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Health policy and public health

4,357 articles · Since 2004

Articles, page 125

Health policy

Will health reform address the racial disparity of the uninsured?

4

For all intents and purposes, the Affordable Care Act (ACA), the president’s signature piece of legislation, will provide more health care coverage to poor and underserved populations. Persistently disadvantaged communities have much further to go than those with insurance, and…

For all intents and purposes, the Affordable Care Act (ACA), the president’s signature piece of legislation, will provide more health care coverage to poor and underserved populations. Persistently disadvantaged communities have much further to go than those with insurance, and new means of accessing and paying for care will benefit them disproportionately. Nevertheless, with more than 20 percent of the nation’s black population uninsured, more than 30 percent of Hispanics …

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Will health reform address the racial disparity of the uninsured?

Health policy

Who’s truly responsible for the $2.7 trillion medical bill?

17

As someone who professionally closely tracks the debate over the transformation of the American health care clinical delivery system, I did not learn much new from the New York Times article: The $2.7 Trillion Medical Bill. I did find the…

As someone who professionally closely tracks the debate over the transformation of the American health care clinical delivery system, I did not learn much new from the New York Times article: The $2.7 Trillion Medical Bill.  I did find the article’s approach useful in explaining how the wide variations in price for procedures contribute to the unnecessary high cost of American health care.

Although the article did document many procedures …

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Who’s truly responsible for the $2.7 trillion medical bill?

Health policy

What if doctors worked for free?

30

Today I am going to write about how the US could save up to 10% on its healthcare bill. The US spends more on health care than any other nation, $8,500 per person per year. Multiply that by 300 million…

Today I am going to write about how the US could save up to 10% on its healthcare bill.

The US spends more on health care than any other nation, $8,500 per person per year. Multiply that by 300 million people and try to grasp the vast sum of $2,5 trillion.

A lot of changes are taking place with the intent to save healthcare dollars. So far, many of those changes have …

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What if doctors worked for free?

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Health policy

A more realistic approach to achieving accountable care

6

Hospitals that are already struggling financially to stay afloat face significant challenges in the coming months and years under some of the provisions of Obamacare. Under the Affordable Care Act's Hospital Readmissions Reduction Program, hospitals that readmit certain patients within…

Hospitals that are already struggling financially to stay afloat face significant challenges in the coming months and years under some of the provisions of Obamacare.

Under the Affordable Care Act’s Hospital Readmissions Reduction Program, hospitals that readmit certain patients within 30 days of discharge could face significant penalties.

The question is whether hospitals really have that much control over factors leading to readmission and whether they are really at fault.

Some readmissions are …

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A more realistic approach to achieving accountable care

Health policy

Quality, cost, and value in health care: How to solve the puzzle

18

I sometimes explain to medical students that they are entering a profession being transformed, like coal to diamonds, under the pressure of a new mandate. “The world is going to push us, relentlessly and without mercy, to deliver the highest…

I sometimes explain to medical students that they are entering a profession being transformed, like coal to diamonds, under the pressure of a new mandate.

“The world is going to push us, relentlessly and without mercy, to deliver the highest quality, safest, most satisfying care at the lowest cost,” I’ll say gravely, trying to get their attention.

“What exactly were you trying to do before?” some have asked, in that wonderful way …

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Quality, cost, and value in health care: How to solve the puzzle

Health policy

The dual narratives that define health reform

42

Doctors are trying to rationalize our current story line: the loss of autonomy and pay cuts are a necessary evil for the greater good. We're taking one for the excess-health care cost team. We're willing to take this personal sacrifice…

Doctors are trying to rationalize our current story line:  the loss of autonomy and pay cuts are a necessary evil for the greater good.   We’re taking one for the excess-health care cost team.  We’re willing to take this personal sacrifice for our fellow man and woman.   It is the noble thing to do.   It will be good for America’s healthcare system if we do our part, work harder …

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The dual narratives that define health reform

Health policy

How the Oregon Medicaid experiment is a failure

91

An important article was recently published in the New England Journal of Medicine, titled The Oregon Experiment — Effects of Medicaid on Clinical Outcomes. This study provides a rare look at the effects of expanding Medicaid coverage (specifically, Oregon Health…

An important article was recently published in the New England Journal of Medicine, titled The Oregon Experiment — Effects  of Medicaid on Clinical Outcomes. This study provides a rare look at the effects of expanding Medicaid coverage (specifically, Oregon Health Plan, Oregon’s version of Medicaid) to a population of previously uninsured patients. Having practiced medicine in Portland, …

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How the Oregon Medicaid experiment is a failure

Health policy

Cultivate more upstreamists to transform health care

An excerpt from The Upstream Doctors: Medical Innovators Track Sickness to Its Source. There’s a story widely known in public health circles about three friends and a river. I retell it this way: Three friends approach a wide, beautiful river…

An excerpt from The Upstream Doctors: Medical Innovators Track Sickness to Its Source.

There’s a story widely known in public health circles about three friends and a river. I retell it this way:

Three friends approach a wide, beautiful river leading to a waterfall. The idyllic scene is shattered by the cries of a small child in the water, flailing his arms while struggling to stay afloat. He’s fast approaching the

…

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Cultivate more upstreamists to transform health care

Health policy

What should medical students expect from health reform?

9

In an ad-hoc poll among classmates, I recently inquired about the most important date (in 2013) to a 2nd year medical student. The overwhelming majority cited their respective USMLE Step 1 exam dates as most important, followed closely by the…

In an ad-hoc poll among classmates, I recently inquired about the most important date (in 2013) to a 2nd year medical student. The overwhelming majority cited their respective USMLE Step 1 exam dates as most important, followed closely by the season finales of ABC’s Scandal and Grey’s Anatomy. While the top three responses all are worth their respective weights, the one date that should bear the most gravity in the minds …

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What should medical students expect from health reform?

Health policy

How Obamacare will largely eliminate price variations

75

If you have been paying attention to US healthcare policy debates lately, you know that hospitals have a price problem. Walk across the street from one hospital to a competitor hospital, and you could easily find yourself facing a $30,000…

If you have been paying attention to US healthcare policy debates lately, you know that hospitals have a price problem. Walk across the street from one hospital to a competitor hospital, and you could easily find yourself facing a $30,000 increase in your medical bills. At one extreme for instance recent information shows that replacing your hip with a surgical implant might cost anywhere from $5000 to …

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How Obamacare will largely eliminate price variations

Physician voices

Where has evidence based medicine taken us in 20 years?

5

A few months ago marked the 20th anniversary of the launch of evidence based medicine (EBM). Now seems a good time for a retrospective. After twenty years what does EBM mean? Where has it taken us? What are the distortions…

A few months ago marked the 20th anniversary of the launch of evidence based medicine (EBM). Now seems a good time for a retrospective. After twenty years what does EBM mean? Where has it taken us? What are the distortions and unintended consequences? You might be surprised.

What I intend to do is start with a little of the history of EBM, talk about the essential notion as originally conceived by …

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Where has evidence based medicine taken us in 20 years?

Health policy

How physician-owned hospitals are making teaching hospitals pay

13

I always believed that, if we could harness the entrepreneurial spirit of the American physician, we could be capable of great things. Physician decisions drive much of what is good and bad about our health care system. Their pens are…

I always believed that, if we could harness the entrepreneurial spirit of the American physician, we could be capable of great things. Physician decisions drive much of what is good and bad about our health care system. Their pens are the biggest driver of cost and their vigilance is the most significant driver of quality. It is a shame that physician-owned hospitals are accelerating the creation of a two-tier system …

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How physician-owned hospitals are making teaching hospitals pay

Health policy

Risk stratify patients to best use non-physician providers

35

“There are two diagnoses you will never make: those you didn’t think about, and those you have never heard of.” This quote, ascribed to many an attending physician over the years, underlies what has become on some levels a vitriolic…

“There are two diagnoses you will never make: those you didn’t think about, and those you have never heard of.”

This quote, ascribed to many an attending physician over the years, underlies what has become on some levels a vitriolic discussion of primary care delivery in the United States today. It was recently highlighted by a study published in the New England Journal of Medicine.

This article showed a real …

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Risk stratify patients to best use non-physician providers

Health policy

A brave new world as more physicians become employed

16

Several physicians have reached out recently to discuss attractive employment offers from health systems. They are invariably conflicted. They understand the trade-offs, that they’ll give up the autonomy they’ve become accustomed to in exchange for more money and fewer practice…

Several physicians have reached out recently to discuss attractive employment offers from health systems. They are invariably conflicted. They understand the trade-offs, that they’ll give up the autonomy they’ve become accustomed to in exchange for more money and fewer practice management headaches. On the down side, they’ll be accountable for generating significant revenues, sometimes independent of care appropriateness.

Most also are aware that the same care services they provide now will …

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A brave new world as more physicians become employed

Health policy

As health care consolidates, physicians face a choice

2

Amid massive change in our healthcare delivery systems and seismic shifts in many regional markets, physicians are increasingly being faced with a simple choice: be acquired or become employed as part of a large healthcare system, or stay independent while…

Amid massive change in our healthcare delivery systems and seismic shifts in many regional markets, physicians are increasingly being faced with a simple choice: be acquired or become employed as part of a large healthcare system, or stay independent while offering a compelling service that hospitals and health systems value.

The changes occurring in our care delivery systems have generated great interest, innovation, and yes, fear among many in healthcare, doctors …

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As health care consolidates, physicians face a choice

Patient voices

Don’t call me a health care consumer

8

The highly charged political debates about reforming American health care have provided tempting opportunities to rename the people who receive health services. But because the impetus for this change has been prompted by cost and quality concerns of health care…

The highly charged political debates about reforming American health care have provided tempting opportunities to rename the people who receive health services.  But because the impetus for this change has been prompted by cost and quality concerns of health care payers, researchers and policy experts rather than emanating from us out of our own needs, some odd words have been called into service.  Two phrases commonly used to describe us …

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Don’t call me a health care consumer

Health policy

Why pay for performance saves lives in the UK but not in the US

2

This past November, the New England Journal of Medicine published results from the “Advancing Quality” program in the United Kingdom: hospitals in the northwest of England were paid up to 4% more based on quality scores for treating several common…

This past November, the New England Journal of Medicine published results from the “Advancing Quality” program in the United Kingdom: hospitals in the northwest of England were paid up to 4% more based on quality scores for treating several common medical conditions.  Patient outcomes were compared to other National Health Service hospitals not eligible for the bonuses, and several other conditions that were not explicitly measured in the same …

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Why pay for performance saves lives in the UK but not in the US

Health policy

Why the Oregon Medicaid study is misunderstood

10

Much has already been written about the Oregon Medicaid study that came out in the New England Journal of Medicine. Unfortunately, the vast majority is reflex, rather than reflection. The study seems to serve as a Rorschach test of sorts,…

Much has already been written about the Oregon Medicaid study that came out in the New England Journal of Medicine. Unfortunately, the vast majority is reflex, rather than reflection.  The study seems to serve as a Rorschach test of sorts, confirming people’s biases about whether Medicaid is “good” or “bad”.  The proponents of Medicaid point to all the ways in which Medicaid seems to help those who were …

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Why the Oregon Medicaid study is misunderstood

Physician voices

America is at war with its doctors, and patients are the losers

47

Not old enough to remember any sort of “glory day” in medicine, I still enjoy hearing from older colleagues who recount days when they were respected, paid fairly, and able to practice medicine autonomously at the highest and most uncompromising…

Not old enough to remember any sort of “glory day” in medicine, I still enjoy hearing from older colleagues who recount days when they were respected, paid fairly, and able to practice medicine autonomously at the highest and most uncompromising level. What was that like, I wonder?

For five years, I’ve been a busy practicing anesthesiologist. And for five years, I’ve listened …

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America is at war with its doctors, and patients are the losers

Health policy

Health reform needs a healthy respect for civil discourse

16

I recently took part in a "civil discourse," an unusual occurrence in this era of media pundit-orchestrated shouting matches. Unlike a debate with winners and losers, a civil discourse begins with the premise that, when there are different points of…

I recently took part in a “civil discourse,” an unusual occurrence in this era of media pundit-orchestrated shouting matches.

Unlike a debate with winners and losers, a civil discourse begins with the premise that, when there are different points of view on a topic, it is better to understand those with whom we disagree than to turn off the sound.

By listening and asking probing questions, we come to understand how such …

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Health reform needs a healthy respect for civil discourse

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