Yusuke Tsugawa

To measure physician-level use of 10 low-value care services that provide no net clinical benefit and to investigate the characteristics of primary care physicians who frequently provide low-value care in Japan. This cross-sectional analysis used a nationwide electronic health record database linked with claims data in Japan to assess visits by adult patients (age ≥18 years) to a solo-practice primary care physician from October 1, 2022, through September 30, 2023. Authors analyzed the rate of low-value care services delivered per 100 patients per year, aggregated across 10 low-value measures, after accounting for case mix and other characteristics.

Findings: Nearly half of these low-value care services were provided by 10% of physicians. After accounting for patient case mix, older physicians (age ≥60 years) delivered 2.1 per 100 patients more low-value care services than those younger than 40 years; not board-certified physicians delivered 0.8 per 100 patients more than general internal medicine board-certified physicians; physicians with higher patient volumes delivered 2.3 per 100 patients more than those with low patient volumes; and physicians practicing in Western Japan delivered 1.0 per 100 patients more than those in Eastern Japan.

Between August 2020 and April 2024, U.S. hospitals were mandated to report weekly occupancy to the Department of Health and Human Services as part of COVID-19 data tracking efforts. Authors repurposed this COVID-19 dashboard to describe several possible U.S. hospital bed occupancy scenarios arising from an aging U.S. population over the next decade, while varying hospitalization rates and staffed hospital bed supply.

Findings: The mean U.S. hospital occupancy was 63.9% from 2009 to 2019 compared with 75.3% in the year following the end of the COVID-19 public health emergency (PHE). The number of staffed hospital beds declined from a prepandemic steady state of 802,000 (2009–2019 mean) to a post-PHE steady state of 674,000, whereas the mean daily census steady state remained at approximately 510,000. There was substantial state-to-state variation in the post-PHE hospital occupancy steady state.

Without changes in the hospitalization rate or staffed hospital bed supply, total annual hospitalizations were projected to increase from 36,174,000 in 2025 to 40,177,000 in 2035 with the aging population. This would correspond to a national hospital occupancy of approximately 85% by 2032 for adult beds and by 2035 for adult and pediatric beds combined.

Experts in developed countries have posited that a national hospital occupancy of 85% constitutes a hospital bed shortage (a conservative estimate). The findings show that the U.S. could reach this dangerous threshold as soon as 2032, with some states at much higher risk than others. These scenarios suggest that an increase in the staffed hospital bed supply by 10%, reduction in the hospitalization rate by 10%, or some combination of the two would offset the aging-associated increase in hospitalizations over the next decade. 
 

Some prior studies have found that patients treated by female physicians may experience better outcomes, as well as lower health care costs than those treated by male physicians. Physician-patient sex concordance may also contribute to better patient outcomes. However, other studies have not identified a significant difference. There is a paucity of pooled evidence examining the association of physician sex with clinical outcomes.

This random-effects meta-analysis was conducted according to the PRISMA guidelines and prospectively registered on PROSPERO. MEDLINE and EMBASE were searched from inception to October 4, 2023, and supplemented by a hand-search of relevant studies. Observational studies enrolling adults (≥ 18 years of age) and assessing the effect of physician sex across surgical and medical specialties were included. The risk of bias was assessed using ROBINS-I. A priori subgroup analysis was conducted based on patient type (surgical versus medical). All-cause mortality was the primary outcome. Secondary outcomes included complications, hospital readmission, and length of stay.

Findings: Across 35 (n = 13,404,840) observational studies, 20 (n = 8,915,504) assessed the effect of surgeon sex while the remaining 15 (n = 4,489,336) focused on physician sex in medical/anesthesia care. Fifteen studies were rated as having a moderate risk of bias, with 15 as severe, and 5 as critical. Mortality was significantly lower among patients of female versus male physicians, which remained consistent among surgeon and non-surgeon physicians. No significant evidence of publication bias was detected. There was significantly lower hospital readmission among patients receiving medical/anesthesia care from female physicians. In a qualitative synthesis of 9 studies (n = 7,163,775), patient-physician sex concordance was typically associated with better outcomes, especially among female patients of female physicians.

Patients treated by female physicians experienced significantly lower odds of mortality, along with fewer hospital readmissions, versus those with male physicians. Further work is necessary to examine these effects in other care contexts across different countries and understand underlying mechanisms and long-term outcomes to optimize health outcomes for all patients.
 

Prior research demonstrates that local government spending on social policies, excluding health care, is linked to improved population health. Whether such spending is associated with better access to primary care and reduced acute care utilization remains unclear.

In this study, authors evaluated the associations between county-level social spending and individual-level health care utilization among low-income Medicare beneficiaries, aged ≥65 years, from 2016 to 2018. Authors linked claims data to 4 categories of county-level government expenditures from the U.S. Government Finance Database, including (1) public welfare, (2) public transit, (3) housing/community development, and (4) infrastructure-related social services. The main outcomes were annual primary care visit rates, emergency department visits, and preventable hospitalizations.

Findings: After adjusting for patient and county characteristics, beneficiaries living in counties with higher spending on housing/community development had 11% higher primary care visit rates. Additionally, those living in counties with higher public transit and housing/community development spending experienced 6%–10% lower preventable hospitalization rates. Lower preventable hospitalization rates were especially pronounced among acute conditions.

These findings suggest that investments in social services that address the health-related social needs of low-income older adults may be an important factor to consider in population-level efforts to reduce acute care utilization.