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NEJM—Health Policy and Reform

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Sergio Bonini, Guido Rasi
On January 10, 2016, a healthy volunteer who had received 50 mg per day of a fatty acid amide hydrolase (FAAH) inhibitor for 5 days as part of a first-in-human phase 1 clinical trial was admitted to Rennes University Hospital with neurologic and gait disturbances. After a dramatic worsening of..
November 3, 2016: New England Journal of Medicine
Dave A Chokshi, Ji E Chang, Ross M Wilson
Safety-net health systems provide essential care to low-income people in the United States, including those who are uninsured. Although the Affordable Care Act (ACA) has reduced the number of uninsured persons, an estimated 28 million to 31 million Americans will remain without health coverage even..
November 3, 2016: New England Journal of Medicine
Tejal K Gandhi
The National Institutes of Health Clinical Center (NIHCC) has a long and storied list of accomplishments. Many practices begun at the NIHCC on the basis of NIH research have become the standard of care worldwide, and in many ways, it’s a hospital like no other. Like other hospitals, however, it is..
November 3, 2016: New England Journal of Medicine
David Merritt Johns, Ronald Bayer
In early 2009, the drafters of the Affordable Care Act (ACA) agreed that as part of their insurance coverage Americans should have access to clinical preventive services without cost sharing. To avert demands for services of unclear effectiveness, they proposed that health plans should, at minimum,..
November 3, 2016: New England Journal of Medicine
Luis Ticona, Kevin A Schulman
In 2010, the department of health in Victoria, Australia, announced the construction of a 500-bed hospital without bricks and mortar. This "virtual hospital" has 33,000 admissions each year, accounting for almost 5% of all acute care bed-days in the state of Victoria and adding much-needed..
November 3, 2016: New England Journal of Medicine
Christopher Robertson, Aaron S Kesselheim
In 2012, the U.S. Court of Appeals for the Second Circuit handed down a landmark decision in the case of pharmaceutical sales representative Alfred Caronia. The Food and Drug Administration (FDA) had approved sodium oxybate (Xyrem) for treating narcolepsy, but Caronia promoted it for a wide range..
November 2, 2016: New England Journal of Medicine
Tetsuhisa Kitamura, Kosuke Kiyohara, Tomohiko Sakai, Tasuku Matsuyama, Toshihiro Hatakeyama, Tomonari Shimamoto, Junichi Izawa, Tomoko Fujii, Chika Nishiyama, Takashi Kawamura, Taku Iwami
Background Early defibrillation plays a key role in improving survival in patients with out-of-hospital cardiac arrests due to ventricular fibrillation (ventricular-fibrillation cardiac arrests), and the use of publicly accessible automated external defibrillators (AEDs) can help to reduce the time to defibrillation for such patients. However, the effect of dissemination of public-access AEDs for ventricular-fibrillation cardiac arrest at the population level has not been extensively investigated. Methods From a nationwide, prospective, population-based registry of patients with out-of-hospital cardiac arrest in Japan, we identified patients from 2005 through 2013 with bystander-witnessed ventricular-fibrillation arrests of presumed cardiac origin in whom resuscitation was attempted...
October 27, 2016: New England Journal of Medicine
Adam C Groff, Carrie H Colla, Thomas H Lee
Most measures of the quality of health care delivery focus on what health care providers do, not what patients want. If "high-value, patient-centered care" is to be more than rhetoric, health care organizations need to measure outcomes that matter to patients. Only when they do so will care be..
October 27, 2016: New England Journal of Medicine
Robert J Blendon, John M Benson, Logan S Casey
This article examines the potential effect of the 2016 election on the future of health policy in the United States. It brings together results from 14 national public opinion polls from various sources and as recently as September 2016 to address four broad questions: What is the mood of the..
October 27, 2016: New England Journal of Medicine
C William Keck
In June 2016, the U.S. Department of Health and Human Services (HHS) and Cuba’s Ministry of Public Health signed an umbrella accord that promises to make health a cornerstone of the new era of cooperation between the two countries. The memorandum of understanding (MOU), signed by HHS Secretary..
October 20, 2016: New England Journal of Medicine
Amy N Finkelstein, Sarah L Taubman, Heidi L Allen, Bill J Wright, Katherine Baicker
The effect of Medicaid coverage on health and the use of health care services is of first-order policy importance, particularly as policymakers consider expansions of public health insurance. Estimating the effects of expanding Medicaid is challenging, however, because Medicaid enrollees and the..
October 20, 2016: New England Journal of Medicine
Todd E Rasmussen, Arthur L Kellermann
Since the end of major combat operations in Iraq and Afghanistan, analysis of the lessons learned from those wars has focused largely on the wisdom of various foreign-policy decisions, the wars’ financial and human costs, and their repercussions for U.S. national security. Although it’s long been..
October 27, 2016: New England Journal of Medicine
Sara Rosenbaum
As the principal source of health insurance for the poor, the dominant payer for long-term services and supports, the most important source of health care financing during public health crises, and the largest source of funding for the health care safety net, Medicaid occupies a central place in..
October 13, 2016: New England Journal of Medicine
Christine Montross
In my work on the intensive treatment unit of a psychiatric hospital, I see many patients whose lives collide with the criminal justice system. Some are admitted to my care because they’re seeking respite. Others are admitted — often brought in by police — because the community seeks respite from..
October 13, 2016: New England Journal of Medicine
Lisa Rosenbaum
In 1985, when internist Jim O’Connell, cofounder of the Boston Health Care for the Homeless Program, began doing outreach to homeless people, one of the toughest questions he faced was whether to commit someone to the hospital for involuntary psychiatric treatment. States vary in their criteria for..
October 13, 2016: New England Journal of Medicine
Rachel R Hardeman, Eduardo M Medina, Katy B Kozhimannil
On July 7, 2016, in our Minneapolis community, Philando Castile was shot and killed by a police officer in the presence of his girlfriend and her 4-year-old daughter. Acknowledging the role of racism in Castile’s death, Minnesota Governor Mark Dayton asked rhetorically, "Would this have happened if..
October 12, 2016: New England Journal of Medicine
Leemore S Dafny, Christopher J Ody, Matthew A Schmitt
In 2015, the U.S. Department of Health and Human Services announced a goal of linking at least 50% of Medicare spending to value-based payment models such as accountable care organizations. Health care providers are now scrambling to reorganize in a way that delivers value while preserving or..
October 12, 2016: New England Journal of Medicine
David Blumenthal, James Morone
All presidential campaigns are unique, and the current one, as George Orwell might have said, seems more unique than most. When it comes to health care, however, there is continuity between the 2016 presidential contest and past elections, reflecting deep underlying political forces and historical..
October 6, 2016: New England Journal of Medicine
Elisha G Brownson, Callie M Thompson, Sarah Goldsberry, H Jonathan Chong, Jeffrey B Friedrich, Tam N Pham, Saman Arbabi, Gretchen J Carrougher, Nicole S Gibran
To the Editor: Electronic nicotine-delivery systems (ENDS) include electronic cigarettes (e-cigarettes) and personal vaporizers. The prevalence of ENDS use is increasing among current, former, and never smokers. E-cigarettes share a basic design; common components include an aerosol generator, a..
October 6, 2016: New England Journal of Medicine
Paul A Gastañaduy, Jeremy Budd, Nicholas Fisher, Susan B Redd, Jackie Fletcher, Julie Miller, Dwight J McFadden, Jennifer Rota, Paul A Rota, Carole Hickman, Brian Fowler, Lilith Tatham, Gregory S Wallace, Sietske de Fijter, Amy Parker Fiebelkorn, Mary DiOrio
Background Although measles was eliminated in the United States in 2000, importations of the virus continue to cause outbreaks. We describe the epidemiologic features of an outbreak of measles that originated from two unvaccinated Amish men in whom measles was incubating at the time of their return to the United States from the Philippines and explore the effect of public health responses on limiting the spread of measles. Methods We performed descriptive analyses of data on demographic characteristics, clinical and laboratory evaluations, and vaccination coverage...
October 6, 2016: New England Journal of Medicine
2016-10-07 05:30:06
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