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When we launched A Health Podyssey in 2020, our goal was to take listeners beyond the research published in Health Affairs.

For A Health Podyssey's one-year anniversary, we wanted to take listeners on an Excursion and speak with someone who epitomizes so much of what brings professionals into the fields of health policy and health services.
  
Ashish Jha from the Brown University School of Public Health is a widely published researcher whose public voice arises from a combination of deep expertise and a unique ability to explain complex concepts in an accessible language. Over the course of the COVID-19 pandemic, Jha's insights on the virus have helped many navigate thorny, complicated public health issues.

Jha's most recent publication in Health Affairs was a commentary article where he and coauthors discussed adding a climate lens to health policy discussion in the U.S. Before joining Brown University, he was at the Harvard T. H. Chan School of Public Health.

Today, Ashish Jha joins Health Affairs' Editor-in-Chief Alan Weil to discuss what he's learned from the COVID-19 pandemic, the bright spots he sees for health care payment reform, and how he uses social media.

This episode is sponsored by the University of Pennsylvania's Master of Health Care Innovation.

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With about 700 pregnancy-related deaths every year, the United States has the worst maternal mortality rates among developed countries.

One response to this crisis has been the creation of state and local maternal mortality review committees (MMRCs), which are multidisciplinary committees that examine the context in which maternal deaths occur.

The October 2021 issue of Health Affairs is focused on the topic of perinatal mental health. MMRC reports provide a treasure trove of information that can help us understand the role perinatal mental health plays in maternal mortality and what it might take to achieve better results.

Susanna Trost, an Oak Ridge Institute for Science and Education Fellow at the Centers for Disease Control and Prevention, joins Health Affairs Editor-in-Chief Alan Weil on A Health Podyssey to discuss addressing perinatal mental health as a factor in maternal mortality.

Trost and co-authors published a paper in the October 2021 issue of Health Affairs analyzing data from 14 state and local MMRCs regarding pregnancy-related maternal death. Studying these determinations from 2008 to 2017, they identified the characteristics of, and factors contributing to, pregnancy-related deaths caused by mental health conditions, including substance use disorder.

They found that mental health conditions are the underlying cause of nearly one-in-nine pregnancy-related deaths, all of which were considered preventable by MMRCs.

This episode is sponsored by the University of Pennsylvania's Master of Health Care Innovation.

If you like this interview, order the October Perinatal Mental Health Theme Issue.

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Postpartum depression is a common condition among people who give birth. Within four weeks of childbirth, 13% of women experience postpartum depression with as many as 19% of women affected three months postpartum.

Mothers who experienced postpartum depression are more likely to experience impaired mother-infant bonding, which has been linked to increased risk for infant maltreatment and socio-emotional behavior and cognitive problems.

Now, acute stress during pregnancy can increase the risk of postpartum depression. The current global COVID-19 pandemic represents a stressor that may have significant repercussions for postpartum depression risk and mother-child relationship development.

Sara Kornfield, assistant professor of psychiatry at the University of Pennsylvania, joins Health Affairs Editor-in-Chief Alan Weil on A Health Podyssey to discuss the relationship between COVID-19, postpartum depression, and mother-infant bonding.

Kornfield and coauthors recently published a paper in the October 2021 issue of Health Affairs - which is dedicated to the topic of perinatal mental health - about mental health and resilience among women who were pregnant during the early lockdown phase of the COVID-19 pandemic. Their analysis suggests prenatal depression is an important risk factor that predicts postpartum depression and uniquely contributes to impaired mother-infant bonding.  

If you like this interview, order the October Perinatal Mental Health Theme Issue.

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Systems of oppression like racism, sexism, and classism lead to poor health outcomes. These factors are a source of poor mental health and have particular implications for pregnant and birthing people.

Black women who face multiple axes of oppression experience higher rates of maternal mental health conditions than the population as a whole. Yet maternal mental health issues among black women are under reported and often under addressed.

Isabel Morgan, director of the Birth Equity Research Scholars Program at the National Birth Equity Collaborative, joins A Health Podyssey to discuss the effects of structural racism on black birthing people's mental health and how we can do better.

Morgan and coauthors published a paper in the October 2021 issue of Health Affairs - which is dedicated to the topic of perinatal mental health - describing what they call pathways to equitable and anti-racist maternal mental health care. Through interviews with black maternal and infant mental health individuals, they identify five key pathways.

Listen to Health Affairs Editor-in-Chief Alan Weil discuss those pathways with Isabel Morgan and other opportunities to improve maternal mental health issues among black women.

If you like this interview, order the October Perinatal Mental Health Theme Issue.

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Mental health conditions, such as mood and anxiety disorders are diagnosed in one of every five pregnant or postpartum people. Despite this high burden of morbidity and mortality and economic costs, perinatal mental illness is poorly addressed by the current US healthcare system.

Jennifer Moore, founding executive director of the Institute for Medicaid Innovation, joins A Health Podyssey to discuss perinatal mental health and what we know about it. Moore was the advisor for the October issue of Health Affairs, which collects a number of articles all on perinatal mental health.

Those papers discuss several dimensions of the issue, including the health and economic costs of poor perinatal mental health; the relationship between mental health and physical health; and the role of race and racism and how the US approaches mental illness among birthing people.

In the issue, Moore co-authored two papers. In the overview, she and colleagues explore policy opportunities to improve the treatment of perinatal mental health conditions. In another paper, Moore and coauthors found that mental health conditions increase severe maternal morbidity by 50% and cost $102 million annually in the US.

Listen to Health Affairs Editor-in-Chief, Alan Weil, interview Jennifer Moore on perinatal mental health and what policy option exist to improve it.

If you like this interview, order the October Perinatal Mental Health Theme Issue.

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Most office workers think of paid sick leave as a benefit for them and their family members, but there are societal benefits to paid sick leave as well.

Since 1993, the United States has guaranteed access to unpaid sick leave through the Family and Medical Leave Act (FMLA) but that guarantee leaves out a large number of workers. A growing number of US states and localities have sought to fill-in some gaps of the FMLA, but many remain.

Jody Heymann from the University of California, Los Angeles joins A Health Podyssey to talk about access to sick leave, both paid and unpaid.

Heymann and colleagues published a paper in the September 2021 issue of Health Affairs documenting how FMLA eligibility requirements contribute to racial and ethnic disparities. They found that FMLA eligibility restrictions exclude over half of private sector and self-employed workers from coverage. In addition, they found higher rates of exclusion among female black, Indigenous and multi-racial workers.

Join the conversation and listen as Health Affairs Editor-in-Chief Alan Weil interviews Jody Heymann about why the US stands alone globally in having such a limited safety net for sick leave — and what it means for population health.

If you like this interview, order the September issue of Health Affairs.

Order the October Perinatal Mental Health Theme Issue.

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Roughly 6 million adults ages 65 and older in the United States have dementia. That number is projected to more than double by 2050.

Family caregivers play an essential role in caring for people with dementia, including help with dressing to eating assistance and more.

In 2020, it's estimated that more than 11 million family members and other unpaid caregivers provided care to people with dementia. But what about those who don't have family members who can provide this needed care?

HwaJung Choi, a research assistant professor from the University of Michigan, joins A Health Podyssey to talk about the availability of family members to provide care to adults with dementia.

Choi and colleagues published a paper in the September 2021 issue of Health Affairs which found that 18% of dementia patients received care from their spouse and 27% received it from an adult child.

The authors also identified racial disparities in caregiver availability, and much more.

Listen to Health Affairs Editor-in-Chief Alan Weil interview HwaJung Choi on family care availability and implications for informal and formal care used by American adults with dementia.

If you like this interview, order the September issue of Health Affairs.

Pre-order the October Perinatal Mental Health Theme Issue.

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Recent reports suggest about six-tenths of a percent of the United States population, or 1.4 million people, identify as transgender. Transgender individuals are people whose personal and gender identity are different from the gender they were thought to be at birth.

Good information about the health status of this group has been hard to come by although research is growing. Some data come from Medicare, which is useful but not representative of the population as a whole.

Landon Hughes, a doctoral candidate at the University of Michigan, joins A Health Podyssey to discuss a paper he and coauthors published in the September issue of Health Affairs describing the morbidity of privately-insured, transgender individuals as compared to cisgender people, or those whose personal identity and gender corresponds with their birth sex.

Using insurance claims data from 2001 to 2019, Hughes and colleagues report that transgender people were at an overall greater risk for morbidity than their cisgender counterparts across a broad range of conditions.

If you like this interview, order the September issue of Health Affairs.

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The US government reports that the total spending on hospital care in 2019 was almost $1.2 trillion. High and highly variable hospital prices have been in the news recently in part due to new information made available under the price transparency rules implemented by the Trump administration.

Competitive markets are supposed to constrain prices, but in much of the US, there's little competition among hospitals and consolidation throughout the healthcare sector has contributed to that consolidation. The result is a number of proposals to regulate health care prices in general and for hospital prices in particular.

Leemore Dafny from the Harvard Business School and Harvard Kennedy School joins Health Affairs Editor-in-Chief Alan Weil to discuss her latest research on hospital prices and market concentration.

Dafny and colleagues published a paper in the September 2021 issue of Health Affairs analyzing hospital prices and relating them to market concentration. The authors found the relationship isn't as straightforward as one might expect — but the findings still have major implications for any consideration of regulating hospital prices.

If you like this interview, order the September issue of Health Affairs.

Pre-order the October Perinatal Mental Health Theme Issue.

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The quality-adjusted life-year (QALY) combines the expected effects on longevity and the expected effects on quality-of-life into a single standard measure. QALYs are often used as part of cost effectiveness analysis, particularly when analyzing the effectiveness of drugs.

QALY as a measurement has received a lot of criticism. It's been criticized in concept or in the specifics of how it's defined or used. This criticism often forms the basis for opposition to price negotiations or any limitations on access to a particular drug.

This kind of criticism can make it difficult to reach a consensus on processes that might yield negotiated or regulated drug prices.

Leah Rand, a postdoctoral fellow at Harvard Medical School and Brigham and Women’s Hospital, joins A Health Podyssey to talk about QALY, its criticism, and how to respond to that criticism.

Rand and coauthor Aaron Kesselheim published in the September 2021 issue of Health Affairs a systematic literature review of critiques of QALYs and their relevance to drug health technology assessments.

They identify three main categories of ethical and practical critiques of QALYS, including methodological concerns, criticisms of neutrality, and potential discrimination.

Rand and Kesselheim conclude that understanding and addressing criticism of the QALY is essential for the move to value-based pricing.

Listen as Health Affairs Editor-in-Chief Alan Weil interviews Leah Rand on the pros and cons of the Quality Adjusted Life Year measurement in health policy.

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