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NEJM—Health Policy and Reform

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Rahul Vanjani
What remained of Mr. P.’s hair had come undone from the tight braid he’d fastened before his last chemotherapy treatment. His facial bones now protruded, as if a sculptor had gotten carried away. There was no mirror in his cell at the maximum-security prison where Mr. P. had spent more than half..
June 22, 2017: New England Journal of Medicine
Justin W Timbie, Claude M Setodji, Amii Kress, Tara A Lavelle, Mark W Friedberg, Peter J Mendel, Emily K Chen, Beverly A Weidmer, Christine Buttorff, Rosalie Malsberger, Mallika Kommareddi, Afshin Rastegar, Aaron Kofner, Lisa Hiatt, Ammarah Mahmud, Katherine Giuriceo, Katherine L Kahn
Background From 2011 through 2014, the Federally Qualified Health Center Advanced Primary Care Practice Demonstration provided care management fees and technical assistance to a nationwide sample of 503 federally qualified health centers to help them achieve the highest (level 3) medical-home recognition by the National Committee for Quality Assurance, a designation that requires the implementation of processes to improve access, continuity, and coordination. Methods We examined the achievement of medical-home recognition and used Medicare claims and beneficiary surveys to measure utilization of services, quality of care, patients' experiences, and Medicare expenditures in demonstration sites versus comparison sites...
June 21, 2017: New England Journal of Medicine
Benjamin D Sommers, Atul A Gawande, Katherine Baicker
The national debate over the Affordable Care Act (ACA) has involved substantial discussion about what effects — if any — insurance coverage has on health and mortality. The prospect that the law’s replacement might lead to millions of Americans losing coverage has brought this empirical question..
June 21, 2017: New England Journal of Medicine
Henry J Aaron, Matthew Fiedler, Paul B Ginsburg, Loren Adler, Alice M Rivlin
In recent weeks, some health insurers have announced that they will not offer individual market coverage in 2018, while others have requested sizable premium increases. In response to this news, President Donald Trump has pronounced the individual market structure created by the Affordable Care Act..
June 21, 2017: New England Journal of Medicine
Jaewon Ryu, Thomas H Lee
When patients wait weeks or months for physician’s appointments, bad things happen. Some adverse consequences are emotional: patients become anxious and even angry. Some are clinical, such as medical issues that worsen, especially if patients don’t show up when their appointments finally roll..
June 15, 2017: New England Journal of Medicine
Louise Aronson
I recently had two doctor’s appointments in the same week, one in general medicine and the other in orthopedics, both at the same highly ranked medical institution. Occurring so close together, these visits quickly morphed in my mind from personal experiences with individual doctors into metaphors..
June 15, 2017: New England Journal of Medicine
Andrew M Ryan, Sam Krinsky, Kristin A Maurer, Justin B Dimick
BACKGROUND: Starting in fiscal year 2013, the Hospital Value-Based Purchasing (HVBP) program introduced quality performance-based adjustments of up to 1% to Medicare reimbursements for acute care hospitals. METHODS: We evaluated whether quality improved more in acute care hospitals that were exposed to HVBP than in control hospitals (Critical Access Hospitals, which were not exposed to HVBP). The measures of quality were composite measures of clinical process and patient experience (measured in units of standard deviations, with a value of 1 indicating performance that was 1 standard deviation [SD] above the hospital mean) and 30-day risk-standardized mortality among patients who were admitted to the hospital for acute myocardial infarction, heart failure, or pneumonia...
June 15, 2017: New England Journal of Medicine
K John McConnell, Michael E Chernew
The federal–state Medicaid program is facing the possibility of the largest and most consequential changes to its funding since its inception in 1965. The American Health Care Act (AHCA), H.R. 1628, as adopted by the House of Representatives on May 4, would replace the current federal matching..
June 14, 2017: New England Journal of Medicine
R Alta Charo
Human reproduction has become the victim of alternative science, rife with alternative definitions of well-understood medical conditions and characterized by rejection of the scientific method as the standard for generating and evaluating evidence. Alternative science begins with alternative facts..
June 14, 2017: New England Journal of Medicine
H Gilbert Welch, Elliott S Fisher
Income has long been known to be an important determinant of health. Four decades ago, the Whitehall study of British civil servants revealed that higher employment grades were associated with better physical and mental health and lower mortality. In 2016, an analysis in which data from U.S. tax..
June 8, 2017: New England Journal of Medicine
Donald R Lannin, Shiyi Wang
The recent article by Welch et al. in the Journal showed clearly that since the adoption of widespread screening mammography, small breast cancers have increased in incidence over three times more than large cancers have decreased. This implies that many small cancers are not destined to progress..
June 8, 2017: New England Journal of Medicine
David R Williams, Morgan M Medlock
A small but growing body of evidence suggests that election campaigns can have both positive and negative effects on health. Campaigns that give voice to the disenfranchised have been shown to have positive but short-term effects on health. Such associations have been observed among black South..
June 8, 2017: New England Journal of Medicine
Jeremy A Greene, William V Padula
Why, in the early 21st century, are so many drugs that were cheaply available in the 20th century becoming prohibitively expensive? The past few years have seen a series of dramatic price hikes on essential off-patent medications, from albendazole to albuterol, digoxin to naloxone, Daraprim to..
June 7, 2017: New England Journal of Medicine
Rachel Clarke, Taryn Youngstein
As you would expect in a pandemic, the headlines were alarmist: we were reportedly locked in a race against time to protect millions of patients from a new virus of unprecedented virulence that had crippled the United Kingdom’s National Health Service (NHS) and was spreading rapidly across the..
June 7, 2017: New England Journal of Medicine
Elizabeth P Griffiths
"What is the best way for me to get involved politically?" Since last November’s election, I have fielded this question frequently from fellow residents as well as medical students. Many of them have never been politically active, having assumed that the arc of progress would continue..
June 22, 2017: New England Journal of Medicine
Joshua A Rolnick, David A Asch, Scott D Halpern
When Luis Kutner, a human rights lawyer, first proposed the idea of the "living will" in 1969, he conceptualized it as a document establishing a trust, with the patient as the beneficiary and physicians as trustees. Kutner expected that such a document would be signed by two witnesses, notarized,..
June 1, 2017: New England Journal of Medicine
William C Becker, David A Fiellin
Death rates among middle-aged adults, the largest demographic group in the United States, are on the rise for the first time in several decades. This trend can largely be explained by an increase in drug-overdose deaths, the majority of which involve opioids. The opioid crisis has attracted..
June 1, 2017: New England Journal of Medicine
Susan A Glod
I’d seen Jerry in pain before, but never like this. He lay prostrate on the gurney in the emergency department, his hands clenched in silent prayer. I laid an apologetic hand on his shoulder and told him we would do what we could to help. Then I logged in to the bedside computer to order his pain..
June 1, 2017: New England Journal of Medicine
Joseph P Newhouse, Sharon-Lise T Normand
Clinical trials are most commonly associated with drugs and devices, but there are notable examples of trials that involve health policy. Many such trials test innovations in the delivery of services, whereas others focus on financial incentives for patients or providers. This review of health..
June 1, 2017: New England Journal of Medicine
Pamela T M Leung, Erin M Macdonald, Matthew B Stanbrook, Irfan A Dhalla, David N Juurlink
To the Editor: The prescribing of strong opioids such as oxycodone has increased dramatically in the United States and Canada over the past two decades. From 1999 through 2015, more than 183,000 deaths from prescription opioids were reported in the United States, and millions of Americans are now..
June 1, 2017: New England Journal of Medicine
2017-06-02 05:15:04
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