Health policy and public health

4,357 articles · Since 2004

Articles, page 150

How basic healthcare can be provided to the truly needy

August 19, 2011Aug 19, 20114

It is in this arena that the public treasury has been most abused by government ineptitude, institutional inertia and Congressional negligence. The waste and fraud in the Medicare and Medicaid system is scandalous and is now the target of well-organized…

The United States Government has done nothing to effectively stop it. Excuses run …

Health policy

Why cutting Medicaid will cost more in the long run

Maggie Kozel, MD

August 19, 2011Aug 19, 2011

I usually write about healthcare reform from a pediatrician’s viewpoint, but what grabbed my attention recently was a story my husband, Randy, told me about an adult in his practice – a patient on Medicaid. Randy is a neurologist in…

Randy is a neurologist in a private practice, and Medicaid patients come from every corner of Rhode Island to see him. They make this cumbersome pilgrimage because he is a member of a dying breed: …

Physician voices

Female doctors and the physician shortage

Darrell E. White, MD

August 13, 2011Aug 13, 201121

Someone has gone and rained the facts down on what is generally considered a feel–good story in American medicine, the dramatic increase in female doctors in America. In response to Dr. Herbert Parde’s "The Coming Doctor Shortage" article in the…

Someone has gone and rained the facts down on what is generally considered a feel–good story in American medicine, the dramatic increase in female doctors in America.

In response to Dr. Herbert Parde’s “The Coming Doctor Shortage” article in the Wall Street Journal, Dr. Curtis Markel pointed out that there is a difference between the raw, gross number of physicians in America, and the effective number of practicing physicians. Not only …

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Health policy

Why doctors should accept protocol medicine

Stephen C. Schimpff, MD

August 13, 2011Aug 13, 20113

We hear that doctors do not like "protocol medicine" – they do not want to follow a "cookbook" when every patient is different. It is not a good understanding of the issues. Some years ago when I worked in a…

We hear that doctors do not like “protocol medicine” – they do not want to follow a “cookbook” when every patient is different. It is not a good understanding of the issues.

Some years ago when I worked in a branch of he National Cancer Institute and then the University of Maryland Cancer Center, we admitted many patients with acute leukemia. The treatment approach including the necessary special tests to …

Health policy

Health reform and the iron triangle of health care

Aaron E. Carroll, MD

August 11, 2011Aug 11, 201112

When I was in medical school, we had a class on health economics taught by William Kissick. I didn’t pay as close attention as I should have (especially given what I do now). But I remember one thing he stressed.…

There are three aspects of health care systems that are essential: quality, cost, and access (thus the triangle). The …

Health policy

Doctors face difficult choices to save Medicare

Nick Dawson

August 10, 2011Aug 10, 201111

So, here we are, between a Medicare rock and budget hard place. Costs are clearly a problem. Our healthcare system is the most expensive in the world. Take a look at the 2003 figures from the Kaiser Family Foundation. Per…

So, here we are, between a Medicare rock and budget hard place.

Costs are clearly a problem. Our healthcare system is the most expensive in the world. Take a look at the 2003 figures from the Kaiser Family Foundation. Per capita costs, in 2003, in the US were $3,394 above those of the UK.

We need to work on the costs. That’s clear.

But …

Health policy

The public’s values of fairness in health inequalities

Brad Wright, PhD

August 9, 2011Aug 9, 20112

There are two camps in America: those who think that health care is a right and those who think that it's a privilege. Well, perhaps that's a bit of an oversimplification, but bear with me. Given these two respective positions,…

There are two camps in America: those who think that health care is a right and those who think that it’s a privilege. Well, perhaps that’s a bit of an oversimplification, but bear with me. Given these two respective positions, what are we to make of the health inequalities that are well documented in the United States? First, we must acknowledge that health is the product of multiple factors …

Health policy

Banned in Boston: Access to psychiatric care

J. Wesley Boyd, MD, PhD & Rachel Nardin, MD

August 5, 2011Aug 5, 20119

Imagine you have severe depression and go to a Boston emergency room for treatment. You are told to follow up with a psychiatrist within two weeks. You have good health insurance, so this shouldn’t be a problem, right? Wrong. In…

Wrong. In a new study just published in the Annals of Emergency Medicine, we found quite the opposite. Access to outpatient psychiatric care in the greater Boston area is severely limited, even for those with …

Health policy

Rationing is a logical outcome, and any changes must be incremental

Mitchell Brooks, MD

August 5, 2011Aug 5, 20116

This post continues my Ten Principles of Affordable Healthcare Reform. Health care changes should be made in small increments, easily understood by the People. Any changes that are made should be made in small increments and they should be cost…

This post continues my Ten Principles of Affordable Healthcare Reform.

Health care changes should be made in small increments, easily understood by the People.

Any changes that are made should be made in small increments and they should be cost effective and easily accepted by the public. It is clear at this juncture that we cannot afford the breadth and the scope of “reform” that is being currently proposed; to …

Health policy

The free market of smartphone apps can teach medicine a lesson

Edwin Leap, MD

August 5, 2011Aug 5, 20112

So I have a Droid. I purchased it in July, not long after taking my old flip-phone for an oceanic bath at Hilton Head, SC. I waffled for a long time. In fact, I almost purchased a Casio phone that…

So I have a Droid. I purchased it in July, not long after taking my old flip-phone for an oceanic bath at Hilton Head, SC. I waffled for a long time. In fact, I almost purchased a Casio phone that was marketed as water and impact resistant. “Mil-spec,” was the phrase used … a phrase which appeals to me as a one-time Air-Guard flight surgeon. What it meant to me …

Health policy

Hope and warnings to other states from California family physicians

Carol S. Havens, MD

August 4, 2011Aug 4, 2011

A guest post from the California Academy of Family Physicians, exclusive to KevinMD.com. Despite the slight upward tick in medical students opting for careers in family medicine over the last two years, efforts aimed at solving the primary care physician…

A guest post from the California Academy of Family Physicians, exclusive to KevinMD.com.

Despite the slight upward tick in medical students opting for careers in family medicine over the last two years, efforts aimed at solving the primary care physician shortage are often thwarted by state and federal policy decisions.

There is reason for hope, however: The number of medical school applications in California is extraordinarily high. A higher proportion of …

Health policy

What would a smart, compassionate, affordable health care system look like?

Maggie Kozel, MD

August 3, 2011Aug 3, 201115

One year after passage of the Patient Protection and Affordable Care Act, the debate roars on, in Congress and everywhere else. And these debates often revolve around a big question, even when it is left unspoken or implied: Is health…

In 1990 I made a quantum leap from practicing in the Navy’s single-payer, universal-coverage health care system into civilian pediatrics. Having been insulated from …

Patient voices

Partnership for Patients to improve patient safety

David B. Nash, MD, MBA

August 3, 2011Aug 3, 2011

When physician blogger Kevin Pho wrote about involving patients in healthcare reform in a recent article in USA Today, one thing he failed to mention is a novel government initiative that has been flying below most of our radar screens…

When physician blogger Kevin Pho wrote about involving patients in healthcare reform in a recent article in USA Today, one thing he failed to mention is a novel government initiative that has been flying below most of our radar screens — the “Partnership for Patients: Better Care — Lower Costs.”

Why was it necessary to call out patient centeredness as a separate initiative?

Although no one disputes that those of us …

Health policy

Can Medicaid be saved with better care coordination?

Benjamin Geisler, MD, MPH

August 3, 2011Aug 3, 2011

Recently, we marked the 66th birthday of Medicaid, the jointly funded but State-run program that supports health care for the poor. Medicaid plays a huge role in selected populations: 70% of nursing home inhabitants, 56% of low-income children and 42%…

Recently, we marked the 66^th birthday of Medicaid, the jointly funded but State-run program that supports health care for the poor. Medicaid plays a huge role in selected populations: 70% of nursing home inhabitants, 56% of low-income children and 42% of adults, and 44% of people living with HIV/AIDS all have their health care paid for by Medicaid. Medicaid is much talked about these days, and the reason is of course …

Physician voices

Pay for performance doesn’t work in difficult patient populations

Kohar Jones, MD

August 2, 2011Aug 2, 201110

Pay for performance. It’s a lovely sounding concept. If you’re a good doctor, defined by having healthy patients who meet predetermined quality indicators, then you get paid more. What could be simpler, right? Wrong. Not all patients are created equal.…

Pay for performance. It’s a lovely sounding concept. If you’re a good doctor, defined by having healthy patients who meet predetermined quality indicators, then you get paid more.

What could be simpler, right?

Wrong.

Not all patients are created equal. Some are highly educated, highly literate, highly motivated to prioritize health. They have good jobs with health insurance, so critical medical care isn’t prohibitively expensive. They don’t need to choose between paying …

Health policy

Why the debt ceiling deal is a horrific outcome for physicians

Kevin Pho, MD

August 2, 2011Aug 2, 201151

If you're a physician or hospital that relies on Medicare payments, grim times are ahead. Yes, even worse than the scheduled 29% payment cut that's scheduled to go into effect in 2013. Emergency physician Shadowfax calls the debt deal "a…

If you’re a physician or hospital that relies on Medicare payments, grim times are ahead. Yes, even worse than the scheduled 29% payment cut that’s scheduled to go into effect in 2013. Emergency physician Shadowfax calls the debt deal “a terrible deal for health care providers.”

Under the contentious debt ceiling agreement, significant cuts in Medicare dollars will be made. But …

Health policy

We need a single payment system instead of single payer

Mitchell Brooks, MD

July 30, 2011Jul 30, 201123

One of the great myths of healthcare is that there is an actual "system" in the United States. If such a system exists, I have yet to become familiarized with it. What we have are mountains of paper that slavishly…

One of the great myths of healthcare is that there is an actual “system” in the United States. If such a system exists, I have yet to become familiarized with it. What we have are mountains of paper that slavishly tie the patient, doctor, hospital and insurance carrier alike to a system of coding interpreted by individuals with no sense of what the codes mean or the labor and …

Health policy

Why Medicare is the solution to the soaring costs of health care

Robert Reich

July 30, 2011Jul 30, 201118

Not only is Social Security on the chopping block in order to respond to Republican extortion. So is Medicare. But Medicare isn’t the nation’s budgetary problems. It’s the solution. The real problem is the soaring costs of health care that…

Not only is Social Security on the chopping block in order to respond to Republican extortion. So is Medicare.

But Medicare isn’t the nation’s budgetary problems. It’s the solution. The real problem is the soaring costs of health care that lie beneath Medicare. They’re costs all of us are bearing in the form of soaring premiums, co-payments, and deductibles.

Medicare offers a means of reducing these costs — if Washington would let …

Medical education

Medical education cost is a health policy imperative

Kevin Pho, MD

July 28, 2011Jul 28, 201110

Whenever I talk about the cost of medical education, I like to bring up this chart. It starkly illustrates just how expensive it is to train a doctor in the United States, compared to Canada and France. New York Times…

New York Times contributor Pauline Chen wrote a column on the issue recently. Most doctors graduate with a debt exceeding $150,000, and …

Health policy

How health care will change in community health centers after reform

Ricky Choi, MD

July 28, 2011Jul 28, 2011

37 years ago, at the very tail of the civil rights movement, my community health center (CHC) was established in Oakland to fill an unmet and urgent need. A growing population of immigrants were settling in downtown Oakland and had few choices for health care. Community surveys conducted by local leaders confirmed that residents received significantly less health care than the rest of the population largely due to a …

Health policy and public health

Articles, page 150

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