A Health Podyssey

This episode is brought to you by Semafor Healthcare.

Delivered weekly from David Lim, Semafor Healthcare connects the dots between decisions in government, business, and technology to reveal how they impact the future of healthcare. Each edition will provide the analysis you need to understand and stay ahead of a rapidly changing landscape. Subscribe for free.

Out of about 5,000 community hospitals in the United States, almost 3,000 are nonprofit. More than a thousand are investor-owned, also called for-profit. The balance are owned by state or local governments.

Nonprofit hospitals, like all nonprofit organizations, must have a charitable mission and for hospitals that mission is generally expressed as providing charity care and various benefits to the community.

In exchange, nonprofit hospitals are exempt from various taxes, they can receive tax-deductible charitable donations and they may have access to tax-exempt bonds.

There's a longstanding debate regarding whether nonprofit hospitals deserve the benefits they receive and whether nonprofit hospitals really behave all that differently from investor-owned hospitals.

Jill Horwitz from the UCLA School of Law joins A Health Podyssey to discuss the similarities and differences in hospital behavior based upon ownership.

Horwitz and Austin Nichols published a paper in the March issue of Health Affairs exploring the relationship between urban hospitals ownership type and which service lines they offer. They found that for-profits, nonprofits, and government-owned hospitals are all more likely to offer a service if its profitable but for-profit hospitals are overall more responsive to service profitability than nonprofits.

If you enjoy this interview, order the March 2022 Health Affairs issue to get research on hospitals, health equity, care delivery and more.

Listen to Health Affairs Pathways.

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This episode is brought to you by Semafor Healthcare.

Delivered weekly from David Lim, Semafor Healthcare connects the dots between decisions in government, business, and technology to reveal how they impact the future of healthcare. Each edition will provide the analysis you need to understand and stay ahead of a rapidly changing landscape. Subscribe for free.

Racism is a social phenomenon. Even though the medical research community has historically relied heavily on racism that treated Black bodies as property that could be experimented upon, clinical medicine has actually been pretty slow to accept racism as a legitimate topic of examination.

Health services, with its ties to the social sciences, has been somewhat more accepting of the notion that racism is a topic worthy of scholarly inquiry. However, direct discourse about racism has been limited.

Despite the squeamishness of mainstream institutions when it comes to talking about racism, a significant and robust body of research has arisen, demonstrating a direct link between racism and health.

Ruth Enid Zambrana from the University of Maryland joins A Health Podyssey to discuss the rich intellectual history of scholarship on racism and health.

Zambrana and coauthor David Williams published a paper in the February 2022 issue of Health Affairs, an issue devoted entirely to the topic of racism and health, tracing the scholarly origins of the understanding of racism as a social determinant of health.

If you enjoy this interview, order the February 2022 Health Affairs Racism & Health theme issue.

Listen to Health Affairs Pathways.

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Subscribe to Semafor Healthcare for free.

This episode is brought to you by Semafor Healthcare.

Delivered weekly from David Lim, Semafor Healthcare connects the dots between decisions in government, business, and technology to reveal how they impact the future of healthcare. Each edition will provide the analysis you need to understand and stay ahead of a rapidly changing landscape. Subscribe for free.

There are more than 22 million people of Asian descent living in the United States. In the aggregate, Asian Americans have mostly better economic and health outcomes than other groups, including White Americans.

Yet within the broad category of Asian Americans, there are dozens of subgroups often with quite different health outcomes and lived experiences. This within-group heterogeneity is often lost, buried under the so-called model minority myth, which is used to deny attention to unmet needs among Asian Americans and to denigrate the experience of other minority groups such of those of Black and Hispanic Americans.

One subset of the larger Asian American population is people whose history traces to the Philippines. 

The relationship between the United States and the Philippines is unique and this history and present day status affect the health of Filipino Americans.

Melanie Sabado-Liwag from California State University, Los Angeles joins A Health Podyssey to discuss the paper she and coauthors published in the February 2022 issue of Health Affairs, an issue devoted entirely to the topic of racism and health. They wrote about the ongoing impact of colonialism and racism on the health inequities faced by Filipino Americans.

Sabado-Liwag and coauthors note that despite Filipino Americans high educational attainment and high employment rates, they still face significant health disparities. 

If you enjoy this interview, order the February 2022 Health Affairs Racism & Health theme issue.

Listen to Health Affairs Pathways.

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Subscribe to Semafor Healthcare for free.

This episode is brought to you by Semafor Healthcare.

Delivered weekly from David Lim, Semafor Healthcare connects the dots between decisions in government, business, and technology to reveal how they impact the future of healthcare. Each edition will provide the analysis you need to understand and stay ahead of a rapidly changing landscape. Subscribe for free.

In a bonus episode of A Health Podyssey, Harriet Washington discusses the history of racism in medicine and research with Vabren Watts, Health Affairs’ director of health equity, and Aletha Maybank, chief health equity officer and senior vice president of the American Medical Association.

Washington is the author of several books on medical ethics, including Medical Apartheid: The Dark History of Medical Experimentation on Black Americans from Colonial Times to the Present.

This featured podcast coincides with the release of "Racism & Health," the February 2022 issue of Health Affairs. Alongside the publication of this special issue, it was important for Health Affairs to provide historical context about the impact of racism on health to inform the research published in the issue.

Listeners can view the video recording of this interview on our website and YouTube page.

Get your copy of the Racism & Health theme issue today.

Find out more on Racism & Health.

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Subscribe to Semafor Healthcare for free.

This episode is brought to you by Semafor Healthcare.

Delivered weekly from David Lim, Semafor Healthcare connects the dots between decisions in government, business, and technology to reveal how they impact the future of healthcare. Each edition will provide the analysis you need to understand and stay ahead of a rapidly changing landscape. Subscribe for free.

Racism manifests in different ways for different people in different environments.

For many Black women, experiences with sexual and reproductive health reveal cross-cutting themes of racism, sexism, and classism, all expressed in the context of strong social norms and prejudices regarding Black women and reproduction. 

Attention to poor health outcomes for Black women has grown recently in part due to stories of negative maternity experiences of prominent Black women, such as Serena Williams. Congress has gotten into the act as well and taken steps to address the crisis of high rates of maternal mortality among Black women. 

But what are the individual experiences behind this crisis?

Monica Simpson, executive director of Sister Song, joins A Health Podyssey to discuss a paper her and coauthors published in the February 2022 issue of Health Affairs, an issue devoted entirely to the topic of racism and health. They examined the reproductive health experiences of Black women in the South.

They found that Black women's experiences navigating sexual and reproductive care were informed by both structural and individual racism, often leading to poorer quality care and likely worst health outcomes.

If you enjoy this interview, order the February 2022 Health Affairs Racism & Health theme issue.

Listen to Health Affairs Pathways.

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Subscribe to Semafor Healthcare for free.

This episode is brought to you by Semafor Healthcare.

Delivered weekly from David Lim, Semafor Healthcare connects the dots between decisions in government, business, and technology to reveal how they impact the future of healthcare. Each edition will provide the analysis you need to understand and stay ahead of a rapidly changing landscape. Subscribe for free.

Listen to this bonus episode from Health Affairs' Narrative Matters podcast, which highlights personal stories from the front lines of care. 

In this episode, host Jessica Bylander interviews Wanda Irving, chair of the board of Dr. Shalon’s Maternal Action Project, before Irving reads an essay from the February 2022 issue of Health Affairs, dedicated to the theme of racism and health.

This essay remembers the life and legacy of Shalon Irving, whose 2017 death brought national attention to maternal mortality among Black women in the US.

Subscribe to the Narrative Matters Podcast.

If you enjoy this essay, order the February 2022 Health Affairs Racism & Health theme issue.

Subscribe to Semafor Healthcare for free.

This episode is brought to you by Semafor Healthcare.

Delivered weekly from David Lim, Semafor Healthcare connects the dots between decisions in government, business, and technology to reveal how they impact the future of healthcare. Each edition will provide the analysis you need to understand and stay ahead of a rapidly changing landscape. Subscribe for free.

"Members of racial and ethnic minority groups have long suffered from health inequities in the United States. These inequities result, in large part, from racial and ethnic minority populations' inequitable access to health care, which persists because of structural racism in health care policy.

Racism includes a complex array of social structures, interpersonal interactions, and beliefs by which the group in power categorizes people into socially constructed 'races' and creates a racial hierarchy in which racial and ethnic minority groups are disempowered, devalued, and denied equal access to resources."

These words come from the opening paragraphs of one of four overview papers in the February 2022 issue of Health Affairs, an issue devoted entirely to the topic of racism and health.

Ruqaiijah Yearby from Saint Louis University joins the A Health Podyssey to discuss how structural racism is embedded in US health policy.

Yearby and coauthors describe structural racism within the US health care policy today and in the past. Structural racism has created a tiered system of care with racial and ethnic minority groups experiencing poorer access and lower quality care than White Americans.

If you enjoy this interview, order the February 2022 Health Affairs Racism and Health theme issue.

Listen to Health Affairs Pathways.

Subscribe: RSS | Apple Podcasts | Spotify | Stitcher | Google Podcasts

Subscribe to Semafor Healthcare for free.

This episode is brought to you by Semafor Healthcare.

Delivered weekly from David Lim, Semafor Healthcare connects the dots between decisions in government, business, and technology to reveal how they impact the future of healthcare. Each edition will provide the analysis you need to understand and stay ahead of a rapidly changing landscape. Subscribe for free.

The February 2022 issue of Health Affairs focuses entirely on racism and health. 

It includes papers that trace the long history of racism to present day policies and practices that are the reasons for large and sustained health disparities.

Racism and bias come in many forms and given the social stigma associated with them, they can be difficult to study. When a study comes along that provides new empirical data on bias, it makes a major contribution to our understanding of this important topic.

One such study in the February issue from Michael Sun, a medical student from the University of Chicago, and colleagues is the focus of today's A Health Podyssey.

Sun and coauthors studied bias in how patients are characterized by clinicians through the history and physical notes entered into a patient's electronic health record, or EHR. When a patient is admitted as an inpatient or an outpatient, the notes document the patient's reason for seeking medical care and summarize the patient's medical, family, and social history. 

The notes can also describe the plan to address the patient's medical problems. But what if the way the patient is characterized in these notes is distorted by clinician bias? 

Sun and colleagues examined racial bias in EHRs and found that Black patients had over 2.5 times the odds of having negative descriptors in their medical records when compared to white patients.

If you enjoy this interview, order the February 2022 Health Affairs Racism and Health theme issue.

Listen to Health Affairs Pathways.

Subscribe: RSS | Apple Podcasts | Spotify | Stitcher | Google Podcasts

Subscribe to Semafor Healthcare for free.

This episode is brought to you by Semafor Healthcare.

Delivered weekly from David Lim, Semafor Healthcare connects the dots between decisions in government, business, and technology to reveal how they impact the future of healthcare. Each edition will provide the analysis you need to understand and stay ahead of a rapidly changing landscape. Subscribe for free.

The COVID-19 pandemic has made the relationship among research, policy, and public health strikingly clear. People who may have given little thought to health policy and research began following the latest study results to guide their own behavior and push governments and businesses to make decisions that reflect a combination of science and their own values and risk tolerance.

Health journals like Health Affairs responded by accelerating editorial processes and publishing free content to meet growing consumer demand. The new environment affected health services researchers as well as placed a new emphasis on timeliness and attention to issues affecting the public.

In this context, George Wehby from the University of Iowa College of Public Health joins Health Affairs Editor-in-Chief Alan Weil for a new A Health Podyssey Excursion.

Wehby co-authored the most read Health Affairs article in 2020. In that paper, Wehby and coauthor Wei Lyu showed the value of state-level mask mandates in the early phase of the COVID-19 pandemic.

More recently in January 2022, Wehby and colleagues published two more papers in Health Affairs, one related to children's educational attainment and the other on racial and ethnic disparities in dental service use among lower income adults receiving Medicaid.

Join Alan Weil and George Wehby as they discuss these topics and how health services research has changed in recent years.

If you enjoy this interview, order the January 2022 Health Affairs issue.

Pre-order the February 2022 Racism and Health issue.

Subscribe: RSS | Apple Podcasts | Spotify | Stitcher | Google Podcasts

Subscribe to Semafor Healthcare for free.

This episode is brought to you by Semafor Healthcare.

Delivered weekly from David Lim, Semafor Healthcare connects the dots between decisions in government, business, and technology to reveal how they impact the future of healthcare. Each edition will provide the analysis you need to understand and stay ahead of a rapidly changing landscape. Subscribe for free.

Precision medicine is built on a platform of big data, or large data bases that permit analysis of correlations among environmental and personal factors, treatments, and health outcomes.

Data bases that once included only paper records now include tissue samples, air and water samples, and more. There's vast potential for significant advances in health care from precision medicine.

But existing large data bases tend to be drawn almost entirely from European and Asian populations, limiting the reach of the benefits of precision medicine. Since big data analytics are often hidden from the patient (and sometimes even the clinician), non-representative data also contributes to mistrust in a health care system that has a long history of excluding certain people.

Kayte Spector-Bagdady from the Center for Bioethics and Social Sciences in Medicine from the University of Michigan Medical School joins Health Affairs Editor-in-Chief Alan Weil on A Health Podyssey to discuss the representativeness of data banks and what to do about it.

Spector-Bagdady and coauthors published a paper in the December 2021 issue of Health Affairs examining the lack of racial and ethnic diversity in data bank recruitment and enrollment at Michigan Medicine, a major academic medical center.

They found failures of representation were in part due to recruitment practices and in part due to the disproportionate rate at which black, Asian, and Hispanic patients declined enrollment when offered, relative to non-Hispanic white patients.

If you enjoy this interview, order the December 2021 Health Affairs issue.

Pre-order the February 2022 Racism and Health issue.

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Subscribe to Semafor Healthcare for free.