The health care sector can be characterized as a complex set of mutual interactions between patients and consumers seeking to enhance personal health status through disease prevention initiatives or by obtaining care for health problems and the professional caregivers who furnish these services. The interactions occur in the wider context of a culture that undergoes steady alterations in ways that contribute to the onset of new health problems. An example of an emerging trend involves cannabis. It was not so long ago that individuals who either used marijuana or distributed it to other users could be incarcerated. Presently, cannabis products are available legally for recreational purposes at commercial dispensaries around the nation. Simultaneously, research findings illustrate some dangers associated with the use of these substances. As reported in the March 5, 2024 issue of the Journal of the American Heart Association, cannabis use has strong, statistically significant associations with adverse cardiovascular outcomes independent of tobacco use. The data suggest that cannabis use may be a risk factor for experiencing cardiovascular disease and premature cardiovascular disease, such as a heart attack and stroke.
Displays by beach goers and athletes on television currently provide evidence that wearing bodily tattoos has entered the mainstream of American life. Tattoo ink often contains carcinogenic chemicals, e.g., primary aromatic amines, polycyclic aromatic hydrocarbons, and metals. The tattooing process invokes an immunologic response that causes translocation of tattoo ink from the injection site. Deposition of tattoo pigment in lymph nodes has been confirmed. In a study reported in the June 2024 issue of the journal cClinical Medicine, tattooed individuals had a higher adjusted risk of overall lymphoma. The results suggest they have a 21% increased risk of overall lymphoma relative to non-tattooed individuals. The authors note that causality cannot be conferred from a single epidemiologic study and acknowledge that more research is needed.
Rural Hospital Closures
According to the May 2024 issue of the Journal of Health Care for the Poor and Underserved, between 1990 and 2020, 334 rural hospitals closed in the United States. Since 2011 hospital closures have outnumbered new hospital openings. A scoping review in that publication evaluates peer-reviewed studies published since 1990 with a focus on rural hospital closures, synthesizing studies across six themes: 1) health care policy environment, 2) precursors to rural hospital closures, 3) economic impacts, 4) effects of rural hospital closures on access to care, 5) health and community impacts, and 6) definitions of rural hospitals and communities. In the 1990s, rural hospitals that closed were smaller, while rural hospitals that closed in the 2010s tended to have more beds. An observation is that given the accelerated rate of hospital closures, more attention should be paid to hospitals that serve rural communities of color and low-income communities. Approximately 46 million individuals live in rural places across the U.S., accounting for nearly 14% of the nation’s population. Rural communities account for two-thirds of primary care health professional shortage areas (HPSAs), a situation exacerbated by their disproportionate risk of hospital closure. Given that rural communities generally are older with higher multi-morbidity and higher preventable mortality, the disparate impact of hospital closures is of great concern.
Politics And Health Spending
Section 508 of Public Law 108-173, the Medicare Prescription Drug, Improvement, and Modernization Act (MMA) of 2003 raised certain hospitals’ regulated payments. A paper in the May 2024 issue of the Journal of Health Economics analyzes the interplay between congressional politics, the actions of the executive branch, and hospitals’ regulated Medicare payments. It shows that Medicare payments are malleable and can be influenced by political dynamics. In the cross-section, hospitals represented by members of Congress who voted “yea” on the MMA were more likely to receive Section 508 payment increases. These increases were designed to win support for the law. They also raised hospitals’ activity and spending. Members of Congress representing recipient hospitals received increased campaign contributions after the increases were extended. Ultimately, the analysis highlights how Medicare payment increases can serve as an appealing tool for legislative leaders working to win votes for wider pieces of legislation.