Potential mechanisms by which cash transfer programmes could improve the mental health and life chances of young people: A conceptual framework and lines of enquiry for research and policy

Mental health is inextricably linked to both poverty and future life chances such as education, skills, labour market attachment and social function. Poverty can lead to poorer mental health, which reduces opportunities and increases the risk of lifetime poverty. Cash transfer programmes are one of the most common strategies to reduce poverty and now reach substantial proportions of populations living in low- and middle-income countries. Because of their rapid expansion in response to the COVID-19 pandemic, they have recently gained even more importance. Recently, there have been suggestions that these cash transfers might improve youth mental health, disrupting the cycle of disadvantage at a critical period of life. Here, we present a conceptual framework describing potential mechanisms by which cash transfer programmes could improve the mental health and life chances of young people. Furthermore, we explore how theories from behavioural economics and cognitive psychology could be used to more specifically target these mechanisms and optimise the impact of cash transfers on youth mental health and life chances. Based on this, we identify several lines of enquiry and action for future research and policy.Copyright © The Author(s), 2023. Published by Cambridge University Press.

10 Years of the Hospital Readmissions Reduction Program-an Analysis of Heart Failure Outcomes in Medicare Fee-for-Service Patients

Background Heart failure (HF) is the leading cause of readmissions among Medicare beneficiaries. The Hospital Readmissions Reduction Program (HRRP) passed under the Patient Protection and Affordable Care Act began assessing financial penalties in October 2012 for hospitals with higher-than-expected readmissions for acute myocardial infarction, heart failure and pneumonia among fee-for-service Medicare beneficiaries. Excess HF readmissions have been a dominant driver of HRRP penalties. Methods We obtained data on 30-day readmissions, observation stay rates and mortality rates from January 2006 to December 2021 from the CMS website. Mean, SD and temporal trends were analyzed for intervals before HRRP penalty implementation (January 2006 to September 2012) and after (October 2012 to December 2021). Results The 30-day HF readmission rate was 24.52% [0.48] before HRRP implementation and decreased to 22.35% [0.44] between October 2012 to December 2021, p<0.001. Observation stay rates increased from 1.14% [0.30] to 2.13% [0.23], p<0.001. Risk-adjusted mortality rates increased from 10.56% [0.44] to 11.25% [0.36], p<0.001. Temporal trend analysis showed mortality peaked after HRRP enactment but declined to pre-HRRP levels until an increase during the COVID-19 pandemic. Conclusion HRRP penalties led to reduced 30-day HF readmissions but had the unintended consequence of increased observation stays. Mortality peaked following HRRP penalty implementation and then decreased until 2020. [Formula presented]Copyright © 2023 American College of Cardiology Foundation