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  1. Article ; Online: Corporate Efforts to Adopt and Distort the Social Determinants of Health Framework.

    Himmelstein, David U / Woolhandler, Steffie

    International journal of social determinants of health and health services

    2023  Volume 53, Issue 3, Page(s) 249–252

    Abstract: ... in capitalist exploitation. Recently, major U.S. corporations have adopted and distorted the social determinants ...

    Abstract Over the past two centuries, progressive scholars have highlighted the health-harming effects of oppressive living and working conditions. Early studies delineated the roots of inequities in these social determinants of health in capitalist exploitation. Analyses in the 1970s and 1980s that adopted the social determinants of health framework emphasized the deleterious effects of poverty but rarely explored its origins in capitalist exploitation. Recently, major U.S. corporations have adopted and distorted the social determinants of health framework, implementing trivial interventions that serve as rhetorical cover for their myriad health-harming behaviors, and the Trump administration cited social determinants to justify imposing work requirements for persons seeking health insurance through Medicaid. Progressives should raise the alarm against the use of social determinants of health rhetoric to bolster corporate power and undermine health.
    MeSH term(s) United States ; Social Determinants of Health ; Insurance, Health ; Medicaid ; Poverty ; Social Factors
    Language English
    Publishing date 2023-03-08
    Publishing country United States
    Document type Journal Article
    ZDB-ID 3156548-7
    ISSN 2755-1946
    ISSN (online) 2755-1946
    DOI 10.1177/27551938231162573
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  2. Article ; Online: Asthma Disparities in the United States Narrowed During the COVID-19 Pandemic: Findings From a National Survey, 2019 to 2022.

    Gaffney, Adam / Himmelstein, David U / Woolhandler, Steffie

    Annals of internal medicine

    2023  Volume 177, Issue 1, Page(s) 103–106

    MeSH term(s) Humans ; United States/epidemiology ; COVID-19/epidemiology ; Pandemics ; Asthma/epidemiology ; White
    Language English
    Publishing date 2023-12-19
    Publishing country United States
    Document type Letter
    ZDB-ID 336-0
    ISSN 1539-3704 ; 0003-4819
    ISSN (online) 1539-3704
    ISSN 0003-4819
    DOI 10.7326/M23-2100
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  3. Article ; Online: Alleviating Medical Debt in the United States.

    Uppal, Nishant / Woolhandler, Steffie / Himmelstein, David U

    The New England journal of medicine

    2023  Volume 389, Issue 10, Page(s) 871–873

    MeSH term(s) Humans ; Delivery of Health Care/economics ; United States ; Financing, Personal/economics ; Health Expenditures
    Language English
    Publishing date 2023-09-02
    Publishing country United States
    Document type Journal Article
    ZDB-ID 207154-x
    ISSN 1533-4406 ; 0028-4793
    ISSN (online) 1533-4406
    ISSN 0028-4793
    DOI 10.1056/NEJMp2306942
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  4. Article ; Online: Rape-Related Pregnancies in the 14 US States With Total Abortion Bans.

    Dickman, Samuel L / White, Kari / Himmelstein, David U / Lupez, Emily / Schrier, Elizabeth / Woolhandler, Steffie

    JAMA internal medicine

    2024  Volume 184, Issue 3, Page(s) 330–332

    MeSH term(s) Pregnancy ; Female ; Humans ; Rape ; Abortion, Induced ; Abortion, Legal ; Survivors
    Language English
    Publishing date 2024-01-23
    Publishing country United States
    Document type Journal Article ; Comment
    ZDB-ID 2699338-7
    ISSN 2168-6114 ; 2168-6106
    ISSN (online) 2168-6114
    ISSN 2168-6106
    DOI 10.1001/jamainternmed.2024.0014
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  5. Article ; Online: Population-level trends in asthma and chronic obstructive pulmonary disease emergency department visits and hospitalizations before and during the coronavirus disease 2019 pandemic in the United States.

    Gaffney, Adam / Himmelstein, David U / Woolhandler, Steffie

    Annals of allergy, asthma & immunology : official publication of the American College of Allergy, Asthma, & Immunology

    2023  Volume 131, Issue 6, Page(s) 737–744.e8

    Abstract: Background: Previous studies have identified reductions in exacerbations of chronic lung disease in many locales after onset of the coronavirus disease 2019 (COVID-19) pandemic.: Objective: To evaluate the population-level impacts of COVID-19 on ... ...

    Abstract Background: Previous studies have identified reductions in exacerbations of chronic lung disease in many locales after onset of the coronavirus disease 2019 (COVID-19) pandemic.
    Objective: To evaluate the population-level impacts of COVID-19 on asthma and chronic obstructive pulmonary disease (COPD) exacerbations-with a focus on disadvantaged communities-in the United States.
    Methods: We analyzed 2016 to 2020 county-level data on asthma and COPD acute care use, with myocardial infarction hospitalizations as a comparator condition. We linked this with county-level lower respiratory disease mortality data. We calculated rates of emergency department (ED) visits, hospitalizations, and deaths and evaluated changes using linear regressions adjusted for year and county-fixed effects. For a supplementary analysis, we calculated ED visit rates nationwide for asthma, COPD, or any diagnosis using the 2016 to 2020 National Hospital Ambulatory Medical Care Survey.
    Results: Our county-level data included 685 counties in 13 states. Rates of each outcome fell in 2020. In adjusted analyses, we found large reductions in asthma and COPD ED visit rates (eg, a 21.5 per 10,000-person reduction in COPD ED visits; 95% confidence interval, -23.8 to -19.1), with smaller reductions in hospitalizations and chronic lower respiratory mortality. Disadvantaged communities had mostly higher baseline rates of respiratory morbidity and larger absolute reductions in some outcomes. Among 90,808 ED visits in the National Hospital Ambulatory Medical Care Survey, asthma ED visits/y fell 33% during the pandemic and COPD visits by 51%; overall ED visits fell by only 7%.
    Conclusion: Onset of the COVID-19 pandemic coincided with reductions in acute care utilization for asthma and COPD. Understanding the mechanism of this reduction might inform future efforts to prevent exacerbations.
    MeSH term(s) Humans ; United States/epidemiology ; Pandemics ; COVID-19/epidemiology ; Pulmonary Disease, Chronic Obstructive/epidemiology ; Asthma/epidemiology ; Hospitalization ; Emergency Service, Hospital
    Language English
    Publishing date 2023-08-23
    Publishing country United States
    Document type Journal Article
    ZDB-ID 1228189-x
    ISSN 1534-4436 ; 0003-4738 ; 1081-1206
    ISSN (online) 1534-4436
    ISSN 0003-4738 ; 1081-1206
    DOI 10.1016/j.anai.2023.08.016
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  6. Article ; Online: Century-Long Trends in the Financing and Ownership of American Health Care.

    Gaffney, Adam / Woolhandler, Steffie / Himmelstein, David U

    The Milbank quarterly

    2023  Volume 101, Issue 2, Page(s) 325–348

    Abstract: Policy Points Over the past century, the tax-financed share of health care spending has risen from 9% in 1923 to 69% in 2020; a large part of this tax financing is now the subsidization of private health insurance. For-profit ownership of health care ... ...

    Abstract Policy Points Over the past century, the tax-financed share of health care spending has risen from 9% in 1923 to 69% in 2020; a large part of this tax financing is now the subsidization of private health insurance. For-profit ownership of health care facilities has also increased in recent decades and now predominates for many health subsectors. A rising share of physicians are now employees. US health care is, increasingly, publicly financed yet investor owned, a trend that has been accompanied by rising medical costs and, in recent years, stagnating or even worsening population health. A reconsideration of US health care financing and ownership appears warranted.
    Context: Who pays for health care-and who owns it-determine what care is delivered, who receives it, and who profits from it. We examined trends in health care ownership and financing over a century.
    Methods: We used multiple historical and current data sources (including data from the American Medical Association, the American Hospital Association, government publications and surveys, and analyses of Medicare Provider of Services files) to classify health care provider ownership as: public, private (for-profit), and private (not-for-profit). We used US Census data to classify physicians' employers as public, not-for-profit, or for-profit entities or "self-employed." We combined estimates from the official National Health Expenditures Accounts with other data sources to determine the public vs. private share of health care spending since 1923; we calculated a "comprehensive" public share metric that accounted for public subsidization of private health expenditures, mostly via the tax exemption for employer-sponsored insurance plans or government purchase of such plans for public employees.
    Findings: For-profit ownership of most health care subsectors has risen in recent decades and now predominates in several (including nursing facilities, ambulatory surgical facilities, dialysis facilities, hospices, and home health agencies). However, most community hospitals remain not-for-profit. Additionally, over the past century, a growing share of physicians identify as employees. Meanwhile, the comprehensive taxpayer-financed share of health care spending has increased dramatically from 9% in 1923 to 69% in 2020, with taxpayer-financed subsidies to private expenditures accounting for much of the recent growth.
    Conclusions: American health care is increasingly publicly financed yet investor owned, a trend accompanied by rising costs and, recently, worsening population health. A reassessment of the US mode of health care financing and ownership appears warranted.
    MeSH term(s) Aged ; United States ; Humans ; Ownership ; Medicare ; Delivery of Health Care ; Health Expenditures ; Insurance, Health ; Financing, Government
    Language English
    Publishing date 2023-04-24
    Publishing country United States
    Document type Journal Article
    ZDB-ID 632829-5
    ISSN 1468-0009 ; 0887-378X
    ISSN (online) 1468-0009
    ISSN 0887-378X
    DOI 10.1111/1468-0009.12647
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  7. Article ; Online: Recovering from Trump: Biden's first 100 days.

    Himmelstein, David U / Woolhandler, Steffie

    Lancet (London, England)

    2021  Volume 397, Issue 10287, Page(s) 1787–1791

    MeSH term(s) COVID-19 ; Financing, Government ; Government Programs ; Health Policy ; Humans ; Politics ; Social Justice ; United States
    Language English
    Publishing date 2021-04-29
    Publishing country England
    Document type Journal Article
    ZDB-ID 3306-6
    ISSN 1474-547X ; 0023-7507 ; 0140-6736
    ISSN (online) 1474-547X
    ISSN 0023-7507 ; 0140-6736
    DOI 10.1016/S0140-6736(21)00979-X
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  8. Article ; Online: Hospital Capital Assets, Community Health, and the Utilization and Cost of Inpatient Care: A Population-Based Study of US Counties.

    Gaffney, Adam / McCormick, Danny / Bor, David / Woolhandler, Steffie / Himmelstein, David U

    Medical care

    2024  

    Abstract: Background: The provision of high-quality hospital care requires adequate space, buildings, and equipment, although redundant infrastructure could also drive service overprovision.: Objective: To explore the distribution of physical hospital ... ...

    Abstract Background: The provision of high-quality hospital care requires adequate space, buildings, and equipment, although redundant infrastructure could also drive service overprovision.
    Objective: To explore the distribution of physical hospital resources-that is, capital assets-in the United States; its correlation with indicators of community health and nonhealth factors; and the association between hospital capital density and regional hospital utilization and costs.
    Research design: We created a dataset of n=1733 US counties by analyzing the 2019 Medicare Cost Reports; 2019 State Inpatient Database Community Inpatient Statistics; 2020-2021 Area Health Resource File; 2016-2020 American Community Survey; 2022 PLACES; and 2019 CDC WONDER. We first calculated aggregate hospital capital assets and investment at the county level. Next, we examined the correlation between community's medical need (eg, chronic disease prevalence), ability to pay (eg, insurance), and supply factors with 4 metrics of capital availability. Finally, we examined the association between capital assets and hospital utilization/costs, adjusted for confounders.
    Results: Counties with older and sicker populations generally had less aggregate hospital capital per capita, per hospital day, and per hospital discharge, while counties with higher income or insurance coverage had more hospital capital. In linear regressions controlling for medical need and ability to pay, capital assets were associated with greater hospital utilization and costs, for example, an additional $1000 in capital assets per capita was associated with 73 additional discharges per 100,000 population (95% CI: 45-102) and $19 in spending per bed day (95% CI: 12-26).
    Conclusions: The level of investment in hospitals is linked to community wealth but not population health needs, and may drive use and costs.
    Language English
    Publishing date 2024-04-10
    Publishing country United States
    Document type Journal Article
    ZDB-ID 411646-x
    ISSN 1537-1948 ; 0025-7079
    ISSN (online) 1537-1948
    ISSN 0025-7079
    DOI 10.1097/MLR.0000000000001999
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  9. Article ; Online: COVID-19 Risk by Workers' Occupation and Industry in the United States, 2020‒2021.

    Gaffney, Adam / Himmelstein, David U / McCormick, Danny / Woolhandler, Steffie

    American journal of public health

    2023  Volume 113, Issue 6, Page(s) 647–656

    Abstract: Objectives. ...

    Abstract Objectives.
    MeSH term(s) Adult ; Humans ; United States/epidemiology ; COVID-19/epidemiology ; Occupations ; Industry ; Workplace ; Employment
    Language English
    Publishing date 2023-04-13
    Publishing country United States
    Document type Journal Article
    ZDB-ID 121100-6
    ISSN 1541-0048 ; 0090-0036 ; 0002-9572
    ISSN (online) 1541-0048
    ISSN 0090-0036 ; 0002-9572
    DOI 10.2105/AJPH.2023.307249
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  10. Article ; Online: A Potential Path to Universal Coverage With Medicare Advantage for All.

    Gaffney, Adam / Himmelstein, David U / Woolhandler, Steffie

    JAMA

    2022  Volume 327, Issue 16, Page(s) 1615

    MeSH term(s) Insurance Coverage ; Medicare Part C ; United States ; Universal Health Insurance
    Language English
    Publishing date 2022-04-26
    Publishing country United States
    Document type Journal Article ; Comment
    ZDB-ID 2958-0
    ISSN 1538-3598 ; 0254-9077 ; 0002-9955 ; 0098-7484
    ISSN (online) 1538-3598
    ISSN 0254-9077 ; 0002-9955 ; 0098-7484
    DOI 10.1001/jama.2022.3146
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