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Health policy and public health

4,357 articles · Since 2004

Articles, page 149

Health policy

Targeting physician salaries is a poor strategy for health care costs

12

A recent study from Health Affairs took aim at physician salaries. Well, not exactly their salaries, but fees. It's a subtle difference, but that nuance is lost in the mainstream media narrative. According to the study, "American primary care and…

A recent study from Health Affairs took aim at physician salaries.

Well, not exactly their salaries, but fees. It’s a subtle difference, but that nuance is lost in the mainstream media narrative.

According to the study, “American primary care and orthopedic physicians are paid more for each service than are their counterparts in Australia, Canada, France, Germany and the United Kingdom.”

Thankfully …

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Targeting physician salaries is a poor strategy for health care costs

Health policy

ACP: Current and future payment and practice trends in medicine

5

A guest column by the American College of Physicians, exclusive to KevinMD.com. In April 2011 I finished seven years on the Board of Regents of the American College of Physicians (ACP) including two years as Chair of the ACP Health…

A guest column by the American College of Physicians, exclusive to KevinMD.com.

In April 2011 I finished seven years on the Board of Regents of the American College of Physicians (ACP) including two years as Chair of the ACP Health and Public Policy Committee and serving during the last year as President. During that time I had the opportunity to be involved in some great discussions on health care within …

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ACP: Current and future payment and practice trends in medicine

Health policy

Can cost accounting save health care?

3

In the September 2011 issue of Harvard Business Review, Harvard Business School professors Robert Kaplan and Michael Porter argue that a better understanding of the actual cost of care patient-by-patient can have a dramatic impact in the effort to control…

In the September 2011 issue of Harvard Business Review, Harvard Business School professors Robert Kaplan and Michael Porter argue that a better understanding of the actual cost of care patient-by-patient can have a dramatic impact in the effort to control health care costs. They maintain that actual costs are poorly understood, that there is a mistaken belief that many costs are too complex to allocate accurately, and that …

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Can cost accounting save health care?

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Physician voices

Human capital makes doctors special

3

If you’ve ever been sick, especially with anything serious, you quickly realize that doctors, nurses and their ilk are an unusual and precious resource. First you have to find smart people with personalities willing and able to put up with…

If you’ve ever been sick, especially with anything serious, you quickly realize that doctors, nurses and their ilk are an unusual and precious resource.

First you have to find smart people with personalities willing and able to put up with a lot of guff in the service of their fellow man.  Then they have to be willing to (usually borrow, and) spend tens or hundreds of thousands of dollars for …

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Human capital makes doctors special

Health policy

Government austerity with Medicare reform as a top priority

7

Medicare needs to be reformed, but there's no easy solution to the problem. As the average life expectancy increases, more-and-more politicians have proposed an increase in the Medicare eligibility age. This increase in life expectancy, however, is an issue that…

Medicare needs to be reformed, but there’s no easy solution to the problem.  As the average life expectancy increases, more-and-more politicians have proposed an increase in the Medicare eligibility age.  This increase in life expectancy, however, is an issue that only affects the wealthiest half of America — the people that need Medicare the least — because the life expectancy has only increased significantly in the richest half of …

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Government austerity with Medicare reform as a top priority

Patient voices

Slipping through the cracks in our health care system

2

Between the cracks is a frightening place to be. During the course of trying to improve our family’s financial stability, my husband and I were blind-sided by one hidden detail: We’d face $10,000 in costs to continue my husband’s serious…

Between the cracks is a frightening place to be.

During the course of trying to improve our family’s financial stability, my husband and I were blind-sided by one hidden detail: We’d face $10,000 in costs to continue my husband’s serious medical treatment because we found ourselves unexpectedly without coverage for 30 days.

This was money we simply did not have. We had been prepared to foot the full bill for good health …

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Slipping through the cracks in our health care system

Health policy

Improving efficiency and requiring Congress to live under our healthcare rules

Here are my next two principles of affordable healthcare reform. First, medicine must be practiced in a manner and in a place that is consistent with economic efficiencies, evidence based outcomes and the needs of the specific community that it…

Here are my next two principles of affordable healthcare reform.

First, medicine must be practiced in a manner and in a place that is consistent with economic efficiencies, evidence based outcomes and the needs of the specific community that it serves.

In healthcare delivery, quantitative must be balanced by qualitative. Specific community needs and the culture of that particular community must have equal and in certain cases, greater value than the …

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Improving efficiency and requiring Congress to live under our healthcare rules

Physician voices

Overcoming barriers to building a direct primary care practice

3

The federal health reform bill included a little-noticed clause allowing for Direct Primary Care (DPC) models to be a part of the state health exchanges. I believe this will fundamentally alter the health insurance market and is leading to what…

The federal health reform bill included a little-noticed clause allowing for Direct Primary Care (DPC) models to be a part of the state health exchanges. I believe this will fundamentally alter the health insurance market and is leading to what I call a “Do it Yourself Health Reform” movement. That little-noticed clause (item #3 in 1301(a) of HR 3590) should have the effect of massively …

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Overcoming barriers to building a direct primary care practice

Health policy

Will replacing fee for service really reduce costs?

6

In this enlightened era of evidence-based medicine, you'd think that the progressive academics, viziers, and mandarins who are cluttering the policy making commentariat would pay more attention to what was tried before. That should be doubly true if those lessons…

In this enlightened era of evidence-based medicine, you’d think that the progressive academics, viziers, and mandarins who are cluttering the policy making commentariat would pay more attention to what was tried before. That should be doubly true if those lessons come from that health care nirvana called Europe, where enlightened central bureaucracies wisely allocate health care for its caffè sipping, plaza strolling and beret adorned citizenry.

Case in point is …

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Will replacing fee for service really reduce costs?

Health policy

The medical legacy of Rick Perry

26

While liability reforms have been good for the health of Texans, many laws favored by Governor Perry have damaged health. As a physician on the Committee on Public Health of Bexar County Medical Society, I have been trying for many…

While liability reforms have been good for the health of Texans, many laws favored by Governor Perry have damaged health.  As a physician on the Committee on Public Health of Bexar County Medical Society, I have been trying for many years to help not only my patients, but also Texans in general.  San Antonio, my home for the last 30 years, is reported to have a population mix very similar …

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The medical legacy of Rick Perry

Health policy

How not to convince doctors to embrace single payer

24

What would happen to physician salaries if the United States adopted a single payer system? The concept of a single payer system is a progressive ideal, and has been vociferously pursued by some left-leaning physician groups. For a variety of…

What would happen to physician salaries if the United States adopted a single payer system?

The concept of a single payer system is a progressive ideal, and has been vociferously pursued by some left-leaning physician groups. For a variety of reasons, not least of which is the political climate in our country, I think the chances of single payer happening …

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How not to convince doctors to embrace single payer

Health policy

Is the health quality bar set high enough?

Yesterday was no different than many other days in my life as a consultant. Two clients, three cities, and finally arriving late evening at the hotel. It had been a long day of travel and I was looking forward to…

Yesterday was no different than many other days in my life as a consultant.  Two clients, three cities, and finally arriving late evening at the hotel. It had been a long day of travel and I was looking forward to getting into my room and off of my feet. As I got onto the elevator, for some reason, the inspection certificate caught my eye and I felt compelled to read …

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Is the health quality bar set high enough?

Health policy

Health insurers have come up with the idea of the century

8

I have come up with the idea of the century. My idea will make your company the richest in the world while attracting millions of new patrons to your credit and debit card services. I don’t know why no one…

I have come up with the idea of the century.  My idea will make your company the richest in the world while attracting millions of new patrons to your credit and debit card services.  I don’t know why no one has done it in the past.  It has made the insurers of America countless billions of dollars and now you can profit as well.  My only request is that you …

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Health insurers have come up with the idea of the century

Health policy

How health reform is like accident reform

3

"Do you know how many people died in car crashes in the United States in 2010? 32,000. That’s the lowest number since 1949. That’s impressive, but wait: It’s far more impressive than it sounds at first, because people in the…

“Do you know how many people died in car crashes in the United States in 2010? 32,000. That’s the lowest number since 1949. That’s impressive, but wait: It’s far more impressive than it sounds at first, because people in the United States drove about 10 times as many vehicle miles in 2010 as they did in 1949. In other words, if you drove a car or truck in 2010, you …

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How health reform is like accident reform

Health policy

Implementing the Affordable Care Act will increase physician tension

3

It's really quite an ancient debate: 400 to 500 years before the birth of Christ, on the island of Kos (home of Hippocrates) originates the myth of Aesculapius, god of healing, son of Apollo and the nymph Coronis. As is…

It’s really quite an ancient debate: 400 to 500 years before the birth of Christ, on the island of Kos (home of Hippocrates) originates the myth of Aesculapius, god of healing, son of Apollo and the nymph Coronis.

As is not unusual in Greek mythology, Coronis meets a violent death, but the infant Aesculapius is saved. He is raised by a wise centaur, becomes skilled in healing arts, and succeeds in …

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Implementing the Affordable Care Act will increase physician tension

Health policy

Adapting the medical home for cancer care

It was 1967. I was an intern in the UCLA-Wadsworth VA Rotating Internship Program when I reported for my physical as part of the Berry Plan deferment. For the younger set, physicians and dentists could elect to delay military service…

It was 1967.  I was an intern in the UCLA-Wadsworth VA Rotating Internship Program when I reported for my physical as part of the Berry Plan deferment.  For the younger set, physicians and dentists could elect to delay military service until completion of their first year of residency training, and we could elect our branch of service we preferred to serve in.  I chose the Air Force.  On the History …

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Adapting the medical home for cancer care

Health policy

How Medicare undermines primary care

8

When I was a family medicine intern, I met a diabetic patient in the hospital who had stopped seeing his regular doctor after he lost his job and his health insurance. His untreated diabetes made his feet go numb. He…

When I was a family medicine intern, I met a diabetic patient in the hospital who had stopped seeing his regular doctor after he lost his job and his health insurance.  His untreated diabetes made his feet go numb.  He stepped on a nail and didn’t realize it until he noticed a smell that cost him his foot.

He spent thousands of dollars on the surgery and subsequent hospital stay—far …

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How Medicare undermines primary care

Health policy

How politics have weakened the USPSTF

35

Health reform was supposed to have been good news for the U.S. Preventive Services Task Force. Until 2009, this independent panel of federally-appointed experts in primary care and preventive health was not particularly well known, and its evaluations of the…

Health reform was supposed to have been good news for the U.S. Preventive Services Task Force. Until 2009, this independent panel of federally-appointed experts in primary care and preventive health was not particularly well known, and its evaluations of the effectiveness of clinical preventive services had no binding authority on public or private insurance plans. Within the small circle of physicians and policymakers who were aware of the their …

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How politics have weakened the USPSTF

Health policy

The interests of doctors and patients sometimes conflict

2

Organized American medicine would like for physicians to "speak with one voice." If they could do so, and if that voice were in the public interest, not only in the self-interest of those physicians, it would be a very powerful…

Organized American medicine would like for physicians to “speak with one voice.”

If they could do so, and if that voice were in the public interest, not only in the self-interest of those physicians, it would be a very powerful voice indeed.

Arnold (Bud) Relman, the esteemed former editor of the New England Journal of Medicine, once rightly told the International Committee of Medical Journal Editors that physicians speak with many …

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The interests of doctors and patients sometimes conflict

Health policy

Why physicians will be sacrificial lambs in future Medicare cuts

6

This year, total federal spending in the U.S. is projected to be $3.6 trillion. The top three budgetary categories are: Medicare/Medicaid -- $826 billion Social Security -- $717 billion Defense/Wars -- $703 billion Medicare and Medicaid costs alone account for…

This year, total federal spending in the U.S. is projected to be $3.6 trillion. The top three budgetary categories are:

  1. Medicare/Medicaid —  $826 billion
  2. Social Security —  $717 billion
  3. Defense/Wars —  $703 billion

Medicare and Medicaid costs alone account for 23% of total federal spending.

If the magnitude of these projections does not alarm you, let’s look at it from a revenue perspective. This year, the total U.S.tax revenue is projected to be $2.2 …

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Why physicians will be sacrificial lambs in future Medicare cuts

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