Health policy and public health

4,357 articles · Since 2004

Articles, page 148

Doctors who cross the line by protesting too much

October 9, 2011Oct 9, 20113

Doctors are in the cross-hairs of the nation's politics more than ever. We're all being asked to achieve more with less. We must cope with nightmare scenarios precipitated by cracks in the social and healthcare infrastructure so often these days…

Doctors are in the cross-hairs of the nation’s politics more than ever. We’re all being asked to achieve more with less. We must cope with nightmare scenarios precipitated by cracks in the social and healthcare infrastructure so often these days that medical schools insist students become effective patient advocates as well as healers. Practicing good medicine necessitates navigating a minefield of competing interests. Doctors are increasingly tempted to just walk …

Health policy

Are physician services to blame for high health costs?

Cedric Dark, MD, MPH

October 9, 2011Oct 9, 201113

Why does health care cost so much more in the United States than in other countries? The answer is exceedingly complex; pharmaceuticals, hospitals, and physician services (among others) comprise the multiple slices of the health care pie that in the…

A new study from one of President Obama’s appointees (note: this study was written prior …

Health policy

Shared decision making is impossible in a government run health system

Norman Briffa, MD

October 8, 2011Oct 8, 201114

The relationship between doctors and their patients has changed dramatically over the past few years. Medical beneficence became paternalism and is now near obsolete. Shared decision making is the new lofty ideal we should all be striving for. It is guiding new health policy both in the UK, with the new mantra “nothing about me without me,” and in the US.

We are at the start of the Century of the …

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Health policy

Palliative care physicians can enhance patient decision making

Mark Novotny, MD

October 7, 2011Oct 7, 20112

Data from the Dartmouth Atlas show patients with chronic illness in their last two years of life account for about 32 percent of total Medicare spending, with much of that expense going toward physician and hospital fees associated with repeated…

Opportunities to reduce medical expenditures during the last 2 years of life are often looked upon as a way to reduce the cost of healthcare while actually improving the …

Health policy

Progressive health reformers need doctors to change the health system

Kevin Pho, MD

October 1, 2011Oct 1, 20117

Doctors order too many tests. That's not a surprise for regular readers of this site, but even the physicians themselves think so. A recent survey reported that, "42% of the 627 respondents believed the patients in their own practice were…

Doctors order too many tests.

That’s not a surprise for regular readers of this site, but even the physicians themselves think so.

A recent survey reported that, “42% of the 627 respondents believed the patients in their own practice were getting too much care. Just 6% of doctors believed their patients were getting too little care … And 28% of the …

Physician voices

Physicians lack harmony in this age of health reform

Gary Oftedahl, MD

September 30, 2011Sep 30, 2011

At every turn, we in health care are being told we must fundamentally change the way we deliver care to the patients who come to us for assistance, advice, and decisions as to how they can, if not maintain health, at least survive in an increasingly burdensome world. Whether referenced as medical home, health care home, advanced primary care, patient-centered approaches, or accountable care organizations, it all sounds the same …

Patient voices

America’s broken disability system

Edwin Leap, MD

September 29, 2011Sep 29, 201127

I once asked a man in his 30’s why he was on disability. He had fallen attempting to ford a swift stream while fishing. He replied: "Well, the judge said I have a bad attitude, I don’t like people and…

I once asked a man in his 30’s why he was on disability. He had fallen attempting to ford a swift stream while fishing. He replied: “Well, the judge said I have a bad attitude, I don’t like people and I can’t hold a job.” Shocking as it sounds, it wasn’t very different from other reasons I’ve heard. “I don’t remember, my Dad put me on it.” “I have anxiety.” …

Read more…

America’s broken disability system

Physician voices

A hospital board needs to understand generative thinking

Kent Bottles, MD

September 29, 2011Sep 29, 20112

Hospital systems and physician groups are faced with unprecedented change demanding decreased per-capita cost and increased quality in American health care. Boards of directors are underutilized resources that must be tapped more effectively in order for such organizations to survive in a time of industry consolidation. Generative thinking is a tool that can help organizations innovate in order to improve patient care and the financial bottom line.

Generative thinking is …

Health policy

Physicians need to be part of the overall wellness process

Joseph Boffa, DDS, MPH

September 28, 2011Sep 28, 2011

After nearing the brink of political collapse, Congress and the President reached agreement on a plan for deficit reduction. Part of the agreement is that a "super committee"will cut an additional $1.5 trillion from the federal budget. Cuts are being…

After nearing the brink of political collapse, Congress and the President reached agreement on a plan for deficit reduction. Part of the agreement is that a “super committee”will cut an additional $1.5 trillion from the federal budget. Cuts are being considered for a range of programs, including Medicare. As director of a wellness program for retirees, however, I remain acutely concerned about the impact Medicare cuts will have on …

Patient voices

It is not easy being a patient-consumer, but it can be done

Jeffrey Rice, MD, JD

September 28, 2011Sep 28, 20118

I would like to share a story about my son’s recent surgery that, while only one simple case, reveals the foundational problem with the U.S. health care system. I write this story as a father of a 12 year old…

I would like to share a story about my son’s recent surgery that, while only one simple case, reveals the foundational problem with the U.S. health care system.

I write this story as a father of a 12 year old boy who has cerebral palsy. Jack is fortunate to be healthy and active with minor medical needs. As he has grown he experienced some issues with contractures in his right lower …

Health policy

The threats to profit in academic medical centers

Robert Wachter, MD

September 27, 2011Sep 27, 20112

My hospital, UCSF Medical Center, is thriving. Our profits this year will be nearly $200 million. We’re building a sparkling clinical complex – a combined women’s, children’s, and cancer hospital – adjacent to our new downtown biomedical research campus. We…

We are installing a state-of-the-art computer system. US News & World Report calls us the 7th best hospital in the country. Our students, residents, and fellows have never been better.

Yet angst is in the air, borne …

Health policy

Patients need help to navigate the health care system

Benjamin Geisler, MD, MPH

September 22, 2011Sep 22, 20118

The New York Times recently ran an op-ed by Paul Krugman with the intriguing title, "Patients Are Not Consumers." Here’s an open letter to him: Dear Dr. Krugman, As a comparative effectiveness researcher, I agree with many of the arguments…

The New York Times recently ran an op-ed by Paul Krugman with the intriguing title, “Patients Are Not Consumers.”

Here’s an open letter to him:

Dear Dr. Krugman,

As a comparative effectiveness researcher, I agree with many of the arguments that you are making in your most recent article. However, I disagree with your main point that patients are not consumers.

I understand your sentiment and agree that patients are …

Physician voices

Unintended consequences of standardizing physician practice

Steve Wilkins, MPH

September 22, 2011Sep 22, 201124

Turns out there is an unintended consequence of many of the current efforts to standardize the way doctor’s practice medicine. It is called de-skilling. De-skilling can occur when physicians and other providers try to adapt to standardized, new ways of doing things. Examples of such standardization include clinical based care guidelines, electronic medical records (EMRs), pay for performance (P4P), patient centered medical home (PCMH) requirements and so on.

Examples of …

Health policy

Why an ACO is essentially an American product

David Harlow

September 21, 2011Sep 21, 2011

There has been a significant outcry against the proposed ACO regulations: everything's wrong and nothing's right about them, or so some would have us believe. Today's "nattering nabobs of negativism" focus on: the estimated price tag for complying with the…

There has been a significant outcry against the proposed ACO regulations: everything’s wrong and nothing’s right about them, or so some would have us believe.

Today’s “nattering nabobs of negativism” focus on: the estimated price tag for complying with the regulatory requirements (IT and other infrastructure included), the slim chance of success by ACOs in righting the wrongs of decades of bloat in the health care system, the …

Health policy

Should Medicare pay for procedures that have no proven benefit?

Bob Doherty

September 18, 2011Sep 18, 201120

"Doctors, with the consent of their patients, should be free to provide whatever care they agree is appropriate. But when the procedure arising from that judgment, however well intentioned, is not supported by evidence, the nation’s taxpayers should have no…

“Doctors, with the consent of their patients, should be free to provide whatever care they agree is appropriate. But when the procedure arising from that judgment, however well intentioned, is not supported by evidence, the nation’s taxpayers should have no obligation to pay for it.”

So argues Dr. Rita Redberg, a cardiologist and professor of medicine at the University of California, in a provocative op-ed published in the New …

Health policy

The root cause of why our health system is unsustainable

Donald H. Taylor, PhD

September 16, 2011Sep 16, 201139

An excerpt from Balancing The Budget is a Progressive Priority. It is our cultural fear of death and inability to discuss the limits of medicine to forestall death that enables the politics of health reform to be so potent. When…

An excerpt from Balancing The Budget is a Progressive Priority.

It is our cultural fear of death and inability to discuss the limits of medicine to forestall death that enables the politics of health reform to be so potent.

When I did a post-doctoral fellowship in England in the mid-1990s, a professor I met who had lived in the U.S. explained to me why he thought health policy discussions in that …

Health policy

Primary care gets caught in the physician pay crossfire

Robert Bowman, MD

September 16, 2011Sep 16, 20114

Major journals have slipped in another article that apparently was designed for controversy and for widespread distribution to media outlets. The New York Times rapidly picked it up. As the nation enters the final months before 29.5% fee cuts for…

Major journals have slipped in another article that apparently was designed for controversy and for widespread distribution to media outlets. The New York Times rapidly picked it up. As the nation enters the final months before 29.5% fee cuts for Medicare physician services, there will be many more of these that reach the light of day – too many if this is an indication.

What is common to major journals, media …

Health policy

United States health care may need reverse innovation

Kent Bottles, MD

September 15, 2011Sep 15, 20114

The realization that the American health care system must simultaneously decrease per-capita cost and increase quality has created the opportunity for the United States to learn from low and middle-income countries. “Reverse innovation” describes the process whereby an inexpensive innovation is used first in countries with limited infrastructure and resources and then spreads to industrialized nations like the United States.

The traditional model of innovation has involved the creation of …

Health policy

AMA: A new opportunity to fix the SGR

American Medical Association & Peter W. Carmel, MD

September 15, 2011Sep 15, 2011

A guest column by the American Medical Association, exclusive to KevinMD.com. Every year since 2001 the threat of severe physician payment cuts, imposed by Medicare’s failed sustainable growth rate formula (SGR), have jeopardized the stability of the Medicare system and…

A guest column by the American Medical Association, exclusive to KevinMD.com.

Every year since 2001 the threat of severe physician payment cuts, imposed by Medicare’s failed sustainable growth rate formula (SGR), have jeopardized the stability of the Medicare system and compromised access to care for patients. And every year – sometimes several times a year – Congress has put in place short-term fixes to stall the cuts.

Elected officials know that allowing these …

Read more…

AMA: A new opportunity to fix the SGR

Health policy

How health reform is reshaping health care markets

Joe Flower

September 15, 2011Sep 15, 20112

The current reorganization of health care could make it better and cheaper for everyone, harnessing real creative and competitive energies to build the "next health care" —or it could lead to local monopolies, higher prices and less real competition where…

The current reorganization of health care could make it better and cheaper for everyone, harnessing real creative and competitive energies to build the “next health care” —or it could lead to local monopolies, higher prices and less real competition where it matters. The many and various moves toward accountability, competition and transparency could defeat themselves.

The theme of the reorganization is clear: new types of cooperation between physicians, hospitals and other …

Health policy and public health

Articles, page 148

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