The United States Postal Service: an Essential Public Health Agency?
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and G. Caleb Alexander, MD, MS2,3,4
1
Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins Medicine, Baltimore, MD, USA; 2Department of Medicine, Johns Hopkins Medicine, Baltimore, MD, USA; 3Center for Drug Safety and Effectiveness, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; 4Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
J Gen Intern Med DOI: 10.1007/s11606-020-06275-2 © Society of General Internal Medicine 2020
August 7, 2020, the United States Postal Service O n(USPS) announced cost-cutting measures and leadership changes to reorient core aspects of the service and to improve efficiency. Considerable debate has since ensued regarding whether, how and when these changes should be implemented, in part due to concerns about potential voter disenfranchisement during the upcoming national election.1 Deliberation regarding these matters, while essential in its own right, also provides an opportunity to consider the broader role of the USPS as a public health agency.
MAIL-ORDER PHARMACY
Over the past few decades, there has been significant growth in the use of mail-order pharmacy, with more than one-fifth of US retail prescriptions, or more than 1.2 billion prescriptions, delivered by mail in 2019. In a recent analysis, 17% (7.3 million) of Medicare Part D beneficiaries in 2018 had at least one medication delivered through a mail-order pharmacy, use of which was more common among women and for cardiovascular medications.2 Such use, which is associated with both greater convenience and medication adherence, was initially pioneered by the Veterans Administration (VA), the largest integrated health care system in the USA; approximately 80– 90% of medicines that the VA provides for its 9 million veterans and their families each year are delivered by US mail. While millions of Americans benefit from the security and convenience of mail-order pharmacy, these services are especially important for vulnerable groups such as homebound elderly and individuals with chronic conditions, including diabetes, asthma, and congestive heart failure, where failure
Received September 14, 2020 Accepted September 25, 2020
to refill medications often triggers the use of more expensive and less efficient ambulatory or inpatient care. This is especially true during a pandemic, when many high-risk patients may otherwise forgo care due to increased risks associated with COVID-19 exposure. Early reports in the media have noted delays in mail-order refills to veterans during this time.
MAIL-IN BALLOT VOTING
In 2016, 33 million ballots, or one-fourth of all votes in the federal election, were cast by mail, and in the midst of the COVID-19 pandemic, mail-in ballot voting also offers a means to safely reduce individuals’ potential exposure to coronavirus infection. Upcoming elections are expected to see a record mail-in ballot voter turnout with a two- to threefold increase over previous national elections. While wait times for in-person voting have decreased duri
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