Category: Statistics

JMIR Form Res. 2026 Aug 3;10:e91887. doi: 10.2196/91887.

ABSTRACT

BACKGROUND: Chronic pain is a growing global public health challenge and the leading cause of years lived with disability. It significantly impacts various aspects of daily life, including participation in working life, resulting in increased sick leave and substantial burdens at both the personal and societal levels. Person-centered care (PCC) is a practiced ethic that recognizes the patient as a partner in care. Partnership is established through incorporating the person’s narrative, shared decision-making, and documentation of jointly agreed goals. Remotely delivered PCC interventions have been shown in other studies to improve self-efficacy and facilitate return to work among persons on sick leave. However, little is known about how self-efficacy and sick leave are affected when a PCC intervention is delivered remotely to persons with chronic pain.

OBJECTIVE: This study aimed to evaluate the efficacy of a home-based person-centered intervention consisting of telephone support and an eHealth platform among persons on sick leave due to chronic pain.

METHODS: A 2-arm, nonblinded randomized controlled trial was conducted. Participants aged 18 to 65 years on sick leave due to chronic, nonmalignant pain lasting more than 3 months were recruited from 10 primary health care centers in Gothenburg, Sweden. Participants were randomly allocated 1:1 to either the control group or the intervention group. Both groups received usual care; the intervention group additionally participated in a 6-month PCC intervention via telephone and an eHealth platform. The primary outcome was a composite score consisting of change in general self-efficacy and sick leave at the 6-month follow-up. Self-efficacy was assessed using the Swedish version of the 10-item General Self-Efficacy Scale, and sick leave was assessed based on participants’ self-reported percentage of sick leave in relation to full-time work. The primary outcome was analyzed according to the intention-to-treat principle using the Mantel-Haenszel chi-square trend test.

RESULTS: A total of 654 patients were assessed for eligibility, of whom 59 were included in the final analysis: 29 in the intervention group and 30 in the control group. More participants in the control group (11/30, 36.7%) than in the intervention group (3/29, 10.3%) showed deterioration, resulting in a significant difference in the composite score between the groups at the 6-month follow-up (P=.04), favoring the intervention. This significance also remained in the nonimputed analysis (P=.04).

CONCLUSIONS: This study suggests that PCC via telephone and an eHealth platform may influence the level of sick leave and self-efficacy among persons with chronic pain. Since the control group deteriorated while the intervention group largely remained unchanged, PCC may play a protective role in supporting persons with chronic pain in returning to work. Further studies are warranted to confirm these findings.

PMID:42546261 | DOI:10.2196/91887

Health Aff (Millwood). 2026 Aug;45(8):925-933. doi: 10.1377/hlthaff.2026.00046.

ABSTRACT

Multiple states have established benchmarks for health care spending growth. Since 2021, spending growth has exceeded most states’ benchmarks, prompting concerns about unsustainable growth. However, these benchmarks largely do not adjust when economywide inflation changes. I collected data on states’ benchmark-setting processes, targets, and reported health care spending and identified a set of six states that reported data on per capita spending growth in both 2022 and 2023. Meeting benchmark spending targets for these years would have required real (inflation-adjusted) per capita health care spending to decline by an average of 1.6 percent per year. The same nominal spending benchmark targets would have allowed real spending growth of 1.9 percent per year if inflation had stayed at its historical average. Actual real spending growth was only 0.7 percent per year. Consistent with this, health care as a share of gross domestic product for these states remained stable, at 10.9 percent in 2021 and 10.7 percent in 2023. These findings suggest that nominal spending benchmark designs can generate misleading performance signals, which can be reduced by adopting inflation-shock adjustment protocols and routinely reporting both nominal and real spending performance.

PMID:42546245 | DOI:10.1377/hlthaff.2026.00046

Health Aff (Millwood). 2026 Aug;45(8):846-854. doi: 10.1377/hlthaff.2026.00054.

ABSTRACT

Whether US pharmaceutical markets reward novel therapies more than incremental follow-on drugs remains unclear. We examined trends in prescription drug revenues across three dimensions of pharmacological novelty-molecular structure, therapeutic target, and delivery properties-using a retrospective analysis of branded small-molecule drugs approved by the Food and Drug Administration and marketed between 2000 and 2019. Novelty measures derived from ChEMBL, a comprehensive database of bioactive molecules with druglike properties, were linked to nationally representative utilization and spending data from the Medical Expenditure Panel Survey, with rebate-adjusted net revenues estimated using SSR Health data. Beginning around 2013, gross and net revenues rose disproportionately for highly novel drugs across all three dimensions of novelty, whereas revenues for medium- and low-novelty drugs remained relatively stable. From 2013 to 2019, mean gross revenue more than tripled for drugs with high molecular or target novelty and more than doubled for those with high delivery novelty. These revenue gains were associated with increased prescription volume, rather than higher prices. The timing of this divergence coincided with the expansion of pharmacy benefit managers’ formulary exclusion policies, which may have reduced the usage of drugs with close substitutes and increased market returns to pharmacological novelty.

PMID:42546243 | DOI:10.1377/hlthaff.2026.00054

Health Aff (Millwood). 2026 Aug;45(8):888-896. doi: 10.1377/hlthaff.2025.01470.

ABSTRACT

Medicare Advantage (MA) has become a major source of dental coverage for older US adults. However, little is known about enrollment in plans with dental coverage or about the scope and continued availability of coverage over time. Using Centers for Medicare and Medicaid Services Plan Benefit Package and enrollment data, we examined county-level variation in dental plan enrollment, generosity of benefits, and continuity of dental plan availability across conventional MA plans and MA Special Needs Plans (SNPs) during the period 2010-25. Enrollment in conventional MA plans with any dental benefits rose from 50.3 percent in 2010 to 97.1 percent in 2025. Enrollment in SNPs with dental benefits increased from 68.6 percent to 93.5 percent during this period. Among plans continuously available for at least five years, benefit generosity rose after 2019, but plan continuity declined after 2021 as a result of plan exits and the withdrawal of dental benefits. Net losses of insurers offering dental benefits in conventional MA plans were more likely in counties with relatively high percentages of Black and Hispanic residents, in dental Health Professional Shortage Areas, and in areas with midlevel social deprivation. These findings underscore the need for strong oversight of MA dental benefits and strategies to achieve sustained and equitable access to dental coverage.

PMID:42546242 | DOI:10.1377/hlthaff.2025.01470

Health Aff (Millwood). 2026 Aug;45(8):880-887. doi: 10.1377/hlthaff.2025.01693.

ABSTRACT

Medicare Advantage (MA) plans receive capitated payments that could lead to greater efficiency compared with traditional Medicare but may also curtail provision of beneficial services. However, MA effects are not fully understood, as most research to date is cross-sectional and could be subject to selection bias. This study investigated a natural experiment in which five states (Alabama, Arizona, Colorado, Connecticut, and New Jersey) shifted health benefits for retired state employees from supplemental plans for traditional Medicare to MA plans during the period 2017-19, leading to 87 percent of the more than 220,000 state retirees in these states shifting to MA. We found increased use of certain outpatient services (annual wellness visits and home evaluation and management visits) and observation stays, along with reduced hospital and postacute care admissions. We found no effect on days spent at home or in the community, or on mortality.

PMID:42546241 | DOI:10.1377/hlthaff.2025.01693

Health Aff (Millwood). 2026 Aug;45(8):934-942. doi: 10.1377/hlthaff.2025.01585.

ABSTRACT

During the unwinding of the continuous coverage requirements related to the COVID-19 public health emergency in 2023, as an unprecedented volume of consumers were transitioning out of Medicaid, California launched a facilitated enrollment program for people who lost Medicaid and were eligible for subsidized Marketplace coverage. We conducted a survey in 2023-24 to assess coverage outcomes among Californians who lost Medicaid coverage, were assigned to a default plan, and had thirty days to opt in to coverage under the program. Although national surveys indicate high rates of uninsurance after loss of Medicaid, we found that 85 percent of those who were eligible for an Affordable Care Act Marketplace subsidy had some form of health insurance. Among those without other available coverage, nearly two-thirds opted in to a Marketplace plan. People with a high school education or less were least likely to enroll in Covered California, as were those who rated their health status as poor. Even after we accounted for premium amounts, income, education, health status, and language preference, take-up was higher among Asian/Asian American (84 percent) and White (79 percent) people than among Hispanic/Latino (53 percent) and Black/African American (54 percent) people. Our findings indicate that facilitated enrollment interventions should be strengthened to overcome administrative and other burdens that persist among subpopulations.

PMID:42546240 | DOI:10.1377/hlthaff.2025.01585

Health Aff (Millwood). 2026 Aug;45(8):871-879. doi: 10.1377/hlthaff.2025.01475.

ABSTRACT

Vertical integration between Medicare Advantage (MA) plans and hospital providers is increasingly common, but little is known about how vertically integrated plans pay affiliated providers for medical services. Providers may accept lower prices from affiliated plans to give those plans a competitive edge in the MA market. Conversely, plans may pay vertically integrated providers higher prices to increase their medical loss ratios-a measure of revenues spent directly on health care required by the Centers for Medicare and Medicaid Services. Using a novel data set of vertically integrated MA plans matched with negotiated hospital pricing data, we found that in 2024, 66-73 percent of hospitals charged similar prices to affiliated and unaffiliated plans, but prices differed at a sizeable minority of hospitals. On average, affiliated plan prices were 5.3 percent higher than unaffiliated plan prices for the same procedure at the same hospital. Affiliated plan prices were higher relative to unaffiliated plan prices in the inpatient (rather than outpatient) setting, in more concentrated MA markets, and where MA hospital prices were lower relative to traditional Medicare hospital prices. Our results suggest that vertically integrated MA plans behave differently from standard MA plans, but strategies vary by market and hospital characteristics.

PMID:42546239 | DOI:10.1377/hlthaff.2025.01475

Health Aff (Millwood). 2026 Aug;45(8):943-951. doi: 10.1377/hlthaff.2025.01754.

ABSTRACT

The opioid crisis has remained a public health challenge in the US for more than two decades. After increasing from 2002 to 2012, opioid-related hospitalizations decreased from 2016 to 2019, but more recent trends are unknown. We sought to determine trends in incidence and outcomes of US opioid-related hospitalizations in recent years. We conducted a serial cross-sectional study of adult primary and secondary opioid-related hospitalizations, using the 2016-23 National Inpatient Survey and regression models, annual percent change, and z-tests to examine change during the study period. Measures included annual opioid-related hospitalizations, hospital stay outcomes, and sociodemographic characteristics. Among the 1.48 million opioid-related hospitalizations during 2016-23, survey-weighted to 7.42 million, 0.93 million were classified as primary and 6.49 million as secondary opioid-related hospitalizations. Hospitalizations decreased through 2023 for all groups except patients who were Hispanic or Native American, who reported Medicaid as their payer, or who were older than age sixty-five. The greatest decline occurred among people younger than age thirty-five. The proportion of hospitalizations ending in death and self-directed discharge increased by 0.58 percentage points and 2.68 percentage points, respectively. Overall, differential reductions in opioid-related hospitalizations and increasing mortality and self-directed discharge highlight opportunities for interventions.

PMID:42546237 | DOI:10.1377/hlthaff.2025.01754

Health Aff (Millwood). 2026 Aug;45(8):897-905. doi: 10.1377/hlthaff.2025.01535.

ABSTRACT

The rapid growth of private equity (PE) and publicly traded corporation (PTC) ownership in hospice has raised concerns that investor-driven profit incentives may undermine care quality. Evidence on how these acquisitions affect care delivery remains limited. We linked a national PE and PTC acquisition database to Medicare claims for a beneficiary sample for the period 2010-21 and used a difference-in-differences event study to compare acquired versus nonacquired for-profit hospices on process-based quality measures and Medicare reimbursement. After PE acquisition, registered nurse, social worker, and home hospice aide minutes per thirty days declined 5.14 percent, 12.32 percent, and 6.62 percent, respectively; after PTC acquisition, registered nurse and home hospice aide minutes per thirty days declined 4.63 percent and 9.09 percent. Declines in visit minutes also were observed in the last seven days of life. Reductions in visit minutes were driven by four large acquirers. These findings highlight the need for increased transparency and oversight policies, as well as payment reforms that align reimbursement with care intensity and quality.

PMID:42546235 | DOI:10.1377/hlthaff.2025.01535

Health Aff (Millwood). 2026 Aug;45(8):915-924. doi: 10.1377/hlthaff.2025.01656.

ABSTRACT

The 2021 expansion of the Child Tax Credit provided advance monthly cash transfers to most US households with children. Although prior evaluations documented overall improvements in household well-being, less is known about variation by household structure. This study examined policy-period changes in parental mental health and material hardship among female-headed households. Using data from 1.3 million respondents to the Census Bureau’s Household Pulse Survey (2020-25) and an intersectional framework, we applied difference-in-differences and multilevel models to estimate changes in parental mental health and material hardship before, during, and after expanded Child Tax Credit implementation. Non-female-headed households showed improvements in depression, anxiety, and housing insecurity, whereas female-headed households, particularly those with low incomes and Black, Hispanic, and Asian households, showed smaller or no comparable gains. Food insecurity did not improve across groups. Intersectional analyses showed that the highest burdens and smallest improvements were concentrated among low-income, female-headed households across racial and ethnic groups. Findings suggest that the expanded Child Tax Credit did not fully close baseline disparities, underscoring the importance of household structure and intersecting social positions in policy design and evaluation.

PMID:42546234 | DOI:10.1377/hlthaff.2025.01656