Inaccuracies in provider directories persist for long periods of time.

A growing literature has identified substantial inaccuracies in consumer-facing provider directories, but it is unclear how long these inaccuracies persist. We re-surveyed inaccurately listed Pennsylvania providers (n = 5170) between 117 to 280 days after a previous secret-shopper survey. Overall, 19.0% (n = 983) of provider directory listings that had been identified as inaccurate were subsequently removed, 44.8% (n = 2316) of provider listings continued to show at least 1 inaccuracy, and 11.6% (n = 600) were accurate at follow-up. We were unable to reach 24.6% (n = 1271) of providers. Longer passage of time was associated with reductions in directory inaccuracies, particularly related to contact information, and to a lesser degree, with removal of inaccurate listings. We found substantial differences in corrective action by carrier. Together, these findings suggest persistent barriers to maintaining and updating provider directories, with implications for how well these tools can help consumers select health plans and access care.

Putting Health care Where the Kids Are: US Public Attitudes About School-Based Health Centers.

BACKGROUND: School-based health centers (SBHCs) have been shown to offer substantial benefits to students but we know little about how the public thinks about them. We sought to assess US public attitudes about SBHCs and the provision of 7 health service lines-primary care, preventive care, vaccinations, preventive dental care, preventive vision care, mental health care, and nutrition counseling. METHODS: We administered a national online survey (N = 4196) of US adults using Lucid, a large, internet-based, opt-in panel to assess public attitudes about SBHCs as well as 7 commonly offered health services in SBHCs. We then used t-tests and weighted linear regression models to carry out our study objectives. RESULTS: Unadjusted analysis revealed that more than 2 in 3 respondents supported SBHCs in general as well as the provision of all health services in SBHCs. Regression analysis indicated that ideology, partisanship, and trust in public school principals served as consistent predictors of attitudes when controlling for demographic and health characteristics. The provision of vaccinations stood out as particularly controversial. Subanalysis of parents found even higher levels of support as well as a more subdued role of ideology and partisanship. CONCLUSIONS: The US public broadly supports the provision of health services in SBHCs. Our results should inform policymakers, advocates, and providers seeking to improve access to health care among school-aged children, particularly for underserved populations. Increasing knowledge about SBHCs and providing stable funding should be a priority. In the immediate future, SBHCs may offer an important buffer against ongoing Medicaid disenrollments.

US seniors' intention to vaccinate against RSV in fall and winter 2023-2024.

In the fall and winter of 2023-2024, the United States may experience a "tripledemic" of COVID-19, influenza, and respiratory syncytial virus (RSV) that may lead to 100 000 deaths. Seniors will be disproportionally affected. The newly released RSV vaccines for those age 60 years and over may reduce the number of deaths for the expected 6000 to 10 000 seniors expected to die from RSV alone. Using a large national survey, we queried Americans over age 60 about their RSV vaccination status and their intention to vaccinate this fall and winter. We found that 9% of seniors had already been vaccinated. Of the remaining unvaccinated, 42% indicated their intent to vaccinate. We found that those with higher levels of concerns for the disease, higher levels of self-assessed risk, believing that vaccines were safe and important, higher levels of trust in health institutions, and men were more likely to seek out vaccinations. Vaccine-hesitant respondents listed a lack of necessity, concerns about side effects and safety, and a lack of information as primary reasons. The large number of unvaccinated seniors will likely lead to an excessive number of hospitalizations and deaths as well as augmented social costs. Evidence-based mitigation measures tailored to seniors' concerns should be implemented immediately.

Assessing parental intention to vaccinate against COVID-19, influenza, and RSV in the United States in late 2023.

Vaccine hesitancy is a substantial public health threat. We used a national survey to query parents about their intention to vaccinate their children against COVID-19, influenza, and RSV in the fall and winter 2023-2024. We found that about 40% of parents intended to vaccinate their children against COVID-19, 63% against influenza, and 71% against RSV. Intention to vaccinate was consistently correlated with concerns about the disease, trust in health institutions, and previous vaccinations. Women showed lower intentions for COVID-19 and influenza. For COVID-19 and RSV, intentions were higher for those who thought vaccines were important. Concerns about autism were negatively associated for COVID-19. Liberals showed larger intentions for COVID-19. Major reasons for hesitancy include concerns about safety, necessity, and lack of information. The large number of unvaccinated children will likely lead to large numbers of excessive disease in children as well as exert large negative externalities on society at large.

Assessing vaccine hesitancy and support for vaccination requirements for pets and potential Spillovers from humans.

BACKGROUND: Growing vaccination hesitancy is well-document among humans. However, we know very little about vaccination hesitancy for pets as well as whether the two phenomena are interconnected. Moreover, support for pet vaccination requirements also remain underassessed. METHODS: We fielded a large, national survey (N = 3,958) on August 18 and August 19, 2023, to assess U.S. public opinion about the vaccination status of dogs (rabies, canine parvovirus, canine distemper, canine influenza, and Lyme disease) and cats (rabies, feline panleukopenia (parvo), feline herpesvirus-1, feline chlamydia, and feline Bordetella) in the United States. We also queried respondents about their support for vaccination requirements for the 10 diseases. RESULTS: We find that the vast majority of cats and dogs are vaccinated. However, a substantial minority of pets is not, particularly for cats and for non-core vaccines. We find that attitudinal measures of human and pet vaccine hesitancy are closely related to each other. Moreover, they are strong predictors of vaccine behavior. Measures of vaccine hesitancy are also strong predictors of support for vaccination mandates. Common measures used to assess human vaccine hesitancy showed inconsistent effects. However, pet vaccinations appear to be less politically polarizing. CONCLUSION: The high correlation between pet and human measures raises the stake for public health efforts to improve attitudes about vaccines and vaccination rates across the board. Strong support for vaccination requirements should encourage policymakers to explore policy change. Moreover, veterinarians and their associations should consider expanding the number of core vaccinations.

Merging Rural And Urban ACA Rating Areas Improved Choice, Premiums In Rural Texas.

Rural consumers often face a limited choice of carriers and plans and high premiums. To mitigate this issue, Texas recently adjusted its Affordable Care Act Marketplace rating areas to integrate rural areas into nearby urban markets for rating purposes. We found that rural consumers subsequently saw increases in carrier and plan choices, as well as decreases in overall plan premiums.

U.S. public support and opposition to vaccination mandates in K-12 education in light of the COVID-19 pandemic.

BACKGROUND: Vaccination mandates have long been an effective tool in increasing vaccination rates and reducing the potential for disease outbreaks. In the wake of COVID-19, opposition to mandates in the K-12 setting has garnered more attention, and policymakers opposed to them have become more active. This study sought to assess whether these efforts are supported by the U.S. public. METHODS: We fielded a large, national survey (N = 16,461) from January to April of 2022 to assess U.S. public opinion about seven specific vaccination mandates (diphtheria, tetanus, & pertussis (DTaP); polio; chickenpox; measles, mumps, and rubella (MMR); hepatitis; human papillomavirus (HPV); and COVID-19) in K-12 educational settings. RESULTS: We found that Americans are overwhelmingly supportive of all vaccination mandates with support ranging from a high 90 percent of respondents for DTaP, polio, chickenpox, and MMR to a low of 68 percent for COVID-19. Individuals who deemed vaccines safe and important, those with trust in the National Institutes of Health and the Food and Drug Administration, urban residents, and ethnic and racial minorities tended to be consistently more supportive. Perceptions about vaccine effectiveness were positively associated with mandate support in most cases, as was trust in medical doctors. Respondents who believed that vaccines cause autism, those with better health and more trust in religious leaders tended to be consistently more opposed. Women were generally more supportive of mandates except for HPV and COVID-19. Ideology and partisanship affected opinion for COVID-19 as did trust in the Centers for Disease Control and Prevention. We found no effects for income or education. CONCLUSION: Vaccination mandates in K-12 have broad support among the American public, even in more controversial cases such as HPV and COVID-19. Vocal opposition and growing interest by policymakers to limit or undo vaccination mandates are not supported by the broader public.

Race And Racial Perceptions Shape Burden Tolerance For Medicaid And The Supplemental Nutrition Assistance Program.

Safety-net programs do not reach all eligible Americans, partly because of administrative burden, or experiencing bureaucratic obstacles in obtaining and maintaining program benefits. This burden often disproportionately affects historically marginalized groups, adding concerns about equity. We used a national survey to examine public thinking about the acceptability of administrative burdens imposed by states when implementing Medicaid and the Supplemental Nutrition Assistance Program and the role of race in these considerations. We found that support for state actions associated with six types of burden was unchanged when respondents were informed about disparate effects by race. Neither racial identity nor prejudice toward other racial groups was associated with support for policies imposing higher burdens. However, non-Hispanic White respondents with higher levels of racial resentment were more supportive of policies that would create burden, whereas respondents who believed that burdens had disparate effects on historically disadvantaged groups favored less burdensome alternatives. Also associated with lower support for more burdensome policies were responses indicative of respondents' empathy, concerns about ability to manage burdens, Democratic party identification, and program experience.

State Efforts to Regulate Provider Networks and Directories: Lessons for the Future.

Managed care arrangements are the dominant form of insurance coverage in the United States today. These arrangements rely on a network of contracted providers to deliver services to their enrollees. After the managed care backlash, governments moved to ensure consumer access by issuing a number of requirements for carriers related to the composition and size of their networks and how this information is shared with consumers. The authors provide a comprehensive review of these state-based efforts to regulate provider network adequacy and provider directory accuracy for commercial insurance markets. In addition to common measures of adequacy, they also include requirements specifically targeted to underserved populations. Their assessment comes on the heels of recent empirical work that has raised significant questions about whether these efforts are effective, particularly considering the limited nature of enforcement. They also provide a brief overview and assessment of recent federal government efforts that replicate these state regulations with a focus on lessons learned from state regulations that may help improve their federal counterparts. Furthermore, they outline a future research agenda focused on a more comprehensive evaluation of efforts to ensure consumer access.

More Than Words? How Highlighting Target Populations Affects Public Opinion about the Medicaid Program.

CONTEXT: The Medicaid program provides health insurance coverage to a diverse set of demographics. We know little about how the policy community describes these populations (e.g., on Medicaid-related websites or in public opinion polls and policy writings) or whether and how these descriptions may affect perceptions of the program, its beneficiaries, and potential policy changes. METHODS: To investigate this issue, we developed and fielded a nationally representative survey of 2,680 Americans that included an experiment for priming respondents by highlighting different combinations of target populations of the Medicaid program as found in the Medicaid policy discourse. FINDINGS: Overall, we find that Americans view Medicaid and its beneficiaries rather favorably. However, there are marked differences based on partisanship and racial animosity. Emphasizing citizenship and residency requirements at times improved these perceptions. CONCLUSIONS: Racial perceptions and partisanship are important correlates in Americans' views about Medicaid and its beneficiaries. However, perceptions are not immutable. In general, the policy community should shift toward using more comprehensive descriptions of the Medicaid population that go beyond the focus on low income and that include citizenship and residency requirements. Future research should expand this work by studying descriptions in the broader public discourse.

Provider directory inaccuracy and timely access for mental health care.

OBJECTIVES: To evaluate the accuracy of provider directories for mental health providers and network adequacy, defined as timely access to urgent and general care appointments in California. STUDY DESIGN: We assessed provider directory accuracy and timely access using a novel, comprehensive, and representative data set of mental health providers for all plans regulated by the California Department of Managed Health Care with 1,146,954 observations (480,013 for 2018 and 666,941 for 2019). METHODS: We used descriptive statistics to assess provider directory accuracy and network adequacy assessed via access to timely appointments. We used t tests to make comparison across markets. RESULTS: We found that mental health provider directories are highly inaccurate. Commercial plans were consistently more accurate than both Covered California marketplace and Medi-Cal plans. Moreover, plans were highly limited in providing timely access to urgent care and general appointments, although Medi-Cal plans outperformed plans from both other markets when it came to timely access. CONCLUSIONS: These findings are concerning from both the consumer and regulatory perspectives and provide further evidence of the tremendous challenge that consumers face in accessing mental health care. Although California's laws and regulations are some of the strongest in the country, they are still falling short, indicating the need to further expand efforts to protect consumers.

Assessing past and future COVID-19 vaccine hesitancy in the United States in light of federal policy changes.

Vaccinations provide an effective solution against the ongoing COVID-19 pandemic. Using a national survey (n = 3958), this study explored vaccination hesitancy for various COVID-19 vaccines and boosters, including the newly released annual vaccine for fall and winter 2023-2024. It also assessed support for federal funding for COVID-19 testing, vaccinations, and treatment. Consistent correlates of past vaccination refusal were perceptions of vaccines as safe and important, previous COVID-19 tests, concern about COVID-19, having voted for President Trump, higher religiosity, being liberal, trust in health institutions, health insurance status, and education. Other predictors showed inconsistent results across the various stages. Drivers of vaccination refusal were concerns about vaccine safety and side effects, perceived lack of information, and having previously contracted COVID-19. Intention to vaccinate was associated with concerns about COVID-19, liberalism, and trust in health institutions. Other factors were intermittently significant. We found consistent support for federal funding for those concerned about COVID-19, those concerned about the effectiveness of existing vaccines, those with trust in health institutions, those who thought vaccines are important, women, and those with lower levels of education. Opposition came from conservatives and Trump voters.

Ten health policy challenges for the next 10 years.

Health policies and associated research initiatives are constantly evolving and changing. In recent years, there has been a dizzying increase in research on emerging topics such as the implications of changing public and private health payment models, the global impact of pandemics, novel initiatives to tackle the persistence of health inequities, broad efforts to reduce the impact of climate change, the emergence of novel technologies such as whole-genome sequencing and artificial intelligence, and the increase in consumer-directed care. This evolution demands future-thinking research to meet the needs of policymakers in translating science into policy. In this paper, the Health Affairs Scholar editorial team describes "ten health policy challenges for the next 10 years." Each of the ten assertions describes the challenges and steps that can be taken to address those challenges. We focus on issues that are traditionally studied by health services researchers such as cost, access, and quality, but then examine emerging and intersectional topics: equity, income, and justice; technology, pharmaceuticals, markets, and innovation; population health; and global health.

Most Americans support minimizing administrative burdens for Medicaid recipients as the public health emergency ends.

During the coronavirus disease 2019 (COVID-19) public health emergency (PHE), states were barred from disenrolling anyone from Medicaid unless the beneficiary asked to be disenrolled, moved out of state, or died. Coverage increased, but as the PHE ends an estimated 7 million eligible Americans are expected to lose insurance due to difficulty navigating the renewal process. The end of the PHE therefore offers state policymakers a chance to reassess the value of such administrative burdens as a variety of policy tools are available to mitigate these losses. We inform this discussion via a national survey that captures public preferences around administrative burdens in public health insurance. We find strong public support for burden-reduction techniques that minimize coverage losses such as using administrative data to shift burdens onto the state and better outreach and communication, with an average of 74% of respondents supporting each policy tool. This support holds across the ideological spectrum and demographic groups, but it is stronger among liberals than conservatives, for those with more direct experience of burdens, those who struggle with such burdens, and for those with lower racial prejudice.

Provider directory accuracy and timely access to mammograms in California.

Provider directory accuracy and access to timely appointments are crucial determinants of health outcomes. However, to our knowledge, no studies have analyzed provider directory accuracies or network adequacy for mammograms, an important preventive service. We fill that gap using large-scale, random, and representative surveys of provider directories and timely access for all managed care plans in California for mammogram providers, obtained from the Department of Managed Health Care for 2018 and 2019 for commercial, ACA marketplace, and Medicaid plans with more than 33,000 observations. Directory inaccuracies ranged from a low of 23 percent to a high of 38 percent. Consumers were able to schedule appointments with specific providers within 15 days in between 59 percent to 73 percent of cases. Comparisons of accuracy and adequacy between the three markets (commercial, ACA, Medicaid) were inconsistent. Even with one of the nation's strictest and most well-resourced regulatory regimes for provider networks, our findings show substantial inaccuracies and inadequacies exist.

Directory Accuracy and Timely Access in Maryland's Medicaid Managed Care Program.

We assessed provider directory accuracy and timely access in Maryland's Medicaid managed care program, using annual surveys from the annual random and representative provider surveys conducted on behalf of the Maryland Department of Health for 2018 and 2019. Based on 3,262 calls to 2,002 providers in 2018 and 2,739 calls to 2,033 providers in 2019, we found that provider directories are highly inaccurate. Insurance coverage could only be verified for 46% of the listed providers in 2018 and 56% of the listed providers in 2019. Among providers whose insurance participation was verified, beneficiaries were able to schedule timely general care appointments in 90% of verified providers in 2018 and 85% of verified providers in 2019; slightly more than 70% of appointments were scheduled on the first call. The success rate for urgent care appointments was lower but improved substantially once alternative providers were accounted for. Even for verified providers, timely access standards were often not met, particularly for general care. We also note the substantial variation across managed care organizations and across years. Our findings raise concerns from both an enrollee as well as a broader policy perspective. More oversight and enforcement are necessary to guarantee access to care.

When a school is more than just a school: Improving school-based health in the wake of COVID-19.

The ongoing COVID-19 pandemic has posed tremendous challenges for economies and individuals around the world. At the same time, it has also laid bare the blatant and growing inequities that many individuals, particularly children, are confronted with on a daily basis. With communities in lockdowns and schools going virtual in many parts of the United States, the important role that schools and school-based services play in the lives of many children have gained new attention. Nonetheless, only 3% of American schools have school-based health centers on campus, and they remain relegated to the fringes of both health care and education. One key limitation has been the lack of appropriately trained health-care professionals. Over the past 2 years, we have interviewed dozens of individuals about their experiences in school-based health centers. Based on this study, we explore what it means for a health-care professional to work in school-based health care and how it differs from more traditional health-care settings. Our analysis particularly focuses on training and education, work environments, and their unique demands that come from being embedded within the educational setting. We conclude by addressing the important role that governmental policies could play in augmenting this crucial workforce.

Potemkin Protections: Assessing Provider Directory Accuracy and Timely Access for Four Specialties in California.

CONTEXT: The accuracy of provider directories and whether consumers can schedule timely appointments are crucial determinants of health access and outcomes. METHODS: We evaluated accuracy and timely access data obtained from the California Department of Managed Health Care, consisting of responses to large, random, representative surveys of primary care providers, cardiologists, endocrinologists, and gastroenterologists for 2018 and 2019 for all managed care plans in California. FINDINGS: Surveys were able to verify provider directory entries for the four specialties for 59% to 76% of listings or 78% to 88% of providers reached. We found that consumers were able to schedule urgent care appointments for 28% to 54% of listings or 44% to 72% of accurately listed providers. For general care appointments, the percentages ranged from 35% to 64% of listed providers or 51% to 87% of accurately listed providers. Differences across markets related to accuracy were generally small. Medi-Cal plans outperformed other markets with regard to timely access. Primary care consistently outperformed all other specialties. Timely access rates were higher for general appointments than for urgent care appointments. CONCLUSIONS: Our finding raise questions about the regulatory regime as well as consumer access and health outcomes.

Past experiences with surprise medical bills drive issue knowledge, concern and attitudes toward federal policy intervention.

Scholars and journalists have devoted considerable attention to understanding the circumstances in which Americans receive surprise medical bills. Previous research on this issue has focused on the scope of the problem, including the conditions that are most likely to lead to surprise bills. However, the existing literature has almost exclusively relied on claims data, limiting our understanding of consumer experiences and attitudes toward policy changes to address surprise billing. Using a survey administered to a nationally representative sample of 4998 Americans, we analyze consumer experiences with surprise billing, knowledge of the issue, how concerned Americans are about receiving surprise bills and how past experiences influence policy preferences toward federal action on surprise billing. Our analysis demonstrates that knowledge and concern about surprise billing are the highest among the educated and those who have previously received a surprise bill. These factors also predict support for federal policy action, with high levels of support for federal policy action across the population, including among both liberals and conservatives. However, more detailed federal policy proposals receive significantly less support among Americans, suggesting that stand-alone policy action may not be viable. Our results show bipartisan support among American consumers for federal action on surprise billing in the abstract but no consistent views on specific policy proposals.

Joining the herd? U.S. public opinion and vaccination requirements across educational settings during the COVID-19 pandemic.

With effective and safe COVID-19 vaccines beginning to be distributed across the United States, questions about who should receive the vaccine first have been the focus of public discussions. Yet, over the long-term, questions about the order of distribution will be displaced by questions about how to achieve high levels of vaccination rates. Historically, absent incentives or mandates, Americans have shown ambivalence, if not general antipathy, towards vaccinations, and vaccination rates have generally been low for many vaccines. There is evidence that vaccination requirements across educational settings are an effective policy instrument to increase vaccination rates. We administered a large national survey to assess American's attitudes towards vaccination requirements across three educational settings (daycare, K-12 schools, and universities) in general and for COVID-19 specifically. Partisanship, gender, race, rurality, and perceptions about the appropriate role schools should play in providing health services are substantive predictors of public opinion. While Americans generally support vaccination mandates across all three settings for both types of requirements, support is consistently and significantly lower for COVID19 requirements. The effect of partisanship is accentuated for COVID-19 requirements as compared to general requirements. Drop off in support between general and COVID-19 specific requirements are driven by partisanship, gender, political knowledge, rurality, and having children in the household. Nonetheless, mandates are supported by a majority of Americans. Assessing Americans' opinions of vaccination requirements in educational settings offers an important opportunity to explore the potential of mandates as policy instrument in the government's arsenal against COVID-19 and guide public policy on the issues.