Aaron E. Carroll's Blog, page 22

The end of the public health emergency and impending coverage loss

In a new op-ed for MedPage Today, Paul Shafer and I explain how the end of the public health emergency (PHE) and Medicaid continuous enrollment condition (CEC) will lead to significant coverage loss, specifically among people who are still eligible for coverage. When regular Medicaid redeterminations resume after the end of the PHE, if people don’t update their contact information or respond to state notices within a certain amount of time, they’ll be at risk of losing their coverage, despite still being eligible. The effect of the end of the CEC won’t be felt equally across populations. People of color and those who aren’t a part of the Modified Adjusted Gross Income (MAGI) Medicaid population are more at risk of falling through the cracks because of these onerous requirements.

As we write,

If you dig into the [August report from HHS], you will see that the disenrollment cliff will likely be a disaster for health equity — as if the inequities of the pandemic itself weren’t enough. A majority of those projected to lose coverage are non-white and/or Latinx, making up . . . 61% [of] those losing coverage because of administrative burdens . . . This represents a disproportionate burden of coverage loss, when still eligible, among those already bearing inequitable burdens of the pandemic and systemic racism more generally.

Read the full piece here.

Research for this piece was supported by Arnold Ventures.

The post The end of the public health emergency and impending coverage loss first appeared on The Incidental Economist.

What Does “Good” Qualitative Research Look Like?

Qualitative research uses non-numerical data to explain what, why, and how something happened. It provides a contextual understanding of people, behaviors, and situations that quantitative studies often can’t.

There are ongoing conversations in the scientific community about what a “good” qualitative study entails. While the specific criteria are subject to debate, there are some widely accepted guidelines to consider. These include:

Use of theory to inform research questions, design, and interpretation of findings.Explaining the decision-making process behind choosing study design, methodology, and sampling.Maintaining study quality through transparency and systematicity of the research process, which includes establishing reflexivity, validity, reliability, and generalizability of the research.

Below, each of these are described further.

Theory

Researchers should provide a theoretical or conceptual framework that motivates their study’s research questions, data gathering, and interpretation of results. Research questions should add to existing theory, and sometimes also generate new theory. This article in SAGE provides introductions to some of the theories used in qualitative research.

Study Design, Methodology, and Sampling

Qualitative research should discuss why the study’s design and methodology were chosen. Below are some common approaches, with consideration of inherent tradeoffs.

Interviews: Interviews allow data to be collected from individuals through unstructured and/or semi-structured questions, with flexibility to gain unanticipated knowledge. The researcher has the freedom to structure the interview to be as formal and in-depth based on the needs of the study. Interviews provide information based on what people say but cannot provide insight based on direct observation of how people behave or interact. They can also be time consuming while conducting interviews and during the transcription and analysis process. Transcription costs also increase as the number of participants increase. On the other hand, the amount of time required can be estimated during study design (e.g., one hour per interview times the number of anticipated interviews).Groups: Focus groups, panels, and other group-based interviews provide a larger venue for capturing both verbal information and observations of group dynamics and interactions, including how individuals influence each other. Disadvantages include more difficulty getting truthful responses (since sensitive topics may be more challenging to discuss in a group), social desirability biases, and groupthink. Like interviews, focus groups can also be time consuming and costly during the interviewing, transcribing, and analysis process.Ethnography: Ethnographic research involves observation of people and culture, allowing for description of what individuals do in their natural environments instead of controlled settings. This method could require a large investment of time, since it is unclear how long it may take to capture and understand authentic behaviors.Content/Document Analysis: Content and document analysis reviews a multitude of secondary sources, ranging from written accounts to recorded media. Content analysis examines all sources in which a searched term appears, while document analysis focuses only on written documents. Both methods are particularly good for studying questions of historical significance, including those where participants are no longer living. A significant limitation is that the data were initially collected by others, potentially with unknown biases, errors, and/or omissions.

A qualitative study should also explicitly discuss its sampling strategy, especially if convenience sampling is taking place since it can result in selection bias and sampling error. The goal of sampling should be to reach theoretical saturation, the point at which more participants or documents would not add more unique information.

Study Quality

A qualitative study’s design should be both transparent and systematic. Transparency means providing a clear description of all techniques and processes used to collect, analyze, and interpret data. Systematicity means the use of data collection and analytic methods follow widely accepted research processes and qualitative research guidelines.

A high-quality qualitative study should also address validity, reliability, researcher reflexivity, and generalizability.

Validity : Validity pertains to how a study’s results would apply to similar populations and settings outside of the study. Some methods to address validity include utilizing description to provide behavioral meaning and context, triangulating (by utilizing multiple research methods, sources, or researchers), and negative case analysis by reviewing contradicting data to the study’s findings. Reliability : A study is reliable when stable and consistent results are produced when the research methods are replicated. Researchers should be transparent about their methods and justify them, clarify how the study could be replicated, and ensure data accuracy. Researcher Reflexivity : Researchers should reflect on their own biases, judgments, and belief systems that may have impacted data generation and analysis. This is typically addressed in a statement from the researcher. Generalizability : The need for generalizability in qualitative research is debated amongst experts. It focuses on how well study findings would transfer to different settings and populations. While study replication would most likely produce some new findings, key concepts and themes can be identified that are reasonably expected to apply across contexts, as well as indicate what it is about their findings that may not generalize. This concept is contested since qualitative research may not always aim to be generalizable but rather descriptive about a certain group or individuals.

By considering these factors and general guidelines, researchers can be more mindful of their own research and when reviewing existing qualitative studies, while reviewers can better assess new qualitative research.

The post What Does “Good” Qualitative Research Look Like? first appeared on The Incidental Economist.

The Diversity Problem in Medical Education

Racial bias is pervasive in American medicine. Part of that can be attributed to the way we train doctors, and another part stems from WHO gets trained as doctors. The barriers to entering medical school and going on to become medical faculty are high, and some schools have improved recruitment while neglecting retention. We can do better at making medical training more broadly accessible and helping students succeed once they’re admitted.

 



The post The Diversity Problem in Medical Education first appeared on The Incidental Economist.

Healthcare Triage Podcast: Science Communication Matters

In this episode, Dr. Krista Hoffmann-Longtin and Dr. Tiffany Doherty talk with Dr. Aaron Carroll about the importance of science communication. They discuss some major challenges to effective communication, as well as ways to try to bridge the communication gap and promote better understanding between scientists and the public.

 

 

This Healthcare Triage podcast episode is co-sponsored by Indiana University School of Medicine, whose mission is to advance health in the state of Indiana and beyond by promoting innovation and excellence in education, research, and patient care, and the Indiana Clinical and Translational Sciences Institute, a three way partnership among Indiana University, Purdue University and the University of Notre Dame, striving to make Indiana a healthier state by empowering research through pilot funding, research education and training. More information on the Indiana CTSI can be found by visiting IndianaCTSI.org.

The post Healthcare Triage Podcast: Science Communication Matters first appeared on The Incidental Economist.

Medical Training Can Reinforce Racial Bias

Racial disparities are rampant in healthcare. In addition to structural inequalities, the issues are partly due to racial bias among healthcare workers. These biases stem, in part, from the way race is presented in medical curricula.

 



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Do Men Face Barriers to Birth Control?

In discussing reproductive health care, men are often left out of the conversation. However, in the wake of recent access restrictions, it is crucial to examine the accessibility of all reproductive health care. A vasectomy, a male sterilization procedure, is safe, non-invasive, and often reversible. But, female sterilization is twice as common in the United States, even though it has more side effects and possible complications.

This article in Public Health Post, I explore why men in the United States rarely utilize vasectomies. I discusses barriers to care such as medical misinformation, limited insurance coverage, and individual provider restrictions. These barriers, as well as social stigma, disproportionately leave female partners with the burden of birth control.

Read the full post here!

Research for this piece was supported by Arnold Ventures. 

The post Do Men Face Barriers to Birth Control? first appeared on The Incidental Economist.

Better Process, Better Health

This article in Tradeoffs discusses a new Notice of Proposed Rulemaking (NPRM) published by the Centers for Medicare and Medicaid in the Federal Register. This notice is part of a larger executive order signed last December aimed at reducing the administrative burdens of public health insurance programs. According to author, Paul Shafer, administrative burdens can impact health by making it more challenging for people to access benefits they are eligible for, doubling down on existing health inequities.

This NPRM, titled “Streamlining the Medicaid, Children’s Health Insurance Program [CHIP], and Basic Health Program Application, Eligibility Determination, Enrollment, and Renewal Processes,” aims to shift some of the administrative burdens of applying for CHIP and Medicaid from the applicants back to the government. For example, it allows Medicaid and CHIP to accept each other’s eligibility determinations, requires states to try harder to reach eligible people, and send pre-populated renewal forms.

Read the full article here!

Research for this piece was supported by Arnold Ventures. 

The post Better Process, Better Health first appeared on The Incidental Economist.

Deadline Extension for Call for Abstracts on Aligning Systems for Health

The deadline for the call for abstracts for the Health Services Research special issue on Aligning Systems for Health has been extended to Monday September 26. Additional details on the HSR website.

The post Deadline Extension for Call for Abstracts on Aligning Systems for Health first appeared on The Incidental Economist.

We need to make sure our response to the opioid crisis benefits all people, not just white people

The opioid epidemic is still decimating communities. While white Americans in areas with lower levels of economic opportunity bore its brunt in the recent past, the epidemic’s impact across racial groups has changed again. Our history suggests a danger that this could negatively affect our perspective and response.

Until recently, the story of the opioid epidemic has largely been about white Americans in areas with declining economic opportunity. The opioid overdose death rate for white people was at least twice as high than that of other racial and ethnic groups in the US through 2015.

The story — connecting the high rates of overdose to lower levels of economic opportunity — became widely popularized through the work of Anne Case and Angus Deaton as “deaths of despair.” They sounded the alarm for the white working class specifically.

Case and Deaton’s initial work focuses on the decrease in life expectancy and worsening health outcomes for middle-aged white people between 1999 and 2013. But, as Keturah James and Ayana Jordan point out in their work on the opioid epidemic in Black communities, opioid deaths among Black Americans nearly doubled during practically the same period (1999-2015). As they explain, “these deaths have been largely overlooked by the media, and non-white victims of the opioid epidemic are conspicuously absent from political discourse. To attribute this lack of discussion entirely to the low relative frequency of non-white deaths offers an incomplete explanation at best and a wholly inaccurate one at worst.”

Furthermore, while white people have historically faced some of the highest rates of drug overdose deaths, in 2020 the trend changed. Drug overdose death rates across all demographic groups had been climbing, and then exploded during the pandemic. But between 2019-2020, the death rate increased by nearly 45 percent among Black people, compared to an increase of 22 percent among white people and 21 percent among Hispanic people. In 2020, Black people experienced the highest opioid overdose death rate of any group (26.3 deaths per 100,000 people).

Race and racism drive policy decisions and inform how we respond to public health crises. Because the focus of the (recent) opioid epidemic has been about white Americans, its response has differed from the responses to other substance use epidemics. Research has revealed how policymakers responded differently to the opioid epidemic and the crack-cocaine era, by introducing more public health, treatment-oriented policies during the former and more punitive criminal justice policies during the latter. This is reflective of the larger differences in the framing of the two epidemics. The opioid epidemic has been viewed as a structural problem, driven by economic and social factors, whereas individuals who struggled during the crack-cocaine epidemic were criminalized; drug use was viewed as an individual’s problem.

The difference in the responses during different eras of the opioid epidemic says enough on its own. In addition to the ravaging effects of the opioid epidemic today, Black Americans were also devastated by an opioid epidemic, driven by heroin use, in the 1960s and 1970s. But, instead of being met with a public health-oriented response, victims were responded to with the Rockefeller Drug Laws, which criminalized drug possession, first in New York State, and later in other states that implemented similar legislation.

Given the changing racial trends of the opioid epidemic, there’s a danger that our political response and cultural views of the crisis could shift again. Racism has been driving the response to the epidemic the whole time; choosing to focus on how to address deaths primarily among white people is a racialized policy decision, too. But now, because the crisis is disproportionately harming Black people, concerns about federal policymakers scaling back policies that were helping all people are well-founded. Given our history, there is a reasonable fear that they could divert resources from programs designed to address the root causes of the epidemic to initiatives designed to criminalize and punish victims.

We’ve made meaningful progress in how we view substance use disorders; many substance use-related policies being implemented today haven’t always been on the table. A part of this may have been driven by the fact that the opioid epidemic has been viewed as a white problem. Because of this, some may be inclined to suggest continuing to frame the epidemic as a problem affecting working-class white Americans, in order to improve outcomes for all people. But prioritizing problems and crises that affect white populations, ostensibly to help all racial and ethnic groups, isn’t a new strategy, and historically, hasn’t worked in the ways we want it to. There’s a real danger with this approach; it contributes to the erasure of the experiences of Black people. In fact, had we addressed the opioid epidemic head-on, when Black people were the face of the problem, it could’ve helped us mount a more effective response today.

Research for this piece was supported by Arnold Ventures.

The post We need to make sure our response to the opioid crisis benefits all people, not just white people first appeared on The Incidental Economist.

What Makes the Latest Covid Variants More Contagious?

Omicron variants BA.4 and BA.5 emerged a little while ago, and they are particularly contagious. Why is that and what are we doing about it?

 



The post What Makes the Latest Covid Variants More Contagious? first appeared on The Incidental Economist.