Health affairs
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Multicenter Study
Thousands Of Lives Could Be Saved In The US During The COVID-19 Pandemic If States Exchanged Ventilators.
It is thought that there are not enough mechanical ventilators in the United States for every patient who may need one during the novel coronavirus disease (COVID-19) pandemic. However, there has been no analysis that measures the potential magnitude of the problem or proposes a solution. ⋯ I evaluate versions of this proposal, including use of the national stockpile, to estimate the potentially substantial number of lives that could be saved. In the absence of other viable solutions, the government should begin this effort in earnest, or else make preparations for such coordination should the country face another pandemic in the future.
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A global health equity movement relies on research showing how social factors affect health.
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The patient-centered medical home model aspires to fundamentally restructure care processes, but a volume-based payment system may hinder such transformations. In 2013 Oregon's Medicaid program changed its reimbursement of traditional primary care services for selected community health centers (CHCs) from a per visit to a per patient rate. Using Oregon claims data, we analyzed the price-weighted volume of care for five service areas: traditional primary care services, including imaging, tests, and procedures; other services provided by CHCs that were carved out from the payment reform; emergency department visits; inpatient services; and other services of non-CHC providers. ⋯ The payment reform was associated with a 42.4 percent relative reduction in price-weighted traditional primary care services, driven fully by decreased use of imaging services. Other outcomes remained unaffected. Oregon's initiative could provide lessons for other states interested in using payment reform to advance the patient-centered medical home model for the Medicaid population.