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The article highlights U.S. congressional focus on bipartisan legislation targeting pharmacy benefit managers (PBMs) to regulate prescription drug prices, aiming to address problems like increasing costs and rebates. Key topics include proposals to mandate passing on negotiated rebates to health plans, efforts to prohibit certain PBM practices, and concerns about the limitations and potential impacts of these reforms on patient costs.

Background: People with limited English proficiency (LEP) face greater barriers to accessing medical care than those who are English proficient (EP). Language-related differences in the use of outpatient care across the full spectrum of physician specialties have not been studied. Objective: To compare outpatient visit rates to physicians in 28 specialties by people with LEP vs EP. Design: Multivariable negative binomial regression analysis of nationally representative data from the Medical Expenditure Panel Survey (pooled 2013–2018) with adjustment for age, sex, and self-reported health status. Participants: 149,611 survey respondents aged 18 and older. Exposure: LEP, defined as taking the survey in a language other than English. Main Measures: Annual per capita adjusted visit rate ratios (ARRs) comparing visit rates by LEP and EP persons to individual specialties, and to three categories of specialties: (1) primary care (internal or family medicine, geriatrics, general practice, or obstetrics/gynecology), (2) medical-subspecialties, or (3) surgical specialties. Key Results: Patients with LEP were underrepresented in 26 of 28 specialties. Disparities were particularly large for the following: pulmonology (ARR, 0.26; 95% CI, 0.20–0.35), orthopedics (ARR, 0.35; 95% CI, 0.30–0.40), otolaryngology (ARR, 0.40; 95% CI, 0.27–0.59), and psychiatry (ARR, 0.43; 95% CI, 0.32–0.58). Among individuals with several specific common chronic conditions, LEP-EP disparities in visits to specialties in those conditions generally persisted. Disparities were larger for medical subspecialties (ARR, 0.41; 95% CI, 0.36–0.46) and surgical specialties (ARR, 0.46; 95% CI, 0.42–0.50) than for primary care (ARR, 0.76; 95% CI, 0.72 to 0.79). Conclusions: Patients with LEP are underrepresented in most outpatient specialty practices, particularly medical subspecialties and surgical specialties. Our findings highlight the need to remove language barriers to physician services in order to ensure access to the full spectrum of outpatient specialty care for people with LEP. [ABSTRACT FROM AUTHOR]

We were unable to distinguish between type 1 and type 2 diabetes; we lacked clinical metrics (e.g., GFR) that might contraindicate the use of some medications; and some individuals may be receiving the medications for conditions other than diabetes. Glucagon-like-peptide-1 receptor agonists (GLP1as) and sodium-glucose cotransporter-2 inhibitors (SGLT2is) offer advantages over older anti-diabetic agents, including increased survival among patients with comorbid cardiac or renal disease.[1], [2] Among privately insured adults, Black individuals are less likely to receive SGLT2is and GLP1as.[3], [4] However, about half of Black (and Hispanic) patients have public or no coverage. [Extracted from the article]

This Viewpoint details how and why improved oversight of private equity acquisition of physician practices and hospitals is needed to mitigate the effects on health care costs, clinicians' jobs, and patients' access to care. [ABSTRACT FROM AUTHOR]

Background: The United States is the only high-income nation without universal, government-funded or -mandated health insurance employing a unified payment system. The US multi-payer system leaves residents uninsured or underinsured, despite overall healthcare costs far above other nations. Single-payer (often referred to as Medicare for All), a proposed policy solution since 1990, is receiving renewed press attention and popular support. Our review seeks to assess the projected cost impact of a single-payer approach.Methods and Findings: We conducted our literature search between June 1 and December 31, 2018, without start date restriction for included studies. We surveyed an expert panel and searched PubMed, Google, Google Scholar, and preexisting lists for formal economic studies of the projected costs of single-payer plans for the US or for individual states. Reviewer pairs extracted data on methods and findings using a template. We quantified changes in total costs standardized to percentage of contemporaneous healthcare spending. Additionally, we quantified cost changes by subtype, such as costs due to increased healthcare utilization and savings due to simplified payment administration, lower drug costs, and other factors. We further examined how modeling assumptions affected results. Our search yielded economic analyses of the cost of 22 single-payer plans over the past 30 years. Exclusions were due to inadequate technical data or assuming a substantial ongoing role for private insurers. We found that 19 (86%) of the analyses predicted net savings (median net result was a savings of 3.46% of total costs) in the first year of program operation and 20 (91%) predicted savings over several years; anticipated growth rates would result in long-term net savings for all plans. The largest source of savings was simplified payment administration (median 8.8%), and the best predictors of net savings were the magnitude of utilization increase, and savings on administration and drug costs (R2 of 0.035, 0.43, and 0.62, respectively). Only drug cost savings remained significant in multivariate analysis. Included studies were heterogeneous in methods, which precluded us from conducting a formal meta-analysis.Conclusions: In this systematic review, we found a high degree of analytic consensus for the fiscal feasibility of a single-payer approach in the US. Actual costs will depend on plan features and implementation. Future research should refine estimates of the effects of coverage expansion on utilization, evaluate provider administrative costs in varied existing single-payer systems, analyze implementation options, and evaluate US-based single-payer programs, as available. [ABSTRACT FROM AUTHOR]

Keywords: COVID-19; anxiety; depression; mental health EN COVID-19 anxiety depression mental health 1841 1843 3 06/05/21 20210601 NES 210601 Prior Presentations: None Background In the first month of the US COVID-19 epidemic, the prevalence of depressive symptoms was higher than that in 2017-2018 [1]. Objective To describe trends in the proportion of the US population for whom screening questionnaires indicate a high likelihood of depression or anxiety symptoms during the spring and summer of 2020. [Extracted from the article]

Acknowledgements Contributors I am grateful for the feedback of Dr. Steffie Woolhandler, Dr. David Himmelstein, Dr. Samuel Dickman, Dr. Iris Borowsky, and Dr. Steve Borowsky on previous versions of this manuscript. Yet, physician opinion on Medicare for All remains split, with most doctors concerned that such reform might decrease their income. [Extracted from the article]

Background: Physician time is a valuable yet finite resource. Whether such time is apportioned equitably among population subgroups, and how the provision of that time has changed in recent decades, is unclear. Objective: To investigate trends and racial/ethnic disparities in the receipt of annual face time with physicians in the USA. Design: Repeated cross-sectional. Setting: National Ambulatory Medical Care Survey, 1979–1981, 1985, 1989–2016, 2018. Participants: Office-based physicians. Measures: Exposures included race/ethnicity (White, Black, and Hispanic); age (<18, 18–64, and 65+); and survey year. Our main outcome was patients' annual visit face time with a physician; secondary outcomes include annual visit rates and mean visit duration. Results: Our sample included n=1,108,835 patient visits. From 1979 to 2018, annual outpatient physician face time per capita rose from 40.0 to 60.4 min, an increase driven by a rise in mean visit length and not in the number of visits. However, since 2005, mean annual face time with a primary care physician has fallen, a decline offset by rising time with specialists. Face time provided per physician changed little given growth in the physician workforce. A racial/ethnic gap in physician visit time present at the beginning of the study period widened over time. In 2014–2018, White individuals received 70.0 min of physician face time per year, vs. 52.4 among Black and 53.0 among Hispanic individuals. This disparity was driven by differences in visit rates, not mean visit length, and in the provision of specialist but not primary care. Limitation: Self-reported visit length. Conclusion: Americans' annual face time with office-based physicians rose for three decades after 1979, yet is still allocated inequitably, particularly by specialists; meanwhile, time spent by Americans with primary care physicians is falling. These trends and disparities may adversely affect patient outcomes. Policy change is needed to assure better allocation of this resource. [ABSTRACT FROM AUTHOR]