 Physical inactivity also costs the nation $117 billion a year for related health care.24
[196] Precision Medicine, AI, and the Future of Personalized Health Care — In a recent National Academy of Medicine report about the current and future state of artificial intelligence (AI) in health care, the authors noted “unprecedented opportunities” to augment the care of specialists and the assistance that AI provides in combating the realities of being human (including fatigue and inattention) and the risks of machine error. Both precision medicine and artificial intelligence (AI) techniques impact the goal of personalizing care in five ways: therapy planning using clincal, genomic or social and behavioral determinants of health, and risk prediction/diagnosis, using genomic or other variables. E. et al AI in Health Care: The Hope, the Hype, the Promise, the Peril (National Academy of Medicine, Washington, DC, 2019).
[199] Bridging the Digital Divide in Health Care: A New Framework for Equity — Bridging the Digital Divide in Health Care: A New Framework for Equity | Johns Hopkins | Bloomberg School of Public Health The Digital Health Care Equity Framework (DHEF), developed through a collaborative process involving a diverse panel of experts and supported by the U.S. Agency for Healthcare Research and Quality, marks a pivotal step toward ensuring that digital health tools benefit all communities equitably. The framework was designed as a comprehensive tool to help stakeholders—health care developers, vendors, health systems, and policymakers—to intentionally assess and address equity across all stages of the digital health care lifecycle. The framework was informed by a two-year research process and included a scoping literature review that analyzed 124 studies and existing frameworks, focusing on health equity and digital health care.
[202] Community Involvement in Health Systems Strengthening to ... - PubMed — Community Involvement in Health Systems Strengthening to Improve Global Health Outcomes: A Review of Guidelines and Potential Roles - PubMed Community Involvement in Health Systems Strengthening to Improve Global Health Outcomes: A Review of Guidelines and Potential Roles Community Involvement in Health Systems Strengthening to Improve Global Health Outcomes: A Review of Guidelines and Potential Roles Definitions of health systems strengthening (HSS) have been limited in their inclusion of communities, despite evidence that community involvement improves program effectiveness for many health interventions. We argue for more carefully designed interactions between health systems policies and structures, planned health systems improvements, and local communities. Keywords: community-based health systems; health systems strengthening; literature reviews; maternal and child health; policy frameworks; universal health coverage. Economic evaluation and health systems strengthening: a review of the literature.
[216] Health Care Access and Quality - Federal Policy to Advance Racial ... — Conclusion 5-1: Medicaid and the Children's Health Insurance Program are the most important federal policies that address the racial and ethnic inequities in access to affordable health care. The Medicaid expansions in eligibility incentivized in the 2010 Affordable Care Act have increased insurance coverage, improved health outcomes, and
[217] Access to Healthcare and Disparities in Access — Contents Search term < PrevNext > ACCESS TO HEALTHCARE AND DISPARITIES IN ACCESS Access to healthcare means having “the timely use of personal health services to achieve the best health outcomes.”1 Access to comprehensive, quality healthcare services is important for promoting and maintaining health, preventing and managing disease, reducing unnecessary disability and premature death, and achieving health equity for all Americans.2 Attaining good access to care means having: Health insurance that facilitates entry into the healthcare system. Measures of access to care tracked in the National Healthcare Quality and Disparities Report (NHQDR) include having health insurance, having a usual source of care,ix encountering difficulties when seeking care, and receiving care as soon as wanted. Historically, Americans have experienced variable access to care based on race, ethnicity, socioeconomic status, age, sex, disability status, sexual orientation, gender identity, and residential location.3 This section of the NHQDR discusses trends in access over time and disparities in access related to the sociodemographic variables for which data were available. Indicators of increased insurance coverage include earlier detection of disease, better medication adherence and management of chronic conditions, and psychological well-being in knowing one can afford care when one gets sick.12 Healthcare access and insurance coverage are major factors that contribute to racial and ethnic disparities.
[218] Cuts to Medicaid Will Shift Costs to Families, Providers and Will Be ... — Residents of rural counties with a large share of American Indian or Alaska Native residents and tribal lands are more likely to rely on Medicaid for coverage for all age groups, including seniors. Large reductions in federal Medicaid funding would put the residents of small towns and rural communities and their health care systems at serious risk.
[220] Eliminating health care inequities through strengthening access to care ... — Recommendations include funding research that not only measures racism within health care but also tests burgeoning anti‐racist practices (e.g., co‐production, provider training, holistic review, discrimination reporting, etc.), acting as a convener and thought leader in synthesizing best practices to mitigate racism, and forging the path forward for research on equity and access. Keywords: health disparities, health services research, health care access, inequities, intersectionality, racially/ethnically minoritized populations, structural racism AHRQ can address inequities in access to care by collaboratively funding research that uses a health equity lens to address key gaps in the five dimensions of health care access.
[223] How Should Economic Value Be Considered in ... - AMA Journal of Ethics — Information on the value of a particular intervention, such as a pharmaceutical or diagnostic test, defined as “the health outcomes achieved per dollar spent,” is relevant to these stewardship requirements.2 Results of economic evaluations, such as societal-level cost-effectiveness analyses (CEAs), together with patient-level evidenced-based medicine (EBM) and value-based care, are 2 approaches to addressing the value of health care.3 Incorporating cost and effectiveness data into physician decision making can serve to advance the related goals of optimal patient care and appropriate stewardship of health care resources at the individual and the societal level.
[225] Ethical Dimensions of Public Health Actions and Policies With Special ... — Ethical Dimensions of Public Health Actions and Policies With Special Focus on COVID-19 - PMC Another important ethical debate is should health care workers be given priority in receiving medical care since they are at the front line fighting the COVID-19 and at increased risk of infection and mortality with insufficient PPE while they help many patients to survive? Public health ethics and Covid-19. Ethics and informatics in the age of COVID-19: challenges and recommendations for public health organization and public policy. Health inequity during the COVID-19 pandemic: a cry for ethical global leadership.
[226] SUPPORT Tools for evidence-informed health Policymaking (STP) 1: What ... — What is evidence-informed policymaking? Evidence-informed health policymaking is an approach to policy decisions that aims to ensure that decision making is well-informed by the best available research evidence. It is characterised by the systematic and transparent access to, and appraisal of, evidence as an input into the policymaking process.
[229] Addressing Health Disparities through Community Participation: A ... — Addressing Health Disparities through Community Participation: A Scoping Review of Co-Creation in Public Health - PMC Conclusions: Co-created public health actions offer the opportunity to reduce health inequity and promote social change; yet, further effort is needed to involve communities in the entire cycle of decision making. The scoping review was carried out to answer the research question: “What methods have been used in co-created public health actions that incorporate the principle of equity, how does community or citizen participation tend to be articulated, and what effects on health and equity have been observed?”. Participatory methodology, equity focus, and community participation in 31 co-created public health actions reviewed. 24.Israel B.A., Schulz A.J., Parker E.A., Becker A.B. Review of Community-Based Research: Assessing Partnership Approaches to Improve Public Health.
[230] Key issues for stakeholder engagement in the development of health and ... — The stakeholder groups identified within our protocol, based on published work , include patients, payers of health research, payers of health services, peer review editors, policymakers, principal investigators and members of the research team, providers, product makers, program managers, and members of the public (See Table 1). Previous stakeholder engagement work��identified 4 levels of engagement adapted from other sources [14–16]: (1) Communication: Stakeholders receive information but have no role in contributing, (2) Consultation: Stakeholders provide their views, thoughts, feedback, opinions or experiences but without a commitment from the guideline developers to act on them, (3) Collaboration: Stakeholders are engaged to influence the production of the guideline (e.g. commenting, advising, ranking, voting, prioritizing, and reaching consensus) without direct control over decisions, and (4) Coproduction: Stakeholders are equal members of the guideline development team and have a key role in decision-making in the guideline development process.
[232] Practical Guidance for Involving Stakeholders in Health Research — This guidance, matrix, and list of resources can assist researchers to consider more systematically which stakeholder groups to involve, in what study roles, and by what modes of engagement. Experience shows that researchers have questions about engaging with stakeholders: what is it, why is it important, who should be involved, how should they be involved, when in the research process should they be involved, and what difference will it make?14 To address these questions, published frameworks describe how to identify stakeholders and how to synthesize the views of multiple groups.15–24 Previous work also characterizes stages of research in which stakeholders can be engaged, such as involvement in prioritizing research questions before a study is underway, or developing robust dissemination and implementation plans once it is completed.16, 20, 21, 24
[233] Health Policy Affects Health Outcomes: Community Determinants of Health ... — Health outcomes are influenced by many determinants both within and outside of the traditional health system. For example, policies related to transportation, living wages, and zoning can dramatically impact health outcomes, especially for vulnerable communities with limited resiliency due to socioeconomic barriers.
[234] The Role of Health Policy in Improving Health Outcomes and Health ... — Policy focused on improving access to care through insurance coverage, such as the Affordable Care Act’s Medicaid expansion, has led to better health and reduced mortality. Here, the evidence is somewhat more mixed; accountable care organizations (ACOs) and bundled payment programs have failed to have much effect on patient outcomes (48-55), but they have improved emphasis on prevention and population health and are broadly considered to be an important mechanism by which to advance further goals related to quality and outcomes. [DOI] [PubMed] [[Google Scholar](https://scholar.google.com/scholar_lookup?journal=Health%20Affairs%20(Millwood&title=At%20federally%20funded%20health%20centers,%20Medicaid%20expansion%20was%20associated%20with%20improved%20quality%20of%20care&author=MB%20Cole&author=O%20Galarraga&author=IB%20Wilson&author=B%20Wright&author=AN%20Trivedi&volume=36&issue=1&publication_year=2017&pages=40-8&pmid=28069845&doi=10.1377/hlthaff.2016.0804&)] [DOI] [PMC free article] [PubMed] [[Google Scholar](https://scholar.google.com/scholar_lookup?journal=Health%20Affairs%20(Millwood&title=Medicaid%20expansion%20and%20outpatient%20cardiovascular%20care%20use%20among%20low-income%20nonelderly%20adults,%202012%E2%80%9315&author=SAM%20Khatana&author=L%20Yang&author=LA%20Eberly&volume=42&issue=11&publication_year=2023&pages=1586-94&pmid=37931196&doi=10.1377/hlthaff.2023.00512&)] [DOI] [PubMed] [[Google Scholar](https://scholar.google.com/scholar_lookup?journal=Health%20Affairs%20(Millwood&title=The%20ACA%20Medicaid%20expansion%20and%20perinatal%20insurance,%20health%20care%20use,%20and%20health%20outcomes:%20a%20systematic%20review&author=M%20Bellerose&author=L%20Collin&author=JR%20Daw&volume=41&issue=1&publication_year=2022&pages=60-8&pmid=34982621&doi=10.1377/hlthaff.2021.01150&)] [DOI] [PubMed] [[Google Scholar](https://scholar.google.com/scholar_lookup?journal=Health%20Affairs%20(Millwood&title=Lack%20of%20access%20to%20specialists%20associated%20with%20mortality%20and%20preventable%20hospitalizations%20of%20rural%20Medicare%20beneficiaries&author=KJ%20Johnston&author=H%20Wen&author=KE%20Joynt%20Maddox&volume=38&issue=12&publication_year=2019&pages=1993-2002&pmid=31794307&doi=10.1377/hlthaff.2019.00838&)]