INTRODUCTION: More than 42 million people in the United States are food insecure. Although some health care entities are addressing food insecurity among patients because of associations with disease risk and management, little is known about the components of these initiatives. METHODS: The Systematic Screening and Assessment Method was used to conduct a landscape assessment of US health care entity-based programs that screen patients for food insecurity and connect them with food resources. A network of food insecurity researchers, experts, and practitioners identified 57 programs, 22 of which met the inclusion criteria of being health care entities that 1) screen patients for food insecurity, 2) link patients to food resources, and 3) target patients including adults aged 50 years or older (a focus of this assessment). Data on key features of each program were abstracted from documentation and telephone interviews. RESULTS: Most programs (n = 13) focus on patients with chronic disease, and most (n = 12) partner with food banks. Common interventions include referrals to or a list of food resources (n = 19), case managers who navigate patients to resources (n = 15), assistance with federal benefit applications (n = 14), patient education and skill building (n = 13), and distribution of fruit and vegetable vouchers redeemable at farmers markets (n = 8). Most programs (n = 14) routinely screen all patients. CONCLUSION: The programs reviewed use various strategies to screen patients, including older adults, for food insecurity and to connect them to food resources. Research is needed on program effectiveness in improving patient outcomes. Such evidence can be used to inform the investments of potential stakeholders, including health care entities, community organizations, and insurers.

CONTEXT: Preventive care has been shown as a high-value health care service. Many employers now offer expanded coverage of preventive care to encourage utilization. OBJECTIVE: To determine whether expanding coverage is an effective means to encourage utilization. DESIGN: Comparison of screening rates before and after introduction of deductible-free coverage. SETTING: People insured through large corporations between 2002 and 2006. PATIENTS & OTHER PARTCIPANTS: Preferred Provider Organization (PPO) enrollees from an employer introducing deductible-free coverage, and a control group enrolled in a PPO from a second employer with no policy change. MAIN OUTCOME MEASURES: Adjusted probability of endoscopy, fecal occult blood test (FOBT), lipid screens, mammography, and Papanicolaou (pap) smears. INTERVENTION: Introduction of first-dollar coverage (FDC) of preventive services in 2003. RESULTS: After adjusting for demographics and secular trends, there were between 23 and 78 additional uses per 1,000 eligible patients of covered preventive screens (lipid screens, pap smears, mammograms, and FOBT), with no significant changes in the control group or in a service without FDC (endoscopy). CONCLUSIONS: FDC improves utilization modestly among healthy individuals, particularly those in lower deductible plans. Compliance with guidelines can be encouraged by lowering out-of-pocket costs, but patients' predisposing characteristics merit attention.

Increases in the number and cost of vaccines routinely recommended for children and adolescents have raised concerns about the ability of the current systems for vaccine financing and delivery to ensure that all children and adolescents have access to all routinely recommended vaccinations without financial barriers. The National Vaccine Advisory Committee (NVAC) was chartered in 1988 to advise and to make recommendations to the director of the National Vaccine Program and the Assistant Secretary for Health at the US Department of Health and Human Services on matters related to the prevention of infectious diseases through vaccination. In October 2006, NVAC established a Vaccine Financing Working Group to explore approaches for child and adolescent vaccine financing. The Vaccine Financing Working Group was charged with establishing a process for obtaining stakeholder input regarding challenges to creating optimal approaches to vaccine financing in both the public and private sectors. The goal of this process was to develop recommendations to ensure that all children and adolescents have access to all routinely recommended vaccinations without financial barriers. | The NVAC considered several overarching principles in formulating its recommendations. First, vaccine-preventable diseases are not constrained by geographic boundaries, and policies on vaccine financing should be national in scope. Second, vaccine financing solutions should address near-term problems with vaccine financing and should anticipate continued changes in recommended child and adolescent immunization schedules and the health care delivery system. Third, because vaccine financing problems are multifactorial, their solutions also should be multifactorial and all stakeholders will need to participate in implementing the solutions. Finally, because it is difficult to achieve uniform national implementation of policies that require state-based legislative or budgetary action, legislative or policy actions at the federal level, when appropriate, are recommended for achieving vaccine financing goals.

OBJECTIVE: Recent studies indicate continuing health disparities across geographic units in the US. This paper provides updated estimates of the association between socioeconomic factors and population health using a new state-level dataset and panel econometric methods that account for state-specific effects and autoregressive error structure. METHODS: Data from multiple sources for the 50 US states and the District of Columbia are merged. The dependent variables are age-adjusted all-cause mortality, self-assessed health status, and number of healthy days. Panel econometric models are used to accommodate state-specific unobserved factors and to incorporate autoregressive random disturbances to provide consistent and robust estimates. RESULTS: A 1-unit increase in the number of physicians per 1000 population is associated with a reduction in mortality by 30/100,000. The effects of physician-to-population ratio on self-reported health measures are mixed. Socioeconomic, demographic, as well as the prevalence of smoking and obesity have varying effects on mortality and self-reported measures of health. CONCLUSIONS: The new estimate of the association between physician supply and lower mortality suggests continuing efforts to assess the need for policies and incentives to induce physician labor supply in underserved states. Strategies and policies to reduce health disparities should address social, economic and individual risk factors.