Health services research
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Health services research · Oct 2020
Relationship of neighborhood social determinants of health on racial/ethnic mortality disparities in US veterans-Mediation and moderating effects.
To examine mediation and moderation of racial/ethnic all-cause mortality disparities among Veteran Health Administration (VHA)-users by neighborhood deprivation and residential segregation. ⋯ Neighborhood characteristics, particularly black and AI/AN residential segregation, may contribute to AI/AN mortality disparities among VHA-users, particularly in communities that were rural, had greater black segregation, or were located on or near AI/AN reservations. This suggests the importance of neighborhood social determinants of health on racial/ethnic mortality disparities. Living near reservations may allow AI/AN VHA-users to maintain cultural and tribal ties, while also providing them with access to economic and other resources. Future research should explore the experiences of AI/ANs living in black communities and underlying mechanisms to identify targets for intervention.
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Health services research · Aug 2020
Comparative Study Observational StudyEarly impact of the implementation of Medicaid episode-based payment reforms in Arkansas.
To evaluate episode-based payments for upper respiratory tract infections (URI) and perinatal care in Arkansas's Medicaid population. ⋯ Upper respiratory infection and perinatal EOCs for Arkansas Medicaid beneficiaries produced mixed results. Aligning shared savings with quality metrics and cost-thresholds may help achieve quality targets and disincentivize over utilization within the EOC, but may also have unintended consequences.
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To understand the effect of physician payment incentives on the allocation of health care resources. ⋯ The problem with current FFS payment is not paying a fee for each service, per se, but the way in which the fees are determined.
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To estimate the net effect of living in a gentrified neighborhood on probability of having serious psychological distress. ⋯ Gentrification levies mental health costs on financially vulnerable community members and can worsen mental health inequities.