Health policy and public health

4,357 articles · Since 2004

Articles, page 124

American’s health cost problem has no easy fixes

July 11, 2013Jul 11, 20139

It is clear that healthcare in the US is more costly than in any other place in the world. We spend 18% of the gross domestic product on healthcare and our outcomes are no different than those of other industrialized nations who spend less than half that amount. How did we get here and what are we to do about it?

Recently, an article appeared in the …

Health policy

Physicians need to speak with a unified voice

Jordan Grumet, MD

July 10, 2013Jul 10, 20137

Many ask of our profession, "Are you knight or knave?" The supposition, that there exists a dichotomy of options for the current physician, is a false one. Likely we are a little bit of both, and many shades in between.…

Many ask of our profession, “Are you knight or knave?”

The supposition, that there exists a dichotomy of options for the current physician, is a false one. Likely we are a little bit of both, and many shades in between. The maddening belief that the future of our healthcare system depends on this delineation is preposterous. I would more aptly characterize us as pawns.

The time for change has come.

After patiently listening to my …

Health policy

Does HIPAA really protect our privacy?

Wes Fisher, MD

July 9, 2013Jul 9, 20136

As my head reels at the implications of the IRS scandal mushrooming in Washington, the IRS's recently disclosed ability to access emails without warrant, the intricacy of the NSA PRISM wiretap techniques that includes their ability to acquire tech firms'…

As my head reels at the implications of the IRS scandal mushrooming in Washington, the IRS’s recently disclosed ability to access emails without warrant, the intricacy of the NSA PRISM wiretap techniques that includes their ability to acquire tech firms’ digital data, and even the Justice Department’s ability to secretly acquire telephone toll records from the Associated Press, I wonder (as a doctor) what all this means for the privacy protections afforded …

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Does HIPAA really protect our privacy?

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Health policy

Quality is a word that lacks universal meaning

Hans Duvefelt, MD

July 9, 2013Jul 9, 20135

In 2009 I wrote a post titled “Quality or Conformity," where I pointed out that many of the quality measures in primary care have more to do with whether doctors follow guidelines than if they deliver care that helps patients…

In 2009 I wrote a post titled “Quality or Conformity,” where I pointed out that many of the quality measures in primary care have more to do with whether doctors follow guidelines than if they deliver care that helps patients live long and well. There is a tendency to focus quality efforts on measuring what is easy to measure, rather than what matters the most.

That phenomenon is called …

Health policy

Either we are suckers, or we think health sucks

David L. Katz, MD

July 7, 2013Jul 7, 20139

Ralph Cramden was the quintessential sucker. I suppose only people of a certain age -- my age, for instance -- will remember Ralph. If you have fewer gray hairs than that, perhaps you will remember the next incarnation of Ralph,…

Ralph Cramden was the quintessential sucker. I suppose only people of a certain age — my age, for instance — will remember Ralph. If you have fewer gray hairs than that, perhaps you will remember the next incarnation of Ralph, Fred Flintstone. The Honeymooners character, brought indelibly to life by Jackie Gleason, was the inspiration for Fred, just …

Health policy

Complicated Obamacare clears a very low bar

Kevin Pho, MD

July 2, 2013Jul 2, 20134

The following column was published on May 29th, 2013 in the New York Times’ Room for Debate blog, which asked the question, "Is Obamacare too complicated to succeed?" Is the Affordable Care Act complicated? Of course it is. Even one…

The following column was published on May 29th, 2013 in the New York Times’ Room for Debate blog, which asked the question, “Is Obamacare too complicated to succeed?”

Is the Affordable Care Act complicated? Of course it is. Even one of its architects concedes that it is phenomenally complex. Why? To pass, it had to be contorted to satisfy a number of special interest groups.

As its major reforms are implemented …

Physician voices

Confronting the reality of uncertainty in medicine

Allen Frances, MD

June 30, 2013Jun 30, 20132

Medical care in the U.S. over-promises and under delivers. It costs about twice as much as in most other developed countries, but compared to them manages to produce only mediocre health outcomes. The profit motive has resulted in badly misallocated…

The impact of advances in medical science on the delivery of …

Physician voices

4 complaints of physician employees and 1 solution to fix them

Dike Drummond, MD

June 30, 2013Jun 30, 20134

Medscape published an article titled, 4 Top Complaints of Employed Doctors, and it was a very interesting read. Turns out the things employed physicians complain about are basically that they are employees. Let me lay out these employed physicians gripes…

Let me lay out these employed physicians gripes for you with a little detail so you will see what I mean. I will finish this article with a solid way to address all of them. These …

Physician voices

The power of culture in health care

David L. Katz, MD

June 30, 2013Jun 30, 20132

Our culture -- at least the movie-going part of it -- seems to have embraced the adage: With great power comes great responsibility. Somehow, at the same time, it seems to have ignored the inevitable, underlying principle: Power and responsibility…

Our culture — at least the movie-going part of it — seems to have embraced the adage: With great power comes great responsibility. Somehow, at the same time, it seems to have ignored the inevitable, underlying principle: Power and responsibility are conjoined. This, in turn, implies a corollary our culture also neglects routinely, if not universally: Before anyone can reasonably be expected to take responsibility, they must be suitably empowered.

After …

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The power of culture in health care

Health policy

Some patients are receiving too little care

Trudy Lieberman

June 28, 2013Jun 28, 2013

Twelve years ago, in its landmark study Crossing the Quality Chasm, the Institute of Medicine (IOM) found that “the health care industry is plagued with overutilization of services, underutilization of services, and errors in health care practice.” In simple English,…

Twelve years ago, in its landmark study Crossing the Quality Chasm, the Institute of Medicine (IOM) found that “the health care industry is plagued with overutilization of services, underutilization of services, and errors in health care practice.” In simple English, the IOM reported that health care was riddled with overuse, underuse and misuse of medical services.

The IOM also defined quality health care as “the degree to which health services for …

Health policy

Obamacare fails by not listening to the voices of the caregivers

John Mandrola, MD

June 28, 2013Jun 28, 201313

When an employee leaves a position, management might conduct an exit interview. The idea is obvious: one can learn a lot from those who are free to speak candidly. This is why I think it’s worth listening to doctors who…

When an employee leaves a position, management might conduct an exit interview. The idea is obvious: one can learn a lot from those who are free to speak candidly.

This is why I think it’s worth listening to doctors who no longer practice medicine.

Enter Dr. Ed Marsh, a former pediatrician, who writes this poignant and relevant essay. His tone and candor is one of a man who still cares about …

Physician voices

Chronic care at Walgreens: Should we see how this plays out?

Ishani Ganguli, MD

June 27, 2013Jun 27, 201326

Walgreens, the country’s largest drugstore chain, announced that its 330+ Take Care Clinics will be the first retail store clinics to both diagnose and manage chronic conditions like asthma, diabetes, high blood pressure, and high cholesterol. The nurse practitioners (NPs) and physician assistants (PAs) who staff these clinics will provide an entry point into treatment for some of these conditions, setting Walgreens apart from competitors like Target and CVS whose …

Patient voices

What will health care teams mean for patients?

Jessie Gruman, PhD

June 27, 2013Jun 27, 201396

Have you heard that soon most primary care in the U.S. will be delivered by teams? Yep. Team-based care is one of the characteristics of the patient-centered medical home, a way of organizing the care of patients that allows primary…

Have you heard that soon most primary care in the U.S. will be delivered by teams?

Yep. Team-based care is one of the characteristics of the patient-centered medical home, a way of organizing the care of patients that allows primary care clinicians to see more patients in a day while at the same time delivering better care. This move toward team-based care started long before health care reform and was embedded …

Health policy

Providing the right amount of healthcare

Noralou Roos, PhD & Thérèse A. Stukel, PhD

June 23, 2013Jun 23, 20133

It is easy to assume that the real problem with our healthcare system is “not enough” – not enough physicians, not enough MRIs, not enough money. But a growing number of studies show that more healthcare is not always better…

It is easy to assume that the real problem with our healthcare system is “not enough” – not enough physicians, not enough MRIs, not enough money.

But a growing number of studies show that more healthcare is not always better and the more expensive drug or treatment option is not necessarily the right choice. In fact, sometimes more care – specifically care that you don’t need – can be harmful for …

Physician voices

A growing culture of hostile dependency toward doctors

Wes Fisher, MD

June 22, 2013Jun 22, 2013108

An interesting phenomenon is occurring in media circles these days. No doubt others have seen it, too. Lately, doctors are being schooled by the media. From how to learn empathy, to improving communication with patients, the breadth and depth of…

An interesting phenomenon is occurring in media circles these days. No doubt others have seen it, too.

Lately, doctors are being schooled by the media.

From how to learn empathy, to improving communication with patients, the breadth and depth of what we should do for our patients is endless. Why, some even have our own colleague experts tell us how we should really do things.

These efforts, while probably well-intentioned, are patronizing. …

Health policy

The Affordable Care Act is more of our broken health care model

Matt McCord, MD

June 22, 2013Jun 22, 201331

Every week we read another article on the fuzzy math and ridiculous mark-up for our routine healthcare. Do your own research; see Elizabeth Rosenthal’s article in a recent Sunday New York Times, the $2.7 Trillion Medical Bill or Steven Brill’s…

Every week we read another article on the fuzzy math and ridiculous mark-up for our routine healthcare. Do your own research; see Elizabeth Rosenthal’s article in a recent Sunday New York Times, the $2.7 Trillion Medical Bill or Steven Brill’s lengthy tome in Time, Bitter Pill.

We spend, and will continue to spend, more on healthcare than any other nation in the world and yet we are 38th in …

Health policy

Will health care price transparency help reduce costs?

Peter Ubel, MD

June 22, 2013Jun 22, 201312

Getting your appendix out can cost between $2,000 and $180,000. Hip replacements run from $10,000 to more than $100,000. Hospitals, we have also learned, frequently mark up the price of cotton swabs and routine X-rays by 300 or 400 percent,…

As a response to the hidden variability in health care prices, an increasing number of states have …

Health policy

A cautionary tale of employing doctors

David Mokotoff, MD

June 21, 2013Jun 21, 201320

For all of those out there anticipating the 2014 official roll out of Obamacare, officially known as Affordable Care Act (ACA), here is a cautionary tale. Many years ago, as I was growing my cardiology practice, it became evident that…

For all of those out there anticipating the 2014 official roll out of Obamacare, officially known as Affordable Care Act (ACA), here is a cautionary tale.

Many years ago, as I was growing my cardiology practice, it became evident that diagnostic services for my specialty, like stress tests and echocardiograms, were done less efficiently and cost more at the local hospital, than in the office. This stimulated many groups in the …

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A cautionary tale of employing doctors

Health policy

A far more interesting lesson from the Oregon experiment

Ashish Jha, MD, MPH

June 21, 2013Jun 21, 201322

It has been a couple of weeks since the landmark Oregon experiment paper came out, and the buzz around it has subsided. So what now? First, with passage of time, I think it is worth reflecting on what worked in Oregon. Second, we should take a step back, and recognize that what Oregon really exposed is that health insurance is a small part of a much bigger story about …

Patient voices

A voice is missing from discussions of the patient experiences

Jessie Gruman, PhD

June 20, 2013Jun 20, 20138

The demand for patient voices is on the rise as hospitals and dialysis centers, research teams and health care advisory groups face requirements to document our participation in governance and program decisions. And many of us have stepped forward to…

Some of us do so as victims of horrific medical errors or uncoordinated care resulting in injury or from disrespectful care that undermines all confidence in health …

Health policy and public health

Articles, page 124

Real physician voices, twice a week

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