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Health policy and public health

4,357 articles · Since 2004

Articles, page 167

Physician voices

The way we practice primary care doesn’t make sense

23

You've probably had the experience of going to see a primary care physician and wondering about the many aspects of that visit that just didn't make sense. Why is it so important for me to arrive on time when, in…

You’ve probably had the experience of going to see a primary care physician and wondering about the many aspects of that visit that just didn’t make sense.

Why is it so important for me to arrive on time when, in reality, I won’t be called back until half an hour (or more) later? What’s the point of waiting for another 20 minutes in a chilly examining room for the doctor …

Read more…

The way we practice primary care doesn’t make sense

Conditions and diseases

Sometimes more expensive care is better treatment

48

A recent publication in the publication Health Affairs has evoked comments and some concern from advocates of comparative effectiveness research and admirers of the Dartmouth Atlas. A survey of "consumers" found a level of skepticism that is alarming to those…

A recent publication in the publication Health Affairs has evoked comments and some concern from advocates of comparative effectiveness research and admirers of the Dartmouth Atlas.

A survey of “consumers” found a level of skepticism that is alarming to those folks who are in the business of claiming to know what aspects of medical care should be offered.

The idea that more care and more costly care gives inferior results to less …

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Sometimes more expensive care is better treatment

Health policy

How seniors will accept cuts in Medicare from health reform

8

Everybody knows politics is a balancing act. One must balance promises against reality. For example, how does government keep Medicare intact for seniors while cutting $500 billion out of Medicare when government has no track record of cutting entitlement spending?…

Everybody knows politics is a balancing act. One must balance promises against reality.

For example, how does government keep Medicare intact for seniors while cutting $500 billion out of Medicare when government has no track record of cutting entitlement spending?

And how one do it without losing the vote of seniors, who hold the key to the balance of power?

The Obama administration and the Democrats hope to keep power by winning the …

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How seniors will accept cuts in Medicare from health reform

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Physician voices

Paying cash to doctors affects the treatment plan

16

If we really want to find out how to damn near perfectly manage any medical problem as efficiently and cost-effectively as possible, we should be studying how doctors manage the medical problems of the cash-paying doctors they see in their…

If we really want to find out how to damn near perfectly manage any medical problem as efficiently and cost-effectively as possible, we should be studying how doctors manage the medical problems of the cash-paying doctors they see in their own practice.

Read part one here.

My visit with Dr. Grubman was fairly simple. We discussed allergy shots and how they could possibly help significantly with my dust allergy. Since I always …

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Paying cash to doctors affects the treatment plan

Health policy

Can patients demand changes in the healthcare system?

32

Are healthy people patients? Sometimes I wonder. If you’re healthy, you rarely see a doctor. If you go for a “routine” checkup every five years, you just aren’t very affected by the system. You might not even know what the…

Are healthy people patients?  Sometimes I wonder.

If you’re healthy, you rarely see a doctor.  If you go for a “routine” checkup every five years, you just aren’t very affected by the system.  You might not even know what the system is.  Your health insurance premium is deducted from your paycheck, so you never really see that money — not the way you would if you had to write a check in that …

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Can patients demand changes in the healthcare system?

Drugs and prescribing

The Massachusetts gift ban benefits health insurance companies

13

With the recent proposal to repeal the so-called Massachusetts “gift ban” (more appropriately referred to as the “interaction ban”), I asked myself who stands to gain the most from such bans? Is it the consumers or patients? Is it the…

With the recent proposal to repeal the so-called Massachusetts “gift ban” (more appropriately referred to as the “interaction ban”), I asked myself who stands to gain the most from such bans?

Is it the consumers or patients? Is it the physicians or their practices? Is it the federal or state governments? Nope. Sadly, it is the insurers who gain the most, at the expense of patients.

The argument for “interaction …

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The Massachusetts gift ban benefits health insurance companies

Health policy

America has a disease industry, not a health care system

8

The decade ahead is one likely to be full of turbulence. How everything will shake out is anybody’s guess. But we can be sure that technology advancements will slow for no one. The rate of medical technology advancement now is…

The decade ahead is one likely to be full of turbulence. How everything will shake out is anybody’s guess.

But we can be sure that technology advancements will slow for no one. The rate of medical technology advancement now is very fast and the speed will only accelerate. One big problem is that technology advances so fast that there is no time for a purchase – say new CT scanner or …

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America has a disease industry, not a health care system

Health policy

Why Medicaid would be better off as a federal program, like Medicare

6

This is a perfect example of why Medicaid is not the same as Medicare: Having counted on Washington for money that may not be delivered, at least 30 states will have to close larger-than-anticipated shortfalls in the coming fiscal year…

This is a perfect example of why Medicaid is not the same as Medicare:

Having counted on Washington for money that may not be delivered, at least 30 states will have to close larger-than-anticipated shortfalls in the coming fiscal year unless Congress passes a six-month extension of increased federal spending on Medicaid.

Governors and state lawmakers, already facing some of the toughest budgets since the Great Depression, said the repercussions would

…

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Why Medicaid would be better off as a federal program, like Medicare

Health policy

Understanding balance billing, a primer for patients

14

The topic of balance billing has arisen once again, this time in this post by Movin’ Meat about the new health care insurance bill and emergency medicine. Without further explanation, “balance billing” is generally thought of as a bad thing;…

The topic of balance billing has arisen once again, this time in this post by Movin’ Meat about the new health care insurance bill and emergency medicine.

Without further explanation, “balance billing” is generally thought of as a bad thing; a way for rich doctors to squeeze even more ill-gotten gains from their poor beleaguered patients. And that’s without even realizing what it is. So …

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Understanding balance billing, a primer for patients

Health policy

Health care needs public acceptance of evidence based medicine

11

Although a majority of Americans probably couldn't give you an accurate description of the differences between fascism, socialism, and communism, they have no trouble applying--and often interchanging--those labels to any effort by government to reform health care. And, based on…

Although a majority of Americans probably couldn’t give you an accurate description of the differences between fascism, socialism, and communism, they have no trouble applying–and often interchanging–those labels to any effort by government to reform health care.

And, based on their efforts, one might conclude that the defining characteristic of any government involvement in health care is rationing. As if we don’t already ration, but will as soon as the government …

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Health care needs public acceptance of evidence based medicine

Health policy

The value of comparative effectiveness reviews is locally based

3

by Craig A. Umscheid, MD, MSCE In its 2010 comparison, the Commonwealth Fund has rendered the verdict yet again: the United States leaves other nations in the dust when it comes to healthcare costs -- and yet provides its residents…

by Craig A. Umscheid, MD, MSCE

In its 2010 comparison, the Commonwealth Fund has rendered the verdict yet again: the United States leaves other nations in the dust when it comes to healthcare costs — and yet provides its residents with the worst outcomes overall. In the study, the U.S. underperformed on virtually every front in comparison to Australia, Canada, Germany, Netherlands, New Zealand, and the United Kingdom.

The …

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The value of comparative effectiveness reviews is locally based

Health policy

How Massachusetts can set hospital payment rates

10

My suggestion last year that Massachusetts move away from the "free market" approach it uses to set hospital reimbursement rates was not well received by the hospital world. But, this year, as people notice that their rates are being set…

My suggestion last year that Massachusetts move away from the “free market” approach it uses to set hospital reimbursement rates was not well received by the hospital world.

But, this year, as people notice that their rates are being set by insurance companies in an unaccountable and unreviewable fashion, more and more are saying, “Well, maybe. What would it look like?”

There is a range of options. Let me lay out …

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How Massachusetts can set hospital payment rates

Health policy

What libraries and community centers have to do with health care

Our grandparents used to tell us, "if it ain't broke, don't fix it". Management gurus, in their race to the finish line have turned this sentiment on its head by telling us that, if it ain't broke now, it will…

Our grandparents used to tell us, “if it ain’t broke, don’t fix it”.

Management gurus, in their race to the finish line have turned this sentiment on its head by telling us that, if it ain’t broke now, it will be soon, and if you do not fix it before it breaks, you will be behind the competition. This sentiment drives the annual corporate reorganization at every corporation that I or …

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What libraries and community centers have to do with health care

Health policy

A new primary care payment model with health savings accounts

9

by Charles Smith, MD Everybody seems to be dissatisfied with the current model of primary care. Concierge and retainer practices are all the rage, but they serve too few patients. While some highly integrated systems (Mayo Clinic, maybe Kaiser Permanente)…

by Charles Smith, MD

Everybody seems to be dissatisfied with the current model of primary care.

Concierge and retainer practices are all the rage, but they serve too few patients. While some highly integrated systems (Mayo Clinic, maybe Kaiser Permanente) may be thriving, they are difficult to replicate. Most primary care physicians are demoralized by a system that overburdens them with administrative hassles and liability while providing insufficient revenue to improve …

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A new primary care payment model with health savings accounts

Health policy

Why general internists are quitting clinical medicine

12

The Association of American Medical Colleges predicts that by 2025, the US health system will have 46,000 fewer primary care physicians than it needs. If the prediction proves correct and we fail to develop effective mitigation strategies, the manpower shortage…

The Association of American Medical Colleges predicts that by 2025, the US health system will have 46,000 fewer primary care physicians than it needs.

If the prediction proves correct and we fail to develop effective mitigation strategies, the manpower shortage will create quite a mess. Ironically, the health reform law signed by President Obama in March will exacerbate the problem by increasing demand for services provided by primary care physicians.

The American …

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Why general internists are quitting clinical medicine

Health policy

Poliomyelitis doesn’t make the health reform cut

2

Early in paralytic poliomyelitis, the patient exhibits weakness; hyperesthesia; muscular pain, frequently quite severe; antalgic (reflexive) immobilization (spasm) of involved muscles; and normal or accentuated tendon reflexes. This phase is rapidly followed by loss of motor function, which is usually…

Early in paralytic poliomyelitis, the patient exhibits weakness; hyperesthesia; muscular pain, frequently quite severe; antalgic (reflexive) immobilization (spasm) of involved muscles; and normal or accentuated tendon reflexes.

This phase is rapidly followed by loss of motor function, which is usually asymmetric and noncontiguous: one or both legs in 60 percent of the cases; one or both arms in 25 percent. Involvement of the diaphragm and intercostal muscles reduces ventilatory capacity. Cranial …

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Poliomyelitis doesn’t make the health reform cut

Health policy

Free clinics need more government funding

10

by Cole Petrochko The nation's free clinics provide medical service to 1.8 million patients annually -- more than half of those clinics operate without government funding and serve patients who are almost all uninsured -- according to the first census…

by Cole Petrochko

The nation’s free clinics provide medical service to 1.8 million patients annually — more than half of those clinics operate without government funding and serve patients who are almost all uninsured — according to the first census of free clinics in 40 years.

Responses to a national mail survey by 764 free clinics in the U.S., reported in the June issue of the Archives of Internal Medicine, revealed that …

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Free clinics need more government funding

Health technology

Final meaningful use rules for electronic health records reaction

9

by Joyce Frieden The Department of Health and Human Services has released its final rule on "meaningful use" of electronic health records with the goal of making it easier for physicians to comply. "We want these objectives to be ambitious…

by Joyce Frieden

The Department of Health and Human Services has released its final rule on “meaningful use” of electronic health records with the goal of making it easier for physicians to comply.

“We want these objectives to be ambitious but achievable,” David Blumenthal, MD, MPP, the department’s National Coordinator for Health Information Technology, said at a press conference on Tuesday announcing the release of the …

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Final meaningful use rules for electronic health records reaction

Health policy

The individual mandate and the impending Supreme Court challenge

54

The individual mandate is the single most controversial feature of the Patient Protection and Affordable Care Act (PPACA). Everyone who can afford coverage—unless an undocumented immigrant or exempted on religious grounds—is required to have it or pay a penalty of…

The individual mandate is the single most controversial feature of the Patient Protection and Affordable Care Act (PPACA). Everyone who can afford coverage—unless an undocumented immigrant or exempted on religious grounds—is required to have it or pay a penalty of $695 or 2.5 percent of income.

The rationale is straightforward: without a mandate, many people would wait until they needed care before buying insurance, driving up premiums for those with ongoing …

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The individual mandate and the impending Supreme Court challenge

Health policy

Healthcare reform: Who’s getting stuck with the bill?

2

by Shelly Towns Many people have the mistaken idea that “socialized healthcare” means that medicine and care will now be free for everyone, but in all actuality, nothing could be further from the truth. The new healthcare bill represents one…

by Shelly Towns

Many people have the mistaken idea that “socialized healthcare” means that medicine and care will now be free for everyone, but in all actuality, nothing could be further from the truth.

The new healthcare bill represents one of the largest, most sweeping domestic policy changes in a generation, and aims to provide an estimated $940 billion in healthcare to over 32 million uninsured Americans (and that’s only for the …

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Healthcare reform: Who’s getting stuck with the bill?

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