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Access to hemodialysis for undocumented immigrants with end stage renal disease (ESRD) is widely variable across the United States and highly dependent upon state policy. Some states have enacted policies to provide coverage for standard dialysis to undocumented immigrants, while other states do not provide coverage. Patients living in some states which do not provide coverage rely on emergency federal coverage through the Emergency Medical Treatment and Active Labor Act. However, this act requires that patients present with an acute, life-threatening condition in order to receive dialysis, which is then referred to as "emergency-only hemodialysis" (EoHD). Because EoHD requires patients to present in life-threatening condition, patients who rely on EoHD suffer from debilitating physical symptoms and psychosocial distress. Undocumented immigrants who receive EoHD also have staggeringly higher mortality rates than those who receive standard hemodialysis. Moreover, in comparison with standard dialysis, EoHD results in greater health care utilization and higher health care costs. Therefore, EoHD represents a very low value care practice, providing substandard care at a greater cost. Policy change is urgently needed to provide undocumented immigrants with ESRD access to the standard of care; that is, three-times weekly standard hemodialysis or peritoneal dialysis., (© 2020 Wiley Periodicals, Inc.)

An estimated 6,500 undocumented immigrants in the United States have been diagnosed with end-stage renal disease (ESRD). These individuals are ineligible for the federal insurance program that covers dialysis and/or transplantation for citizens, and consequently are subject to local or state policies regarding the provision of healthcare. In 76% of states, undocumented immigrants are ineligible to receive scheduled outpatient dialysis treatments, and typically receive dialysis only when presenting to the emergency center with severe life-threatening symptoms. 'Emergency-only hemodialysis' (EOHD) is associated with higher healthcare costs, higher mortality, and longer hospitalizations. In this paper, we present an ethical critique of existing federal policy. We argue that EOHD represents a failure of fiduciary and professional obligations, contributes to moral distress, and undermines physician obligations to be good stewards of medical resources. We then explore potential avenues for reform based upon policies introduced at the state level. We argue that, while reform at the federal level would ultimately be a more sustainable long-term solution, state-based policy reforms can help mitigate the ethical shortcomings of EOHD.

The American College of Physicians (ACP) has long advocated for universal access to high-quality health care in the United States. Yet, it is essential that the U.S. health system goes beyond ensuring coverage, efficient delivery systems, and affordability. Reductions in nonfinancial barriers to care and improvements in social determinants of health are also necessary. This ACP position paper calls for ending discrimination based on personal characteristics; correcting workforce shortages, including the undersupply of primary care physicians; and understanding and ameliorating social determinants of health. The ACP calls for increased efforts to address urgent public health threats, including injuries and deaths from firearms; environmental hazards; climate change; maternal mortality; substance use disorders; and the health risks associated with nicotine, tobacco use, and electronic nicotine delivery systems in order to achieve ACP's vision for a better U.S. health care system.

This paper is part of the American College of Physicians' policy framework to achieve a vision for a better health care system, where everyone has coverage for and access to the care they need, at a cost they and the country can afford. Currently, the United States is the only wealthy industrialized country that has not achieved universal health coverage. The nation's existing health care system is inefficient, unaffordable, unsustainable, and inaccessible to many. Part 1 of this paper discusses why the United States needs to do better in addressing coverage and cost. Part 2 presents 2 potential approaches, a single-payer model and a public choice model, to achieve universal coverage. Part 3 describes how an emphasis on value-based care can reduce costs.

In the United States, undocumented residents face unique barriers to healthcare access that render them disproportionately dependent on the emergency department (ED) for care. Consequently, ED providers are integral to the health of this vulnerable population. Yet special considerations, both clinical and social, generally fall outside the purview of the emergency medicine curriculum. This paper serves as a primer on caring for undocumented patients in the ED, includes a conceptual framework for immigration as a social determinant of health, reviews unique clinical considerations, and finally suggests a blueprint for immigration-informed emergency care.

The federal system for allocating donated livers in the United States is often criticized for allowing geographic disparities in access to livers. Critics argue that such disparities are unfair on the grounds that where one lives is morally arbitrary and so should not influence one's access to donated livers. They argue instead that livers should be allocated in accordance with the equal opportunity principle , according to which US residents who are equally sick should have the same opportunity to receive a liver, regardless of where they live. In this paper, we examine a central premise of the argument for the equal opportunity principle, namely, that geographic location is a morally arbitrary basis for allocating livers. We raise some serious doubts regarding the truth of this premise, arguing that under certain conditions, factors closely associated with geographic location are relevant to the allocation of livers, and so that candidates' geographic location is sometimes a morally non-arbitrary basis for allocating livers. Geographic location is morally non-arbitrary, we suggest, since by taking it into account, the UNOS may better fulfill its central goals of facilitating the effective and efficient placement of organs for transplantation and increasing organ donation.

The Veterans Health Administration (VHA) is the United States' largest integrated health care delivery system, serving over 9 million enrollees at nearly 1300 health care facilities. In addition to providing health care to the nation's military veterans, the VHA has a research and development program, trains thousands of medical residents and other health care professionals, and conducts emergency preparedness and response activities. The VHA has been celebrated for delivering high-quality care to veterans, early adoption of electronic medical records, and high patient satisfaction. However, the system faces challenges, including implementation of an expanded community care program, modernization of its electronic medical records system, and providing care to a population with complex needs. The position paper offers policy recommendations on VHA funding, the community care program, medical and health care professions training, and research and development. [ABSTRACT FROM AUTHOR]

Nearly one in ten US residents have difficulty speaking and understanding English and are deemed to have limited English proficiency (LEP). Despite federal mandates for provision of interpreters and other language access services, individuals with LEP experience notable health disparities. Occupational therapists must be prepared to equitably serve this population, however there is a dearth of research evidence and practical recommendations about our profession's readiness to serve this growing population. This paper maps the current healthcare policy environment and existing language access research relevant to occupational therapy. Implications for the future of occupational therapy research, education and practice are discussed.

The quality of maternity care in the United States is variable, and access to care is tenuous for rural residents, low-income individuals, and people of color. Without accessible, timely, and high-quality care, certain clinical and sociodemographic characteristics of individuals may render them more vulnerable to poor birth outcomes. However, risk factors for poor birth outcomes do not occur in a vaccum; rather, health care financing, delivery, and organization as well as the policy environment shape the context in which patients seek and receive maternity care. This paper describes the relationship between access and quality in maternity care and offers a systems-level perspective on the innovations and strategies needed in research, clinical care, and policy to improve equity in maternal and infant health., (Copyright © 2017 Elsevier Inc. All rights reserved.)

As it stands there is no viable health care option for undocumented immigrants of low socioeconomic status. Even more worrisome is that Affordable Care Act simply does not address this issue with any direct plan. The US is in a very influential time period in terms of undocumented immigration and its relationship with health care. The purpose of this paper is to examine international examples of undocumented immigrant health care and their implications for the United States' undocumented immigrant health care. This study found that physicians in the US must work to prevent the initiation of policies which exclude undocumented immigrants from accessing health care. Exclusionary policies implemented in European nations have had disastrous effects on physicians and patients. This paper examines the implications which similar policies would have if implemented in the US.

Telemedicine-the use of technology to deliver care at a distance-is rapidly growing and can potentially expand access for patients, enhance patient-physician collaboration, improve health outcomes, and reduce medical costs. However, the potential benefits of telemedicine must be measured against the risks and challenges associated with its use, including the absence of the physical examination, variation in state practice and licensing regulations, and issues surrounding the establishment of the patient-physician relationship. This paper offers policy recommendations for the practice and use of telemedicine in primary care and reimbursement policies associated with telemedicine use. The positions put forward by the American College of Physicians highlight a meaningful approach to telemedicine policies and regulations that will have lasting positive effects for patients and physicians. [ABSTRACT FROM AUTHOR]

Aims: To identify the barriers and facilitators to healthcare for people without documentation status. Design: We conducted a systematic integrative literature review following the Whittemore and Knafl methodology. Methods: Literature search was conducted to identify studies addressing barriers or facilitators to healthcare for people without documentation status in the United States between 2012 and 2022. Studies were critiqued for quality, with results analysed thematically using the social‐ecological model. Data Sources: Searches were conducted in PubMed, PAIS, Web of Science, CINAHL and Psych Info in October 2022. Results: The review incorporated 30 studies (19 qualitative and 11 quantitative). People without documentation status encountered numerous healthcare barriers such as intrapersonal (lack of financial resources and health insurance, fear), interpersonal (language and cultural discrepancies, discrimination), community (bureaucratic requirements, anti‐immigrant rhetoric) and policy‐related barriers. Conversely, linguistically and culturally competent care, empathetic and representative staff, health navigators, safety‐net clinics and supportive federal policies emerged as key facilitators. Conclusion: These findings illuminate the complex healthcare disparities experienced by people without documentation status and underscore facilitators enhancing care accessibility. Future research is needed to explore interventions to increase access to care for this population. Impact: This paper provides a comprehensive examination of the complex barriers and facilitators to healthcare for people without documentation status in the United States. The findings support the value of universal healthcare access, a priority of the World Health Organization, and can inform healthcare policies and practices worldwide. Reporting Method: The review was reported following the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses framework. Patient or Public Contribution: No patient or public contribution was needed. Trial and Protocol Registration: The study protocol was registered with the PROSPERO database (registration number: CRD42022366289). [ABSTRACT FROM AUTHOR]

Introduction: Innovative interventions are needed to address the growing burden of breast cancer globally, especially among vulnerable patient populations. Given the success of Community Health Workers (CHWs) in addressing communicable diseases and non-communicable diseases, this scoping review will investigate the roles and impacts of CHWs in breast cancer screening programs. This paper also seeks to determine the effectiveness and feasibility of these programs, with particular attention paid to differences between CHW-led interventions in low- and middle-income countries (LMICs) and high-income countries (HICs).Methods: A scoping review was performed using six databases with dates ranging from 1978 to 2019. Comprehensive definitions and search terms were established for 'Community Health Workers' and 'breast cancer screening', and studies were extracted using the World Bank definition of LMIC. Screening and data extraction were protocolized using multiple independent reviewers. Chi-square test of independence was used for statistical analysis of the incidence of themes in HICs and LMICs.Results: Of the 1,551 papers screened, 33 were included based on inclusion and exclusion criteria. Study locations included the United States (n=27), Bangladesh (n=1), Peru (n=1), Malawi (n=2), Rwanda (n=1), and South Africa (n=1). Three primary roles for CHWs in breast cancer screening were identified: education (n=30), direct assistance or performance of breast cancer screening (n=7), and navigational services (n=6). In these roles, CHWs improved rates of breast cancer screening (n=23) and overall community member knowledge (n=21). Two studies performed cost-analyses of CHW-led interventions.Conclusion: This review extends our understanding of CHW effectiveness to breast cancer screening. It illustrates how CHW involvement in screening programs can have a significant impact in LMICs and HICs, and highlights the three CHW roles of education, direct performance of screening, and navigational services that emerge as useful pillars around which governments and NGOs can design effective programs in this area. [ABSTRACT FROM AUTHOR]

This critical essay evaluates the potential integration of distinct kinds of expertise in policymaking, especially during situations of critical emergencies, such as the COVID-19 pandemic. This article relies on two case studies: (i) herd immunity (UK) and (ii) restricted access to ventilators for disabled people (USA). These case studies are discussed as examples of experts' recommendations that have not been widely accepted, though they were made within the boundaries of expert epistemic authority. While the fundamental contribution of biomedical experts in devising public health policies during the COVID-19 pandemic is fully recognized, this paper intends to discuss potential issues and limitations that may arise when adopting a strict expert-based approach. By drawing attention to the interests of minorities (disenfranchized and underrepresented groups), the paper also claims a broader notion of "relevant expertise." This critical essay thus calls for the necessity of wider inclusiveness and representativeness in the process underlying public health policymaking. [ABSTRACT FROM AUTHOR]

In this paper, we apply the reproductive justice framework to discuss how gendered racism disadvantages pregnant and parenting young Black women aging out of foster care. Specifically, we highlight the reversal of Roe v Wade as reflective of the United States' long legacy of efforts to control Black women's reproduction. We then discuss the structural factors contributing to the reproductive injustices of young Black women aging out of care, including a lack of access to sexual and reproductive health education, barriers to educational attainment, and foster care-based relational and placement deficits. We conclude with research, practice, and policy enhancements. [ABSTRACT FROM AUTHOR]

Using 2021 data and information related to COVID‐19, this paper discusses the contribution of colonization, medical mistrust and racism to vaccine hesitancy. Vaccine hesitancy is defined as 'delay in acceptance or refusal of vaccines despite availability'. Colonization is described as the 'way the extractive economic system of capitalism came to the United States, supported by systems of supremacy and domination, which are a necessary part of keeping the wealth and power accumulated in the hands of the colonizers and ultimately their financiers'. The system of colonization results in policies and practices, including those related to health, that continue to create oppression and support racism. Persons experience trauma as the byproduct of colonization. Chronic stress and trauma create chronic inflammation and all diseases, whether genetic or lifestyle, have a common pathogenesis that is a component of inflammation. Medical mistrust is the absence of trust that healthcare providers and organizations genuinely care for patients' interests, are honest, practice confidentiality and have the competence to produce the best possible results. Finally, racism is described as everyday racism and perceived racism in healthcare. [ABSTRACT FROM AUTHOR]

In June 2022, the United States Supreme Court decision Dobbs v. Jackson Women's Health Organization overturned Roe v. Wade, removing almost 50 years of precedent and enabling the imposition of a wide range of state‐level restrictions on abortion access. Historical data from the United States and internationally demonstrate that the removal of safe abortion options will increase complications and the health risks to pregnant patients. Because the emergency department is a critical access point for reproductive health care, emergency clinicians must be prepared for the policy, clinical, educational, and legal implications of this change. The goal of this paper, therefore, is to describe the impact of the reversal of Roe v. Wade on health equity and reproductive justice, the provision of emergency care education and training, and the specific legal and reproductive consequences for emergency clinicians. Finally, we conclude with specific recommended policy and advocacy responses for emergency medicine clinicians. [ABSTRACT FROM AUTHOR]

The Migrant Protection Protocols (MPP) and border closure to asylum seekers during the COVID-19 pandemic created a humanitarian crisis at the U.S.-Mexico border. This paper outlines the public health challenges and health care access barriers for asylum seekers living in a tent encampment in Matamoros, Mexico resulting from these policies. Thirty participants, including asylum seekers (n=20) and health care professionals (n=10) in the Matamoros asylum camp, were interviewed. Public health challenges included environmental exposures and inadequate infrastructure; poor sanitation and disease control; and limited safety, nutrition, education, and employment. Health care access barriers included lack of continuity of care and emergency services, resource insufficiencies, and interpersonal barriers. Policy responses to address these challenges include outlawing MPP and other immigration policies that infringe on human rights, collaborating with international partners, and implementing more creative and community-based approaches to asylum processing. [ABSTRACT FROM AUTHOR]

The number of undocumented migrants in high-income countries has increased in recent decades, imposing considerable political, fiscal, and social pressures on governments. This has fostered discussions on whether and to what extent undocumented migrants should get access to public programs and public benefits. Looking at the 2012 Spanish health reform, this is the first paper to document the impacts of a restriction on access to the health-care system for undocumented migrants on health-care utilization, health-care system perceptions, and self-reported health in a high-income country. We show that such restrictions may significantly reduce planned care for undocumented migrants and result in sharp fall in positive opinions about the health-care services still left available to them. We also exploit the heterogeneity in implementing the policy across regions and report stronger effects in regions that enforced the national ban more fully. Furthermore, in the first 3 years since the implementation of the reform, we find suggestive evidence of a worsening in self-assessed health. This study is relevant for policymakers in the developed world, especially in countries that have recently implemented initiatives aimed at reducing the health-care coverage for targeted groups, such as the United Kingdom and the United States. [ABSTRACT FROM AUTHOR]

International graduate students deal with an array of stress when arriving in the United States for the purpose of their studies. This stress relates to various difficulties with regards to their acculturation process. In the absence of family and friends, the importance of counselling services on campus is a vital resource for the support of international graduate student. This paper highlights the provisions and importance of culturally competent counselling for international graduate students on US campuses. Key implications are discussed for how university practitioners and administrators might best provide resources and support international graduate students in the future. This could lead to more effective results in the improvement of international students' mental health. [ABSTRACT FROM AUTHOR]

This paper is a statement of the American Geriatrics Society's (AGS) core policy priorities and the Society's positions on federal programs and policies that support older Americans as articulated to the new administration. Among the AGS priorities discussed in this paper are health reform, Medicare, and Medicaid. The AGS is committed to leveraging its expertise to inform regulatory and legislative policy proposals. [ABSTRACT FROM AUTHOR]

Background: COVID-19 pandemic has tremendously caused significant health impacts leading to high load of ICU critical patients. Multiple Intensive Care Unit (ICU) admission framework and triaging score have been adapted worldwide for admission of COVID-19 patients. The aim of this article is to review the COVID-19 ICU admission policy in five (5) countries, identify challenges and provide recommendations. Materials and Methods: Literature review was carried out through searching available literature from online databases such as EBSCO, PubMed, Research Gate, Google Scholar and Google search engine. The selected information used in this review is taken from any journal, article, report, thesis, national report, news update regarding the topic. Result: The ICU admission policy in 5 countries, namely South Africa, USA, UK, Hong Kong and Malaysia were reviewed. Different countries apply different guidelines to triage, prioritize and admit severe COVID-19 patients to ICU such as Color-coded Priority Scale in South Africa, Critical Care Triage Tool in USA, COVID-19 Critical Care Guideline in UK, COVID- 19 Critical Care Triage Tool in Hong Kong and ICU Admission Prioritization Criteria in Malaysia. The ICU admission decision-making is supported with multiple ICU scorings such as Sequential Organ Failure Assessment (SOFA), Clinical Frailty score and National Early Warning score 2 (NEWS2). Conclusion: The COVID-19 ICU admission policies in these countries are well established and have been practised appropriately despite challenges faced by the ICU practitioners. All five selected national guidelines in this paper correspond to the WHO framework on the ICU admission policy. Ethical issues and legal supports on the ICU practitioners in ICU admission decision-making requires great attention form government and relevant policy stakeholders. [ABSTRACT FROM AUTHOR]

Mental illness is an epidemic in the United States, and there is a gap in care due to minimal integrated programs and transitional community resources. This paper reports the development of a conceptual framework to identify challenges facing families living with mental illness and the integral role nursing plays to positively impact health. An inductive, bottom-up approach was used to develop the Nursing Science, Mental Illness and Family model. Concepts clustered around family health, cycle of suffering, improving outcomes, healthcare policy, and nursing science. Successful, goal-directed interprofessional collaborations are essential for individual-, family-, and system-level interventions to be effective. [ABSTRACT FROM AUTHOR]

Foster parents are required to learn and to navigate a range of policies and regulations in order to make decisions that are in the best interest of the foster child. This paper reviews four policies and regulations (foster parent handbooks, pre-service and in-service training, respite care, and information on points of contact) intended to support family foster homes and examines whether these policies and regulations are available and accessible to the foster parents. Data were collected using a mixed methods research design, including an online search and a survey for child welfare administrators. Findings and implications for policy and practice are discussed. [ABSTRACT FROM AUTHOR]

The US South Asian population has grown tremendously, and is now over 2.5 million. South Asians often face tremendous cultural, socioeconomic, linguistic and structural obstacles to good health, and face staggering cardiovascular disease (CVD) and cancer risk. Coupled with this is a paucity of detailed data on the population's unique CVD and cancer risk profiles, etiologic mechanisms, and effective interventions to address South Asian health disparities. This data gap compelled an initiative to develop more targeted research and evidence-based practice and policy approaches. The South Asian Health Initiative (SAHI), a community based participatory research partnership between the Immigrant Health and Cancer Disparities Center at Memorial Sloan Kettering Cancer and the South Asian Council for Social Services (SACSS), and the Palo Alto Medical Foundation Research Institute thus partnered to effect the first national South Asian translational research endeavor, South Asian Health: From Research to Practice and Policy, summarized in this paper. [ABSTRACT FROM AUTHOR]

The mass incarceration of pregnant and parenting women is a serious problem in U.S. A policy focus is needed that takes a public health approach. This paper outlines the problems with health care delivery in correctional facilities. It is argued that correctional facilities are not the place for pregnant and parenting women. Alternative policies and programs are recommended that align with a public health approach and directly targets the pathways for imprisonment. [ABSTRACT FROM AUTHOR]

Abstract Awareness about the commercial sexual exploitation of children (CSEC) in the United States has increased during the last ten years. The increased awareness is reflected in the U.S. government's substantial efforts to address the problem of human trafficking through legislation including the Trafficking Victims Protection Act (TVPA) of 2000 and its four subsequent reauthorizations. Despite these policy efforts, addressing the needs of CSEC victims who are U.S.-born children continues to be a major challenge in the implementation of the federal anti-trafficking policy. This paper reviews and critiques the responses to CSEC in the United States. Following an overview of the literature on the identification, characteristics and needs of CSEC victims, the paper discusses issues in the identification of CSEC victims and their needs. Then, the paper examines and critiques the policy responses of the U.S to CSEC within its borders. Finally, the paper provides an overview of best practices for addressing the needs of CSEC victims and critiques the availability and accessibility of services. Implications and recommendations are discussed for each of the key issues. [ABSTRACT FROM AUTHOR]

The paper outlines the policy context and summarizes the numerous policy issues that AD raises from the more generic to the unique. It posits that strong public fears of AD and its future prevalence projections and costs, raise increasingly difficult policy dilemmas. After reviewing the costs in human lives and money and discussing the latest U.S. policy initiatives, the paper presents two policy areas as examples the demanding policy decisions we face. The first focuses on the basic regulatory function of protecting the public from those who would exploit these fears. The second centers on the well-debated issues of advance directives and euthanasia that surround AD. Although more dialogue, education and research funding are needed to best serve the interests of AD patients and families as well as society at large, this will be challenging because of the strong feelings and divisions AD engenders. [ABSTRACT FROM AUTHOR]

Awareness of policy issues and determinations of their causes affect levels of support for government intervention, and media framing plays an important role, reflecting and shaping public understanding. In the contemporary United States, racial and ethnic health disparities persist, yet knowledge of disparities and support for recent health care policy measures vary significantly by race. This article utilizes a qualitative interpretive approach to examine mainstream and Black presses' framing of causes and solutions to racial and ethnic health disparities. Analysis is conducted on papers in New York, Philadelphia, and Washington DC between 2009–2011 in the context of the passage of the Affordable Care Act and significant national level actions to address health disparities. The analysis shows that the two genres demonstrate overlapping but distinct patterns, made apparent by attention to features of the framing context. Causal attributions were most often present and systemic in both genres, although mainstream coverage was more likely to convey health disparities' causes as tentative, unfolding, and with less detail. Coverage of solutions varied, with the Affordable Care Act and its likely impact on health disparities given greater attention in African-American newspapers. In some significant respects, then, mainstream and Black press audiences can be said to be receiving rather different senses of health disparities' origins and solutions. [ABSTRACT FROM PUBLISHER]

Abstract Economic theory suggests that a binding minimum wage increase may reduce the generosity of employer-sponsored insurance (ESI) or other fringe benefits, yet previous empirical studies reach conflicting conclusions about the existence of a trade-off between minimum wages and ESI. We study whether recent state and federal minimum wage increases affect the level or the source of health insurance coverage for low-income families using the 2005–16 Current Population Survey. Our research design uses state and year fixed effects to isolate within-state minimum wage changes while controlling for Medicaid eligibility and other changes in health policy related to implementation of the Affordable Care Act. Because dependent coverage might also be affected by minimum wage hikes, we examine ESI coverage for both low-wage workers and their dependents. We find robust evidence that minimum wage increases lead to reductions in ESI coverage in families below 300 percent of the federal poverty level, with a nominal $1 increase in the minimum wage reducing the probability of ESI coverage by 0.99 percentage points. Reductions in coverage were observed both for workers and for their dependents. [ABSTRACT FROM AUTHOR]

In this research note, we demonstrate that trends in the likelihood of child support agreements differ by marital history (i.e., never-married vs. ever-married) and by whether measures rely on the stock of families (i.e., allthose in which children live apart from a parent) or the flow (i.e., those that include children who newly live apart from a parent) in a given year. While previous research has highlighted difference by marital history, the contrast between stock and flow is a new contribution. Trends are typically measured with reference to the stock of cases, even while the flow of cases, which more immediately reflects concurrent policy changes, is more relevant in many contexts. Interpretations of recent declines in child support agreements in the stock of cases--referenced as evidence for both mandating participation and the impracticality of requiring child support-- may be better informed by considering the flow of cases. We find the flow of previously married mothers increasingly likely to have child support agreements while the likelihood is relatively consistent over time for nevermarried mothers. For both groups, using the flow measure, we find notable increases in agreements without payments due in the most recent period. These findings underscore the importance of differentiating stock and flow, and by marital history, in considering the proportion with agreements as an indicator of the effectiveness of current policy. [ABSTRACT FROM AUTHOR]

Purpose: More than 7% of the U.S. population identifies as LGBTQ+ (lesbian, gay, bisexual, transgender, queer, and other identities), meaning clinical audiologists in all settings are likely to encounter LGBTQ+ patients seeking audiological services. This conceptual clinical focus article (a) introduces contemporary LGBTQ+ terms, definitions, and pertinent issues; (b) summarizes the current state of knowledge on barriers to equitable hearing health care access and utilization for people who identify as LGBTQ+; (c) explores the legal, ethical, and moral obligations for audiologists to provide equitable care to people who identify as LGBTQ+; and (d) provides resources to continue to learn about salient LGBTQ+ issues. Conclusions: This clinical focus article provides actionable guidance to clinical audiologists on providing inclusive equitable care to LGBTQ+ patients. Practical actionable guidance on how clinical audiologists can make their clinical practice more inclusive for their patients who identify as LGBTQ+ is provided. [ABSTRACT FROM AUTHOR]

Increasing the diversity of practitioner and patient populations has been identified as a worthy goal in the chiropractic profession, which has predominantly white male practitioners and white female patients in the USA. Toward that end, 'diversity' has been the topic of several papers and was the theme of a 2012 conference of chiropractic educators. However, generally just the microcosm of the interactions of practitioners with patients or teachers with students has been discussed. The macrocosm of larger societal issues and government policies has not been broached. Examples of issues and policies that affect diversity within a profession include portrayals of, and value judgements on diversity by the media and politicians, as well as public funding for healthcare and education. Diversity was defined in this paper to mean differences in race, sex, sexual orientation, economic status, ethnicity, religion and other life circumstances in a population. The purpose of this paper is to raise awareness of evidence that social issues and government policy affect the diversity of practitioners and patients, and to suggest that the barriers to diversity present in these realms be addressed with a cogent, profession-wide effort in order to help increase the diversity of people involved with chiropractic. [ABSTRACT FROM AUTHOR]

Intimate partner violence (IPV) is a well-recognized public health problem. IPV affects women's physical and mental health through direct pathways, such as injury, and indirect pathways, such as a prolonged stress response that leads to chronic health problems. The influence of abuse can persist long after the violence has stopped and women of color are disproportionately impacted. Successfully addressing the complex issue of IPV requires multiple prevention efforts that target specific risk and protective factors across individual, interpersonal, institutional, community, and societal levels. This paper includes examples of community-based, state led and federally funded public health programs focused on IPV along this continuum. Two community-based efforts to increase access to mental health care for low income, women of color who had experienced IPV, Mindfulness-Based Stress Reduction, and a telehealth intervention are discussed. Core tenets of a patient-centered comprehensive approach to assessment and responses and strategies for supporting a statewide comprehensive response are described in Project Connect: A Coordinated Public Health Initiative to Prevent Violence Against Women. Project Connect provides technical assistance to grantees funded through the Violence Against Women Act's health title and involves developing, implementing, and evaluating new ways to identify, respond to, and prevent domestic and sexual violence and promote an improved public health response to abuse in states and Native health programs. Health care partnerships with domestic violence experts are critical in order to provide training, develop referral protocols, and to link IPV victims to advocacy services. Survivors need a comprehensive response that addresses their safety concerns and may require advocacy around housing or shelter, legal assistance, and safety planning. Gaps in research knowledge identified are health system readiness to respond to IPV victims in health care settings and partner with domestic violence programs, effects of early IPV intervention, and models for taking interventions to scale. [ABSTRACT FROM AUTHOR]

'Evidence-based' is the key criterion for decision making not only in medicine and other health professions, where it originated and revolutionized what was previously subjective, opinion-based practice, but also across policy and service development. The 'evidence-based' epistemology uses the hierarchy of evidence - a qualitative ranking of information for consideration, as to its cogency - based on a biomedical view of human health. Evidence-based medicine originally proposed that it would contribute to justice by providing the means to make objective, and therefore, fair and equitable decisions, as well as helping to stop the use of ineffective treatments, thus minimizing costs. In this paper, we argue, however, that due to the epistemological ranking of evidence and its implications, only one type of question can ever be answered using this framework and that some groups are unjustly disregarded or excluded because of the limitations inherent in its epistemology; therefore, evidence-based decision making, whether in medicine, other health professions, or policy settings, using the hierarchy of evidence, in fact, can contribute to injustice. This injustice occurs through preferenced evidence generation set against a highly pressurized and competitive research environment, where funding is restricted and the mantra 'publish or perish' creates separate drivers and considerations for research design other than the research problem. We provide evidence of the lack of evidence generation for three specific minority groups and suggest that the epistemological foundations of an evidence-based strategy be revised to include measures of quality that reflect a connectedness not only between the researchers and the affected stakeholders (patient population, service providers, etc.) but also between the methodology/analysis and the problem trying to be solved. [ABSTRACT FROM AUTHOR]

This article seeks to understand the changes in federal health care policy that led to greater telehealth adoption during COVID-19 pandemic. For decades, telehealth was identified as a possibility for increasing health care access, but the policies needed for greater telehealth reimbursement were stalled until the public health emergency was declared. Applying the dynamic concepts within punctuated equilibrium theory (PET) model to traditional fee-for-service Medicare policy, the influential factors are identified and specify how policy change occurred as a response to the pandemic, resulting in swift and large-scale changes in Medicare telehealth reimbursement requirements and widespread telehealth adoption. The model also explains how the same forces that led to Medicare policy response are at work to maintain and broaden or contract and limit the future of telehealth reimbursement as the public health emergency recedes. [ABSTRACT FROM AUTHOR]

The federal system for allocating donated livers in the United States is often criticized for allowing geographic disparities in access to livers. Critics argue that such disparities are unfair on the grounds that where one lives is morally arbitrary and so should not influence one's access to donated livers. They argue instead that livers should be allocated in accordance with the equal opportunity principle, according to which US residents who are equally sick should have the same opportunity to receive a liver, regardless of where they live. In this paper, we examine a central premise of the argument for the equal opportunity principle, namely, that geographic location is a morally arbitrary basis for allocating livers. We raise some serious doubts regarding the truth of this premise, arguing that under certain conditions, factors closely associated with geographic location are relevant to the allocation of livers, and so that candidates' geographic location is sometimes a morally non-arbitrary basis for allocating livers. Geographic location is morally non-arbitrary, we suggest, since by taking it into account, the UNOS may better fulfill its central goals of facilitating the effective and efficient placement of organs for transplantation and increasing organ donation. [ABSTRACT FROM AUTHOR]

Abstract Even among commercially insured individuals, opioid use disorder is undertreated in the United States: nearly half receive no treatment within six months of a new diagnosis. Using a difference-in-differences specification exploiting the extension of insurance parity requirements for substance use disorder treatment to small-group enrollees in 2014, we find that parity increases utilization of residential treatment but decreases utilization of agonist medications, the standard of care. We find direct interventions to increase access to medication may be more promising: increases in the county-level share of physicians able to prescribe agonists are associated with substitution toward treatment that includes medication. [ABSTRACT FROM AUTHOR]

Context: Although community health centers (CHCs) arose in the 1960s as part of a Democratic policy push committed to social justice, subsequent support has been shaped by paradoxical politics wherein Republican and Democratic support for CHCs continually morphed in response to changes in the health policy landscape. Methods: Drawing on the CHC literature and empirical examples from firsthand accounts and reporting, this article explains CHCs' curious historical development from 1965 to the present. Findings: Both Republicans and Democrats have calibrated their support for CHCs in response to a broader set of political considerations, from antiwelfare policy commitments to aspirations of establishing a national health care plan. Conclusions: CHCs have proven to be a politically malleable policy tool within the broader context of American health care policy. The COVID-19 pandemic raised new questions about CHCs' sustainability and future, but CHCs will continue to play a critical role in providing health care access to underserved populations. They also will continue to be an attractive bipartisan policy option within the larger framework of US health policy. [ABSTRACT FROM AUTHOR]

Purpose: Home health agencies delivering care in rural counties face unique challenges when providing care to older adults; long travel times between each visit can limit the number of patients seen each day. In 2010, Medicare began paying home health (HH) providers 3% more to serve rural beneficiaries without evaluating the policy's impact on patient outcomes. Methods: Using 100% Medicare data on postacute HH episodes from 2007 to 2014, we estimated the impact of higher payments on beneficiaries outcomes using difference‐in‐differences analysis, comparing rehospitalizations between rural and urban postacute HH episodes before and after 2010. Findings: Our sample included 5.6 million postacute HH episodes (18% rural). In the preperiod, the 30‐ and 60‐day rehospitalization rates for urban HH episodes were 11.30% and 18.23% compared to 11.38% and 18.39% for rural HH episodes. After 2010, 30‐ and 60‐day rehospitalization rates declined, 10.08% and 16.49% for urban HH episodes and 9.87% and 16.08% for rural HH episodes, respectively. The difference‐in‐difference estimate was 0.29 percentage points (P =.005) and 0.57 percentage points (P <.001) for 30‐ and 60‐day rehospitalization, respectively. Conclusions: Increasing payments resulted in a statistically significant reduction in rehospitalizations for rural postacute HH episodes. The add‐on payment is set to sunset in 2022 and its impact on access and quality to HH for rural older adults should be reconsidered. [ABSTRACT FROM AUTHOR]

The present study explored how individual- and neighborhood-level factors contribute to predicting the use of preventive health care in a sample of Asian Americans. The cross-level interaction between individual- and neighborhood-level factors was also examined. We found a significant interaction between individual-level health insurance coverage and neighborhood health care providers' availability. Those who were uninsured and living in areas with limited health care provider availability (bottom 20%) were the most disadvantaged. This study adds to the growing literature on the effect of neighborhood-level factors on health care as sources of disparities. For health care policy, identifying individuals without health insurance coverage and living in a neighborhood with limited health care providers should be a priority to diminish disparities in access to care. [ABSTRACT FROM AUTHOR]

There has been a great deal of state-level legislative activity focused on immigration and immigrants over the past decade in the United States. Some policies aim to improve access to education, transportation, benefits, and additional services while others constrain such access. From a social determinants of health perspective, social and economic policies are intrinsically health policies, but research on the relationship between state-level immigration-related policies and Latino health remains scarce. This paper summarizes the existing evidence about the range of state-level immigration policies that affect Latino health, indicates conceptually plausible but under-explored relationships between policy domains and Latino health, traces the mechanisms through which immigration policies might shape Latino health, and points to key areas for future research. We examined peer-reviewed publications from 1986 to 2016 and assessed 838 based on inclusion criteria; 40 were included for final review. These 40 articles identified four pathways through which state-level immigration policies may influence Latino health: through stress related to structural racism; by affecting access to beneficial social institutions, particularly education; by affecting access to healthcare and related services; and through constraining access to material conditions such as food, wages, working conditions, and housing. Our review demonstrates that the field of immigration policy and health is currently dominated by a “one-policy, one-level, one-outcome” approach. We argue that pursuing multi-sectoral, multi-level, and multi-outcome research will strengthen and advance the existing evidence base on immigration policy and Latino health. [ABSTRACT FROM AUTHOR]

A major challenge in managing disasters during a pandemic is assessing the inequalities in society and protecting vulnerable people. The objective of this paper is to geographically understand the discrimination and inequality against minorities by COVID-19. This study designed a locational discrimination index (LDI) to measure COVID-19 discrimination against minorities at county-level in the US. LDI is the difference between the death proportion of a minority and the proportion of a minority's population. If LDI >0 is significant, COVID-19 discrimination is identified against a minority in a county. I further developed a locational minority inequality index (LMII), and LMII of a minority is directly quantified by comparing its LDI with the LDI of the majority population (i.e., the White population in the US). If LMII>0 is significant, a significant health inequality is confirmed against a minority in a county. In the US, I found 157 counties with significant discrimination against Black people, and 103 counties with significant inequality against Black people; 58 counties with significant discrimination against the American Indian population, but 38 counties with significant inequality against the American Indian population; 17 counties with significant discrimination against Native Hawaiians, but only 8 counties with significant inequality; for Hispanic people, 47 counties had significant discrimination, and 64 counties had significant inequality; for Asians, 7 counties had significant discrimination, but 28 had significant inequality. LDI, LMII, and the thematic mapping provide novel insight into COVID-19 discrimination and inequalities. To the best of our knowledge, this is the first time anyone has quantitatively and statistically defined and mapped COVID-19 discrimination and inequality against minorities at a county-level across the US. Based on this, governments and communities could make efficient decisions and take effective action to addressthe significant discrimination and inequality against Black, American Indian, Native Hawaiian, Hispanic, and Asian people, which can be applied to other pandemics or public health disasters in the USA or other countries. • The significant discrimination and inequality of COVID-19 are tested and mapped. • Locational discrimination index to quantify minority's vulnerability is developed. • Locational minority inequality index is developed to further compare inequality in vulnerability. • COVID-19 caused significant spatial inequality between minorities and the white population in the USA. [ABSTRACT FROM AUTHOR]

Purpose – The purpose of this paper is to describe divergent recent developments in provision of reproductive health services to North Americans. Design/methodology/approach – Narrative review. Findings – Two North American countries with very different histories present similar governance challenges today. The challenge is to provide all women with the full range of reproductive health options to which they are legally entitled now. In Canada, those contraception and abortion options are covered under the medical service plan insurance but not always available in convenient locations. In USA, those options are not uniformly covered under health insurance plans due to statutory limitations. In Canada, where federal law limiting abortion was struck down as unconstitutional, the leader of one of its three major federal political parties sees the way forward being to limit his party to pro-choice candidates. In USA, where new laws limiting abortion have been introduced at an unprecedented rate, the judiciary is being asked to define the way forward. Originality/value – Clinical governance needs to balance the moral beliefs of individual providers against the rights of patients to have their lawful choices available within reasonable convenience. Progress has been made but needs are still not adequately met, in these North American examples. [ABSTRACT FROM AUTHOR]