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The prevalence of hepatitis C virus (HCV) in U.S. prisoners is high; however, HCV testing and treatment are rare. Infected inmates released back into society contribute to the spread of HCV in the general population. [Researchers sough to] evaluate the health and economic effect of HCV screening and treatment in prisons on the HCV epidemic in society. ... Implementing risk-based and opt-out screening could diagnose 41 900 to 122 700 new HCV cases in prisons in the next 30 years. Compared with no screening, these scenarios could prevent 5500 to 12 700 new HCV infections caused by releasees, wherein about 90% of averted infections would have occurred outside of prisons. HCV screening could also prevent 4200 to 11 700 liver-related deaths. (He et al., 11/24)

Efforts to maximize the value of our health care dollars have focused on situations where expensive therapies are used when less costly, equally effective options are available. The underuse of generic medications is an important example. Prescription drugs now account for more than $325 billion in annual spending in the United States and play a central role in the management of chronic disease, yet physicians and other providers frequently treat patients with more expensive brand-name products even when equally effective, well-proven, and less expensive generic therapies are available. The purpose of this article is to help guide internists and other clinicians in making high-value, cost-conscious decisions about the use of generic drugs. (Choudhry et al., 11/24)

The Affordable Care Act (ACA) gave the Centers for Medicare and Medicaid Services (CMS) broad authority to test out new payment models that have the potential to reduce Medicare spending .... CMS is testing a variety of new approaches , including paying providers for episodes of care instead of for each service provided. The Bundled Payments for Care Improvement (BPCI) initiative tests four different models .... One model focuses on care provided during the hospital stay, while the other three models include postacute care provided once the patient is released from the hospital. ... This brief describes the different models being tested and CMS's experience with the project to date. (Cassidy, 11/23)

The health sector is still characterized by (1) the predominance of fixed-rate payment incentives that fragment care ...; (2) a fragmented system of health care purchasers ...; and (3) a powerful provider sector that is increasingly consolidated and able to exert more leverage over prices .... Although insurers are also consolidating, there is little hope that ... would temper the “must-have” providers’ ability to negotiate rates that permit extravagant profits .... State-based rate setting can support a better-functioning health care market: it has a positive record of addressing both what hospitals can charge and receive in payment and protecting against the volume increases .... Successful all-payer systems require the development of a politically independent regulatory body that is free of conflicts of interest and resistant to both industry capture and political meddling. (Berenson, 11/17)

[T]here is no centralized source of information that tracks what share of nonprofit employers have requested an accommodation [for religiously affiliated nonprofit employers that argue the health law's requirement to provide contraceptive coverage violates their religious rights] .... Based on employer responses in the Kaiser Family Foundation/Health Research & Education Trust (Kaiser/HRET) 2015 Annual Employer Benefits Survey, overall 3% of nonprofits offering health benefits (with 10 or more workers) reported that they elected the accommodation. Only 2% of very small nonprofits offering health benefits (with between 10 and 49 workers) reported that they elected the accommodation. ... 10% of nonprofits with 1,000 to 4,999 workers, and 10% of nonprofits with over 5,000 workers reported that they elected the accommodation. (Sobel, Rae and Salganicoff, 12/1)

[This report] provides information on how insurance changed under the ACA, how many people remain uninsured, who they are, and why they lack health coverage. ... even with the ACA, ... millions of people [are left] without coverage. Approximately half of the remaining uninsured are outside the reach of the ACA either because their state did not expand Medicaid, they do not meet immigration rules, or their income makes them ineligible for financial assistance. The remainder are eligible for assistance under the law but may still struggle with affordability and knowledge of options .... For both eligible and ineligible remaining uninsured people, health care needs persist regardless of insurance status, underscoring the importance of safety net providers. (Majerol, Newkirk and Garfield, 11/13)

White and black patients reported severe pain with the same frequency — about 59 percent. But after controlling for age, insurance status, income, degree of pain and other variables, the researchers found that compared with non-Hispanic white people, non-Hispanic blacks and other minorities were 22 percent to 30 percent less likely to receive pain medication. Patients were also less likely to receive pain medicine if they were over 75 or male, lacked private insurance or were treated at a hospital with numerous minority patients. The study is in the journal Medical Care. (Bakalar, 11/30)

Medicare recipients who have arthritis, cancer or other complex conditions may find they have to pay thousands of dollars a year for their medications, even if their insurance plan covers most prescriptions. For 2016 the out-of-pocket costs can reach as high as $11,538 for a single drug — far more than the maximum catastrophic threshold of $4,850 for Medicare beneficiaries, according to an analysis of Medicare Part D drug coverage released Tuesday by the Kaiser Family Foundation and Georgetown University's Health Policy Institute. (Kodjak, 12/3)

After a year of treatment with the drug ranibizumab (Lucentis), some people with vision loss due to diabetes regain their confidence to drive and have vision good enough to do so, according to a new study. Seeing well enough to drive confidently is an important measure of independence, the authors write. Up to 45 percent of people in the U.S. with type 1 or type 2 diabetes have some level of vision loss, most commonly diabetic retinopathy. And half of those with retinopathy will develop diabetic macular edema (DME), a fluid build-up in the retina that affects sharp, straight-ahead vision, according to the National Eye Institute. (Doyle, 11/26)

Parents who go online to find out about the vaccine for human papillomavirus (HPV), a sexually transmitted disease that causes cervical cancer, may have a hard time finding accurate information, a recent U.S. study suggests. In the U.S., the HPV vaccine is recommended for children at age 11 or 12 years, with the goal of protecting them against the virus before they become sexually active, and also for teens and young adults who may not have previously been vaccinated. (Rapaport, 11/27)

Fewer than 1 in 10 cardiologists in the U.S. are women, and those who do choose this male-dominated specialty earn less money, according to a new study. Researchers adjusted for differences in job characteristics, like how much time a doctor is on-call, the types of practices doctors worked in and other factors, and still found women cardiologists making slightly less. (Doyle, 11/18)

When it costs more to smoke, fewer babies die, according to a new study that links rising cigarette taxes with declines in infant mortality, especially among blacks. With nearly 4 million annual births nationwide, the results suggest that a $1 increase in cigarette taxes would be expected to lead to 750 fewer infant deaths each year, the researchers said. (Tanner, 12/1)

Women who have an abnormal mammogram should stay vigilant for cancer for for the next decade, even when follow-up tests fail to detect cancer, a study released Wednesday finds. That's because there's a "modest" risk that cancer will develop during the next decade, says lead author Louise M. Henderson of the University of North Carolina School of Medicine in Chapel Hill. (Neighmond and Neel, 12/2)

The cost of prescription skin treatments has skyrocketed since 2009, as the burden of escalating drug prices increasingly weighs on family budgets. Retail prices have surged 401 percent since 2009 for brand-name drugs for skin conditions, according to research published in JAMA Dermatology, a medical journal. That compares to an overall inflation rate of just 11 percent during the same period. (Boak, 11/26)

Sitting around watching TV and not doing any physical activity as a young adult may cause a decline in brain functioning even earlier than scientists had thought, according to a new study. Researchers at the Northern California Institute for Research and Education analyzed data from a 25-year-long study of more than 3,200 18-to 30-year-olds. Those who reported watching the most TV (usually more than three hours a day) and doing the least physical activity (usually less than two and half hours a week) had the worst decline in cognitive functioning over the course of the study, even before the participants were middle-aged. (Luscombe, 12/2)

Mandibular advancement devices are almost as effective as continuous positive airway pressure (CPAP) for lowering blood pressure in patients with obstructive sleep apnea, according to a systematic review and meta-analysis. The analysis showed slightly greater systolic and diastolic blood pressure (BP) reductions in patients treated with CPAP, but the difference was not statistically significant, wrote Daniel Bratton, PhD, of University Hospital Zurich, and colleagues, in the Journal of the American Medical Association. (Boyles, 12/2)