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What is known about this topic? We discuss a recently published paper that alleges clinicians are causal agents of non-compliant billing of Medicare. What does this paper add? The paper's arguments are partially supported by unreferenced assertions, potential logical fallacies, inaccurate reporting of referenced material and unsubstantiated rhetoric. What are the implications for practitioners? Due to the lack of substantive evidence, it cannot be concluded that clinicians are the causal agents of non-compliant billing of Medicare. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic is an unprecedented event that has shocked economies worldwide, propelling large-scale adaptation of expansionary policies. This paper examines how, specifically in the scope of developed countries, key economic indicators such as tax revenue and burden, labor force participation rate, and federal budget have been impacted by the pandemic. The specific nations examined in the paper include the United States of America (USA), Japan, Germany, France, and the United Kingdom (UK). The article reveals that tax revenue had fallen at a rate similar to the GDP, and a redistribution of the tax burden has also occurred to some extent. Simultaneously, a fall in the labor force participation rate and increased government deficit were observed. This observation is primarily consistent across all five countries sampled. [ABSTRACT FROM AUTHOR]

With the development of the market economy, agricultural trade has become more and more significant for the development of the agricultural economy, which has triggered people's further thinking and exploration on the impact of agricultural trade on agricultural carbon emissions. This paper takes the measurement of trade implied carbon as the carbon dioxide emission index under the impact of agricultural trade and analyzes the impact of trade implied carbon and implied carbon balance on carbon emission. Taking the impact of Sino-US agricultural trade as an empirical background, this paper measures the impact of environmental changes in agricultural trade opening on China's agricultural development and its carbon emissions, so as to predict changes in China's regional agricultural carbon emissions performance. After calculation, it is found that the scale of China's exports has decreased by 0.089%, which is lower than the decline of 0.361% in the United States. The trade conflict has a significant impact on China's import and export structure. Under the scenario of mutual tariffs on agricultural products, China's exports to the United States are expected to decrease by 6.28%, while China's imports from the United States decreased by 13.02%. The Sino-US agricultural trade dispute will reduce China's carbon emissions by 0.013% and the United States' carbon emissions by 0.024%, which is related to the negative impact on the economy. Improving the performance of agricultural carbon emissions is not only the need for the green and sustainable development of the agricultural economy but also conducive to improving the international competitiveness of agricultural products. [ABSTRACT FROM AUTHOR]

Abstract Public pay-for-performance (P4P) programs tie hospital payments to predetermined sets of quality measures and are intended to encourage or discourage certain outcomes. To the extent that financial penalties from these programs induce some response by hospitals, such penalties may translate into higher negotiated payments from commercial insurance payers. In this paper, we employ data on commercial insurance payments from a large, multi-payer database to study the extent to which penalties levied under the Hospital Readmission Reduction Program (HRRP) and the Hospital Value-Based Purchasing (HVBP) program, two major P4P components of the Affordable Care Act, caused changes in private hospital payments. We find that the bulk of any penalties resulting from HRRP and HVBP are borne by private insurance patients in the form of higher private insurance payments. Specifically, we show that HRRP and HVBP financial penalties led to increases in private payments of 1.9 percent, with effects concentrated among circulatory system procedures. These penalties were also associated with a 3.1 percent reduction in Medicare discharges. Our estimates are larger for hospitals with higher shares of privately insured patients, which suggests the importance of hospital bargaining power in facilitating higher commercial insurance payments. [ABSTRACT FROM AUTHOR]

Background and Objectives: Despite the prevalence of published opinions about the use of professional academic writers to help disseminate the results of clinical research, particularly opinions about the use of ghost writers, very little information has been published on the possible roles for professional writers within academic medical departments or the mechanisms by which these departments can hire and compensate such writers. To begin addressing this lack of information, the Association of Departments of Family Medicine hosted an online discussion and a subsequent webinar in which we obtained input from three departments of family medicine in the United States regarding their use of academic writers. This discussion revealed three basic models by which academic writers have benefitted these departments: (1) grant writing support, (2) research and academic support for clinical faculty, and (3) departmental communication support. Drawing on specific examples from these institutions, the purpose of this paper is to describe the key support activities, advantages, disadvantages, and funding opportunities for each model for other departments to consider and adapt. [ABSTRACT FROM AUTHOR]

In this paper I challenge the pernicious aspects of Milton Friedman's methodological outlook that continues to hold sway over mainstream neoclassical economists. I do this by showing how Friedman's own methodological dicta could have been used against him when he famously advanced the expectations critique of the Phillips curve at his presidential address to the American Economic Association. I use this case study to further suggest that psychological and neurophysiological data should not be deemed irrelevant to economic science., (Copyright © 2022 Elsevier Ltd. All rights reserved.)

With its long coastline, vast exclusive economic zone (EEZ), skilled labor force, advanced technology, and one of the largest seafood markets in the world, the United States could be a major marine aquaculture producer of fish, mollusks, crustaceans, and marine algae. Despite all its promise, U.S. marine aquaculture production is tiny relative to its potential. The constraints often cited are lack of social license, an inefficient and uncoordinated permitting system, and the absence of supportive government programs similar to those enjoyed by terrestrial agriculture. National commissions have noted these constraints for more than 30 years. The paper first outlines key policy drivers prompting a reevaluation of US marine aquaculture policy (human health and nutrition, climate change, and market disruptions caused by the coronavirus) and then focuses on three critical policy goals that could contribute to expanding U.S. seafood farming: improve public understanding and acceptance, enhance the efficiency and timeliness of the aquaculture permitting process, and expand economic incentives to foster aquaculture development. [ABSTRACT FROM AUTHOR]

The US government response to the coronavirus pandemic has prompted renewed debate about the size and structure of the welfare state. Particular attention has been paid to prenatal and early childhood policy, domains in which the US safety net is less robust than those of its peer countries. Contra claims that the so-called care economy constitutes a sharp break with the neoliberal consensus, this article argues that the shift in social policy focus toward early life is consistent with changes in economic ideas about the best environment in which to grow "human capital": the economization of early life. Building on insights about "critical periods" of development drawn from diverse fields including epigenetics and neurobiology, economists estimate that human capital gains are greatest when "investments in people" occur before the age of five. This article traces the history of how this research was brought to the attention of federal policy makers in the United States. While much human capital–focused social policy traditionally placed the burden of risk on the private family (e.g., with student loan debt or health insurance), in recent years, economists have instead argued that social programs dedicated to early childhood development are more "efficient" sources of public investment. [ABSTRACT FROM AUTHOR]

International research and collaboration has been a part of the National Cancer Institute's (NCI) mission since its creation in 1937. Early on, efforts were limited to international exchange of information to ensure that US cancer patients could benefit from advances in other countries. As NCI's research grant portfolio grew in the 1950s, it included a modest number of grants to foreign institutions, primarily in the United Kingdom and Europe. In the 1960s, the development of geographic pathology, which aimed to study cancer etiology through variations in cancer incidence and risk factors, led to an increase in NCI-funded international research, including research in low- and middle-income countries. In this paper, we review key international research programs, focusing particularly on the first 50 years of NCI history. The first NCI-led overseas research programs, established in the 1960s in Ghana and Uganda, generated influential research but also struggled with logistical challenges and political instability. The 1971 National Cancer Act was followed by the creation of a number of bilateral agreements with foreign governments, including China, Japan, and Russia, to support cooperation in technology and medicine. Although these agreements were broad without specific scientific goals, they provided an important mechanism for sustained collaborations in specific areas. With the creation of the NCI Center for Global Health in 2011, NCI's global cancer research efforts gained sustained focus. Because the global cancer burden has evolved over time, increasingly impacting low- and middle-income countries, NCI's role in global cancer research remains more important than ever. [ABSTRACT FROM AUTHOR]

In the twenty-first century, voter choice and the broader political debate are within the reach of those that can access and channel the vast streams of user data that are generated online. How digital platforms utilize personal user data to influence the outcome of democratic processes has become a central issue that liberal democracies must confront. The paper explores whether competition law has a role to play when it comes to addressing this intersection of Big Tech, data, and democracy. It first sets out the democratic roots of competition or antitrust law in the United States and the European Union. From these, the paper deduces that competition law cannot remain inactive when it comes to maintaining a democratic society in the face of the abilities of Big Tech to influence democratic processes and outcomes. The paper then goes a step further and asks what role competition law could play in this regard. Should democratic values simply be reflected in the procedural set-up of antitrust law, or is there a role for democratic values in the substantive provisions as well? And if so, does antitrust law's focus on keeping market power in check suffice to fulfill its role in a democratic society, or does this role require the law to specifically target antidemocratic market behavior as anticompetitive harm? In navigating these questions, the paper contributes to the ongoing debate on political antitrust and sets out an ambitious research agenda on how to carry this discussion forward. [ABSTRACT FROM AUTHOR]

Abstract We seek to understand how the labor market decisions of the family adjust in response to plausibly exogenous health shocks. Family members might work less to provide caregiving, or work more in response to medical expenditures and loss of income by the ill individual. We use records of emergency department (ED) visits and hospitalizations to empirically determine the size of these effects. Using ED events, we find evidence of intra-family insurance. By exploring how insurance varies by the severity of the health shock, we find that family labor supply responses decrease as the caregiving need increases. [ABSTRACT FROM AUTHOR]

The United States offers two markedly different subsidy structures for private health insurance. When covered through employer-based plans, employees and their dependents benefit from the exclusion from taxable income of the premiums. Individuals without access to employer coverage may obtain subsidies for Marketplace coverage. This paper seeks to understand how the public subsidies embedded in the privately financed portion of the U.S. healthcare system impact the payments families are required to make under both ESI and Marketplace coverage, and the implications for finance equity. Using the Household Component of the Medical Expenditure Panel Survey (MEPS-HC) and Marketplace premium data, we assess horizontal and vertical equity by calculating public subsidies for and expected family spending under each coverage source and using Lorenz curves and Gini and concentration coefficients. Our study pooled the 2018 and 2019 MEPS-HC to achieve a sample size of 10,593 observations. Our simulations showed a marked horizontal inequity for lower-income families with access to employer coverage who cannot obtain Marketplace subsidies. Relative to both the financing of employer coverage and earlier Marketplace tax credits, the more generous Marketplace premium subsidies, first made available in 2021 under the American Rescue Plan Act, substantially increased the vertical equity of Marketplace financing. While Marketplace subsidies have clearly improved equity within the United States, we conclude with a comparison to other OECD countries highlighting the persistence of inequities in the U.S. stemming from its noteworthy reliance on employer-based private health insurance. • United States uses employer and individual private health insurance coverage. • No recent investigations of horizontal and vertical equity of U.S. private coverage. • Analysis of Gini coefficients and Lorenz curves suggests regressivity. • Public policies including insurance subsidies can reduce inequities. [ABSTRACT FROM AUTHOR]

Abstract The number of disability beneficiaries has doubled in the past two decades. It is difficult to determine how much is explained by changes in health, as we lack a counterfactual. We use undocumented immigrants to form the counterfactual, as they cannot claim benefits. Using data from the National Health Interview Survey, we show that the relationship between health and disability is stronger for the legal population than for the undocumented. Much of the difference in disability rates between the populations is due to different labor supply responses to underlying health impairments and demographic differences, rather than to differences in the impairments or demographic variables themselves. [ABSTRACT FROM AUTHOR]

A majority of individuals with limited English proficiency (LEP) in the U.S. are foreign-born, creating a complex intersection of language, socio-economic, and policy barriers to healthcare access and achieving good outcomes. Mapping the research literature is key to addressing how LEP intersects with healthcare. This scoping review followed PRISMA-ScR guidelines and included PubMed/MEDLINE, CINAHL, Sociological Abstracts, EconLit, and Academic Search Premier. Study selection included quantitative studies since 2000 with outcomes specified for adults with LEP residing in the U.S. related to healthcare service access or defined health outcomes, including healthcare costs. A total of 137 articles met the inclusion criteria. Major outcomes included ambulatory care, hospitalization, screening, specific conditions, and general health. Overall, the literature identified differential access to and utilization of healthcare across multiple modalities with poorer outcomes among LEP populations compared with English-proficient populations. Current research includes inconsistent definitions for LEP populations, primarily cross-sectional studies, small sample sizes, and homogeneous language and regional samples. Current regulations and practices are insufficient to address the barriers that LEP individuals face to healthcare access and outcomes. Changes to EMRs and other data collection to consistently include LEP status and more methodologically rigorous studies are needed to address healthcare disparities for LEP individuals. [ABSTRACT FROM AUTHOR]

The article focuses on the significance and implications of enforcing the Robinson-Patman Act (RPA) as a means of controlling buyer and seller power in the U.S. It explores the historical context, objectives, and enforcement measures related to the RPA, highlighting its role in promoting fair competition, preventing market concentration, and safeguarding democracy within the political economy.

Introduction: An appropriate economic evaluation of post-exposure prophylaxis (PEP) should consider the effectiveness of different regimens prescribed for patients. Studies have not evaluated the comparative effectiveness of different PEP antiretrovirals (ARVs) based on their costs. Therefore, the aim of the present study was to determine the cost-effectiveness of ARVs regimens used for PEP in Nigerian tertiary hospitals. Material and methods: This cross-sectional study collated patients' demographic and clinical data from PEP databases of United States' President Emergency Plan for AIDS Relief - AIDS Prevention Initiative in Nigeria hospitals. Costs of ARVs were obtained from donors' price list. Effectiveness was measured as the percentage of human immunodeficiency virus (HIV)-negative patients one-month post-PEP. Average cost-effectiveness ratios (ACERs) were computed as the unit cost of the regimens/HIV infection averted (HIA). Probabilistic sensitivity analysis was conducted using 1,000 iterations using Monte-Carlo simulation. Results: Out of 575 patients identified, 198 (34.4%) had non-occupational exposure. Of the 14 regimens, tenofovir (TDF) + lamivudine (3TC) + ritonavir-boosted atazanavir (ATV/r) was prescribed for 230 (40.00%) patients. HIV-negative results were documented in 129 (22.4%) of the 185 patients with post-PEP test. Zidovudine (AZT) + 3TC + ATV-r was the most effective (95.5%, n = 63 of 66) regimen, while TDF + emtricitabine (FTC) + ritonavir-boosted lopinavir (LPV/r) was the most expensive ($23.66). With an ACER of $8.110/HIV infection prevented (95% CI: $8.052-$8.168), TDF + 3TC + efavirenz (EFV) was the most cost-effective regimen. Conclusions: AZT + 3TC + LPV/r was the most effective regimen, while TDF + FTC + ATV/r was the most expensive. However, TDF + 3TC + EFV combination was the most cost-effective regimen used in providing PEP service to HIV patients in Nigerian hospitals. [ABSTRACT FROM AUTHOR]

Objective: Parental leave and breastfeeding breaks influence the ability to initiate and continue breastfeeding. We investigated how eligibility criteria in the Family and Medical Leave Act (FMLA) and Affordable Care Act (ACA) affect access to unpaid parental leave and breastfeeding breaks and assessed affordability and alternative policy models. Methods: We used family income data to assess the affordability of unpaid leave by race and ethnicity. We used 2017-2018 US Current Population Survey data to determine the percentage of private sector workers aged 18-44 years who met the minimum hour (1250 hours of work during a 12-month period), tenure (12 months), and firm size (≥50 employees) requirements of FMLA and ACA. We analyzed eligibility by gender, race and ethnicity, and age. We also examined parental leave and breastfeeding break policies in 193 countries. Results: Most Latinx (66.9%), Black (60.2%), and White (55.3%) workers were ineligible and/or unlikely to be able to afford to take unpaid FMLA leave. Of 69 534 workers, more women (16.9%) than men (10.3%) did not meet the minimum hour requirement. Minimum tenure excluded 23.7% of all workers and 42.2% of women aged 18-24 years. Minimum firm size excluded 30.3% of all workers and 37.7% of Latinx workers. Of 27 520 women, 28.8% (including 32.9% of Latina women) were excluded from ACA breastfeeding breaks because of firm size. Nearly all other countries guaranteed mothers paid leave regardless of firm size or minimum hours and guaranteed ≥6 months of paid leave or breastfeeding breaks. Conclusions: Adopting a comprehensive, inclusive paid parental leave policy and closing gaps in breastfeeding break legislation would remove work-related barriers to breastfeeding; reduce racial, ethnic, and gender inequities; and align US national policies with global norms. [ABSTRACT FROM AUTHOR]

Battery-based electric vehicles (BEVs) in the United States (U.S.) set a new sales record in 2022, driven by technology, policy, environmental, and economic objectives. However, the rapid deployment of BEVs and charging infrastructure without a careful review of their integration with the electric grid can have negative economic impacts on reliable and resilient electricity supply. Bi-directional power transfer (Bi-Di) vehicle-grid integration technologies and services such as vehicle-to-home or building (V2H/B) and vehicle-to-grid (V2G) can potentially lower local and system peak demand, improve economics for grid operators, and benefit BEV customers. Original equipment manufacturers (OEMs) in the automotive industry are exploring technologies and economics (techno-economics) for Bi-Di services. The study conducted a literature review of eleven case studies in the U.S. and Europe that featured Bi-Di demonstrations from 2005 to 2022 to highlight insights and techno-economic opportunities and challenges for OEMs. The findings should motivate the OEMs to prioritize technology innovation and business models to increase BEV sales and gain continuous revenue from Bi-Di services, which can potentially transition "car makers" to "technology solution" companies. [ABSTRACT FROM AUTHOR]

Health equity is an aspirational goal for health outcomes that can be achieved when systemic inequalities are addressed. The human cost of health inequities is without number; we can and must ameliorate health inequities. This essay summarizes the impact of continued health disparities and inequities in the United States and outlines the ways in which increasing diversity in the nursing workforce and graduating equity-minded nurses can promote innovation and problem-solving to address these disparities and inequities. We then present multiple pathways for nurses in academia to advance health equity. [ABSTRACT FROM AUTHOR]

The past several years have seen calls from QuantCrit scholars to "disaggregate" samples into same-race groups. To date, however, there has been no attempt to empirically evaluate the benefits of disaggregation within a child welfare sample. Using a child maltreatment dataset derived from the National Child Abuse and Neglect Data System and Census data, we empirically evaluate the utility of employing sample disaggregation (in which separate records are created for White, Black and Latino populations in each county) as well as variable creation disaggregation (in which we avoid using "full county" economic measures, but instead employ "same race/ethnicity" measures). Using model fit and convergence with findings from individual-level studies as evaluation metrics, we find that both kinds of disaggregation are demonstrably beneficial. We recommend that sample and variable disaggregation be considered by any future researchers using national geographically structured child maltreatment data. [ABSTRACT FROM AUTHOR]

Background: Advancing healthcare access and quality for underserved populations requires a diverse, culturally competent interprofessional workforce. However, high educational debt may influence career choice of healthcare professionals. In the United States, health professions lack insight into the maximum educational debt that can be supported by current entry-level salaries. The purpose of this interprofessional economic analysis was to examine whether average educational debt for US healthcare graduates is supportable by entry-level salaries. Additionally, the study explored whether trainees from minoritized backgrounds graduate with more educational debt than their peers in physical therapy. Methods: The study modeled maximum educational debt service ratios for 12 healthcare professions and 6 physician specialties, incorporating profession-specific estimates of entry-level salary, salary growth, national average debt, and 4 loan repayment scenarios offered by the US Department of Education Office of Student Financial Aid. Net present value (NPV) provided an estimate for lifetime "economic power" for the modeled careers. The study used a unique data source available from a single profession (physical therapy, N = 4,954) to examine whether educational debt thresholds based on the repayment model varied between minoritized groups and non-minoritized peers. Results: High salary physician specialties (e.g. obstetrics/gynecology, surgery) and professions without graduate debt (e.g. registered nurse) met debt ratio targets under any repayment plan. Professions with strong salary growth and moderate debt (e.g. physician assistant) required extended repayment plans but had high career NPV. Careers with low salary growth and high debt relative to salary (e.g. physical therapy) had career NPV at the lowest range of modeled professions. 29% of physical therapy students graduated with more debt than could be supported by entry-level salaries. Physical therapy students from minoritized groups graduated with 10–30% more debt than their non-minoritized peers. Conclusions: Graduates from most healthcare professions required extended repayment plans (higher interest) to meet debt ratio benchmarks. For several healthcare professions, low debt relative to salary protected career NPV. Students from minoritized groups incurred higher debt than their peers in physical therapy. [ABSTRACT FROM AUTHOR]

The article examine the factors contributing to the decline of antitrust enforcement in the U.S. It challenge the conventional narrative that attributes this decline solely to the influence of the Chicago School's economic theories. It further explore whether special interests and political factors played a role in shaping antitrust policies.

This article seeks to understand the changes in federal health care policy that led to greater telehealth adoption during COVID-19 pandemic. For decades, telehealth was identified as a possibility for increasing health care access, but the policies needed for greater telehealth reimbursement were stalled until the public health emergency was declared. Applying the dynamic concepts within punctuated equilibrium theory (PET) model to traditional fee-for-service Medicare policy, the influential factors are identified and specify how policy change occurred as a response to the pandemic, resulting in swift and large-scale changes in Medicare telehealth reimbursement requirements and widespread telehealth adoption. The model also explains how the same forces that led to Medicare policy response are at work to maintain and broaden or contract and limit the future of telehealth reimbursement as the public health emergency recedes. [ABSTRACT FROM AUTHOR]

Autistic adolescents and emerging adults experience high rates of mental health conditions—a risk factor for hospitalization. Using nationally representative data from the 2016 HCUP KID, we estimated the prevalence and costs of mental health–related hospitalizations for autistic adolescents and emerging adults in the United States. Hospital discharges for ages 10–20 years (n = 1,346,849) were analyzed using survey-adjusted logistic regression and general linear modeling. Mental health–related hospitalizations among autistic young people (n = 14,368) were mostly for neurodevelopmental, disruptive, depressive, and bipolar disorders. Mental health–related hospitalizations were almost 11 times more likely (OR = 10.98, 95% CI = 10.00–12.00) for autistic youth compared youth with complex and chronic conditions, and two times (OR = 2.03, 95% CI = 1.88–2.19) more likely compared to population controls. Predicted mean service delivery costs of mental health–related hospitalizations for autistic adolescents and emerging adults were US$7,401.23 per stay, resulting in US$106 million in estimated total service delivery costs in 2016. Mental health–related hospitalizations can indicate poor quality care, be traumatic, and increase suicide risk. Community mental health care for autistic young people is needed. Autistic young people are more likely to have mental health conditions, like depression and bipolar disorder, than people without autism. These mental health issues sometimes lead to hospitalizations, which can be expensive and traumatic. Because of this, we wanted to understand mental health–related hospitalizations among autistic young people aged 10–20. We found that the main mental health reasons for the hospitalization of autistic young people were neurodevelopmental, disruptive, depressive, and bipolar disorders. These hospitalizations cost an average of US$7401.23 per stay, for a total of US$106 million in service delivery costs in 2016. Mental health–related hospitalizations were compared between young people with autism, young people with complex and chronic conditions, and young people with no chronic conditions. Autistic young people were almost 11 times more likely to be hospitalized for mental health reasons than young people with complex and chronic conditions, and two times more likely than young people with no complex and chronic conditions. We believe the United States needs better community-based mental health care for young people with autism. [ABSTRACT FROM AUTHOR]

Objectives: To examine the association between chronic obstructive pulmonary disease status and indicators of economic instability and stress to better understand the magnitude of these issues in persons with chronic obstructive pulmonary disease. Methods: Analyzed 2017 Behavioral Risk Factor Surveillance System data from 16 states that administered the 'Social Determinants of Health' module, which included economic instability and stress measures (N = 101,461). Associations between self-reported doctor-diagnosed chronic obstructive pulmonary disease status and each measure were examined using multinomial logistic models. Results: Adults with chronic obstructive pulmonary disease were more likely (p < 0.001) than adults without to report not having enough money at month end (21.0% vs. 7.9%) or just enough money (44.9% vs. 37.2%); being unable to pay mortgage, rent, or utility bills (19.2% vs. 8.8%); and that often or sometimes food did not last or could not afford to eat balanced meals (37.9% vs. 20.6%), as well as stress all or most of the time (27.3% vs. 11.6%). Associations were attenuated although remained significant after adjustments for sociodemographic and health characteristics. Discussion: Financial, housing, and food insecurity and frequent stress were more prevalent in adults with chronic obstructive pulmonary disease than without. Findings highlight the importance of including strategies to address challenges related to economic instability and stress in chronic obstructive pulmonary disease management programs. [ABSTRACT FROM AUTHOR]

An editorial is presented on increasing amounts of confusion and debate among rehabilitation. Topics include receiving much more attention when the Workforce Innovation and Opportunity Act (2014) was passed by Congress and CE; and debate among rehabilitation and other disability policy makers and practitioners.

The article examines the evolving strategic landscape in the Indo-Pacific region, focusing on the power transitions and competition between the United States and China. It highlights the significance of the Indo-Pacific's economic and military dynamism and explores India's response to these challenges, emphasizing its involvement in groups like the Quadrilateral Security Dialogue (QUAD) to secure its interests.

Policy PointsPublic health science regarding alcohol consumption and problems, alcohol's role in equity and social justice, and identification of effective policy interventions has grown steadily stronger in the past 30 years.Progress on effective alcohol policies has stalled or gone backward in the United States and much of the world.Because alcohol influences at least 14 of the 17 sustainable development goals, as well as more than 200 disease and injury conditions, reducing alcohol problems should offer a platform for collaboration across public health silos but will require that public health itself respect and follow its own science. [ABSTRACT FROM AUTHOR]

Policy PointsIn America, wages appear to be growing relative to purchasing power over time. However, while the ability to purchase consumer goods has indeed improved, the cost of basic survival needs such as health care and education has increased faster than wages have grown.America's weakening social policy landscape has led to a massive socioeconomic rupture in which the middle class is disappearing, such that most Americans now cannot afford basic survival needs, such as education and health insurance.Social policies strive to rebalance societal resources from socioeconomically advantaged groups to those in need. Education and health insurance benefits have been experimentally proven to also improve health and longevity. The biological pathways through which they work are also understood. [ABSTRACT FROM AUTHOR]

Non-timber forest products (NTFPs) are derived from natural populations of plants or fungi, or farmed in forests. Harvesters and producers often benefit from NTFPs by selling them to generate income. This article explores research on the producers, production, marketing, and sales of NTFPs in the United States, including the continuum of production from wild-harvesting to forest farming of NTFPs, and their costs and benefits. Specific examples are presented, but the concepts and generalizations are broadly applicable to many NTFPs throughout the U.S. and other parts of the world. Integrating NTFPs into forest management can enhance economic opportunities but also will increase complexity, and will entail balancing multiple and potentially conflicting objectives among a diverse community of stakeholders. We identify information gaps including the need for inventories and yield models of NTFPs, understanding the effect of silvicultural activities on NTFP survival and yield, time series and trends in collection of NTFPs by U.S. households, identification of vulnerable and marginalized communities associated with NTFP harvest, and harvesters' motivations and drivers. [ABSTRACT FROM AUTHOR]

Introduction: Increased legalization of cannabis use across the United States has been correlated with increased cannabis use in the clinical setting. However, little is known regarding the characteristics and postoperative outcomes after primary joint arthroplasty (TJA) for patients with cannabis use disorder (CUD). Methods: This retrospective cohort study used data from the National Inpatient Sample of patients undergoing primary TJA between 2006 to 2015. Patients were grouped based on presence of concomitant CUD. Patient demographic characteristics and outcome data between groups were analyzed. Propensity score methodology was used to compare immediate in-hospital complications and economic outcomes. Results: A total of 8,740,798 TJAs were included. The prevalence of CUD increased nearly five-fold from 0.05% to 0.26% during this time (P < 0.0001). CUD patients were significantly younger, more likely to be male, most frequently of non-Hispanic Black race, and had higher rates of Medicaid insurance. Patients with CUD had a significantly shorter length of hospital stay (3.04 vs. 3.24 days, P = 0.0297), while incurring significantly higher daily ($22,614 vs. $17,955, P < 0.0001) and total charges during admission ($58,507 vs. $50,924, P < 0.0001), compared to patients without CUD. When compared with the control group, CUD was associated with significantly greater odds of home discharge (odds ratio (OR): 1.45, P = 0.0007), and significantly lower odds of rehab discharge (OR: 0.70, P = 0.0013). There were no differences in overall complication profile or in the vast majority of individual in-hospital complications between groups. Conclusion: While CUD is correlated to shorter length of stay and increased home discharge after TJA, it does not show a strong effect on complications in an inpatient postoperative setting. It is important for clinicians to appreciate the demographic profile and expected clinical and economic outcomes for patients with CUD undergoing TJA, particularly in the context of evolving laws surrounding cannabis use. [ABSTRACT FROM AUTHOR]

We introduce the consideration of human migration into research on economic losses from extreme weather disasters. Taking a comparative case study approach and using data from the Federal Reserve Bank of New York/Equifax Consumer Credit Panel, we document the size of economic losses attributable to migration from 23 disaster-affected areas in the United States before, during, and after some of the most costly hurricanes, tornadoes, and wildfires on record. We then employ demographic standardization and decomposition to determine if these losses primarily reflect changes in out-migration or the economic resources that migrants take with them. Finally, we consider the implications of these losses for changing spatial inequality in the United States. While disaster-affected areas and their populations differ in their experiences of and responses to extreme weather disasters, we generally find that, relative to the year before an extreme weather disaster, economic losses via migration from disaster-affected areas increase the year of and after the disaster, these changes primarily reflect changes in out-migration (vs. the economic resources that migrants take with them), and these losses briefly disrupt the status quo by temporarily reducing spatial inequality. [ABSTRACT FROM AUTHOR]

Historical, feminist scholarship demonstrates that the welfare state underwrote the work of social reproduction, enabling procreation, socialization, sexuality, nurturance, and family maintenance. Carried out by families and other public and private social institutions, social reproduction includes making food, clothing, and shelter available for immediate consumption; ensuring the health and productivity of the current and future labor force; providing for people too old, too young, or too sick to care for themselves; and socializing family members. Historically, social reproduction includes both women's unpaid labor in the home and low-paid labor in the market and converts the wages of paid workers into the means of subsistence for the entire household. The economic crisis of the mid-1970s marked the end of the "golden age" of capitalism, and yielded neoliberal politics that sought to undo the redistributive elements of the New Deal and the Great Society. It called for a smaller state, greater reliance on market forces, and reduced expenditure on family maintenance. This article, a reprint of a 2017 book chapter, explores the crisis in social reproduction in the United States that surfaced with the rise of neoliberalism and the "carceral state." [ABSTRACT FROM AUTHOR]

Background: Travel expenditures are important to consumers, and to the economy of the nation as a whole. Previous studies have found that there are differences in economic status and expenditure pattern among different racial/ethnic groups in the U. S. This study aimed to describe the travel expenditures and components in the United States in year 2017, and to evaluate if there is any racial difference in travel expenditures. Methods: Data from the 2017 Quarterly Interviews of the Consumer Expenditure (CE) Surveys were used. Average annual travel expenditure, its components, and how much proportion it took among the total expenditure were described. Linear regression analysis was employed to examine if there is difference in the proportion of expenditure on travel among different racial groups. Results: On average, consumers in the United States spend 4% of total expenditure on travel. Among all consumers in the nation, Asian consumers spend 1.4% more proportion of expenditure on travel than Whites. Black and Native Americans spend less (1.32% and 1.09%, respectively) than Whites. Conclusion: There is any racial difference in proportion of expenditures on travel, with Asians higher than Whites, and Blacks and Native Americans lower than Whites. [ABSTRACT FROM AUTHOR]

Context: To what extent does pharmaceutical revenue growth depend on new medicines versus increasing prices for existing medicines? Moreover. does using list prices, as is commonly done. instead of prices net of confidential rebates offered by manufacturers. which are harder to observe, change the relative importance of the sources of revenue growth? Methods: This study uses data from SSR Health LLC to address these research questions using decomposition methods that analyze list prices, prices net of rebates, and sales for branded pharmaceutical products sold primarily through retail pharmacies. Findings: From 2009 to 2019, retail pharmaceutical revenue growth was primarily driven by new products rather than by price increases on existing products. Failing to account for confidential rebates creates a more prominent role for price increases in explaining revenue growth, because list price inflation during this period was 10.9%, whereas net price inflation was 3.3%. Conclusions: Policies that restrict price growth on existing medicines likely need to be coupled with policies that reduce launch prices to have a meaningful long-term impact on pharmaceutical revenue growth. Using pharmaceutical list prices is often an inadequate approximation for net prices because the role of rebates has increased and varies by drug class. [ABSTRACT FROM AUTHOR]

We sought to estimate the impact of temporary financial assistance (TFA) for housing-related expenses from the U.S. Department of Veterans Affairs on costs for a variety of health care services. We conducted a retrospective cohort study of Veterans who entered the Supportive Services for Veteran Families (SSVF) program between 10/2015 and 9/2018. We assessed the effect of TFA on health care costs using a multivariable difference-in-difference approach. Outcomes were direct medical costs of health care encounters (i.e. emergency department, outpatient mental health, inpatient mental health, outpatient substance use disorder treatment, and residential behavioral health) in the VA system. Temporary financial assistance was associated with a decrease in ED (–$11, p<.003), outpatient mental health (–$28, p<.001), outpatient substance use disorder treatment (–$25, p<.001), inpatient mental health (–$258, p<.001), and residential behavioral health (–$181, p<.001) costs per quarter for Veterans in the rapid re-housing component of SSVF. These results can inform policy debates regarding proper solutions to housing instability. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic's global scope and resulting social distancing measures have caused unprecedented economic, lifestyle, and social impacts to personal and relationship well-being. While lockdowns have prompted individuals to increase reliance on intimate partners for support, stressful external contexts can also interfere with partners' capacity to request and provide support, resulting in relationship dissatisfaction and even dissolution. Guided by a risk and resilience framework, this study examined the impact of perceived stress, social contextual factors, and dyadic coping on self-reported relationship satisfaction changes during the initial United States COVID-19 lockdown period. Participants were adults in romantic relationships who completed an online survey between April 13 and June 8, 2020. Overall, survey respondents (N = 1106) reported higher perceived stress levels than established population norms, and small but significant decrements in relationship satisfaction. Multivariable models revealed that higher perceived stress levels were associated with lower relationship satisfaction levels. Additionally, dyadic coping was found to moderate the impact of perceived stress on relationship satisfaction (B =.05, 95% CI =.02–.07), suggesting that engaging in dyadic coping buffered individuals from adverse effects of perceived stress on their relationships. Findings emphasize heightened stress experienced by individuals during the pandemic, potential detrimental effects of stress on couple relationships, and suggest dyadic coping may help buffer couples from adverse effects of the pandemic on their relationships. As such, dyadic coping may be an important target for future interventions designed to assist couples during the ongoing pandemic and future pandemics/natural disasters. [ABSTRACT FROM AUTHOR]

This article analyzes differences in prescription drug pricing transparency practices among 3 Organisation for Economic Co-operation and Development member nations: the United Kingdom, Germany, and Canada. Specifically, this article compares these countries' policies on list and net price disclosures and on how international reference pricing is used to evaluate merits and drawbacks of different pricing transparency approaches. Finally, the article summarizes what policymakers in the United States should learn from these comparisons. [ABSTRACT FROM AUTHOR]

In many parts of the world including the western United States, the allocation of water is governed by complex water laws that dictate who receives water, how much they receive, and when. Because these rules are generally based on the seniority of water rights, they are not necessarily focused on maximizing economic value across the entire economy. The maximization of value from water use economy-wide is a complex optimization problem that must explicitly consider each user's water demand, willingness to pay (WTP) function, and the feedbacks among users in a coupled natural-human system model. In this study, we distill these complexities into a simple MATLAB® model developed to represent a two-user economy with water-dependent sectors representative of agriculture and industry. We feed the model with realistic values of relative water use, relative willingness to pay, and return flows to explore the relationships among these factors in water-limited systems. We find that the total economic value generated from water-dependent users depends primarily on the total water available in the system. However, for a given volume of water available, economic value is not necessarily maximized when all the water is appropriated to the user with the highest WTP. Rather, total economic value depends on the amount of water available, the relative WTP between the two users, and on the return flows generated from each sector's water use. While our simple two-user model is a significant abstraction of the complexities inherent in natural systems, our study provides important insights into the coupled natural-human system dynamics of water allocation and use in water-limited environments. [ABSTRACT FROM AUTHOR]

Introduction: Points of entry (POE) in Pakistan serve as key conduits for international travel, transport, and trade. Central Health Establishment (CHE) is a key stakeholder in the implementation of the International Health Regulations 2005 (IHR) core capacities at POE and National Action Plan 2020 against COVID-19. A comprehensive screening plan for COVID-19 was carried out effectively despite limitations. Methods: A descriptive study on CDC guidelines for health screening at POE was conducted from February 2020 to March 2021. Guidelines are based on 11 attributes to be implemented; these include legal and regulatory bodies to detain the travelers as suspect, isolate, and coordinate at POEs, funds for screening, well-equipped quarantine facilities, referral health care facilities, protocols for primary and secondary screening, capacity building, supply of personal protective equipment and screening tools, and provision of basic facilities at isolation areas. Data were collected using both qualitative and quantitative methods from health officers and quarantine assistants of PoEs. The analysis of CHE's information system was performed to assess the management of traveler surveillance. Results: Eleven attributes were addressed for health screening according to CDC guidelines and well implemented at POE by CHE under the flagship of the MNHR&C. Primary health screening of 4,088,119 inbound travelers was conducted. Secondary health screening led to the referral of performed at airports for inbound travelers, with a positivity rate of 0.32. Conclusion: Preparedness and response for COVID-19 at POE are in line with the National Action Plan of the Government of Pakistan and IHR (2005). [ABSTRACT FROM AUTHOR]

Over twenty years ago, an article by Richard Phelps addressed the benefits of the United States (US) educational system carrying out a complete adoption of the metric system of measurement. Today we find that the US is still in the same position in teaching both measurement systems in schools, which is a financial drain. This study sought to identify the monetary savings that the US would obtain by teaching only the metric system of measurement in today's schools. A cost–benefit analysis of data, used in economics, provided evidence there is great benefit to the US in only teaching the metric system of measures. Calculations show annual savings due to the elimination of English measures from instruction ranging from $1.603 billion to $2.506 billion per year. Over time the total savings would accumulate to a present discounted value of between $53.4 to $83.5 billion. Such savings are significant and should impact policy decisions related to the US transitioning to a full metric conversion. [ABSTRACT FROM AUTHOR]

Neutropenia and febrile neutropenia (FN) are common complications of myelosuppressive chemotherapy. This review provides an up-to-date assessment of the patient and cost burden of chemotherapy-induced neutropenia/FN in the US, and summarizes recommendations for FN prophylaxis, including the interim guidance that was recommended during the coronavirus disease 2019 (COVID-19) pandemic. This review indicates that neutropenia/FN place a significant burden on patients in terms of hospitalizations and mortality. Most patients with neutropenia/FN presenting to the emergency department will be hospitalized, with an average length of stay of 6, 8, and 10 days for elderly, pediatric, and adult patients, respectively. Reported in-hospital mortality rates for neutropenia/FN range from 0.4% to 3.0% for pediatric patients with cancer, 2.6% to 7.0% for adults with solid tumors, and 7.4% for adults with hematologic malignancies. Neutropenia/FN also place a significant cost burden on US healthcare systems, with average costs per neutropenia/FN hospitalization estimated to be up to $40 000 for adult patients and $65 000 for pediatric patients. Evidence-based guidelines recommend prophylactic granulocyte colony-stimulating factors (G-CSFs), which have been shown to reduce FN incidence while improving chemotherapy dose delivery. Availability of biosimilars may improve costs of care. Efforts to decrease hospitalizations by optimizing outpatient care could reduce the burden of neutropenia/FN; this was particularly pertinent during the COVID-19 pandemic since avoidance of hospitalization was needed to reduce exposure to the virus, and resulted in the adaptation of recommendations to prevent FN, which expanded the indications for G-CSF and/or lowered the threshold of use to >10% risk of FN. [ABSTRACT FROM AUTHOR]

Background: Anterior cruciate ligament reconstruction (ACLR) is one of the most commonly performed orthopaedic procedures in the United States, and the number of procedures is increasing annually, as is the cost. Patients are expected to shoulder a larger out-of-pocket expenditure. Purpose: To answer the following questions: (1) How is reimbursement changing for ACLR, and how is this affecting patients' out-of-pocket expenditures? (2) How are reimbursements from payers and patients' out-of-pocket expenses for ACLR distributed, and how is this changing? (3) Does performing ACLR in an ambulatory surgery center (ASC) result in lower costs for payers and patients? Study Design: Economic and decision analysis study; Level of evidence, 4. Methods: A total of 37,763 patients who underwent outpatient primary arthroscopic ACLR in the United States between 2013 and 2017 were identified using the IBM MarketScan Commercial Claims and Encounters Database. Patients with concomitant procedures and revision ACLR were excluded. Recorded outcomes were total patient payments and reimbursed claim totals in US dollars. Results: Day-of-surgery reimbursement decreased 4.3% from $11,536 in 2013 to $11,044 in 2017, while patient out-of-pocket expenses increased 36% from $1085 in 2013 to $1480 in 2017. Day-of-surgery charges were the highest expense for patients, followed by physical therapy and magnetic resonance imaging (MRI) costs. Total reimbursement for MRI decreased 22.5%, while patient out-of-pocket expenses for MRI increased 166%. ACLR performed in an outpatient hospital resulted in 61% greater day-of-surgery expenditure for payers compared with ACLR performed in an ASC; however, the median total patient out-of-pocket savings for ACLRs performed in an ASC versus outpatient hospital was only $11. Conclusion: Out-of-pocket expenses for patients are increasing as they are forced to cover a larger percentage of their health care costs despite overall payer reimbursement decreasing. High-deductible health plans reimbursed the least out of all insurance types while having the highest patient out-of-pocket expenditure. [ABSTRACT FROM AUTHOR]

Research Summary: We examine how learning‐by‐doing (LBD) rates in manufacturing, the extent to which performance depends on own production experience, are associated with firms' diversification decisions. We argue that the LBD rates of industries affect the characteristics of not only the first‐order knowledge that firms generate via operating a particular process but also the second‐order knowledge that firms develop about the learning process itself. We maintain that first‐order knowledge generated via LBD has low transferability; accordingly, firms are less likely to diversify as their industries exhibit higher rates of LBD. We also argue that second‐order knowledge about LBD affects the locus of diversification; specifically, firms are more likely to choose target industries with similar LBD rates. Hypotheses are tested using data from over 350 U.S. manufacturing industries. Managerial Summary: We investigate how manufacturing firms' diversification decisions differ depending on the LBD rates of their industries. LBD rates reflect the extent to which production performance depends on own production experience. Consistent with our argument that production knowledge generated from LBD is difficult to transfer to new contexts, results indicate that firms in high‐LBD industries are less likely to diversify than those in low‐LBD industries. We also argue, however, that firms in high‐LBD industries can develop general know‐how to accelerate LBD and that this know‐how is applicable in other high‐LBD manufacturing contexts. Therefore, they prefer to enter other high‐LBD industries to leverage that know‐how. Our results show that firms are more likely to choose diversification into industries with similar LBD rates. [ABSTRACT FROM AUTHOR]

Policy PointsPolicies that increase county income levels, particularly for middle‐income households, may reduce low birth weight rates and shrink disparities between Black and White infants.Given the role of aggregate maternal characteristics in predicting low birth weight rates, policies that increase human capital investments (e.g., funding for higher education, job training) could lead to higher income levels while improving population birth outcomes.The association between county income levels and racial disparities in low birth weight is independent of disparities in maternal risks, and thus a broad set of policies aimed at increasing income levels (e.g., income supplements, labor protections) may be warranted. Context: Low birth weight (LBW; <2,500 grams) and infant mortality rates vary among place and racial group in the United States, with economic resources being a likely fundamental contributor to these disparities. The goals of this study were to examine time‐varying county median income as a predictor of LBW rates and Black‐White LBW disparities and to test county prevalence and racial disparities in maternal sociodemographic and health risk factors as mediators. Methods: Using national birth records for 1992–2014 from the National Center for Health Statistics, a total of approximately 27.4 million singleton births to non‐Hispanic Black and White mothers were included. Data were aggregated in three‐year county‐period observations for 868 US counties meeting eligibility requirements (n = 3,723 observations). Sociodemographic factors included rates of low maternal education, nonmarital childbearing, teenage pregnancy, and advanced‐age pregnancy; and health factors included rates of smoking during pregnancy and inadequate prenatal care. Among other covariates, linear models included county and period fixed effects and unemployment, poverty, and income inequality. Findings: An increase of $10,000 in county median income was associated with 0.34 fewer LBW cases per 100 live births and smaller Black‐White LBW disparities of 0.58 per 100 births. Time‐varying county rates of maternal sociodemographic and health risks mediated the association between median income and LBW, accounting for 65% and 25% of this estimate, respectively, but racial disparities in risk factors did not mediate the income association with Black‐White LBW disparities. Similarly, county median income was associated with very low birth weight rates and related Black‐White disparities. Conclusions: Efforts to increase income levels—for example, through investing in human capital, enacting labor union protections, or attracting well‐paying employment—have broad potential to influence population reproductive health. Higher income levels may reduce LBW rates and lead to more equitable outcomes between Black and White mothers. [ABSTRACT FROM AUTHOR]

This article discusses issues that arise when service providers place network equipment on publicly owned lands in the United States. Based on land use policy at the Federal Communications Commission, this paper theorizes that the use of public lands for 5G network development will create a moral hazard, as service providers may be tempted to take risks in the way they use public lands. Per economic theory the firm could behave recklessly when knowing that the costs will be borne by someone else – in this case local citizens. This is an example of the moral hazard problem in economics. [ABSTRACT FROM AUTHOR]