World Medical & Health Policy

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World Medical & Health Policy is a quarterly, peer-reviewed journal that considers the many factors shaping global health. We publish articles employing overlapping disciplines that include health policy and politics, political science, health economics, medical ethics, and public health. The journal’s approach is unified by a thoroughgoing concern with critically examining the contexts within which policy is made, as well as more traditional considerations of processes, outcomes, and influences.

Latest documents

  • Messaging and Advocacy in U.S. Tobacco Control Policy, 2009–19

    Social science and public health researchers have spent decades investigating the effectiveness of various interventions designed to lower smoking rates and educate the U.S. public about the damages of tobacco consumption. This manuscript addresses two deficiencies in the existing literature. First, it examines important changes in tobacco control policy since the passage of the 2009 Family Smoking Prevention and Tobacco Control Act, the most significant antismoking legislation in decades. Second, it analyzes the ways in which governmental and nongovernmental anti‐tobacco advocates have framed their arguments. Using a seminal article by Donley Studlar (2008) as its point of departure, this paper employs data from annual reports, press releases, and advertising campaigns to explore the similarities and differences in the antismoking strategies and messaging of two government agencies (the Food and Drug Administration and the Centers for Disease Control and Prevention) and two advocacy groups (the Truth Initiative and the Campaign for Tobacco‐Free Kids) from 2009 to 2019. The analysis reveals an ongoing tension between themes of industry denormalization (which generates arguments grounded in morality) and harm reduction (which generates a more regulatory approach to policymaking) in modern tobacco control policy.

  • A Tale of Two Programs: Access to High Quality Providers for Medicare Advantage and Affordable Care Act Beneficiaries in New York State

    Medicare Advantage and the Affordable Care Act's insurance marketplaces provide coverage to millions of beneficiaries. This paper assesses network design and access to percutaneous coronary intervention (PCI or angioplasty with stent) in New York for both programs. A specific focus is on access to higher quality providers. The findings indicate that both programs significantly restricted access and choice as compared to an unconstrained network. However, network design only rarely created areas devoid of any providers. In terms of access to quality, both programs tended to have slightly worse mean and median quality ratings than the overall physician supply. Findings with regard to access to above‐average providers were mixed. With respect to access to the highest quality providers, both ACA and Medicare Advantage plans generally fared slightly worse than unrestricted networks. In micropolitan and rural areas, access issues became apparent. Network regulation may do little to address these concerns. However, adding non‐emergency medical transportation benefits to insurance coverage may prove to be desirable going forward.

  • Issue Information
  • Variations in HCBS Spending, Use, and Hospitalizations among Medicaid 1915(c) Waiver Enrollees

    Medicaid home‐ and community‐based services (HCBS) waiver programs serve a population at high risk for hospitalization. We examined whether enrollees in HCBS programs, in 21 states representing all regions of the United States, with higher intensity of services, measured by HCBS spending per enrollee, have lower rates of hospitalization and potentially avoidable hospitalization (PAH). We found no statistically significant association with hospitalization. This suggests that HCBS programs that provide higher intensity services are not focusing effort on reducing hospitalization. We also found that HCBS waiver enrollees in programs with greater generosity in eligibility, measured by a higher proportion of HCBS receipt among long‐term services and supports (LTSS) users, had statistically significantly lower rates of hospitalization and PAH. This suggests that more generous programs serve waiver enrollees who are at lower risk of hospitalization, which may be relevant to policymakers in establishing the eligibility criteria.

  • Reducing Harm Through Evidence‐Based Alcohol Policies: Challenges and Options

    This article examines challenges in implementing and sustaining effective alcohol policies and proposes several strategies to counter them. A narrative review was undertaken of recent publications that document challenges in implementing alcohol policies in various contexts. MEDLINE/PubMed were searched for publications in English between 2011 and 2018. Twenty‐five keywords and 25 scholar names were used in the search. From 1,169 hits, 168 full research papers and commentaries were examined. Eight main groups of challenges were identified: interventions of inadequate dose, support, scope, or fidelity; confounding impacts from alcohol industries and other sectors; uneven implementation or inadequate enforcement; popular policies are largely ineffective and effective policies unpopular; policy decision‐making focusing on short‐range perspectives and skewed to favor commercial interests; low awareness of alcohol as a health risk; challenges in getting information on relevant interventions, local data, and insider information; and insufficient capacity or training to implement a policy. Several strategies are offered to counter these challenges: provide evidence to policymakers: conduct assessment and pilot studies; provide enhanced training on alcohol issues and policy implementation; develop allies; promote strong leadership; use media advocacy; engage voices of those impacted by flawed policies; and promote a comprehensive approach.

  • Positively Influencing Policy Prescriptions
  • Can Adoption of Cuban Maternity Care Policy Guide the Rural United States to Improve Maternal and Infant Mortality?

    In the rural United States the infant mortality rate (IMR) is 6.5 per 1,000, and in rural states like Alabama this rate jumps to 9.1. Rural obstetric services are disappearing such that over half of U.S. rural counties do not have enough obstetric services. In contrast, Cuba's IMR is 4.3 while spending half as much as a percent of their gross domestic product than the United States. This raises the question: how has Cuba achieved this health outcome and what lessons can be learned and applied in the United States given decreased availability of obstetric services? This paper presents a field case study of one of Cuba's national public health policies. Specifically, we explore Cuba's Hogares Maternos, or maternity homes. We argue that the Cuban model, which focuses on social determinants of health, ought to be explored. We discuss how Hogares Maternos may be adopted and adapted within the rural United States by leveraging existing infrastructure.

  • Modeling the Effect of Income Segregation on Communicable Disease Transmission

    Income segregation has been on the rise in developing countries, where many communicable diseases are still prevalent. This study investigates how income segregation affects communicable disease transmission through the development of a novel model that includes income segregation and individuals’ health‐seeking behavior. The general model proposed here assumes that health of an individual is affected by (i) the health‐seeking behavior of individuals (e.g., going to the hospital, taking medicine); (ii) the communal health stock; and (iii) exposure to the communal health stock. The communal health stock is comprised of the amenities that make people healthier in a given community (e.g., the number of health‐care facilities). Income segregation is defined here as a combination of income inequality and residential segregation, which exists when some people have higher exposure to the communal health stock than other people. In this model, income segregation exists when poor people disproportionately live in neighborhoods with lower exposure to the communal health stock than rich people. A decrease in income segregation means the income of the poor increases along with their exposure to the communal health stock. The general model applied here predicts that an increase in the poor's income will increase their health by enabling them to afford more health‐seeking behavior and finds that higher exposure to the communal health stock directly increases the health of the poor. Higher exposure to the communal health stock, however, is found to decrease the poor's health‐seeking behavior, which reduces their health. The general model finds, therefore, that a decrease in income segregation will have an ambiguous effect on the health of individuals and the overall community. Probing further, the analysis replaces the general model with a more specific model, which predicts that overall, a decrease in income segregation increases individual health. Furthermore, in the more specific model, it is possible that the poor get stuck in a low‐health equilibrium while the rich stay in a high‐health equilibrium.

  • Erratum
  • Pharmacies and the Pharmaceutical Industry in Latin America

    Latin American community pharmacies treat large segments of the population, especially the poor. Self‐medication rates are high, and prescription‐only medicines are often available without a prescription. Patients rely more on pharmacists’ advice than clinicians’, but conflicts of interest are rampant: companies may offer discounts, extra drugs, or a higher profit margin to pharmacy owners; pharmacy staff recommendations may be compromised by lack of education or financial incentives, including bonuses and commissions for recommending specific drugs. Pharmacists and staff rely on pharmaceutical company education on drugs. Pharmacy chains, which tend to provide poorer service, are replacing family owned pharmacies in most Latin American countries. Pharmacies are a de facto safety net for the poor and uninsured and should be considered part of the health‐care system, not just commercial establishments. Medicine dispensation should be professionalized, and pharmaceutical company‐funded education should be banned to minimize the conflicts of interest that affect medication recommendations.

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