The June issue of Health Affairs, released today, features various approaches to cost-savings in the U.S. health care system. A variety of articles analyze the effects of potential policy solutions on the Medicare and Medicaid programs and their impact on the health of beneficiaries and tax payer wallets.
Federal approaches to reduce obesity and Type 2 diabetes rates by improving nutrition could work—but the how matters. Sanjay Basu of the Stanford University School of Medicine and coauthors modeled the effects of two policy approaches to reforming the Supplemental Nutrition Assistance Program (SNAP), which serves one in seven Americans. They found that ending a subsidy for sugar-sweetened beverage purchases with SNAP dollars would result in a decrease in obesity of 281,000 adults and 141,000 children, through a 15.4 percent reduction in calories by the lowering of purchases of this source. They also found that a $0.30 credit back on every dollar spent on qualifying fruits and vegetables could more than double the number of SNAP participants who meet federal guidelines for fruit and vegetable consumption.
With more than forty-six million people receiving SNAP food stamp benefits, the authors suggest that policy makers closely examine the implications of such proposals at the population level to determine which will benefit people’s health the most and prove most cost-effective.
If you’re between ages 15–39 when you are diagnosed with cancer, the implications later in life extend well beyond your health. Gery P. Guy Jr. of the Centers for Disease Control and Prevention and coauthors examined Medical Expenditure Panel Survey data and determined that survivors of adolescent and young adult cancers had annual per person medical expenditures of $7,417, compared to $4,247 for adults without a cancer history. They also found an annual per capita lost productivity of $4,564 per cancer survivor — because of employment disability, missed workdays, and an increased number of additional days spent in bed as a result of poor health — compared to $2,314 for adults without a cancer history.
The authors suggest that the disparities are associated with ongoing medical care needs and employment challenges connected to cancer survivorship, and that having health insurance alone is not enough to close the gap. They stress the importance of access to lifelong follow-up care and education to help lessen the economic burden of this important population of cancer survivors.
Optional Medicaid policies can help pregnant women quit smoking, but do they result in healthier babies? Marian Jarlenski of the Johns Hopkins Bloomberg School of Public Health and coauthors analyzed the effects in nineteen states of Medicaid presumptive eligibility (coverage while an application is pending) and the unborn-child option (coverage without documentation of citizenship or residency) and found that neither approach significantly improved rates of preterm birth or babies born small for their gestational age. However, they did find that presumptive eligibility resulted in a 7.7 percentage-point increase in smoking cessation among low-income pregnant women eligible for Medicaid, whose smoking rates are almost twice as high as in the general population of pregnant women. The authors recommend presumptive eligibility enrollment for consideration as a mechanism to promote both smoking cessation and earlier prenatal care, but point out that multiple, concurrent interventions may be necessary to ultimately affect birth outcomes.
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