2022’s most interesting health care research papers, according to the experts

Though the pandemic and all its attendant health care crises remained the major health care story of 2022, churning all the while in the background has been the critical work of academic scholars, operating on longer timelines, who are still trying to make sense of US health care and of medicine itself, to get a better idea of what’s wrong and how to make it better.

To wrap up this year, I asked a couple dozen health policy experts what research released this year (though, as one of them reminded me, these papers are often years in the making) had surprised them, changed their thinking, or struck them as especially notable.

Here are five particularly interesting papers, at least in my view. Because many more than that warrant mention, I have tried to cram in as many references to other work as I could. One of my lessons from this exercise was that there are noteworthy new studies being produced all the time. The US health system certainly merits such extensive investigation, given the number and diversity of its flaws.

These studies cover a broad range of subjects, from the intricacies of Medicaid provider networks to prescription uptake by Medicare beneficiaries to how bystanders react when a person experiences a cardiac episode in public. But first, on the topic of the pandemic…

1) Vaccination education campaigns in nursing homes didn’t make much difference

Several experts pointed me to data sets related to Covid-19 vaccination in nursing homes, the scenes of so much illness and death in that frightening first year of the pandemic. Larry Levitt, executive vice president of the Kaiser Family Foundation, flagged one recent KFF survey that found less than half of nursing-home residents are up to date on their vaccines.

That put into sharp relief the findings of a study that Harvard Medical School’s David Grabowski cited as one of his favorites of the year. The paper, published in JAMA Internal Medicine in January 2022, evaluated an effort to use educational campaigns and other incentives to improve vaccination rates among residents and staff in nursing homes.

They did not find a meaningful effect, despite three months of programming. There was plenty of room to grow, particularly among the staff, roughly half of whom were unvaccinated during the study period. (Vaccination rates among residents were already high at the time, though the experiment still did not find a significant effect of the multi-faceted campaign.)

“The conventional wisdom was that a big part of lagging vaccination rates was a lack of information and knowledge about the benefits of vaccination,” Grabowski said. But this study found instead that “these educational efforts were unsuccessful at encouraging greater vaccination. Although information campaigns sound like great policy, they really aren’t.”

He lamented that the study had been ignored by policymakers, noting federal efforts to increase vaccination rates among this population remain focused on education. Grabowski said the policies with the strongest evidence are vaccine clinics and vaccine mandates for staff.

2) Medicaid’s

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St. Joe Corporation, Tallahassee Memorial and FSU split floor on new overall health care campus

Growth strategies incorporate an 80,000-sq.-foot professional medical office environment constructing scheduled to be complete in 2024. This developing will in the long run property TMH Health practitioner Partners – Principal Treatment, Tallahassee Memorial Urgent Care Heart, an ambulatory surgical procedures middle, as well as cardiology and orthopedic services.

Strategies include a 100-mattress clinic with an unexpected emergency center and other inpatient companies, together with surgical procedures, cardiology procedures and imaging, to be finish by the finish of 2027.

Customers of the FSU community celebrated the construction kickoff of the FSU Health-TMH medical campus in Panama Metropolis Seaside. From Left: University of Nursing Dean Jing Wang, Panama Town Campus Dean Randy Hanna, FAMU-FSU Higher education of Engineering Dean Suvranu De, FSU Faculty of Medicine Senior Associate Dean Alma Littles, FSU President Richard McCullough, 1st Woman Jai Vartikar, VP for Investigate Stacey Patterson and Main Medical Officer Joe Frascella.

This will also include things like possibilities for FSU researchers concentrated on getting older and electronic well being, as effectively as residency plans and clinical rotations for FSU health-related pupils.

“Today’s building kickoff will come at a pivotal time for TMH as we rejoice our 75th anniversary this yr,” said Mark O’Bryant, president and CEO of TMH, which serves a 21-county location in North Florida, Georgia and Alabama. “We have developed from a modest, city-owned clinic into a detailed overall health treatment program. As the population in our location boosts, TMH has recognized a substantial need to expand health treatment products and services. Over the earlier 7 and a 50 % a long time, we’ve crafted a standing for excellent, compassionate and local treatment, and we are proud to now give our products and services to the Panama Town Beach front communities.”

The St. Joe Company, Florida State University and Tallahassee Memorial HealthCare celebrated the construction kickoff of a health care campus in Panama City Beach Jan. 17, 2023. (Photo by Tori Schneider)
The St. Joe Company, Florida Point out College and Tallahassee Memorial Health care celebrated the construction kickoff of a well being care campus in Panama City Seaside Jan. 17, 2023. (Photograph by Tori Schneider)

Above the previous various a long time, Florida Condition University has been growing its wellbeing study portfolio even though also pursuing partnerships with major well being care devices this sort of as TMH and many others. It is also enhanced alternatives for students via its College of Medication, opening a doctor assistant schooling method, and is welcoming the first cohort of its new doctoral program in nursing at the College of Nursing this fall.

“FSU has extensive enjoyed becoming a portion of this community by means of our Panama Town Campus,” said FSU President Richard McCullough. “Now, we’re searching ahead to expanding our existence and continuing to serve the inhabitants listed here by this health treatment initiative. Analysis universities can play an vital part in a lively wellness care shipping program, and FSU appears to be forward to taking part in that job correct in this article in Bay County. This place is suffering from an extraordinary boom in inhabitants and the possibilities — and desires — have under no circumstances been better. There are incredible prospects

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Homeless health care crisis: Will street teams remedy?

In summary

Homeless people often have sporadic or no access to health care, resulting in costly, chronic conditions. A new statewide effort encourages Medi-Cal insurers to partner with street teams to improve care.

Lea este artículo en español.

Living on the streets of California is a deadly affair. The life expectancy of an unsheltered person is 50, according to national estimates, nearly 30 years less than that of the average Californian. As homelessness spirals out of control throughout the state, so too do deaths on the street, but it’s those whose lives are the most fragile who are least likely to get medical care.

Now, the state Medi-Cal agency is endeavoring to improve health care access for people experiencing homelessness. Through a series of incentives and regulatory changes, the Health Care Services Department is encouraging Medi-Cal insurers to fund and partner with organizations that bring primary care into encampments.

They’re known as street medicine teams. There are at least 25 in California.

“Oh crap. This is where she was, and they just swept that,” said Brett Feldman on a Friday morning in November, looking at a green tent, crumpled and abandoned on Skid Row in Los Angeles. Feldman, a physician assistant, is searching for a female patient in her 40s with severe and unmanaged asthma. She cycles predictably in and out of the hospital, and Feldman knows she’s due for another hospitalization soon.

Physician’s assistant Brett Feldman asks a man in his encampment if he has seen a patient along Skid Row on Nov. 18, 2022. The patient was likely pushed out of the area as the Los Angeles sanitation department cleared the unhoused to clean the street near Skid Row. Photo by Larry Valenzuela for CalMatters

The road is streaked with water from a cleaning truck, and sanitation workers in fluorescent vests sweep up debris. Parking enforcement and police cruisers line the section of road where a homeless encampment once stood. Nearly 5,000 people live in the half-mile block infamous for the hypervisibility it affords the state’s unrelenting homeless crisis.

Burdened by disproportionate rates of addiction, mental health disorders and chronic disease, people experiencing homelessness are some of the state’s neediest patients, but few receive anything more than emergency services. Barriers like lack of transportation and cumbersome insurance rules keep most from getting regular health care. Instead, they drift through the emergency room during a crisis, racking up high costs to the system and deteriorating physically in the interim. 

Delivering health care this way is costly and not particularly effective for the patient or the system. More than half of the state’s $133-billion Medi-Cal budget is spent on the top 5% of high-needs users, according to the California Department of Health Care Services

“Where we have been falling short, especially with this population, is their reality is so different from ours that we haven’t been building reality-based systems for them,” Feldman said. “They have Medi-Cal. They’re eligible for all these benefits, but they can’t access

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To prevent medical debt, the U.S. could learn from Germany’s health care system : Shots

Dr. Eckart Rolshoven examines a patient at his clinic in Püttlingen, a small town in Germany’s Saarland region. Although Germany has a largely private health care system, patients pay nothing out-of-pocket when they come to see him.

Pasquale D’Angiolillo for KHN


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Pasquale D’Angiolillo for KHN


Dr. Eckart Rolshoven examines a patient at his clinic in Püttlingen, a small town in Germany’s Saarland region. Although Germany has a largely private health care system, patients pay nothing out-of-pocket when they come to see him.

Pasquale D’Angiolillo for KHN

PÜTTLINGEN, Germany — Almost every day, Dr. Eckart Rolshoven sees the long shadow of coal mining in his clinic near the big brownstone church that dominates this small town in Germany’s Saarland.

The region’s last-operating coal shaft, just a few miles away, closed a decade ago, ending centuries of mining in the Saarland, a mostly rural state tucked between the Rhine River and the French border. But the mines left a difficult legacy, as they have in coal regions in the United States, including West Virginia.

Many of Rolshoven’s patients battle lung diseases and chronic pain from years of work underground. “We had an industry with a lot of illnesses,” said Rolshoven, a genial primary care physician who at 71 is nearing the end of a long career.

The Saarland’s residents are sicker than elsewhere in Germany. And like West Virginia, the region faces economic hurdles. For decades, German politicians, business leaders and unions have labored to adjust to the mining industry’s slow demise.

But this is a healthier place than West Virginia in many respects. The region’s residents are less likely to die prematurely, data shows. And on average, they live four years longer than West Virginians.

There is another important difference between this former coal territory and its Appalachian counterpart: West Virginia’s economic struggles have been compounded by medical debt, a burden that affects about 100 million people in the U.S. — in no state more than West Virginia.

In the Saarland, medical debt is practically nonexistent. It’s so rare in Germany that the federal government’s statistical office doesn’t even track it.

The reason isn’t government health care. Germany, like the U.S., has a largely private health care system that relies on private doctors and private insurers. Like Americans, many Germans enroll in a health plan through work, splitting the cost with their employer.

But Germany has long done something the U.S. does not: It strictly limits how much patients have to pay out of their own pockets for a trip to the doctor, the hospital or the pharmacy.

Rolshoven’s patients pay nothing when they see him. That not only bolsters their health, he said. It helps maintain what Rolshoven called social peace. “It’s really important not to have to worry about these problems,” he said.

German health officials, business leaders and economists say the access to affordable health care has also helped the Saarland get back on its feet economically, bolstered by the assurance that workers

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Racist Medical doctors and Organ Burglars: Why So Lots of Black People today Distrust the Well being Care Procedure

Discrimination, absence of accessibility, mistrust and mistreatment are not one of a kind to Black Us citizens Latinos and other minority teams practical experience it, far too. Inadequate men and women often hold out more time for worse treatment in underfunded, understaffed — and normally de facto racially segregated — public hospitals and clinics than richer, superior-insured men and women. And they know it.

Increasing up in Detroit, Michael Winans, now in his early 40s, was “too active obtaining by” to spend consideration to a syphilis experiment that finished right before he was born. But distrust of the professional medical establishment flowed in his spouse and children. His grandmother survived a stroke but died in the course of program observe-ups the loved ones suspected sub-par treatment. Later, his mother hesitated when she necessary fibroid surgery. When she last but not least went in, she ended up with an unforeseen hysterectomy. Winans appreciates that from time to time takes place, that the considerably less invasive procedure is not always more than enough. But was it required for his mom? He miracles.

“When you expand up in a predominantly Black town like Detroit, you can go significantly of your lifestyle without seriously interacting with somebody of yet another race,” he says. “If the initially time is when you have a well being concern … you request your self, ‘Does this man or woman care for me? Or see me as a variety?’ It is another level of prospective trepidation or worry.”

The Black American working experience is acquiring distinct scrutiny correct now, together with hopes for improve. Some of the folks interviewed for this story have been additional optimistic than other individuals about development. But none saw the wellness program as colour-blind.

“People see that I’m Black before they recognize — if they ever get to the place that they notice — that I have a PhD.,” claims Cara James, who ran the Office environment of Minority Wellness at the Centers for Medicare and Medicaid Companies throughout the Obama administration. James, who also formerly led operate on racial disparities at the Kaiser Loved ones Basis, is now the president and CEO of Grantmakers in Wellbeing, which operates with foundations and philanthropies to enhance well being care.

Points may have gotten better since the days when James would thoroughly pick which go well with to use as she accompanied her grandmother, an agricultural employee in the South with tiny formal training, to health-related appointments. But they have not enhanced plenty of.

“We are human,” she says, “We have perceptions and biases about others.”

All those biases can be refined — or not.

When Matthew Thompson, a economic officer at a reproductive wellbeing business in Texas, fell ill shortly immediately after relocating to Austin a couple yrs again, he did not however have a regular health practitioner but managed to get an appointment with a person. That health care provider, who was white, took a person appear at Thompson, a 40-some thing Black male,

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What to know about Problem 2, which would call for dental insurers to expend a minimal rate on patient care

Voters in Massachusetts will shortly come to a decision regardless of whether insurance policy companies need to be necessary to shell out the bulk of their customers’ premiums — 83 cents of each and every dollar — on patient treatment.

Numerous men and women fork out for dental insurance policy just about every thirty day period, but only some of that funds goes to dental treatment. The rest stays with the dental insurer for administrative charges, and some of it becomes income for the enterprise.

Ballot referendum Dilemma 2 would make Massachusetts the only state in the country to call for dental insurers to expend a set share of rates on affected person care.

Dentists are rallying guiding the “Yes on 2” campaign, arguing the evaluate would guarantee consumers get superior value from their dental insurance plan and maintain insurers accountable.

In the meantime, dental insurers oppose it. The “No on 2” campaign warns that if the ballot measure passes, it will result in sizeable value raises that will induce some men and women to get rid of dental protection.

Below is a look at what Issue 2 would do, what every aspect states, and what industry experts think the effects may possibly be.

What precisely would Problem 2 do?

The proposal has two primary factors.

Very first, the evaluate would involve insurance policies providers to invest 83 cents of each individual greenback subscribers shell out in month to month premiums on client treatment and initiatives that increase the high quality of treatment. That involves treatment plans like cleanings, fillings, root canals and gum surgeries. The remaining 17 cents would be accessible to insurers to invest on expenditures like personnel salaries, investigating fraud and running purchaser hotlines. The formal expression for the share of premium dollars that go toward patient treatment is “medical decline ratio.”

The Economical Care Act established up a comparable technique for overall health insurers. Across the region, health-related insurers should commit at minimum 80% of rates on client treatment or problem rebates to consumers. In Massachusetts, overall health insurers have to commit 85%-88% of premiums on affected person treatment.

In 2019, this plan led to $34 million in rebates for customers in Massachusetts. Nationwide, about $1 billion are predicted to be returned in 2022.

Issue 2 would demand dental insurers to problem very similar rebates if they really don’t hit the 83% minimum amount. And it gives the state’s division of coverage oversight over top quality improvements, so it can block “unreasonable” price tag hikes.

The next significant ingredient of the ballot initiative

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