Improving Healthcare Access

India now spends ₹2 trillion/year (0.6% of GDP) on cash transfers to 130M+ women—yet we know little about their effects. In a new paper, we present findings from the first large-scale randomized-controlled trial (RCT) of maternal cash transfers in India. The intervention: ₹500/month (~10% of HH consumption) for 2 years to ~1,200 new mothers across 8 Jharkhand districts; given unconditionally, but labeled as support for nutritious food. We tracked food, nutrition, and child development over 3 years. We find that food consumption rose significantly: household food spending up >11%; calorie intake up 9% (Y1) and 14% (Y2) for mothers and children; protein and iron intake also improved. Dietary diversity gains persisted 18 months after the transfers ended. We find substantial improvements in intra-household equity: in Y2, maternal calorie intake rose ~3x more than the household average, helping narrow pre-existing gender gaps in nutrition. Measures of empowerment (e.g., health-seeking behavior for children) also increased. Despite better diets, we do not find average gains in standard anthropometric outcomes (WAZ/HAZ) for targeted children. However, we do find some evidence of gains in areas with better sanitation, consistent with sanitation mediating nutrition-to-growth translation. Older siblings (not directly targeted) saw gains: sibling WAZ scores rose by 0.11–0.13σ, with no heterogeneity by sanitation. Thus, cash transfers benefited other children too, but the mediating role of sanitation in nutrition-to-growth translation may be greater for infants. Child functional development improved. We find a 0.12σ gain in ASQ-3 scores at age 3 — including cognition, and both gross and fine motor skills. These effects may matter even more than physical growth over time as labor markets reward ‘brains’ more than ‘brawn’. Increased food spending from cash transfers to women was at par with in-kind PDS transfers (similar marginal propensity to consume or MPC on food). Thus, cash versus kind debates may be second order when the value of cash transfers is less than what HH are spending on the in-kind item anyway. Overall, we find: a) Positive impacts on food intake, nutrition, and gender equity b) Meaningful gains in child functional development c) Limited average anthropometric gains, mediated by sanitation (highlighting need to pair nutrition efforts with sanitation investments) These positive effects contrast with recent U.S. evidence: Noble et al. (2025) found no developmental gains from large 4-year transfers. Context matters—underscoring the importance of testing in relevant settings. Full paper at: https://bit.ly/4mE6EtW Paul Niehaus Sandip Sukhtankar Jeff Weaver UC San Diego J-PAL South Asia

Bridging the Digital Divide: A New Role for Hospitals in the 21st Century In today’s world, where technology is inextricably linked to every aspect of our lives, the stark reality of the digital divide has never been more pronounced. This divide does not merely separate the tech-savvy from the technophobes; it delineates a chasm between those who have access to critical online health resources and services and those who do not. As we navigate the complexities of healthcare in the digital age, it's clear that hospitals have a unique and potent role to play in bridging this gap. For too long, the digital divide has been a pervasive barrier to equitable healthcare access. It's a divide that disproportionately affects the most vulnerable among us—low-income families, the elderly, and communities of color. These are the same communities that are often hardest hit by health disparities and systemic inequities. The COVID-19 pandemic has only magnified these issues, making it abundantly clear that internet access is not a luxury; it's a lifeline. Hospitals stand at the crossroads of healthcare and technology. They are not just institutions for healing but pivotal community resources with the potential to lead transformative change. Imagine a hospital where every patient, regardless of their socio-economic status, leaves not just with a care plan but with the tools and knowledge to access telehealth services, manage their health records online, and utilize digital platforms for follow-up care. This vision is not only achievable; it's essential. Initiatives to get patients connected can take various forms, from simple measures like providing Wi-Fi access in hospital waiting rooms to more comprehensive strategies like deploying digital navigators—staff members trained to assist patients in setting up and using online health tools. Hospitals can partner with community organizations and leverage existing programs to offer internet access subsidies and distribute devices to those in need. These efforts, while seemingly straightforward, can dramatically alter the healthcare landscape for millions. Moreover, by integrating digital access into patient care, hospitals can also enhance patient engagement, improve adherence to treatment plans, and reduce readmissions. It's a win-win situation where improved patient outcomes go hand in hand with the democratization of healthcare information. While some argue hospitals are overwhelmed, our duty as healthcare providers extends beyond the exam room. Closing the digital divide is part of ensuring patient welfare. From ER to policy advising, one truth stands: healthcare innovation must be inclusive. The digital future of healthcare isn't just an opportunity. Hospitals should be more than healing centers—they're pathways to a connected, empowered society. Access to health services shouldn't depend on zip codes or income. Let's bridge the gap and ensure health is a right for all. #healthcare

“Black women are more likely to have fibroids.” 📘 It’s a sentence I heard repeatedly in medical school and during my junior doctor years. But we never questioned why and no explanation was ever given. Now, in my NHS clinics, I see the real-world consequences of that missing context. A disproportionate number of Black women come to me with heavy periods, pelvic pain, pressure symptoms and anaemia, often with fibroids that are large by the time they are diagnosed. 🩺 The issue is not simply biological. It is the intersection of biology with chronic stress, racism, delayed diagnosis, environmental exposures and a long, uncomfortable history within gynaecology, including the dismissal of Black women’s pain. ⚠️ We know that sustained stress and discrimination can alter hormonal and inflammatory pathways (the concept of weathering) 🌧️ and create the conditions in which fibroids grow. We also know that structural inequalities across the NHS influence whose symptoms are taken seriously, how quickly investigations are arranged and which treatment options are offered. 🏥 When we teach statistics without context, we risk reinforcing inequity. When we understand the “why,” we can start to change outcomes. 🔍 For me, this means: -Listening earlier 👂 -Investigating sooner 🖥️ -Challenging symptom minimisation 🙅♀️ -Recognising the historical and structural forces shaping women’s health today 📚 Black women are not predisposed in a vacuum. Their health outcomes reflect lived experience, past and present. 🌍 As clinicians and educators, we owe our patients more than memorised facts. We owe them an understanding that leads to better care. 💡 Dawn Heels Tanya Simon-Hall ADEBUKOLA (BUKKY) AYOADE Itunuoluwa Johnson-Sogbetun #WomensHealth #Fibroids #BlackWomensHealth #HealthInequalities #RacialHealthInequity #PrimaryCare #GeneralPractice #GPConfessions #NHS #MedicalEducation #MedEd #ReproductiveHealth #Gynaecology #HealthEquity #PublicHealth #Weathering #ClinicalLeadership #UKHealth

If you're interested in the role of pharmacists in primary care and how they can provide better health outcomes, check out this new community pharmacist program. --- I've posted many times about the value of community pharmacists as a supplement or extension of #PrimaryCare, particularly in rural communities. As I've posted in the past, pharmacists: -are the best healthcare professional for managing blood pressure -increase the percentage of prescriptions within guidelines for hypertension, diabetes, hyperlipidemia, AFib, etc. -added to a primary care team are so effective at controlling blood pressure that the CDC is copying the model and expanding to the southeast -are just as good at treating minor illnesses as primary care and ER doctors, but cost $278 less per episode on average Blue Cross NC and University of North Carolina at Chapel Hill are now partnering in a new program called "More Than A Script" (in the comments) to better utilize community #pharmacists. --- The program pairs a patient with a community pharmacist, essentially acting as a nearby primary care contact. The program specifically serves people with #diabetes and #hypertension, disease states perfectly within a pharmacist's expertise. Pharmacists in this program will help with medications as usual, but will also offer: -routine testing like blood sugar and blood pressure monitoring -education about how to track these at home -create personalized diet and exercise plans -adjustments to medications -access to other primary care services like screenings and vaccinations --- Every #pharmacy involved in the program seems to be an independent pharmacy. Blue Cross NC is paying pharmacists to offer these extra services, at no extra cost to patients. From what I've seen, More Than A Script appears to be the only program like this in NC, but there are others that have had great success in other states. Would you go to your local independent pharmacy for monthly check-ins on your chronic conditions?

Last week, the U.S. Department of Health and Human Services announced that the Office of Minority Health should expect to be dissolved —a move that’s received far too little attention for the weight it carries. For decades, this office has played a central role in confronting health disparities that disproportionately affect Black, Latino, Indigenous, and other historically marginalized communities. From funding community-based initiatives to shaping policy and research, the work of the OMH has been critical in pushing our health systems to see and address structural inequities. Dismantling this office isn’t just administrative—it sends a message. One that risks unraveling years of advocacy, research, and culturally competent care models that have started to make a dent in centuries-old disparities that W.E.B Dubois wrote about in the 1890s. The public health community cannot afford to be silent. We must continue to advocate, organize, and hold institutions accountable for the health of all communities. #HealthEquity #PublicHealth #HealthDisparities

In today's healthcare the real problem isn’t a lack of tech. It’s a lack of connection. Patients want the same smooth experience they get everywhere else. But most hospitals still run on old, clunky systems. The result is friction at every step — from booking to follow-up. Here’s how we’re changing that in my hospital. We mapped the entire patient journey. Not just one app. Not just one tool. The whole experience. This is what we found: • Pre-arrival: Online booking and digital triage cut confusion and save time. • Check-in: Mobile check-in and digital forms end the paperwork shuffle. • During care: Patients get real-time results and can message their care team securely. • Follow-up: Digital discharge, reminders, and tele-reviews keep care going at home. The impact is clear. Digital appointment systems push satisfaction above 90%. No-shows drop. Clinic flow improves. Patients feel informed, prepared, and in control. But here’s the key: Tech should amplify the human touch, not replace it. A single app is not enough. You need a journey map to spot the “moments that matter.” That’s where you find the friction — and fix it. My advice to leaders: • Start with the journey, not the tool. • Cut friction with care. • Build digital pathways that boost empathy and connection. When you redesign the journey, you restore dignity to every patient. This is the future of healthcare. Simple. Human. Connected.

People don’t “fail” healthcare. They’re often just blocked by social conditions that healthcare hasn’t accounted for. This isn’t about noncompliance. It’s about no transport, no childcare, no stable housing, no trust, no safe time to be sick. These are social problems. And they’re the real reasons people can’t engage with care—not ignorance, not laziness, not cost alone. 📉 Yet clinical systems still design pathways assuming that if we just offer more services or spend more money, outcomes will improve. But health doesn’t happen in the clinic. It happens in the neighborhood, long before (or if) someone ever walks through the door. So what needs to change in boardrooms? Too often, power and control sit far from the lived realities of patients. We need: - Investment in community-rooted care models, not just institutional ones - Inclusion of neighborhood voices in decision-making - Metrics that reflect social impact, not just throughput or compliance - Systems that accommodate, not punish, social complexity If healthcare wants different results, it must design for the world people actually live in—not the one we assume they do. It’s not about “fixing patients.” It’s about dismantling the barriers to what health can offer people #SocialDeterminants #NeighborhoodHealth #HealthEquity #SystemicChange #ClinicalPathways #PublicHealth #BoardroomToStreet #PowerShift #PatientCentredCare

Telehealth only leads to over-utilization of care. It does not actually replace in-person visits, it only costs us more money. 🤨 Sound right? That concern has shaped the policy conversation for years. It began due to a widely cited study demonstrating DTC telehealth increased total utilization. It became a benchmark for both caution and debate, especially in Medicare policy debates (can read here: https://lnkd.in/erZ4qYXV) Btw, that study was from 2017. Yet we still had that story ingrained and was hard to shake despite some research showing different results. Well in a new study, we have new evidence to may get rid of this belief once and for all. This study analyzed 100% of Medicare Fee-For-Service (FFS) claims from 2019 to 2024 to assess how telehealth has affected outpatient visit volume. It focused on evaluation and management (E&M) visits across three specialties with different levels of telehealth use: 🔹 Low: Orthopedic surgery 🔹 🔹 Medium: Primary care 🔹 🔹 🔹 High: Behavioral health Here’s what stood out: 1️⃣ Telehealth stabilized: After its initial spike, telehealth found its place. In 2024, it made up 38.4% of behavioral health visits, 6.3% in primary care, and just 1.2% in orthopedics. 2️⃣ More telehealth didn’t mean more visits. Total E&M visits were actually lower in specialties that used telehealth more: 📉 Behavioral health: 4.1% relative decline 📉 Primary care: 7.2% relative decline (Compared to orthopedics as a baseline) 3️⃣ Telehealth was substitutive, *not* additive: This is a key difference. Virtual care mostly replaced in-person visits rather than creating new demand. It met patients where they were without overwhelming the system. 4️⃣ Overall utilization stayed steady: Despite new care models, visit rates held consistent. Telehealth expanded flexibility, but capacity constraints and clinical workflows still shaped how care was delivered. These findings challenge long-held assumptions (I can't believe that it has been 8 years). We now have strong, early data suggesting that broad telehealth adoption doesn’t drive overutilization in Medicare. That’s a meaningful shift. It is time to move beyond outdated fears and into more thoughtful, evidence-based policy. As someone who’s worked in both emergency medicine and telehealth, I’ve seen how virtual care can meet real needs without excess. I hope we continue building systems that reflect that. Not just in theory, but in how we support access, quality, and sustainability in practice. 🧠 Curious to hear your thoughts especially if you're working in policy, digital health, or any corner of the system where these questions come up daily. 🔗 Read the full study here: https://lnkd.in/eyam4jHF Note: this is a preprint so might be more to add post peer review #digitalhealth #telemedicine #telehealth