A Legal Approach to Cancer Epidemiology in Public Health

The Public Health Act encompasses scientific research and law enforcement as causes, distributions, and preventive factors for diseases and injuries of a particular population. Today, the Public Health Law is growing into a field that expects to cultivate and utilize lawful practitioners who can apply specialized legal skills in health policy development and public health performance. The multidisciplinary approach of the Public Health Act integrates the legal and scientific elements of the field and the workforce, characterized by a more dynamic understanding of the health impact of legislation and the rapid deployment of effective policies. Thus, legal health interventions that manage and treat diverse populations need to be evaluated more rigorously and quickly. In addition, funding for policy surveillance and other legislation and policy mapping needs to be more sophisticated to maximize utility and avoid duplication. This study investigated legal interventions to manage and treat various groups of populations for health and discussed the necessity of public health laws.     

The Affordable Care Act's “community first choice” option: Effect on long-term care expenditures

Objective

To empirically assess the effect of adopting Affordable Care Act's Community First Choice (CFC) option on overall state home and community-based services (HCBS) expenditures as well as distribution of HCBS expenditures across different HCBS mechanisms. We also explore the heterogeneous effect of CFC across adopting states.

Data Source

We used data from the Medicaid Long Term Services and Support (LTSS) expenditure reports prepared by Truven Analytics and Mathematica for the Centers for Medicare & Medicaid Services from 2008–2018 for all 48 states and the District of Columbia.

Study Design

An event-study difference-in-differences model was used to estimate the effect of CFC on HCBS expenditures using Medicaid LTSS expenditure reports from 2008–2018. We also employ the synthetic control method to unmask heterogeneity across CFC adopting states using data from 2008–2018.

Data Collection/Extraction Methods

Not applicable.

Principal Findings

Overall, CFC was not associated with a change in HCBS expenditures per capita or HCBS expenditures as a proportion of LTSS expenditures. However, there appears to be an increase in HCBS expenditures among states that were institutionally-oriented prior to CFC adoption. Additionally, CFC adoption was associated with an overall decrease in expenditures in alternative HCBS mechanisms (Personal Care Services State Plan Option and 1915(c) waivers), suggesting potential substitution across overlapping programs.

Conclusion

Results indicate heterogeneity across states adopting CFC. More institutionally-oriented states appear to use CFC to expand HCBS. In contrast, more HCBS-oriented states appear to employ CFC to strategically restructure their overall portfolio and processes.     

Accessibility of Medical Diagnostic Equipment for Patients With Disability: Observations From Physicians

ObjectiveTo explore attitudes and practices of physicians relating to accessible medical diagnostic equipment in serving patients with mobility disability.DesignOpen-ended individual telephone interviews, which reached data saturation. Interview recordings were transcribed verbatim for qualitative conventional content analysis.SettingMassachusetts, the United States, October 2017-January 2018.ParticipantsPracticing physicians from 5 clinical specialties (N=20).InterventionsNot applicable.Main Outcome MeasuresCommon themes concerning physical accessibility.ResultsMean ± SD time in practice was 27.5±12.5 years; 14 practices had height-adjustable examination tables; and 7 had wheelchair-accessible weight scales. The analysis identified 6 broad themes: height-adjustable examination tables have advantages; height-adjustable examination tables have drawbacks; transferring patients onto examination tables is challenging; rationale for examining patients in their wheelchairs; perceptions of wheelchair-accessible weight scales; and barriers and facilitators to improving physical accessibility. Major barriers identified by participants included costs of equipment, limited space, and inadequate payment for extra time required to care for persons with disability. Even physicians with accessible examination tables sometimes examined patients seated in their wheelchairs.ConclusionsEven if physicians have accessible equipment, they do not always use it in examining patients with disability. Future efforts will need to consider ways to eliminate these access barriers in clinical practice. Given small sample size, results are not generalizable to physicians nationwide and globally.