Abstract Introduction USAspending.gov represents an important potential source of expenditure data, covering trillions of federal outlays. However, this valuable data source has not commonly been used by researchers due to notable challenges acquiring, processing, or validating data. Our study examines the potential utility of USAspending.gov data to characterize federal health investments pre- and peri-COVID. Methods We retrieved all HHS federal award data from USAspending.gov for fiscal years 2018-2025. Substantial processing and cleaning was performed, with resulting data used to assess overall and sub-agency trends, and examine sociodemographic correlates of HHS spending changes. Results Total inflation-adjusted HHS spending rose from $1.6 trillion in FY18 to a pandemic peak of $2.0 trillion in FY20, before declining sharply to a low of $1.9 trillion in FY22-FY24. Spending for CMS increased substantially. Non-CMS spending, overall and at health departments, declined to levels below pre-Covid amounts as of FY25, driven by post-pandemic award cancellations and budget reductions. Conclusion Data utility was constrained due to substantial work needed to prepare data for analysis. Sharply diverging spending trends within HHS for CMS versus non-CMS programs may have important policy implications in coming years.
Abstract Introduction State policies that authorize pharmacists to prescribe contraception could make contraceptive care more accessible in the US. Over half of states have implemented such a policy, either via: collaborative practice agreement (most restrictive), standing order, statewide protocol, or prescriptive authority (least restrictive). Methods We used national prescription claims to measure variation in pharmacist-prescribed contraception by state policy type and by pharmacy affiliation in the thirty-one states that had a relevant policy in place as of 2024. Results We identified a total of 3,447 pharmacists, or 3.3% of all retail pharmacists in the US, prescribing contraception. Pharmacists prescribing contraception were most commonly affiliated with Walmart (17.4%), CVS (15.7%), Rite Aid (10.1%), and Safeway (9.4%). States with prescriptive authority or statewide protocols had significantly higher rates of pharmacist-prescribed contraception (11.6% and 5.9% of retail pharmacists, respectively), compared with states with standing orders (1.0%) or collaborative practice agreements (2.3%). Conclusion This study found that the type of policy mechanism authorizing pharmacists to prescribe contraception plays a key role in determining uptake of this practice. State policies must be considered as part of a broader set of factors, including retail pharmacies’ policies, pharmacist training, and reimbursement.
Abstract Background Canada provides publicly funded influenza vaccination for adults aged ≥65 years under universal healthcare, yet persistent coverage gaps remain. Existing research frequently conflates forms of primary-care fragmentation and rarely disentangles system-level and socioeconomic barriers to immunisation. This study examines vaccination inequities across primary-care continuity, inter-provider coordination, and socioeconomic dimensions among community-dwelling older Canadians. Methods Pooled 2015-2018 Canadian Community Health Survey data (n = 53,033 adults ≥65 years) were analysed. Multivariable logistic regression generated adjusted odds ratios (OR) and 99% confidence intervals (CI); interaction terms and income-stratified analyses were deployed to test effect modification. Exposures encompassed usual source of care, provider attachment, care coordination, household income, and educational attainment. Results Overall vaccination uptake reached 60.9%. Hierarchical gradients of primary-care fragmentation were detected; absence of a regular provider constituted the strongest structural barrier (OR=0.45, 99%CI 0.40-0.50). Income-stratified analyses identified a buffering effect of community health centres (CHCs), whereby CHCs partially offset vaccination deficits for low-income older adults facing moderate care fragmentation. Independent socioeconomic gradients and declining uptake with worsening inter-provider coordination were also observed. Conclusions Despite zero-cost influenza vaccination in Canada, primary-care fragmentation and socioeconomic disadvantage are independently associated with immunisation inequities. Results support gradient-tailored system-level interventions and targeted investment in CHCs to potentially mitigate disparities for marginalised older adults.
Abstract Rapid growth in open-access publishing has reshaped the economics of scientific communication. In response to concerns about the cost and process of commercial publishing, the National Institutes of Health (NIH) issued a request for information (RFI) in 2025. This study presents an independent analysis of the responses of all 914 responses from individuals and organizations, comprising more than 1300 pages. Narrative comments were categorized into themes and examined in relation to policy options. Response patterns varied by topic. Critical comments were most frequent regarding article processing charges (APCs) (445/914, 48.7%), followed by concerns about commercial publishing (210/914, 23.0%), unpaid academic labor (96/914, 10.5%), and peer review (50/914, 5.5%). Supportive comments were most common for peer review (84/914, 9.2%) and rare for APCs (0.2%), unpaid labor (1.2%), and commercial publishing (2.1%). The public comments highlight tensions in the current publishing system. Respondents endorsed the central role of peer review while expressing concern about APCs, market concentration, and reliance on unpaid labor. Differences between individual and organizational responses suggest competing stakeholder incentives. Policies focused narrowly on cost containment, such as APC caps, may fail to address structural issues and risk unintended consequences.
