NEJM â Collection Updates for Health Care Delivery

PERSPECTIVE: Cottage Industry to Postindustrial Care â The Revolution in Health Care Delivery

Thu, 04Â FebÂ 2010 00:00:00 -05:00

U.S. health care is broken. Although other industries have transformed themselves using tools such as standardization of value-generating processes, performance measurement, and transparent reporting of quality, the application of these...

SOUNDING BOARD: Comparative Effectiveness and Health Care Spending â Implications for Reform

Milton C. Weinstein, Ph.D., and Jonathan A. Skinner, Ph.D. — Thu, 04Â FebÂ 2010 00:00:00 -05:00

Title VIII of the American Recovery and Reinvestment Act of 2009 authorizes the expenditure of $1.1 billion to conduct research comparing âclinical outcomes, effectiveness, and appropriateness of items, services, and...

PERSPECTIVE: Launching HITECH

Thu, 04Â FebÂ 2010 00:00:00 -05:00

Information is the lifeblood of modern medicine. Health information technology (HIT) is destined to be its circulatory system. Without that system, neither individual physicians nor health care institutions can perform...

PERSPECTIVE: Medicare and Medical Technology â The Growing Demand for Relevant Outcomes

Thu, 04Â FebÂ 2010 00:00:00 -05:00

In deciding whether to pay for new medical technologies, the Centers for Medicare and Medicaid Services (CMS) is becoming more specific about its requirements for evidence of improved health outcomes...

SPECIAL ARTICLE: Increased Ambulatory Care Copayments and Hospitalizations among the Elderly

Amal N. Trivedi, M.D., M.P.H., Husein Moloo, M.P.H., and Vincent Mor, Ph.D. — Thu, 28Â JanÂ 2010 00:00:00 -05:00

Background: When copayments for ambulatory care are increased, elderly patients may forgo important outpatient care, leading to increased use of hospital care.

Methods: We compared longitudinal changes in the use of...

PERSPECTIVE: American Values and Health Care Reform

Thu, 28Â JanÂ 2010 00:00:00 -05:00

With the national debate over health care reform careening between tired, well-rehearsed talking points, on the one hand, and deep-in-the-weeds debates over technical details, initiatives, and financing mechanisms, on the...

PERSPECTIVE: Medicine's Ethical Responsibility for Health Care Reform â The Top Five List

Thu, 28Â JanÂ 2010 00:00:00 -05:00

Early in 2009, members of major health careârelated industries such as insurance companies, pharmaceutical manufacturers, medical device makers, and hospitals all agreed to forgo some future profits to show support...

PERSPECTIVE: Patient-Centered Medical Homes in Ontario

Thu, 21Â JanÂ 2010 00:00:00 -05:00

As the United States debates health care reform, the concept of âpatient-centered medical homesâ is receiving increasing attention.1 Many experts believe that medical homes with multidisciplinary teams and financial incentives...

PERSPECTIVE: Health Care Reform and the Need for Comparative-Effectiveness Research

Thu, 21Â JanÂ 2010 00:00:00 -05:00

Health care reform will eventually pit the goal of expanding health insurance coverage against strong pressure to reduce the growth in health care costs. If left to measures in the...

PERSPECTIVE: Accelerating the Use of Electronic Health Records in Physician Practices

Thu, 21Â JanÂ 2010 00:00:00 -05:00

North Shore Hospital System on Long Island in New York recently announced that it will pay an incentive of up to $40,000 to each physician in its network who adopts...

PERSPECTIVE: Carrots, Sticks, and Health Care Reform â Problems with Wellness Incentives

Thu, 14Â JanÂ 2010 00:00:00 -05:00

Chronic conditions, especially those associated with overweight, are on the rise in the United States (as elsewhere). Employers have used both carrots and sticks to encourage healthier behavior. The current...

PERSPECTIVE: Implementation and Enforcement of Health Care Reform â Federal versus State Government

Thu, 14Â JanÂ 2010 00:00:00 -05:00

Health care reform lurches forward. The House and Senate have both passed reform bills. How well reform works in practice, however, will depend on one key difference between the two...

PERSPECTIVE: Ranking 37th â Measuring the Performance of the U.S. Health Care System

Thu, 14Â JanÂ 2010 00:00:00 -05:00

Evidence that other countries perform better than the United States in ensuring the health of their populations is a sure prod to the reformist impulse. The World Health Report 2000,...

PERSPECTIVE: Uncomfortable Arithmetic â Whom to Cover versus What to Cover

Thu, 14Â JanÂ 2010 00:00:00 -05:00

Much of the current debate about expanding health insurance coverage avoids addressing an uncomfortable trade-off: with a limited budget, making benefits more generous means being able to cover fewer people....

PERSPECTIVE: âPlay-or-Payâ Insurance Reforms for Employers â Confusion and Inequity

Thu, 14Â JanÂ 2010 00:00:00 -05:00

One prominent feature of the current health care reform bills is a âplay-or-payâ rule for employers: workers must receive part of their compensation in the form of employer-sponsored health insurance,...

ORIGINAL ARTICLE: Preventing Surgical-Site Infections in Nasal Carriers of

Thu, 07Â JanÂ 2010 00:00:00 -05:00

Background: Nasal carriers of Staphylococcus aureus are at increased risk for health careâassociated infections with this organism. Decolonization of nasal and extranasal sites on hospital admission may reduce this risk.

Methods:...

EDITORIAL: Minimizing Surgical-Site Infections

Richard P. Wenzel, M.D. — Thu, 07Â JanÂ 2010 00:00:00 -05:00

Primitive ancestors of Homo sapiens and their colonizing bacteria have coevolved for approximately 500,000 years; some experts estimate that the total number of human cells is 1013 and the total...

PERSPECTIVE: Googling Ourselves â What Physicians Can Learn from Online Rating Sites

Thu, 07Â JanÂ 2010 00:00:00 -05:00

I open the Google search page on my laptop, type in my name, and click âsearch.â In the 0.22 second it takes for the 1540 results to appear, I have...

PERSPECTIVE: Payment Reform â The Need to Harmonize Approaches in Medicare and the Private Sector

Thu, 07Â JanÂ 2010 00:00:00 -05:00

In the midst of heated debate over health care reform, there is an emerging consensus that the way we pay for health care â with our widespread reliance on fee-for-service...

ORIGINAL ARTICLE: ChlorhexidineâAlcohol versus PovidoneâIodine for Surgical-Site Antisepsis

Thu, 07Â JanÂ 2010 00:00:00 -05:00

Background: Since the patient's skin is a major source of pathogens that cause surgical-site infection, optimization of preoperative skin antisepsis may decrease postoperative infections. We hypothesized that preoperative skin cleansing...

PERSPECTIVE: Ensuring the Fiscal Sustainability of Health Care Reform

Thu, 07Â JanÂ 2010 00:00:00 -05:00

Much of the recent health care reform debate has focused on achieving budget neutrality over a 10-year period, but this goal is less important than the reform's long-run fiscal sustainability....

PERSPECTIVE: Ending End-of-Life Phobia â A Prescription for Enlightened Health Care Reform

Thu, 31Â DecÂ 2009 00:00:00 -05:00

Reform is coming to U.S. health care. A sense of urgency regarding the redesign of policies prevailed well before Barack Obama was elected president under the banner of change. A...

SPECIAL ARTICLE: Public Reporting of Discharge Planning and Rates of Readmissions

Ashish K. Jha, M.D., M.P.H., E. John Orav, Ph.D., and Arnold M. Epstein, M.D. — Thu, 31Â DecÂ 2009 00:00:00 -05:00

Background: A reduction in hospital readmissions may improve quality and reduce costs. The Centers for Medicare and Medicaid Services has initiated a national effort to measure and publicly report on...

PERSPECTIVE: Industry Influence on Comparative-Effectiveness Research Funded through Health Care Reform

Thu, 31Â DecÂ 2009 00:00:00 -05:00

Much attention has been focused on the ongoing efforts in Washington to pass a health care reform bill. Comprehensive health care should reduce the use of ineffective and suboptimal medical...

PERSPECTIVE: The Emotional Epidemiology of H1N1 Influenza Vaccination

Thu, 31Â DecÂ 2009 00:00:00 -05:00

Last spring, when 2009 H1N1 influenza first came to our attention, my patients were in a panic. Our clinic was flooded with calls and walk-in patients, all with the same...

PERSPECTIVE: Australia's Winter with the 2009 Pandemic Influenza A (H1N1) Virus

Thu, 31Â DecÂ 2009 00:00:00 -05:00

When the World Health Organization declared a âpublic health emergency of international concernâ on April 25, 2009, after the emergence in Mexico of pandemic influenza A (H1N1) virus, Australia activated...

PERSPECTIVE: Abortion Politics and Health Insurance Reform

Thu, 31Â DecÂ 2009 00:00:00 -05:00

President Barack Obama has made it clear that he does not want abortion politics to sabotage health care reform. In his September 10 speech about health care to a joint...

OTHER POINTS OF VIEW: Act II â Curve Bending

Thu, 24Â DecÂ 2009 00:00:00 -05:00

Health care reform seems to be a two-act play. We are moving toward the conclusion of the first act, universal coverage. The second act will consist of controlling the cost...

PERSPECTIVE: Cervical-Cancer Screening â New Guidelines and the Balance between Benefits and Harms

Thu, 24Â DecÂ 2009 00:00:00 -05:00

One of the greatest challenges in developing cancer-screening guidelines is devising strategies that maximize screening benefits and minimize screening harms. The benefits of cancer screening â decreased cancer-related morbidity and...

PERSPECTIVE: Screening Mammography and the âRâ Word

Thu, 24Â DecÂ 2009 00:00:00 -05:00

The new recommendations from the U.S. Preventive Services Task Force on screening for breast cancer1 were front-page news for several consecutive days, and they sent the Obama administration scrambling to...

PERSPECTIVE: On Mammography â More Agreement Than Disagreement

Thu, 24Â DecÂ 2009 00:00:00 -05:00

Breast cancer is the most common cancer in women in the United States, with more than 190,000 women receiving a diagnosis of invasive disease annually1 and more than 40,000 dying...

PERSPECTIVE: Getting the Facts Straight on Health Care Reform

Thu, 24Â DecÂ 2009 00:00:00 -05:00

The United States stands on the verge of the most significant change to our health care system since the 1965 introduction of Medicare. The bill that was passed by the...

PERSPECTIVE: Leveling the Field â Ensuring Equity through National Health Care Reform

Thu, 17Â DecÂ 2009 00:00:00 -05:00

The United States is in the midst of a profound demographic transition. By 2050, non-Hispanic whites will account for less than half the U.S. population and members of racial and...

PERSPECTIVE: The Consequences of âNoâ

Thu, 17Â DecÂ 2009 00:00:00 -05:00

In the next few weeks, Congress will determine the fate of health care reform. An early and important objective of the Obama administration, reform once carried an air of inevitability....

PERSPECTIVE: Primary Care and Accountable Care â Two Essential Elements of Delivery-System Reform

Thu, 10Â DecÂ 2009 00:00:00 -05:00

With discussions about U.S. health care reform focused heavily on insurance reforms, relatively little attention has been paid to the delivery-system reforms that will be required to improve the quality...

OTHER POINTS OF VIEW: Eliminating a Viable Primary Care Workforce â A Primary Care Perspective

Thu, 03Â DecÂ 2009 00:00:00 -05:00

When physicians or health policy experts propose that the United States move to a single-payer health care system, with all doctors on salary,1 I find it disheartening: I am hoping...

PERSPECTIVE: America's Safety Net and Health Care Reform â What Lies Ahead?

Thu, 03Â DecÂ 2009 00:00:00 -05:00

To say that the current U.S. health care âsystemâ is a dysfunctional and costly patchwork of employer-based insurance, private markets, public programs, and special initiatives is, by any measure, an...

OTHER POINTS OF VIEW: Dead Souls â Comparing Dartmouth Atlas Benchmarks with CMS Outcomes Data

Thu, 26Â NovÂ 2009 00:00:00 -05:00

The premise, based on the Dartmouth Atlas of Health Care, that geographic variations in end-of-life Medicare spending can be used to identify wasted resources was popularized by Peter Orszag, director...

OTHER POINTS OF VIEW: Looking beyond the Market

Thu, 26Â NovÂ 2009 00:00:00 -05:00

For the most part, the market doesn't work where health care is concerned. It has been particularly ineffective in constraining costs over the past half-century, with stakeholders (insurance companies, organized...

PERSPECTIVE: Controlling U.S. Health Care Spending â Separating Promising from Unpromising Approaches

Thu, 26Â NovÂ 2009 00:00:00 -05:00

High U.S. health care spending has been characterized not only as a barrier to affordable insurance but also as the preeminent long-term threat to the economy and the competitiveness of...

PERSPECTIVE: Getting to the Real Issues in Health Care Reform

Thu, 26Â NovÂ 2009 00:00:00 -05:00

No issue has dominated the health care reform debate as much as whether the U.S. government should offer a health insurance plan to compete with private insurers â the so-called...

PERSPECTIVE: A Difficult Balance â Pain Management, Drug Safety, and the FDA

Thu, 26Â NovÂ 2009 00:00:00 -05:00

Pain is a common medical problem, and relief of pain is an important therapeutic goal. Although nonpharmacologic approaches to treating pain (e.g., behavioral techniques) show promise for certain conditions, pain...

PERSPECTIVE: Not âSocialized Medicineâ â An Israeli View of Health Care Reform

Thu, 19Â NovÂ 2009 00:00:00 -05:00

In 2007, the United States spent about 15% of its gross domestic product (GDP) on health care, whereas Israel's health care spending was about 8% of its GDP (see graph,...

OTHER POINTS OF VIEW: Cost Expansion versus Cost Control â Lessons from the Canadian System

Thu, 19Â NovÂ 2009 00:00:00 -05:00

The health care reform effort in the United States is driven by the desires for cost control and expanded coverage. However, as Daniel Callahan recently wrote, âcost controls that are...

PERSPECTIVE: Mandatory Vaccination of Health Care Workers

Thu, 19Â NovÂ 2009 00:00:00 -05:00

Mandatory vaccination of health care workers raises important questions about the limits of a state's power to compel individuals to engage in particular activities in order to protect the public....

PERSPECTIVE: Massachusetts Health Care Reform â Near-Universal Coverage at What Cost?

Thu, 19Â NovÂ 2009 00:00:00 -05:00

Massachusetts has long been known for its academic medical centers, biomedical research, high-quality health care, and perhaps not unrelatedly, high health care costs. In 2006, the state captured national attention...

PERSPECTIVE: Medicaid and National Health Care Reform

Thu, 19Â NovÂ 2009 00:00:00 -05:00

Defined by a history of both achievement and controversy, Medicaid has once again become central to the U.S. health policy debate, this time figuring as a key to national health...

PERSPECTIVE: Ensuring Progress in Primary Care â What Can Health Care Reform Realistically Accomplish?

Thu, 12Â NovÂ 2009 00:00:00 -05:00

In the current political environment, forging consensus on health care reform has proven challenging. Yet the value of a strengthened primary care infrastructure is one apparent zone of agreement among...

PERSPECTIVE: Communal Responsibility for Health Care â The Example of Benefit Assessment in Germany

Thu, 12Â NovÂ 2009 00:00:00 -05:00

Many German observers are bewildered over the U.S. health care reform debate. Most Europeans see affordable health insurance for everyone as a fundamental element of a stable and prosperous society...

OTHER POINTS OF VIEW: Which Medicine, Which America?

Michael Fine, M.D. — Thu, 12Â NovÂ 2009 00:00:00 -05:00

Underlying the debate over health care reform are two competing visions of medicine. According to one vision, medicine aims to care for people in their communities and to provide affordable...

EDITORIAL: Preparing for 2009 H1N1 Influenza

Richard P. Wenzel, M.D., and Michael B. Edmond, M.D., M.P.H. — Thu, 12Â NovÂ 2009 00:00:00 -05:00

In 1743, when disease was presumed to be astral in origin, European newspapers reported on a contagious influence (influenza in Italian) that was being visited on the citizens of Rome....

ORIGINAL ARTICLE: Critical Care Services and 2009 H1N1 Influenza in Australia and New Zealand

The ANZIC Influenza Investigators — Thu, 12Â NovÂ 2009 00:00:00 -05:00

Background: Planning for the treatment of infection with the 2009 pandemic influenza A (H1N1) virus through health care systems in developed countries during winter in the Northern Hemisphere is hampered...

PERSPECTIVE: Balancing Innovation, Access, and Profits â Market Exclusivity for Biologics

Thu, 12Â NovÂ 2009 00:00:00 -05:00

Twenty-five years ago, Congress enacted the WaxmanâHatch Act to facilitate the approval by the Food and Drug Administration (FDA) of low-cost generic drugs that are bioequivalent to approved brand-name drugs....

PERSPECTIVE: Physicians' Views of the Massachusetts Health Care Reform Law â A Poll

Thu, 05Â NovÂ 2009 00:00:00 -05:00

In 2006, Massachusetts enacted the country's first law mandating near-universal health care coverage,1 and the state now has the lowest proportion of uninsured residents in the United States. The Massachusetts...

PERSPECTIVE: Reform and the Health Care Workforce â Current Capacity, Future Demand

Thu, 05Â NovÂ 2009 00:00:00 -05:00

As Democrats press to enact health care reform legislation, they have emphasized their commitment to greatly expanding coverage, slowing the growth of medical spending, and more tightly regulating private insurers,...

PERSPECTIVE: Novel H1N1 Influenza and Respiratory Protection for Health Care Workers

Thu, 05Â NovÂ 2009 00:00:00 -05:00

Your hospital has been seeing a large number of patients with influenza-like symptoms, many of whom turn out to be infected with the novel H1N1 influenza A virus. You have...

PERSPECTIVE: Payment Reform for Safety-Net Institutions â Improving Quality and Outcomes

Thu, 05Â NovÂ 2009 00:00:00 -05:00

In the U.S. health care system today, many hospitals have the market power to raise the prices of their services without showing evidence of improvements in the quality of care.1...

PERSPECTIVE: Litigation amidst Reform â The Boston Medical Center Case

Thu, 05Â NovÂ 2009 00:00:00 -05:00

Nearly 175 years ago, Alexis de Tocqueville wrote in Democracy in America, âThere is hardly a political question in the United States which does not sooner or later turn into...

PERSPECTIVE: Doctors, Patients, and the Need for Health Care Reform

Thu, 05Â NovÂ 2009 00:00:00 -05:00

One Montanan wrote to me recently about her father's death. Six months away from qualifying for Medicare coverage, he did not have health insurance or the cash to pay for...

PERSPECTIVE: The Baucus Bill and the Hope for Reform

Thu, 29Â OctÂ 2009 00:00:00 -05:00

After months of wrangling with Republicans over the appropriate role of government in health care, the Senate Finance Committee's 13 Democrats were joined by a lone Republican, Senator Olympia Snowe...

PERSPECTIVE: Implementing Evidence-Based Health Policy in Washington State

Thu, 29Â OctÂ 2009 00:00:00 -05:00

The Obama administration's infusion of stimulus funds into enhanced comparative-effectiveness research (CER) is in keeping with the conclusion of a recent Commonwealth Fund report that, of the top 15 ways...

PERSPECTIVE: Four Health Care Reforms for 2009

Thu, 29Â OctÂ 2009 00:00:00 -05:00

Prospects for the enactment of some reform look good, but comprehensive, sustainable reform of the health care system must wait for another day. Republican support for President Barack Obama's ambitious...

PERSPECTIVE: Lost in Transmission â FDA Drug Information That Never Reaches Clinicians

Thu, 29Â OctÂ 2009 00:00:00 -05:00

The 2009 federal stimulus package included $1.1 billion to support comparative-effectiveness research about medical treatments. No money has been allocated â and relatively little would be needed â to disseminate...

PERSPECTIVE: How Health Care Reform Can Benefit Children and Adolescents

Thu, 22Â OctÂ 2009 00:00:00 -05:00

Medical and scientific advances have reduced the rates of acute childhood illnesses and childhood mortality and increased the positive outcomes of a wide variety of serious childhood illnesses; nevertheless, children's...

PERSPECTIVE: Group Health Cooperative â One Coverage-and-Delivery Model for Accountable Care

Thu, 22Â OctÂ 2009 00:00:00 -05:00

âOn January 1, 1947, Group Health Cooperative of Puget Sound began delivering a new kind of healthcare. Consumers paid flat monthly dues for comprehensive care. Members elected the board of...

PERSPECTIVE: Poor Substitutes â Why Cooperatives and Triggers Can't Achieve the Goals of a Public Option

Thu, 22Â OctÂ 2009 00:00:00 -05:00

According to a recent survey, a majority of U.S. physicians support health care reform that includes a new national public health insurance plan, which would compete with private plans.1 Polls...

HEALTH POLICY REPORT: The Public Health and Economic Benefits of Taxing Sugar-Sweetened Beverages

Thu, 15Â OctÂ 2009 00:00:00 -05:00

The consumption of sugar-sweetened beverages has been linked to risks for obesity, diabetes, and heart disease123; therefore, a compelling case can be made for the need for reduced consumption of...

EDITORIAL: Dying from Dementia

Greg A. Sachs, M.D. — Thu, 15Â OctÂ 2009 00:00:00 -05:00

As a teenager, I had the unfortunate but ultimately career-shaping experience of watching my maternal grandmother decline from Alzheimer's disease. She resided in a nursing home, where her final months...

ORIGINAL ARTICLE: The Clinical Course of Advanced Dementia

Thu, 15Â OctÂ 2009 00:00:00 -05:00

Background: Dementia is a leading cause of death in the United States but is underrecognized as a terminal illness. The clinical course of nursing home residents with advanced dementia has...

PERSPECTIVE: Drug Shortages and Public Health

Thu, 15Â OctÂ 2009 00:00:00 -05:00

Because the public discussion of drugs is dominated by considerations of their safety, effectiveness, and cost, it is easy to forget that medications have to be manufactured from raw materials...

PERSPECTIVE: Follow the Money â Controlling Expenditures by Improving Care for Patients Needing Costly Services

Thu, 15Â OctÂ 2009 00:00:00 -05:00

In the United States today, 10% of patients account for 70% of total health care expenditures. Many patients who require high-cost care are people with multiple chronic conditions, many medications,...

PERSPECTIVE: Will the Cost Curve Bend, Even without Reform?

Thu, 08Â OctÂ 2009 00:00:00 -05:00

If there is one certainty about the health care sector, it is that its costs increase over time. U.S. health care spending has more than doubled as a share of...

PERSPECTIVE: Doctors on Coverage â Physicians' Views on a New Public Insurance Option and Medicare Expansion

Thu, 01Â OctÂ 2009 00:00:00 -05:00

In the past few months, a key point of contention in the health care reform debate has been whether a public health insurance option should be included in the final...

SOUNDING BOARD: Balancing âNo Blameâ with Accountability in Patient Safety

Robert M. Wachter, M.D., and Peter J. Pronovost, M.D., Ph.D. — Thu, 01Â OctÂ 2009 00:00:00 -05:00

This year marks the 10th anniversary of the Institute of Medicine's report To Err Is Human,1 the document that launched the modern patient-safety movement. Although the movement has spawned myriad...

EDITORIAL: Variation in Hospital Mortality Associated with Inpatient Surgery â An S.O.S.

Danny O. Jacobs, M.D., M.P.H. — Thu, 01Â OctÂ 2009 00:00:00 -05:00

Health care organizations have appropriately begun to focus increased attention on the quality of medical services they provide to their patients.1 Reports from the Institute of Medicine (IOM) have illustrated...

SPECIAL ARTICLE: Variation in Hospital Mortality Associated with Inpatient Surgery

Thu, 01Â OctÂ 2009 00:00:00 -05:00

Background: Hospital mortality that is associated with inpatient surgery varies widely. Reducing rates of postoperative complications, the current focus of payers and regulators, may be one approach to reducing mortality....

PERSPECTIVE: Putting U.S. Health Care on the Right Track

Thu, 01Â OctÂ 2009 00:00:00 -05:00

Americans do not consistently receive high-value health care. Collectively, our country spends more on health care than any other nation, but our people do not receive the best outcomes, safety,...

PERSPECTIVE: 21st-Century Health Care â The Case for Integrated Delivery Systems

Thu, 01Â OctÂ 2009 00:00:00 -05:00

It was 1933. The United States was in the midst of a severe economic downturn that was to become the Great Depression. Data from 1929 showed that U.S. health care...

PERSPECTIVE: British Lessons on Health Care Reform

Thu, 24Â SepÂ 2009 00:00:00 -05:00

Amid widespread recognition that the U.S. health care system cannot continue its current upward cost spiral, forever widening the life-expectancy gap between rich and poor, Britain's National Health Service (NHS)...

PERSPECTIVE: New, but Not Improved? Incorporating Comparative-Effectiveness Information into FDA Labeling

Thu, 24Â SepÂ 2009 00:00:00 -05:00

New technologies, including prescription drugs and medical devices, are a major driver of increases in U.S. health care expenditures, which have grown by an estimated 71% since 2000.1 The U.S....

PERSPECTIVE: Getting Past Denial â The High Cost of Health Care in the United States

Thu, 24Â SepÂ 2009 00:00:00 -05:00

What seemed to be a golden opportunity to achieve badly needed health care reform now appears to be threatened. Many Americans believe that we simply cannot afford to cover the...

PERSPECTIVE: Doctors as the Key to Health Care Reform

Thu, 24Â SepÂ 2009 00:00:00 -05:00

Experts agree that sustainable health care reform requires reining in rising costs, but few people understand that the control of medical expenditures is largely in the hands of the medical...

PERSPECTIVE: Poverty, Wealth, and Access to Pandemic Influenza Vaccines

Thu, 17Â SepÂ 2009 00:00:00 -05:00

On June 11, 2009, Margaret Chan, director general of the World Health Organization (WHO), declared that the status of the influenza A (H1N1) pandemic had reached phase 6 â active...

PERSPECTIVE: The End of Fee-for-Service Medicine? Proposals for Payment Reform in Massachusetts

Thu, 10Â SepÂ 2009 00:00:00 -05:00

Health care reform has multiple goals, including expanding insurance coverage, improving quality and access to care, and controlling costs. Since Massachusetts enacted reforms in 2006, the proportion of residents lacking...

CLINICAL PRACTICE: Should Coronary Calcium Screening Be Used in Cardiovascular Prevention Strategies?

Robert O. Bonow, M.D. — Thu, 03Â SepÂ 2009 00:00:00 -05:00

A 52-year-old man requests a coronary-artery calcium (CAC) scan for assessment of his risk of coronary events after seeing an advertisement from a local facility that offers the test. He...

ORIGINAL ARTICLE: Exposure to Low-Dose Ionizing Radiation from Medical Imaging Procedures

Thu, 27Â AugÂ 2009 00:00:00 -05:00

Background: The growing use of imaging procedures in the United States has raised concerns about exposure to low-dose ionizing radiation in the general population.

Methods: We identified 952,420 nonelderly adults (between...

PERSPECTIVE: H1N1 Influenza, Public Health Preparedness, and Health Care Reform

Thu, 27Â AugÂ 2009 00:00:00 -05:00

In December 2009, the Department of Health and Human Services will present to Congress its first-ever national health security strategy, outlining high-priority activities and areas of investment for strengthening the...

PERSPECTIVE: Elements of Danger â The Case of Medical Imaging

Thu, 27Â AugÂ 2009 00:00:00 -05:00

According to the Book of Exodus, a man who assaults another must pay a physician to heal the wounds. A careful examination of the Hebrew text reveals that the word...

PERSPECTIVE: Multinational Medicines â Ensuring Drug Quality in an Era of Global Manufacturing

Thu, 20Â AugÂ 2009 00:00:00 -05:00

Rickee Rudowitz, a 56-year-old New Jersey woman with hypertension, believes that a generic version of long-acting metoprolol played havoc with her health last year. Rudowitz said her blood pressure had...

PERSPECTIVE: Cost Control â Time to Get Serious

Thu, 13Â AugÂ 2009 00:00:00 -05:00

Although everyone seems to agree that controlling health care costs is no less critical a need than improving access to health care, the evidence suggests that cost control is not...

PERSPECTIVE: A Time for Revolutions â The Role of Clinicians in Health Care Reform

Thu, 06Â AugÂ 2009 00:00:00 -05:00

William Beveridge, the economist whose 1942 report led to the founding of Britain's National Health Service (NHS), famously said that âa revolutionary moment in the world's history is a time...

SOUNDING BOARD: Health Care Reform â Toward More Freedom, and Responsibility, for Physicians

Harold S. Luft, Ph.D. — Thu, 06Â AugÂ 2009 00:00:00 -05:00

Most discussions about health care reform focus on efforts to expand the number of people who are covered by health insurance. Yet the current system does not work well even...

PERSPECTIVE: Keeping the Patient in the Equation â Humanism and Health Care Reform

Thu, 06Â AugÂ 2009 00:00:00 -05:00

Over the past decade, two major movements have emerged in medicine, both intended to improve patient care. The medical humanism movement seeks to understand the patient as a person, focusing...

PERSPECTIVE: The Shifting Mission of Health Care Delivery Organizations

Thu, 06Â AugÂ 2009 00:00:00 -05:00

An important transition has begun in payment for health care delivery in the United States: organizations that have long been paid for transactions, such as visits or procedures, are beginning...

PERSPECTIVE: The Next Wave of Corporate Medicine â How We All Might Benefit

Thu, 06Â AugÂ 2009 00:00:00 -05:00

The thought of âcorporate medicineâ makes patients and providers panic. Medicine is individualistic; corporations are not. Doctors look out for patients; corporations make money. And yet the current economic situation...

HEALTH POLICY REPORT: Medicare Part D Update â Lessons Learned and Unfinished Business

Patricia Neuman, Sc.D., and Juliette Cubanski, Ph.D. — Thu, 23Â JulÂ 2009 00:00:00 -05:00

Since 2006, more than 40 million elderly and disabled people have had the opportunity to enroll in a Medicare Part D prescription-drug plan, as established under the Medicare Modernization Act...

SPECIAL ARTICLE: Effects of Pay for Performance on the Quality of Primary Care in England

Thu, 23Â JulÂ 2009 00:00:00 -05:00

Background: A pay-for-performance scheme based on meeting targets for the quality of clinical care was introduced to family practice in England in 2004.

Methods: We conducted an interrupted time-series analysis of...

PERSPECTIVE: Prioritizing Comparative-Effectiveness Research â IOM Recommendations

Thu, 23Â JulÂ 2009 00:00:00 -05:00

Directed by Congress to rapidly develop a list of broad-based priorities for the Department of Health and Human Services (DHHS) to consider as it implements a new agenda for comparative-effectiveness...

PERSPECTIVE: Finding Money for Health Care Reform â Rooting Out Waste, Fraud, and Abuse

Thu, 16Â JulÂ 2009 00:00:00 -05:00

In their quest to enact health care reform legislation, Democrats' major challenge is securing the money to pay for greatly expanded insurance coverage and more government regulation in the face...

PERSPECTIVE: Managing and Reducing Uncertainty in an Emerging Influenza Pandemic

Thu, 09Â JulÂ 2009 00:00:00 -05:00

The early phases of an epidemic present decision makers with predictable challenges1 that have been evident as the current novel influenza A (H1N1) virus has spread. The scale of the...

PERSPECTIVE: A Strategy for Health Care Reform â Toward a Value-Based System

Thu, 09Â JulÂ 2009 00:00:00 -05:00

Despite many waves of debate and piecemeal reforms, the U.S. health care system remains largely the same as it was decades ago. We have seen no convincing approach to changing...

PERSPECTIVE: A Higher Bar â Vermont's New Law on Marketing Prescribed Products

Thu, 02Â JulÂ 2009 00:00:00 -05:00

As Congress continues to discuss the reform of physicianâindustry relations, individual states are enacting new laws. In July 2009, regulations on the conduct of pharmaceutical and medical-device manufacturers take effect...

PERSPECTIVE: The Individual Mandate â An Affordable and Fair Approach to Achieving Universal Coverage

Thu, 02Â JulÂ 2009 00:00:00 -05:00

Some of the most prominent shortcomings of the U.S. health insurance market are rooted in the fact that the system is a voluntary one. Outside the state of Massachusetts, which...

SPECIAL ARTICLE: The Effect of Medicare Part D on Drug and Medical Spending

Thu, 02Â JulÂ 2009 00:00:00 -05:00

Background: It is not known what effect the increased use of prescription drugs by enrollees in Medicare Part D has had on spending for other medical care.

Methods: We compared spending...

PERSPECTIVE: A WinâWin Approach to Financing Health Care Reform

Thu, 02Â JulÂ 2009 00:00:00 -05:00

No hurdle facing health care reform in the United States today is more daunting than the problem of financing universal coverage. There is an inescapable logic of reform that lies...

PERSPECTIVE: A New Era of For-Profit Hospice Care â The Medicare Benefit

Thu, 25Â JunÂ 2009 00:00:00 -05:00

To ensure that a reluctant medical community would embrace Medicare at its inception in 1965, Congress declared that any willing provider could participate. Since that time, the vast majority of...

PERSPECTIVE: CMS's Landmark Decision on CT Colonography â Examining the Relevant Data

Thu, 25Â JunÂ 2009 00:00:00 -05:00

In an unprecedented endorsement of evidence-based medicine, the Centers for Medicare and Medicaid Services (CMS) recently decided to deny coverage of computed tomographic (CT) colonography for cancer screening, concluding that...

PERSPECTIVE: Easing the Shortage in Adult Primary Care â Is It All about Money?

Thu, 25Â JunÂ 2009 00:00:00 -05:00

As Americans debate health care reform, it is easy to forget that success may depend as much on the availability of primary care physicians for adults as on the specifics...

PERSPECTIVE: A Lifeline for Primary Care

Thu, 25Â JunÂ 2009 00:00:00 -05:00

Primary care in the United States needs a lifeline. In 2009, for the 12th straight year, the number of graduating U.S. medical students choosing primary care residencies reached dismally low...

EDITORIAL: Implications of the Emergence of a Novel H1 Influenza Virus

Robert B. Belshe, M.D. — Thu, 18Â JunÂ 2009 00:00:00 -05:00

In this issue of the Journal, there are two reports of recent transmissions of swine influenza viruses in humans. One group of viruses, described by Shinde et al.,1 are triple...

EDITORIAL: H1N1 Influenza A Disease â Information for Health Professionals

Thu, 18Â JunÂ 2009 00:00:00 -05:00

In the first 2 weeks in April, cases of infection with an untypable influenza A virus began to be identified in Mexico and southern California.1 Although the exact sequence of...

PERSPECTIVE: Left Atrial Appendage Occlusion â Closure or Just the Beginning?

Thu, 18Â JunÂ 2009 00:00:00 -05:00

More than 3 million Americans have atrial fibrillation, which increases their risk of stroke by a factor of 5.12 Patients with atrial fibrillation account for one of every six strokes,...

PERSPECTIVE: Rescuing the Safety Net

Thu, 18Â JunÂ 2009 00:00:00 -05:00

As the recession deepens, layoffs are swelling the ranks of the uninsured. Despite federal stimulus support for state Medicaid programs, some cash-strapped states have cut Medicaid payments, and others are...

PERSPECTIVE: The Signature Features of Influenza Pandemics â Implications for Policy

Thu, 18Â JunÂ 2009 00:00:00 -05:00

Vast amounts of time and resources are being invested in planning for the next influenza pandemic, and one may indeed have already begun. Data from past pandemics can provide useful...

PERSPECTIVE: Congressional Action on Health Care Reform â An Update

Thu, 18Â JunÂ 2009 00:00:00 -05:00

The pursuit of health care reform continues to gather steam, as Democrats, with a nudge from President Barack Obama, set an ambitious target for action â House and Senate passage...

PERSPECTIVE: Achieving Health Care Reform â How Physicians Can Help

Thu, 11Â JunÂ 2009 00:00:00 -05:00

This year, we have the best chance in a generation of enacting legislation worthy of being called health care reform and of setting the United States on the path to...

CORRESPONDENCE: Insurance-Industry Investments in Tobacco

Thu, 04Â JunÂ 2009 00:00:00 -05:00

To the Editor: The Obama administration is proposing a major overhaul of the U.S. health care system, and the insurance industry is poised to play a major role in the...

PERSPECTIVE: Medicare Nonpayment, Hospital Falls, and Unintended Consequences

Thu, 04Â JunÂ 2009 00:00:00 -05:00

In 2005, in response to disturbing and widely cited findings by the Institute of Medicine about the prevalence of life-threatening conditions acquired by patients in U.S. hospitals, Congress authorized the...

PERSPECTIVE: Ending Extra Payment for âNever Eventsâ â Stronger Incentives for Patients' Safety

Thu, 04Â JunÂ 2009 00:00:00 -05:00

On September 1, 2008, Medicare eliminated a long-standing presumption in its payment rules that, since hospitals were doing everything possible to prevent complications of treatment, taxpayers and patients should primarily...

PERSPECTIVE: Building Momentum as Democrats Forge Health Care Reform

Thu, 04Â JunÂ 2009 00:00:00 -05:00

In the midst of dealing with countless challenges, both foreign and domestic, and a deep ideological divide in Congress, the Obama administration and its Democratic allies have nevertheless made important...

PERSPECTIVE: The Proposed Government Health Insurance Company â No Substitute for Real Reform

Thu, 28Â MayÂ 2009 00:00:00 -05:00

As pressure builds on the White House and Congress to deliver on their promise of health care reform, the idea of a government health insurance company to compete with for-profit...

PERSPECTIVE: Public Health Care and Health Insurance Reform â Varied Preferences, Varied Options

Thu, 28Â MayÂ 2009 00:00:00 -05:00

Health care and health insurance reform will surely require a mixture of public and private efforts for different population groups in different settings. One feature that might help with the...

PERSPECTIVE: Healthy Competition â The Why and How of âPublic-Plan Choiceâ

Thu, 28Â MayÂ 2009 00:00:00 -05:00

The debate over health care reform has increasingly centered on the issue of âpublic-plan choiceâ â whether Americans younger than 65 who lack employment-based coverage should have the choice of...

EDITORIAL: To Nap or Not to Nap? Residents' Work Hours Revisited

Thu, 21Â MayÂ 2009 00:00:00 -05:00

The medical profession must provide quality, cost-effective care and seek high standards of patient safety. To improve patient safety in our teaching hospitals, a committee of the Institute of Medicine...

SPECIAL ARTICLE: Cost Implications of Reduced Work Hours and Workloads for Resident Physicians

Thu, 21Â MayÂ 2009 00:00:00 -05:00

Background: Although the Accreditation Council for Graduate Medical Education (ACGME) limits the work hours of residents, concerns about fatigue persist. A new Institute of Medicine (IOM) report recommends, among other...

PERSPECTIVE: What Works in Market-Oriented Health Policy?

Thu, 21Â MayÂ 2009 00:00:00 -05:00

There is a widespread belief, embraced by President Barack Obama as well as congressional and industry leaders, that the next round of health care reform should leverage market forces to...

PERSPECTIVE: Influenza A (H1N1) Virus, 2009 â Online Monitoring

Thu, 21Â MayÂ 2009 00:00:00 -05:00

The value of Web-based information for early disease detection, public health monitoring, and risk communication has never been as evident as it is today, given the emergence of the current...

PERSPECTIVE: Digital Disease Detection â Harnessing the Web for Public Health Surveillance

Thu, 21Â MayÂ 2009 00:00:00 -05:00

The Internet has become a critical medium for clinicians, public health practitioners, and laypeople seeking health information. Data about diseases and outbreaks are disseminated not only through online announcements by...

PERSPECTIVE: Medicare and HMOs â The Search for Accountability

Thu, 14Â MayÂ 2009 00:00:00 -05:00

Twenty-five years after the introduction of health maintenance organizations (HMOs) as an alternative to fee-for-service Medicare, the promise of these private plans â that competition among them would lead to...

PERSPECTIVE: Picking the Right Poison â Options for Funding Health Care Reform

Thu, 14Â MayÂ 2009 00:00:00 -05:00

The Clinton administration's ill-fated 1993 Health Security Act has at last become a model for health care reform â though not in the way its architects envisioned. The Obama administration...

BOOK REVIEW:

Thu, 07Â MayÂ 2009 00:00:00 -05:00

In Aravind Adiga's novel The White Tiger (New York: Free Press, 2008), the narrator describes his weekly visits to the liquor store. On the wall, in dripping red paint, were...

PERSPECTIVE: The Neglected Purpose of Comparative-Effectiveness Research

Thu, 07Â MayÂ 2009 00:00:00 -05:00

On February 17, 2009, President Barack Obama signed into law an initiative providing $1.1 billion to support research on the comparative effectiveness of drugs, medical devices, surgical procedures, and other...

PERSPECTIVE: Debate about Funding Comparative-Effectiveness Research

Thu, 07Â MayÂ 2009 00:00:00 -05:00

The proposal to include $1.1 billion for comparative-effectiveness research (CER) in the federal stimulus package encountered a vigorous and well-coordinated backlash. The campaign to gut this funding ultimately failed, but...

PERSPECTIVE: Does Comparative-Effectiveness Research Threaten Personalized Medicine?

Thu, 07Â MayÂ 2009 00:00:00 -05:00

The American Reinvestment and Recovery Act gives comparative-effectiveness research (CER) a large boost in funding over the next 2 years. Despite a consensus that better information about the relative effectiveness...

BOOK REVIEW:

Thu, 23Â AprÂ 2009 00:00:00 -05:00

The number of women entering medical school and residency and practicing medicine in the United States has grown steadily over the past four decades. The Changing Face of Medicine is...

SPECIAL ARTICLE: Changes in the Incidence and Duration of Periods without Insurance

David M. Cutler, Ph.D., and Alexander M. Gelber, Ph.D. — Thu, 23Â AprÂ 2009 00:00:00 -05:00

Background: Policymakers have recently proposed ways of providing health care coverage for an increased number of uninsured persons. However, there are few data that show how the incidence and duration...

PERSPECTIVE: The Struggle for Reform â Challenges and Hopes for Comprehensive Health Care Legislation

Thu, 23Â AprÂ 2009 00:00:00 -05:00

Undaunted by a soaring federal deficit, competing legislative priorities, and skeptical Republicans, leading Democrats are relentlessly pursuing health care reform, as they hold hearings, engage key stakeholders, plot strategy, and...

SPECIAL ARTICLE: Use of Electronic Health Records in U.S. Hospitals

Thu, 16Â AprÂ 2009 00:00:00 -05:00

Background: Despite a consensus that the use of health information technology should lead to more efficient, safer, and higher-quality care, there are no reliable estimates of the prevalence of adoption...

PERSPECTIVE: Care of War Veterans with Mild Traumatic Brain Injury â Flawed Perspectives

Thu, 16Â AprÂ 2009 00:00:00 -05:00

Researchers estimate that more than 300,000 U.S. veterans of the wars in Iraq and Afghanistan (20% of the 1.6 million) have sustained a mild traumatic brain injury (TBI), also known...

EDITORIAL: The Medical Device Safety Act of 2009

Gregory D. Curfman, M.D., Stephen Morrissey, Ph.D., and Jeffrey M. Drazen, M.D. — Thu, 09Â AprÂ 2009 00:00:00 -05:00

Patient safety is a national concern. Major stakeholders throughout our health care system agree that every step must be taken to ensure that medical interventions, used with the intention of...

PERSPECTIVE: Conscientious Objection Gone Awry â Restoring Selfless Professionalism in Medicine

Thu, 09Â AprÂ 2009 00:00:00 -05:00

A new rule from the Department of Health and Human Services (DHHS) has emerged as the latest battleground in the health care conscience wars. Promulgated during the waning months of...

PERSPECTIVE: Stimulating the Adoption of Health Information Technology

Thu, 09Â AprÂ 2009 00:00:00 -05:00

The recently enacted stimulus bill â the American Recovery and Reinvestment Act of 2009 (ARRA) â touches almost every aspect of the U.S. economy. Health care is no exception. In...

EDITORIAL: Revisiting Readmissions â Changing the Incentives for Shared Accountability

Arnold M. Epstein, M.D., M.A. — Thu, 02Â AprÂ 2009 00:00:00 -05:00

When legislation was enacted in 1983 establishing prospective payment for hospitals, the incentives for hospitals changed dramatically. Cost-based payments for hospital days and services were replaced with a set payment...

SPECIAL ARTICLE: Rehospitalizations among Patients in the Medicare Fee-for-Service Program

Thu, 02Â AprÂ 2009 00:00:00 -05:00

Background: Reducing rates of rehospitalization has attracted attention from policymakers as a way to improve quality of care and reduce costs. However, we have limited information on the frequency and...

PERSPECTIVE: Budgeting for Change â Obama's Down Payment on Health Care Reform

Thu, 02Â AprÂ 2009 00:00:00 -05:00

Outlining a bold set of initiatives that would increase the role of government well beyond the boundaries sketched out by the $787 billion economic stimulus package, President Barack Obama has...

PERSPECTIVE: A To-Do List for the New FDA Commissioner

Thu, 02Â AprÂ 2009 00:00:00 -05:00

A week before President Barack Obama's inauguration, the departing commissioner of the Food and Drug Administration (FDA), oncologist Andrew von Eschenbach, compared the agency he has led for the past...

PERSPECTIVE: No Small Change for the Health Information Economy

Thu, 26Â MarÂ 2009 00:00:00 -05:00

The economic stimulus package signed by President Barack Obama on February 17 included a $19 billion investment in health information technology. How can we best take advantage of this unprecedented...

PERSPECTIVE: Your Doctor's Office or the Internet? Two Paths to Personal Health Records

Thu, 26Â MarÂ 2009 00:00:00 -05:00

Mary is 68 years old, has four chronic conditions, takes seven medications, and averages 12 visits per year to her six physicians. In between visits, she spends a lot of...

PERSPECTIVE: Health Care and Medicaid â Weathering the Recession

Thu, 26Â MarÂ 2009 00:00:00 -05:00

These are tough economic times. Since December 2007, the U.S. economy has shed 4.4 million jobs, and as of February, the unemployment rate had risen from 4.9% to 8.1%. Millions...

BOOK REVIEW:

Thu, 19Â MarÂ 2009 00:00:00 -05:00

Progress in the United States is traditionally measured in terms of economic growth, trade, and investment, and that makes The Measure of America a welcome book. Its editors introduce the...

PERSPECTIVE: Denial

Thu, 19Â MarÂ 2009 00:00:00 -05:00

The medical student is watching closely. In an overfilled clinic, time is scarce and the teaching staccato. I point out a malignant lymph node here, an enlarged liver there. She...

PERSPECTIVE: Eliminating Racial and Ethnic Disparities in Cardiac Care

Thu, 19Â MarÂ 2009 00:00:00 -05:00

The Institute of Medicine (IOM) includes âequityâ as one of six key domains of health care quality, yet equal treatment for Americans of all races and ethnic groups remains an...

EDITORIAL: The Growth of Hospitalists and the Changing Face of Primary Care

Thu, 12Â MarÂ 2009 00:00:00 -05:00

Two decades ago, most doctors who chose a career as a primary care physician did not imagine a professional life restricted to the outpatient setting. The architects of training programs...

SPECIAL ARTICLE: Growth in the Care of Older Patients by Hospitalists in the United States

Thu, 12Â MarÂ 2009 00:00:00 -05:00

Background: National and population-based information on the increase in patient care by hospitalists in the United States is lacking.

Methods: Using a 5% sample of Medicare beneficiaries in 1995, 1997, 1999,...

PERSPECTIVE: Rotavirus Vaccines â Early Success, Remaining Questions

Thu, 12Â MarÂ 2009 00:00:00 -05:00

In 2006, the results of pivotal clinical trials of two new rotavirus vaccines â RotaTeq (Merck) and Rotarix (GlaxoSmithKline) â were published, and high efficacy (85 to 98%) against severe...

PERSPECTIVE: Health Care and the American Recovery and Reinvestment Act

Thu, 12Â MarÂ 2009 00:00:00 -05:00

On February 17, 2009, four weeks after his inauguration, President Barack Obama signed into law a $787 billion economic stimulus package.12 The economic impact of the American Recovery and Reinvestment...

PERSPECTIVE: Coming to Grips with Foodborne Infection â Peanut Butter, Peppers, and Nationwide Salmonella Outbreaks

Thu, 05Â MarÂ 2009 00:00:00 -05:00

Two years ago, a nationwide outbreak of Shiga toxinâproducing Escherichia coli O157:H7 enteritis linked to consumption of contaminated spinach from one California supplier captured the attention of the national media...

HEALTH POLICY REPORT: Health Insurers and Medical-Imaging Policy â A Work in Progress

John K. Iglehart — Thu, 05Â MarÂ 2009 00:00:00 -05:00

The impressive strides that have been made in the field of advanced imaging technology have led to major enhancements in a physician's ability to diagnose a variety of diseases. However,...

PERSPECTIVE: Expanding Coverage for Children â The Democrats' Power and SCHIP Reauthorization

Thu, 26Â FebÂ 2009 00:00:00 -05:00

In the first demonstration of Democratic dominance on health care issues since Barack Obama captured the White House, the new Congress quickly reauthorized the State Children's Health Insurance Program (SCHIP),...

PERSPECTIVE: Investing in Health Care Reform

Thu, 26Â FebÂ 2009 00:00:00 -05:00

Indicating that health care reform is integral to his policy agenda, President Barack Obama has moved swiftly to incorporate elements of reform into his economic recovery bill and signed reauthorization...

PERSPECTIVE: Slowing the Growth of Health Care Costs â Lessons from Regional Variation

Thu, 26Â FebÂ 2009 00:00:00 -05:00

The expansion of health insurance coverage in the United States is likely to be on the front burner of health care reform efforts in the new presidential administration. But boiling...

PERSPECTIVE: Health, Medical Care, and Economic Crisis

Thu, 19Â FebÂ 2009 00:00:00 -05:00

On December 1, 2008, the National Bureau of Economic Research declared that the U.S. economy had been in recession since December 2007. The number of Americans seeking unemployment compensation has...

PERSPECTIVE: Commercial versus Social Goals of Tracking What Doctors Do

Thu, 19Â FebÂ 2009 00:00:00 -05:00

On November 18, 2008, the U.S. Court of Appeals for the First Circuit upheld the constitutionality of a New Hampshire statute that was the first in the nation to restrict...

PERSPECTIVE: Prescribing Records and the First Amendment â New Hampshire's Data-Mining Statute

Thu, 19Â FebÂ 2009 00:00:00 -05:00

In November 2008, the U.S. Court of Appeals for the First Circuit upheld against constitutional attack a New Hampshire statute that prohibits data miners from selling information about physicians' prescribing...

PERSPECTIVE: The Independent Physician â Going, Going . . .

Thu, 12Â FebÂ 2009 00:00:00 -05:00

Despite the current focus on expanding health insurance coverage, relatively little attention has been paid to the future of the physicians who provide care for the insured and uninsured alike...

PERSPECTIVE: Reforming Medicare's Physician Payment System

Thu, 12Â FebÂ 2009 00:00:00 -05:00

This past July, after intense lobbying from physician groups, Congress once again stepped in to prevent physicians who provide care to Medicare patients from seeing a 4.5% reduction in their...

HEALTH POLICY REPORT: Limits on Medicare's Ability to Control Rising Spending on Cancer Drugs

Peter B. Bach, M.D., M.A.P.P. — Thu, 05Â FebÂ 2009 00:00:00 -05:00

Fifteen years ago, the only commonly used cancer drug on the market that cost more than $2,500 per month was paclitaxel (Taxol, Bristol-Myers Squibb), which Chabner and Roberts labeled the...

PERSPECTIVE: PhysicianâIndustry Relations â Will Fewer Gifts Make a Difference?

Thu, 05Â FebÂ 2009 00:00:00 -05:00

The most common industry payments to physicians have taken the form of gifts, such as meals, tickets to sporting or cultural events, and pens, mugs, and other tchotchkes that prominently...

BOOK REVIEW:

Thu, 29Â JanÂ 2009 00:00:00 -05:00

The widespread conviction that a defining moment is at hand has led many to hope that the goal of providing universal access to health care in the United States may...

SPECIAL ARTICLE: A Surgical Safety Checklist to Reduce Morbidity and Mortality in a Global Population

Thu, 29Â JanÂ 2009 00:00:00 -05:00

Background: Surgery has become an integral part of global health care, with an estimated 234 million operations performed yearly. Surgical complications are common and often preventable. We hypothesized that a...

PERSPECTIVE: Fighting On

Thu, 29Â JanÂ 2009 00:00:00 -05:00

She had been living with multiple myeloma for more than 7 years before she showed up in our intensive care unit (ICU). It had not been easy, but she had...

PERSPECTIVE: Universal Health Insurance Coverage or Economic Relief â A False Choice

Thu, 29Â JanÂ 2009 00:00:00 -05:00

These are exciting times for advocates of universal health care coverage, with sizable Democratic majorities in both houses of Congress and a Democratic president who made universal coverage a central...

PERSPECTIVE: Health Care and the Recession

Thu, 22Â JanÂ 2009 00:00:00 -05:00

The U.S. economy has been in recession for more than a year, the unemployment rate is climbing, the ranks of the uninsured are growing rapidly, and health care provider organizations...

PERSPECTIVE: Medicaid and the U.S. Path to National Health Insurance

Thu, 22Â JanÂ 2009 00:00:00 -05:00

Health Care and the Recession...

PERSPECTIVE: Great Expectations â The Obama Administration and Health Care Reform

Thu, 22Â JanÂ 2009 00:00:00 -05:00

Health Care and the Recession...

PERSPECTIVE: Health Care Reform â Why So Much Talk and So Little Action?

Thu, 15Â JanÂ 2009 00:00:00 -05:00

As promised during his campaign, and under pressure from many quarters, President-elect Barack Obama may seek badly needed changes in the way the United States finances and delivers health care....

PERSPECTIVE: Visions for Change in U.S. Health Care â The Players and the Possibilities

Thu, 15Â JanÂ 2009 00:00:00 -05:00

Under the incoming presidential administration, U.S. Democratic leaders are determined to achieve a long-elusive goal: securing âaffordable, accessible health care for every single American,â as President-elect Barack Obama put it...

PERSPECTIVE: The Neurontin Legacy â Marketing through Misinformation and Manipulation

Thu, 08Â JanÂ 2009 00:00:00 -05:00

Old drugs usually fade away. Sometimes, however, they leave surprising legacies. In 1997, for example, a study comparing the effects of brand-name and generic formulations of levothyroxine led to an...

PERSPECTIVE: Money and the Changing Culture of Medicine

Thu, 08Â JanÂ 2009 00:00:00 -05:00

Rapidly rising health care costs over recent decades have prompted the application of business practices to medicine, with the goals of improving efficiency, restraining expenses, and increasing quality. In the...

BOOK REVIEW:

Thu, 01Â JanÂ 2009 00:00:00 -05:00

It is the year 1908. In the United States, more than 150,000 people will die from tuberculosis. If you contract tuberculosis, your best hope is to be shipped off to...

BOOK REVIEW:

Thu, 01Â JanÂ 2009 00:00:00 -05:00

Hope and Suffering is an apt title for this dense, encyclopedic, and riveting book. It includes narratives from patients and their family members that detail the hope, suffering, and despair...

PERSPECTIVE: Communicating Medical News â Pitfalls of Health Care Journalism

Thu, 01Â JanÂ 2009 00:00:00 -05:00

Whether they realize it or not, journalists reporting on health care developments deliver public health messages that can influence the behavior of clinicians and patients. Often these messages are delivered...

BOOK REVIEW:

Thu, 25Â DecÂ 2008 00:00:00 -05:00

As Paul S. Frame observed at a meeting of the U.S. Preventive Services Task Force in the early 1990s, âAn ounce of prevention is a ton of work.â This observation...

BOOK REVIEW:

Thu, 25Â DecÂ 2008 00:00:00 -05:00

Bioethics has reformed medical practice by elevating patient autonomy over physician paternalism. Robert Veatch was a leader of this movement, but in his view, the transformation has stalled. In this...

PERSPECTIVE: Culture Shock â Patient as Icon, Icon as Patient

Thu, 25Â DecÂ 2008 00:00:00 -05:00

On my first day as an attending physician in a new hospital, I found my house staff and students in the team room, a snug bunker filled with glowing monitors....

BOOK REVIEW:

Thu, 18Â DecÂ 2008 00:00:00 -05:00

Sixteen years short of the centennial of Wilhelm Roentgen's discovery of the x-ray, the Nobel Committee recognized a signal development in the use of the ray that would revolutionize medical...

PERSPECTIVE: The Future of Primary Care â The Community Responds

Thu, 18Â DecÂ 2008 00:00:00 -05:00

In a collection of Perspective articles published in the November 13 issue of the Journal and a videotaped roundtable discussion posted online, experts in the field discussed the current crisis...

PERSPECTIVE: Revisiting Duty-Hour Limits â IOM Recommendations for Patient Safety and Resident Education

Thu, 18Â DecÂ 2008 00:00:00 -05:00

Has the 80-hour workweek been good for patients and residents?...

PERSPECTIVE: Learning from Our Mistakes? Testing New ICD Technology

Thu, 11Â DecÂ 2008 00:00:00 -05:00

More than 160,000 implantable cardioverterâdefibrillators (ICDs) are implanted annually in the United States to prevent sudden death from cardiac causes in high-risk patients. Recently, concerns have been raised about the...

PERSPECTIVE: Screening for Prostate Cancer among Men 75 Years of Age or Older

Thu, 11Â DecÂ 2008 00:00:00 -05:00

Prostate-cancer screening with the prostate-specific antigen (PSA) test remains one of the most controversial issues in modern medicine. The U.S. Preventive Services Task Force (USPSTF), an independent group of experts...

EDITORIAL: Physicians and the First Amendment

Thu, 04Â DecÂ 2008 00:00:00 -05:00

In the November elections, the citizens of three states resoundingly defeated initiatives aimed at curtailing reproductive rights. In Colorado, a proposed amendment to the state's Constitution would have given the...

PERSPECTIVE: Home Delivery â Bringing Primary Care to the Housebound Elderly

Thu, 04Â DecÂ 2008 00:00:00 -05:00

Nurse practitioner Gail Metcalf toted her medical bag up the steep stairway of a triple-decker house in Dorchester, a low-income neighborhood of Boston, and greeted her patient, Mrs. E, a...

PERSPECTIVE: Pay Now, Benefits May Follow â The Case of Cardiac Computed Tomographic Angiography

Thu, 27Â NovÂ 2008 00:00:00 -05:00

The average American might assume that new medical procedures are proved beneficial before insurers pay for them. In reality, many new procedures are paid for even with no persuasive evidence...

PERSPECTIVE: Innovation in Primary Care â Staying One Step Ahead of Burnout

Thu, 27Â NovÂ 2008 00:00:00 -05:00

Since joining a large multispecialty medical group in Dubuque, Iowa, 21 years ago, general internist Christine Sinsky has been tweaking her practice's systems and testing strategies for improving efficiency. Her...

PERSPECTIVE: South Dakota's Abortion Script â Threatening the PhysicianâPatient Relationship

Thu, 20Â NovÂ 2008 00:00:00 -05:00

Under a law that went into effect in July, physicians in South Dakota must tell any woman seeking an abortion that she is terminating the life of âa whole, separate,...

PERSPECTIVE: Refocusing the System