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1. Mental Health Conditions and Substance Use: Comparing U.S. Needs and Treatment Capacity with Those in Other High-Income Countries

Author:
Melinda K. Abrams, Reginald D. Williams II, Katharine Fields, and Roosa Tikkanen
Publication Date:
05-2021
Content Type:
Special Report
Institution:
The Commonwealth Fund
Abstract:
About one-quarter of U.S. adults report having a mental health diagnosis such as anxiety or depression or experiencing emotional distress. This is one of the highest rates among 11 high-income countries. While U.S. adults are among the most willing to seek professional help for emotional distress, they are among the most likely to report access or affordability issues. Emotional distress is associated with social and economic needs in all countries. Nearly half of U.S. adults who experience emotional distress report such worries, a higher share than seen in other countries. The United States has some of the worst mental health–related outcomes, including the highest suicide rate and second-highest drug-related death rate. The U.S. has a relatively low supply of mental health workers, particularly psychologists and psychiatrists. Just one-third of U.S. primary care practices have mental health professionals on their team, compared to more than 90 percent in the Netherlands and Sweden.
Topic:
Health, Health Care Policy, Mental Health, Drugs, and Substance Abuse
Political Geography:
United States, Europe, and Global Focus

2. Maternal Mortality and Maternity Care in the United States Compared to 10 Other Developed Countries

Author:
Laurie Zephyrin, Molly FitzGerald, Munira Z. Gunja, and Roosa Tikkanen
Publication Date:
11-2020
Content Type:
Policy Brief
Institution:
The Commonwealth Fund
Abstract:
The U.S. has the highest maternal mortality rate among developed countries. Obstetrician-gynecologists (ob-gyns) are overrepresented in its maternity care workforce relative to midwives, and there is an overall shortage of maternity care providers (both ob-gyns and midwives) relative to births. In most other countries, midwives outnumber ob-gyns by severalfold, and primary care plays a central role in the health system. Although a large share of its maternal deaths occur postbirth, the U.S. is the only country not to guarantee access to provider home visits or paid parental leave in the postpartum period.
Topic:
Health, Health Care Policy, Women, and Reproductive Health
Political Geography:
United States and Global Focus

3. Do Americans Face Greater Mental Health and Economic Consequences from COVID-19? Comparing the U.S. with Other High-Income Countries

Author:
Michelle M. Doty, Eric C. Schneider, Roosa Tikkanen, Arnav Shah, and Reginald D. Williams II
Publication Date:
08-2020
Content Type:
Special Report
Institution:
The Commonwealth Fund
Abstract:
With more than 4 million confirmed cases and 150,000 deaths as of August, the United States is failing to control the COVID-19 pandemic. At a time when many nations are reopening their economies and societies, the U.S. is struggling in its attempts to do the same. To examine the early impact of the pandemic on the well-being of adults in the U.S. and abroad, the Commonwealth Fund joined the survey research firm SSRS to interview 8,259 adults age 18 and older between March and May 2020. It is the latest in the Commonwealth Fund’s series of cross-national comparisons featuring the United States and nine other high-income countries that participate in the Fund’s annual International Health Policy Survey. The following exhibits illustrate COVID-19’s effects on people’s mental health and economic security and compare levels of public trust in national leaders in responding to the pandemic.
Topic:
Health, Health Care Policy, Mental Health, and Public Health
Political Geography:
United States, Europe, and Global Focus

4. Bundled-Payment Models Around the World: How They Work and What Their Impact Has Been

Author:
Meredith B. Rosenthal, Paul F. van Gils, Caroline A. Baan, Eline F. de Vries, and Jeroen Struijs
Publication Date:
04-2020
Content Type:
Special Report
Institution:
The Commonwealth Fund
Abstract:
We identified 23 initiatives in eight countries that have implemented bundled-payment models, focusing on procedures such as total joint replacements and cardiac surgery, as well as chronic conditions like diabetes and breast cancer. Of the 35 studies retrieved, 32 reported effects on quality of care and 32 reported effects on medical spending. Twenty of 32 studies reported modest savings or a modest reduction in spending growth, while two studies (both based on the same initiative) demonstrated increased spending in the early years of the bundled-payment model’s implementation. Eighteen of 32 studies reported quality improvements for most evaluated measures, while other studies showed no difference in measured quality. Our study provides evidence that bundled-payment models have the potential to reduce medical spending growth while having either a positive impact or no impact on quality of care.
Topic:
Economics, Health, Health Care Policy, Income Inequality, Macroeconomics, Coronavirus, and COVID-19
Political Geography:
United States and Global Focus

5. U.S. Health Care from a Global Perspective, 2019: Higher Spending, Worse Outcomes?

Author:
Roosa Tikkanen and Melinda K. Abrams
Publication Date:
01-2020
Content Type:
Special Report
Institution:
The Commonwealth Fund
Abstract:
A 2015 Commonwealth Fund brief showed that — before the major provisions of the Affordable Care Act were introduced — the United States had worse outcomes and spent more on health care, largely because of greater use of medical technology and higher prices, compared to other high-income countries. By benchmarking the performance of the U.S. health care system against other countries — and updating with new data as they become available — we can gain important insights into our strengths and weaknesses and help policymakers and delivery system leaders identify areas for improvement. This analysis is the latest in a series of Commonwealth Fund cross-national comparisons that uses health data from the Organisation for Economic Co-operation and Development (OECD) to assess U.S. health care system spending, outcomes, risk factors and prevention, utilization, and quality, relative to 10 other high-income countries: Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, and the United Kingdom. We also compare U.S. performance to that of the OECD average, comprising 36 high-income member countries.
Topic:
Health and Health Care Policy
Political Geography:
United States, Europe, and Global Focus

6. An Expanded View of Government’s Role in Providing Social Insurance and Investing in Children

Author:
Sandra E. Black and Jesse Rothstein
Publication Date:
01-2019
Content Type:
Policy Brief
Institution:
Economics for Inclusive Prosperity (EfIP)
Abstract:
While private provision of goods often yields the efficient outcome, there are a number of goods that are not efficiently provided in the private market. Here, we outline two such situations: investments in child care and education, and insurance against risks created by business cycles, poor health, and old age. Because private markets work poorly for these goods, and the costs of market failure are large, standard economic reasoning implies a significant role for government provision. The reduction in economic insecurity that this would bring could help to improve political stability as well, by reducing the stakes that people perceive in discussions of trade, immigration, technological change, and countercyclical policy (Inglehart and Norris, 2016). Many observers (e.g, Hacker, 2018) have pointed to economic anxiety as a potential contributor to populist reactions in the U.S. and many European countries; a public sector that acts to reduce the risk that households face could ameliorate this, generating political spillovers and improving the state of the country more broadly.
Topic:
Economics, Education, Health, Health Care Policy, Children, Economic Policy, and Economic Theory
Political Geography:
United States and Europe

7. Thoughts on Medicare for All

Author:
Ilyana Kuziemko
Publication Date:
07-2019
Content Type:
Policy Brief
Institution:
Economics for Inclusive Prosperity (EfIP)
Abstract:
My read of the evidence (and my own social welfare weights, which place great weight on the un- and under-insured as well as middle-class workers who are implicitly taxed via expensive health plans) lead me to conclude that Medicare for All would increase welfare in the US. However, I also want to highlight what I consider the biggest risks of such a policy.
Topic:
Economics, Health, Health Care Policy, and Economic Policy
Political Geography:
United States

8. Affluence, Risk and Community Engagement: The Case of Ascon and Huntington Beach

Author:
David P. Adams, Meriem Doucette, and Justin Tucker
Publication Date:
06-2019
Content Type:
Journal Article
Journal:
California Journal of Politics and Policy
Institution:
Institute of Governmental Studies, UC Berkeley
Abstract:
This paper explores the engagement and mobilization of an affluent community in relation to a known environmental hazard. It extends our understanding of individual responses to environmental risk and provides at least one response to the long-unanswered question: how would affluent communities respond to hazardous sites? Despite the contention that these resource-rich communities will respond differently than the less affluent communities that traditionally have these environmental hazards, we find no meaningful difference in their mobilization and engagement. Despite their perception of risk associated with the Ascon landfill in Huntington Beach and relatively little trust in government to clean up the site, the community is largely unwilling to engage in activities related to site cleanup. This is an important contribution to our understanding of what generates individual action for environmental hazards and compels us to re-examine our understanding of what (if any) role socio-economic status plays in an individual’s response.
Topic:
Environment, Health, and Public Health
Political Geography:
United States and California

9. Transitory Legality: The Health Implication of Ending DACA

Author:
Marie L. Mallet and Lisa Garcia Bedolla
Publication Date:
06-2019
Content Type:
Journal Article
Journal:
California Journal of Politics and Policy
Institution:
Institute of Governmental Studies, UC Berkeley
Abstract:
This paper examines the effects of the rescission announcement of the DACA program on the health outcomes of Latino DACA recipients in California. Research shows that undocumented immigrants face poorer health outcomes than their documented counterparts and U.S. citizens, and that being offered legal status (e.g. DACA) considerably improves their health outcomes. Even though studies have examined the impact of shifting legal status on incorporation, to our knowledge no studies have considered the effects of announcing the rescission of the DACA program on its recipients. However, this is important because it may have implications on their health outcomes. This study addresses this gap by using in-depth interviews with 43 Latino DACA recipients living in the California San Francisco Bay Area in 2017 and 2018. Our findings suggest that rescission announcement of DACA has led to worsening health outcomes for DACA recipients. Specifically, we find that it created what we call a state of transitory legality among the 1.5 generation, which causes DACA recipients to experience health outcomes that are worse than those before DACA. Our results are important in the field of sociology, public policy and heath care because they show the negative effects of reversing inclusionary immigration policies on the health outcomes of undocumented Latino immigrants.
Topic:
Health, Immigration, Citizenship, Immigrants, and Public Health
Political Geography:
United States and California

10. The Contributions of Socioeconomic and Opioid Supply Factors to Geographic Variation in U.S. Drug Mortality Rates

Author:
Shannon Monnat
Publication Date:
02-2019
Content Type:
Working Paper
Institution:
Institute for New Economic Thinking (INET)
Abstract:
Over the past two decades deaths from opioids and other drugs have grown to be a major U.S. population health problem, but the magnitude of the crisis varies across the U.S., and explanations for widespread geographic variation in the severity of the drug crisis are limited. An emerging debate is whether geographic differences in drug mortality rates are driven mostly by opioid supply factors or socioeconomic distress. To explore this topic, I examined relationships between county-level non-Hispanic white drug mortality rates for 2000-02 and 2014-16 and several socioeconomic and opioid supply measures across the urban-rural continuum and within different rural labor markets. Net of county demographic composition, average non-Hispanic white drug mortality rates are highest and increased the most in large metro counties. In 2014-16, the most rural counties had an average of 6.2 fewer deaths per 100,000 population than large metro counties. Economic distress, family distress, persistent population loss, and opioid supply factors (exposure to prescription opioids and fentanyl) are all associated with significantly higher drug mortality rates. However, the magnitude of associations varies across the urban-rural continuum and across different types of rural labor markets. In rural counties, economic distress appears to be a stronger predictor than opioid supply measures of drug mortality rates, but in urban counties, opioid supply factors are more strongly associated with drug mortality rates than is economic distress. Ultimately, the highest drug mortality rates are disproportionately concentrated in economically distressed mining and service sector dependent counties with high exposure to prescription opioids and fentanyl.
Topic:
Economics, Health, Inequality, Macroeconomics, and Drugs
Political Geography:
United States