Equity And The Uneven Distribution Of Federal COVID-19 Relief Funds To US Hospitals.

People of color, immigrants, and those relying on the safety net have experienced a disproportionate share of the death and disease resulting from COVID-19 in the US. At the same time, Congress delegated great power to the Trump administration to distribute $178 billion in funding to health care providers. We studied the relationship between the relief received by 2,709 hospitals and community- and hospital-level characteristics. Funding through early February 2021 averaged $25.7 million per hospital. Our findings offer a mixed picture. Some correlates of real-world need, including serving a community with a very high share of Black residents or having a very high ratio of Medicaid revenue to beds, were associated with meaningfully increased funding. Other correlates of need-including serving a very high share of Hispanic residents or a Medically Underserved Area-were associated with decreased funding or no difference in funding. Our findings emphasize that funding formulas reflect consequential political judgments. In future allocations, the relationship between need and aid should be strengthened by de-emphasizing historical net patient revenue in favor of a broader set of community and hospital characteristics.

Contributions Of Public Health, Pharmaceuticals, And Other Medical Care To US Life Expectancy Changes, 1990-2015.

Life expectancy in the US increased 3.3 years between 1990 and 2015, but the drivers of this increase are not well understood. We used vital statistics data and cause-deletion analysis to identify the conditions most responsible for changing life expectancy and quantified how public health, pharmaceuticals, other (nonpharmaceutical) medical care, and other/unknown factors contributed to the improvement. We found that twelve conditions most responsible for changing life expectancy explained 2.9 years of net improvement (85 percent of the total). Ischemic heart disease was the largest positive contributor to life expectancy, and accidental poisoning or drug overdose was the largest negative contributor. Forty-four percent of improved life expectancy was attributable to public health, 35 percent was attributable to pharmaceuticals, 13 percent was attributable to other medical care, and -7 percent was attributable to other/unknown factors. Our findings emphasize the crucial role of public health advances, as well as pharmaceutical innovation, in explaining improving life expectancy.