Health affairs
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Randomized Controlled Trial
Health And Economic Outcomes Up To Three Years After A Workplace Wellness Program: A Randomized Controlled Trial.
Workplace wellness programs aim to improve employee health and lower health care spending. Recent randomized studies have found modest short-run effects on health behaviors, but longer-run effects remain poorly understood. We analyzed a clustered randomized trial of a workplace wellness program implemented at a large multisite US employer. ⋯ At the end of three years, employees at the treatment worksites had better self-reported health behaviors, including a higher rate of actively managing their weight. No significant differences were found in self-reported health; clinical markers of health; health care spending or use; or absenteeism, tenure, or job performance. Improvements in health behaviors after three years were similar to those at eighteen months, but the longer follow-up did not yield detectable improvements in clinical, economic, or employment outcomes.
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Prior research and the popular press have anecdotally reported inadequate nursing home staffing levels during the COVID-19 pandemic. Maintaining adequate staffing levels is critical to ensuring high-quality nursing home care and an effective response to the pandemic. We therefore sought to examine nursing home staffing levels during the first nine months of 2020 (compared with the same period in 2019), using auditable daily payroll-based staffing data from the Centers for Medicare and Medicaid Services. ⋯ When we accounted for changes in census, the number of nurse staff hours per resident day remained steady or, if anything, increased slightly during the pandemic. The observed increases in staff hours per resident day were small but concentrated in nursing homes operating in counties with high COVID-19 prevalence, in nursing homes with low Medicaid census (which typically have more financial resources), and in not-for-profit nursing homes (which typically invest more in staffing). These findings raise concerns that although the number of staff hours in nursing homes did not decline, the perception of shortages has been driven by increased stresses and demands on staff time due to the pandemic, which are harder to quantify.
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The COVID-19 pandemic has prompted concern about the integrity of the US public health infrastructure. Federal, state, and local governments spend $93 billion annually on public health in the US, but most of this spending is at the state level. Thus, shoring up gaps in public health preparedness and response requires an understanding of state spending. ⋯ We obtained data from the Census Bureau for all states except California and coded the data by public health category. Although overall national health expenditures grew by 4.3 percent in this period, state governmental public health spending saw no statistically significant growth between 2008 and 2018 except in injury prevention. Moreover, state spending levels on public health were not restored after cuts experienced during the Great Recession, leaving states ill equipped to respond to COVID-19 and other emerging health needs.
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How New Models Of Vaccine Development For COVID-19 Have Helped Address An Epic Public Health Crisis.
Coronavirus disease 2019 (COVID-19) vaccine development and manufacturing have proceeded at a historically unprecedented pace. This speed may be accounted for by the unprecedented scale of resources being devoted to addressing COVID-19; an unusual intensity of cooperation, encompassing the public and private sectors and occurring both within and across national borders; and innovation with respect to both technologies (for example, new vaccine platforms) and processes (for example, vaccine clinical trials). In this article we describe and analyze how resources, cooperation, and innovation have contributed to the accelerated development of COVID-19 vaccines. Similar levels and types of public investment, models of cooperation, and harnessing of innovative processes and technologies could be applied to future epidemics and other global health challenges.
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The coronavirus disease 2019 (COVID-19) pandemic response brought forth major changes in innovation policy. This article takes stock of the key features of the COVID-19 innovation system-the network of public and private actors influencing the development and diffusion of technologies to combat the pandemic. Before the pandemic, biomedical research and development policy consisted largely of "push" funding from the public sector in support of basic research and "pull" incentives from patents to motivate private companies to invest in clinical trials and develop drugs and vaccines. ⋯ Nonpatent barriers to competition may also have incentivized innovation. The challenges to ensuring diffusion have gained in prominence during the pandemic, though it is unclear what role patents will play in pricing and access. Some aspects of this approach to biomedical innovation may be unique to crises, but others could provide lessons for policy beyond the pandemic.