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NEJM—Health Policy and Reform

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Gary H Lyman, Robin Zon, R Donald Harvey, Richard L Schilsky
Biologic therapies for cancer and other disorders contribute to improved outcomes for many patients but also account for a large proportion of health care expenditures. Opportunities for cost containment may emerge as the patents on originator products expire and highly similar agents known as..
May 24, 2018: New England Journal of Medicine
Katherine Choi, Yevgeniy Gitelman, David A Asch
Nearly all U.S. health care systems and many physician practices have by now migrated from paper charts to electronic health records (EHRs). But though this shift could have been a transformative change, current EHRs are largely digital remakes of traditional systems, just as many early motion..
May 24, 2018: New England Journal of Medicine
Julie M Donohue, Haiden A Huskamp
The Medicare Prescription Drug Improvement and Modernization Act (MMA) of 2003 created a new Medicare benefit (Part D), a new insurance product (prescription-drug–only plans), and a new market. Fifteen years later, Part D is widely regarded as a success, providing drug coverage to 42.5 million..
May 24, 2018: New England Journal of Medicine
Jason P Block
Passing the 2010 Affordable Care Act (ACA) was a landmark event in health care policy. The ACA’s scope also went beyond health care. Included among myriad health insurance reforms and coverage expansions was Section 4205, a federal requirement for food-establishment chains with 20 or more locations..
May 23, 2018: New England Journal of Medicine
Douglas B White, Derek C Angus, Anne-Marie Shields, Praewpannarai Buddadhumaruk, Caroline Pidro, Cynthia Paner, Elizabeth Chaitin, Chung-Chou H Chang, Francis Pike, Lisa Weissfeld, Jeremy M Kahn, Joseph M Darby, Amy Kowinsky, Susan Martin, Robert M Arnold
Background Surrogate decision makers for incapacitated, critically ill patients often struggle with decisions related to goals of care. Such decisions cause psychological distress in surrogates and may lead to treatment that does not align with patients' preferences. Methods We conducted a stepped-wedge, cluster-randomized trial involving patients with a high risk of death and their surrogates in five intensive care units (ICUs) to compare a multicomponent family-support intervention delivered by the interprofessional ICU team with usual care...
May 23, 2018: New England Journal of Medicine
Dan Liljenquist, Ge Bai, Gerard F Anderson
Robust competition usually keeps the price of generic drugs well below that of brand-name drugs. When there is little or no competition, however, generic-drug manufacturers can substantially increase prices, and drug shortages may occur. Such market failures can compromise care and negatively..
May 17, 2018: New England Journal of Medicine
Katherine Pryor, Kevin Volpp
In 2002, Knowler et al. reported results of a landmark study — a large, randomized, controlled trial comparing a behavioral intervention with medical therapy in the prevention of diabetes. Over a mean follow-up period of 2.8 years, the lifestyle-modification program, known as the Diabetes..
May 10, 2018: New England Journal of Medicine
Evan M Bloch, Paul M Ness, Aaron A R Tobian, Jeremy Sugarman
The rapid, pandemic spread of Zika virus (ZIKV) spurred an international public health emergency in 2015. Cases of ZIKV infection have now been reported in 85 countries or territories; in 72 of those locations, no such cases had been reported previously. The association of ZIKV with severe..
May 10, 2018: New England Journal of Medicine
Lachlan Forrow, Tilman Ruff, Setsuko Thurlow
The awarding of the 2017 Nobel Peace Prize to the International Campaign to Abolish Nuclear Weapons (ICAN) may mark a turning point in efforts to ensure that humanity survives the nuclear-weapons era. The urgency of ICAN’s work was recently highlighted when the Bulletin of the Atomic Scientists..
May 9, 2018: New England Journal of Medicine
Brendan M Reilly
The first few days he was here, they didn’t know about his defibrillator. That would seem shocking in a palliative care hospital where people come to die, but to one who knows Kenneth’s story, it’s no surprise. He didn’t tell them about the ICD, and the doctors didn’t ask. (Why would they? Do you..
May 3, 2018: New England Journal of Medicine
A Taylor Kelley, Renuka Tipirneni
Ever since President Donald Trump took office, the Department of Health and Human Services (HHS) has promised that states would enjoy more flexibility in structuring their Medicaid programs than had been allowed under prior administrations. HHS leadership promised, among other things, to improve..
May 3, 2018: New England Journal of Medicine
Raphael Rush
"I’ve been coughing real bad, Doc," the man told me. He couldn’t seem to stop. His green sputum was tinged with blood. His lungs crackled. Although his fever had briefly abated, he still shivered beneath his rough hospital blanket. Despite his illness, he looked relieved. Violent snow squalls..
May 3, 2018: New England Journal of Medicine
Scott Levy, Nicholas Bagley, Rahul Rajkumar
In an ambitious effort to slow the growth of health care costs, the Affordable Care Act created the Center for Medicare and Medicaid Innovation (CMMI) and armed it with broad authority to test new approaches to reimbursement for health care (payment models) and delivery-system reforms. CMMI was..
May 3, 2018: New England Journal of Medicine
Alisa B Busch, David W Bates, Scott L Rauch
Psychiatric illnesses are common, disabling, and costly to patients, their families and communities, and the health care system. By 29 years of age, more than half of Americans will have had an impairing and clinically significant psychiatric illness, such as an anxiety disorder, a psychotic..
May 3, 2018: New England Journal of Medicine
Evan Wood
North America is in the midst of its most serious drug-overdose crisis in history. From 1999 through 2015, drug-overdose deaths approximately tripled in the United States, and the majority of such deaths now involve an opioid. In 2016 alone, there were 64,000 drug-overdose deaths in the United..
April 26, 2018: New England Journal of Medicine
Gregory R Ciottone
Terrorist attacks are increasing in both frequency and complexity around the world. In 2016 alone, there were more than 13,400 terrorist attacks globally, killing more than 34,000 people. Of equal concern, chemical-warfare agents that were developed for the battlefield are being used on civilians..
April 26, 2018: New England Journal of Medicine
Maria A Oquendo, Nora D Volkow
As the toll of opioid-overdose deaths in the United States rises, we face an urgent need for prevention. But preventing such deaths will require a better understanding of the diverse trajectories by which overdoses occur, including the distinction between intentional (suicide) and unintentional..
April 26, 2018: New England Journal of Medicine
Usama Bilal, Ana V Diez-Roux
To the Editor: A recent report on mortality by the National Center for Health Statistics (NCHS) confirmed that life expectancy decreased in the United States for a second year in a row, from 78.9 years in 2014 to 78.7 years in 2015 to 78.6 years in 2016. Although these decreases were small, they..
April 19, 2018: New England Journal of Medicine
Catherine H MacLean, Eve A Kerr, Amir Qaseem
Performance measurement in the U.S. health care system has expanded dramatically over the past 30 years. The National Quality Measures Clearinghouse now lists more than 2500 performance measures. These measures are used in various quality-reporting, accountability, and payment programs sponsored by..
April 18, 2018: New England Journal of Medicine
Jonathan J Darrow, Jerry Avorn, Aaron S Kesselheim
In 2012, Congress created the "breakthrough therapy" designation to expedite Food and Drug Administration (FDA) testing and approval of medications that were intended to treat serious or life-threatening conditions and that preliminary evidence suggested may provide a substantial improvement over..
April 12, 2018: New England Journal of Medicine
2018-04-13 05:15:07
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