About The Milbank Quarterly

Prescription drug prices in the United States are substantially higher than in other high-income countries, with US prices reported to be an average of 2.78 times those of other countries in the Organisation for Economic Co-operation and Development.1 In response to these high prices, along with an opaque supply chain that can lead to substantial discrepancies in prices across different payors, states have passed drug price transparency laws that require manufacturers to disclose information on drug prices. More

Leaders at many of the country’s top academic medical centers earned—in addition to their institutional salaries—hundreds of thousands of dollars a year as directors of pharmaceutical and device companies. Critics have urged academic institutions to rethink conflict of interest policies governing leaders’ outside activities, which are understood to pose not only individual conflicts for leaders themselves but also institutional conflicts for their academic employers. More

People in the United States are dying at record numbers from overdose. Overdose deaths increased from fewer than 17,000 deaths in 1999 to an estimated 100,000 deaths approximately 25 years after, with a peak of almost 108,000 deaths in 2022. Racial/ethnic minoritized groups are now particularly affected: in 2023, the highest rates of overdose were among non-Hispanic Black and American Indian/Alaska Native Americans. Although overdoses increasingly involve both opioids and stimulants, opioids contribute to over three-quarters of all overdose deaths, primarily driven by illegally manufactured synthetic opioids like fentanyl. More

The potential adverse effects of social media use for adolescents have received substantial attention. In response, a growing number of state-level social media regulations are emerging in the United States. These policy interventions are being implemented in the context of mixed scientific evidence, forcing policymakers to weigh the need for proactive regulation against the limitations of extant research. We explore policymakers’ publicly stated rationales for social media regulations and contextualize their claims within extant scientific literature. More

The Trauma Recovery Center (TRC) model brings comprehensive care to underserved victims of crime, with improvements in PTSD symptoms and quality of life. Funding concerns were the central limitation in model implementation according to TRC staff. More

Medicaid has both greatly advanced the scope and integration of mental health and substance use disorder services among payers and remains a work in progress with respect to scaling and funding these services across the country. More

Mental health (e.g., anxiety, depression) continues to be a major public health concern in the United States that impacts millions of individuals, their families, and communities. Approximately 21% of adults 18 years and older, or 55 million adults, reported symptoms of recent depression in 2022, demonstrating the wide reach of mental health challenges. More

In this article, we provide an overview of emergent models for funding crisis systems in the United States and the policy and service contexts related to these models. Our review assesses the status of crisis system financing recommendations proposed by Hogan and Goldman proposed in 2020 and complements prior reports about financing crisis services. More

See all articles in the special issue, Mental Health and Substance Use Challenges Facing the United States: What Can State Policymakers Do? Access… More

Behavioral health access gaps are well documented in Medicaid, in which managed care now covers most enrollees, and for which there are typically fewer options for going out-of-network for care. Despite the growing role of managed care organizations (MCOs) in financing and delivering behavioral health services, little is known about MCO levers that can improve access to care. More

This Perspective examines the role of Medicaid in the innovation of substance use disorder (SUD) treatment. In 2023, an estimated 49 million Americans met criteria for an SUD and more than 100,000 people died of a drug overdose. Compared with the general population, people with SUD experience worse self-rated health, a higher burden of other chronic diseases, and more hospital care. More