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We trace the evolution of open government data (OGD) publication among U.S. health agencies to illustrate how OGD goals and benefits might be achieved. Our novel conceptual framework illustrates the implicit logic underlying OGD activities in the health domain and their anticipated impact on population health. We conducted semi-structured interviews with 50 diverse practitioners and policymakers from local, state, and federal agencies, and non-governmental organizations. Using a positive deviance approach, we identified innovative U.S. health agencies that were early OGD adopters. We analyzed transcripts using a grounded theory methodological approach to identify common themes. Results indicate that the OGD movement is marked by three major eras (pre-OGD early activities, Open Data 1.0, and Open Data 2.0), and U.S. health agencies are in different stages of evolution. Among innovative jurisdictions, OGD transitioned from an early focus on releasing large volumes of data to a more demand-driven approach to promote meaningful user engagement with data. Although engagement strategies could yield benefits, limited evidence exists on best practices for engaging diverse data users and many jurisdictions have not yet transitioned to this later phase. Our conceptual framework could be adapted for other domains to help visualize how successful OGD initiatives might unfold.

IMPORTANCE: Since the terrorist attacks on September 11, 2001, the US government has promoted household disaster preparedness, but preparedness remains low. OBJECTIVE: To identify disparities in disaster preparedness among US households. DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study used data from a nationally representative sample of US households from the 2017 American Housing Survey's topical section on preparedness to assess associations of disaster preparedness with households' socioeconomic characteristics, composition, and region. Logistic regressions were used to assess associations of household characteristics with overall preparedness, resource- and action-based preparedness, and specific preparedness items. Data analyses were completed on March 27, 2020. EXPOSURES: Combined household income, head of household's education level, race/ethnicity, marital status of head of household, head of household aged 65 years or older, presence of children or a household member with a disability, and region. MAIN OUTCOMES AND MEASURES: Nine actionable preparedness items, such as having an emergency carry-on kit (resource), food and water stockpiles (resource), and alternative communication plans and meeting locations (action). Items were summed for the measures of overall, resource-based, and action-based preparedness, with preparedness defined as meeting at least half of the criteria. RESULTS: Among 16 725 included households, 9103 household heads were men (54.4%), 11 687 were married (69.9%), and 10 749 (66.1%) had some college education or higher. In all, 1969 household heads (11.8%) were black, while 2696 were Hispanic/Latino (16.1%); 3579 household heads (21.4%) were 65 years or older. A total of 7163 households (42.8%) included children, and 3533 households (21.2%) included a person with a disability. Households were more likely to fulfill at least half of the criteria for resource-based preparedness (10 950 households [65.5%]) than for action-based preparedness (6876 households [41.1%]). ...

The Patient Protection and Affordable Care Act (ACA), more commonly known as health reform, is designed to expand health coverage to 32 million uninsured Americans by 2019 and makes significant changes to public and private health insurance systems that will affect providers of HIV care. We review the major features of the legislation and when they will be implemented, discuss the ways in which it will affect HIV care for different patient populations, and outline implementation challenges that are relevant for HIV care. We conclude with ways in which HIV providers can get involved to learn more about the law and help their patients take advantage of the new opportunities for health coverage.

While substantial research examines the dynamics prompting policy adoption, few studies have assessed whether enacted policies are modified to meet distributional equity concerns. Past research suggests that important forces limit such adaptation, termed here "policy inertia." We examine whether block grant allocations to states from the Ryan White HIV/AIDS Program have evolved in response to major technological and political changes. We assess the impact of initial allocations on later funding patterns, compared to five counterfactual distributional equity standards. Initial allocations strongly predict future allocations; in comparison, the standards are weak predictors, suggesting the importance of policy inertia. Our methodology of employing multiple measures of equity as a counterfactual to policy inertia can be used to evaluate the adaptability of federalist programs in other domains.

While substantial research examines the dynamics prompting policy adoption, few studies have assessed whether enacted policies are modified to meet distributional equity concerns. Past research suggests that important forces limit such adaptation, termed here policy inertia. We examine whether block grant allocations to states from the Ryan White HIV/AIDS Program have evolved in response to major technological and political changes. We assess the impact of initial allocations on later funding patterns, compared to five counterfactual distributional equity standards. Initial allocations strongly predict future allocations; in comparison, the standards are weak predictors, suggesting the importance of policy inertia. Our methodology of employing multiple measures of equity as a counterfactual to policy inertia can be used to evaluate the adaptability of federalist programs in other domains. Adapted from the source document.

Emergency department (ED) utilization has increased nationally, leading to overcrowding, which in turn increases wait times, adverse clinical outcomes, and costs. We constructed a state‐level panel dataset of 50 U.S. states and the District of Columbia from 1999 to 2011 and used a first‐differencing regression model to investigate the extent to which changes in public and private health insurance coverage could account for increased ED utilization. We found that changes in health insurance coverage explained some of the variations in ED utilization; however, the magnitudes of health insurance coverage variables were very small relative to the mean of ED utilization. This suggests that anticipated increases in private health insurance coverage and the Medicaid expansion due to the Affordable Care Act will not drive large changes in ED utilization.

With the Affordable Care Act set to expand insurance coverage to millions more Americans next year, existing discretionary health programs that receive federal support might find themselves competing for funds as the health reform law is fully implemented. To assess the implications the Affordable Care Act might have on discretionary health programs, we focused on state AIDS Drug Assistance Programs, which provide free medications to low-income HIV patients. We conducted semistructured interviews with program managers from twenty-one states. Many of the managers predicted that their programs will change focus to provide "wrap-around services," such as helping newly insured clients finance out-of-pocket expenses, including copays, deductibles, and premiums. Although program managers acknowledged that they must adapt to a changing environment, many said that they were overwhelmed by the complexity of the Affordable Care Act and some expressed fear that state AIDS Drug Assistance Programs would be eliminated entirely. To remain viable, such programs must identify and justify the need for services in the context of the Affordable Care Act and receive sufficient political support and funding.

Although the federal government will finance most of the coverage expansions of the Patient Protection and Affordable Care Act (ACA), implementation is largely devolved to states. Drawing from interviews with HIV policy experts and program managers and a documents review, the authors enumerate actions that must occur at multiple levels of government in order for ACA implementation in the context of HIV care to improve access to health care and health outcomes and the conditions under which these may fall short. Positive outcomes are predicted for HIV patients in states with sufficient political support and resources to implement the ACA. However, outcomes may worsen in states that do not implement the Medicaid expansion or other ACA provisions, particularly if federal funding for discretionary safety net programs is reduced. Transitioning patients from HIV‐specific programs to other coverage sources may also reduce HIV services in states that previously were at the forefront of HIV care.