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UNASSIGNED: Approximately one-fifth of Medicare Advantage (MA) contracts terminated their participation in the MA program between 2011 and 2020. Little is known about subsequent insurance choices following a termination.
UNASSIGNED: To examine the insurance destinations of MA enrollees and the characteristics of enrollees who switch into traditional Medicare (TM) after a contract termination.
UNASSIGNED: This cross-sectional study examined MA program data of MA beneficiaries in the Medicare Master Beneficiary File from 2016 to 2018. Statistical analysis was performed from June 2023 to April 2024.
UNASSIGNED: Beneficiary characteristics, including age, sex, race and ethnicity, dual eligibility; hospital, nursing home, and home health utilization; and contract characteristics, including plan type, vertical integration, premium, and MA star rating.
UNASSIGNED: The main outcome was switching to TM in the year immediately after termination. We also evaluated the characteristics of contracts among those who remained in MA.
UNASSIGNED: A total of 117 681 beneficiaries were included in this analysis (64 654 [54.9%] female; 409 [0.4%] American Indian or Alaska Native; 2817 [2.4%] Asian; 76 725 [16.8%] Black; 11 131 [9.5%] Hispanic; 81 226 [69.0%] White; and 2373 [2.0%] other race or ethnicity; 27 078 [23.0%] dual-eligible; mean [SD] age, 71.2 [10.4] years). Following a contract termination, 20.1% (95% CI, 19.9%-20.4%) of enrollees switched to TM, including 32.7% (95% CI, 32.4%-33.1%) of dual-eligible beneficiaries and 16.4% (95% CI, 16.2%-16.5%) of non-dual-eligible beneficiaries. In nonterminated contracts, the concurrent switch rate was 6.2% (95% CI, 6.2%-6.2%) for all, 10.4% (95% CI, 10.4%-10.4%) for dual-eligible beneficiaries and 5.1% (95% CI, 5.1%-5.1%) for non-dual-eligible enrollees. The highest switch rates to TM were among Black enrollees (32.3% [95% CI, 31.7%-32.8%]) and those with prior use of hospital (31.3% [95% CI, 30.7%-31.9%], nursing home, 41.4% [95% CI, 40.4%-42.4%], or home health care (28.3% [95% CI, 27.4%-29.2%]). Beneficiaries who stayed in MA selected higher-rated star plans (mean posttermination contract star rating of 3.8 [95% CI, 3.8-3.8] stars compared with 3.3 [95% CI, 3.3-3.3] stars in the terminated year), but did not pay more in monthly premiums with 66.5% (95% CI, 66.2%-66.8%) paying the same or lower premiums.
UNASSIGNED: In this cross-sectional study, 1 in 5 MA beneficiaries switched to TM after a contract termination, with Black beneficiaries and those with more intensive health needs having the highest switch rates. These findings highlight the need to examine consequences of contract terminations and subsequent insurance destinations on access to care and health outcomes, especially among those with marginalized race and ethnicity, those who are dual-eligible, and beneficiaries with higher health care needs.

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This paper examined the psychological impact of contextual influences (i.e., contract type and playing experience) on sport anxiety in elite women cricketers participating in The Hundred. A sample of 71 elite female cricketers playing during the 2021-2022 season took part. Forty-nine of the sample (69%) held professional contracts, and 22 (31%) had yet to sign a professional contract. Participants provided details about their contract type and playing experience and completed self-report measures assessing sport anxiety, mental toughness, and general self-efficacy. Since mental toughness and self-efficacy are non-cognitive constructs, which buffer competitive trait anxiety, analysis controlled for these variables. Multivariate analyses of covariance examined sport anxiety scores among participants in relation to Hundred matches played (either 0, 1-10, or more than 10) and contract type (whether participants had a professional contract in place or not). Subfactors of Worry, Somatic, and Confusion assessed sports anxiety. No significant main effects existed. However, alongside a significant interaction, a covariate mental toughness effect occurred. Examination of the interaction revealed Worry scores were lower in cricketers who were yet to play a Hundred match who had not received a professional contract. Furthermore, Worry and Somatic scores were higher in cricketers that had played more than 10 Hundred matches and had not received a professional contract. These findings have important implications for the development of elite women cricketers. Particularly, they highlight the need to differentially support players through their career progression.

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This Viewpoint explains the 3 trends—personal conscience, employment contracts, and laws—that challenge physicians from putting their patients first and offers ways to reverse these barriers.

Some feminists hold that surrogacy contracts should be unenforceable or illegal because they contribute to and perpetuate unjust gender inequalities. I argue that in developed countries, surrogacy contracts either wouldn\'t have these negative effects or that these effects could be mitigated via regulation. Furthermore, the existence of a regulated surrogacy market is preferable on consequentialist grounds.

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