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The public health success of diabetic retinopathy (DR) screening programs depends on patients’ adherence to the timetable of follow-up eye care recommended by the screening program. African Americans are among those at highest risk for DR and have one of the lowest rates of eye care use. ... After a DR screening program in a public clinic largely serving an African American population, only one-third of participants adhered to interval recommendations for follow-up eye appointments, even though cost and accessibility were minimized as barriers to care. Our findings suggest that DR screening programs are not likely to meet their public health goals without incorporation of eye health education initiatives successfully promoting adherence to recommended comprehensive eye care for preventing vision loss. (Keenum et al., 9/15)

Patient cost sharing for contraceptive prescriptions was eliminated for certain insurance plans as part of the Affordable Care Act. ... we examined the contraceptive choices made by women in employer groups whose coverage complied with the mandate, compared to the choices of women in groups whose coverage did not comply. We found that the reduction in cost sharing was associated with a 2.3-percentage-point increase in the choice of any prescription contraceptive, relative to the 30 percent rate of choosing prescription contraceptives before the change in cost sharing. A disproportionate share of this increase came from increased selection of long-term contraception methods. Thus, the removal of cost as a barrier seems to be an important factor in contraceptive choice. (Carlin, Fertig and Dowd, 9/7)

We analyzed insurance claims for 635,075 women with employer-sponsored insurance who were initiating use of the pill, to examine rates of discontinuation and nonadherence, their relationship with cost sharing, and trends before and during the first year after implementation of the ACA mandate. We found that cost sharing for oral contraceptives decreased markedly following implementation, more significantly for generic than for brand-name versions. Higher copays were associated with greater discontinuation of and nonadherence to generic pills than was the case with zero copayments. Discontinuation of the use of generic or brand-name pills decreased slightly but significantly following ACA implementation, as did nonadherence to brand-name pills. Our findings suggest a modest early impact of the ACA on improving consistent use of oral contraceptives among women initiating their use. (Pace, Dusetzina and Keating, 9/7)

Block grants and per capita caps have been proposed as mechanisms for controlling Medicaid expenditures. Block grants would allocate money to states based on current overall spending levels in each state, and per capita caps would allocate funds based on current spending per enrollee. In this brief we show that federal spending (adjusted for the size of each state’s low income population) varies across states by more than 5 to 1 and spending per enrollee varies on the order of 2 to 1. In general, high income states will get larger block grants and higher spending per enrollee caps because they spend more today. These disparities would be locked in under these kinds of proposals. (Holahan and Buettgens, 9/8)

Data from the 2012 School Health Policies and Practices Study indicated that 79.9% of school districts required schools to have a comprehensive plan that includes provisions for students and staff members with special needs, whereas 67.8% to 69.3% of districts required plans that addressed family reunification procedures, procedures for responding to pandemic influenza or other infectious disease outbreaks, and provision of mental health services for students, faculty, and staff members, after a crisis. (Silverman et al., 9/16)

The number of physician practices owned by hospitals and health systems jumped 86% from 2012 to 2015, according to a survey conducted by Avalere Health for the Physicians Advocacy Institute (PAI). The number of physicians employed by hospitals increased by nearly 50% during the same period, from 95,000 doctors in 2012 to more than 140,000 physicians in 2015, the survey shows. (Terry, 9/14)

Exposing physicians to a tool to identify high variability in costs and outcomes on a patient encounter level reduced costs and improved quality within three key areas in a large healthcare system, according to a new study published in the September issue of JAMA. The gains were found in total hip and knee joint replacements, hospitalists' use of laboratory services, and management of sepsis. (Frellick, 9/14)

In the United States, 25 states have legalized medical marijuana, including 19 that let patients with a prescription buy pot from dispensaries. Proponents argue that expanding the availability of medical marijuana reduces opioid abuse and overdose deaths because it gives people an alternative for pain relief. About 3 out of 5 opioid overdoses occur in people with legitimate prescriptions for pain pills. These are the people who might opt for medical marijuana instead. Three recent studies support that claim. (Begley, 9/14)

The more that vaping takes hold in England, the better the odds that smokers there will succeed in their attempts to stop using regular cigarettes. These parallel trends, reported Wednesday in the BMJ medical journal, don’t prove that electronic cigarettes help smokers kick the habit. But that possibility is looking more and more likely, experts said. (Kaplan, 9/13)