Introduction

Improving Value in Healthcare

The current emergency standards for training, exercises, communication, coordination, and response utilized by the United States (US) healthcare system are inadequate to meet patient needs before, during, and after disasters. Through a focused review of the literature and supporting expert interviews, this study aims to identify major barriers to US healthcare system resiliency in an emergency management context. Findings include that organizations across the healthcare system remain fragmented, often acting as standalone entities instead of being part of a larger ecosystem, which weakens the overall healthcare response framework. Despite advances in collaborative technology, many healthcare organizations rely on technologies that cannot meet their needs during a major emergency or disaster. Additionally, this research indicates that training and education standards need updates to match current and future disaster healthcare needs. Finally, based on the findings, seven recommendations were made as a starting point to what must be an ongoing discussion. While the recommendations are based on data from the US, this research has both national and international implications.

Where do poor people in the United States (US) go when they get sick? Often, they go to Federally Qualified Health Centers (FQHCs) and hospital emergency departments. Even after the implementation of the Patient Protection and Affordable Care Act (ACA), these safety-net health care organizations will continue to play a crucial role in the US health care system. FQHCs have long grappled with some of the biggest questions facing the US health care system and their leaders and clinicians face ethical challenges in everyday practice. Ethical and policy challenges in the US health care safety-net are not usually 'tragic choices' involving the allocation of transplantable organs, or ventilators during a pandemic. They are everyday choices with a tragic dimension because, even with the adoption of the ACA, the US has not yet decided whether poor people deserve a 'home' or a 'net' when they are sick, and whether even a net should be in good repair.

From the Editor-In-Chief Health AffairsVol. 18, No. 3 The Global Pursuit Of Health Policy LessonsJohn K. Iglehart AffiliationsFounding EditorPUBLISHED:May/June 1999Free Accesshttps://doi.org/10.1377/hlthaff.18.3.7AboutSectionsView PDFPermissions ShareShare onFacebookTwitterLinked InRedditEmail ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsDownload Exhibits TOPICSSystems of careGovernment programs and policiesCosts and spendingWellness Travel the developed world in search of lessons that can be drawn from health care systems foreign to one's own, and you likely will be struck by two recurring if contradictory themes: No matter how much money a country spends to finance personal health services for its citizens, it's too much or it's too little, depending upon where you stand in relation to the elephant. But whatever your attitude, if you're reading Health Affairs you are fascinated (or perhaps concerned) with the health care system in the country where you live or the policies upon which it is based. For most of our readers that means the United States, which has a pluralistic system that is envied in some respects (its heavy public investment in biomedical research and graduate medical education and its commitment to innovate) but faulted in others, particularly for its failure to provide basic coverage for all of its citizens. Interest in the comparative study of health care systems has dwindled in the past decade, even though most industrialized nations are grappling with many of the same cost and quality issues. With the publication of this international thematic issue, Health Affairs is launching a more concerted effort to pursue common issues that engage health care systems, regardless of their configuration. This step is consistent with the roots of the journal's publisher, Project HOPE, which has devoted forty years to international health education efforts in some twenty-five developing nations. We are joined in this publishing venture by the Commonwealth Fund, a New York City–based private philanthropy with a long and illustrious record of public service. In November 1996 the fund, under the leadership of its president, Karen Davis, established the International Program in Health Policy as a successor to the Harkness Fellowships, an international exchange program it had operated since 1925. Commonwealth's redesigned program aims to build an international network of policy-oriented health care researchers, and to provoke creative thinking and international health policy exchanges that can benefit the United States and other industrialized countries. Health Affairs plans to devote one of its six issues every year to an international theme and cosponsor an annual international symposium with the Commonwealth Fund. While Commonwealth has taken the lead in supporting comparative research, other U.S. foundations began to devote an increasing proportion of their international grant dollars to health in the early 1990s, as Lauren LeRoy (p. 234) reports. As George Schieber and Akiko Maeda (p. 193) and Jerry Anderson and Jean-Pierre Poullier (p. 178) document, modern economies spend more money for personal health services as they prosper. High-income countries—those with yearly per capita incomes above $8,500—accounted for 89 percent of global health spending in 1994, even though they comprised only 16 percent of the global population and represented just 7 percent of the estimated number of disability-adjusted years of life worldwide that were lost to disease. Developing nations, with 84 percent of the world's population, accounted for only 11 percent of all health spending.Recently, as Karen Donelan and colleagues report (p. 206), public attitudes of systems in five countries (Australia, Canada, New Zealand, the United Kingdom, and the United States) have deteriorated. David Naylor depicts the Canadian experience in our lead essay (p. 9). But as Donna Shalala points out in her conversation with Uwe Reinhardt (p. 47), “Simple dissatisfaction with the current system was not enough to drive through a major change.” In the July/August 1999 issue of Health Affairs we plan to inaugurate a new feature called “Narrative Matters: Beyond the Data,” which we are introducing with support from the W. K. Kellogg Foundation. Through this section, which reflects Kellogg's abiding interest in documenting the experiences of individuals and communities with the health care system, we plan to publish the personal accounts of individuals (be they patients, family members, physicians, nurses, and other health professionals and interested parties) who interact with the health care system. (See insert in this issue for more details.) Among the first of these offerings will be a paper written by Fitzhugh Mullan, a contributing editor of Health Affairs who will oversee the section with Kyna Rubin, an associate editor. Loading Comments... Please enable JavaScript to view the comments powered by Disqus. DetailsExhibitsReferencesRelated Article MetricsCitations: Crossref 2 History Published online 1 May 1999 InformationCopyright © by Project HOPE: The People-to-People Health Foundation, Inc.PDF downloadCited byUK and US health-care systems: divided by more than a common languageThe Lancet, Vol. 355, No. 9201Public Reporting of Performance: Lessons from the USA23 June 2016 | Journal of Health Services Research & Policy, Vol. 5, No. 1

This position paper concerns improving health care in the United States. Unlike previous highly focused policy papers by the American College of Physicians, this article takes a comprehensive approach to improving access, quality, and efficiency of care. The first part describes health care in the United States. The second compares it with health care in other countries. The concluding section proposes lessons that the United States can learn from these countries and recommendations for achieving a high-performance health care system in the United States. The articles are based on a position paper developed by the American College of Physicians' Health and Public Policy Committee. This policy paper (not included in this article) also provides a detailed analysis of health care systems in 12 other industrialized countries. Although we can learn much from other health systems, the College recognizes that our political and social culture, demographics, and form of government will shape any solution for the United States. This caution notwithstanding, we have identified several approaches that have worked well for countries like ours and could probably be adapted to the unique circumstances in the United States.

Impact of Physician Education and a Dedicated Inferior Vena Cava Filter Tracking System on Inferior Vena Cava Filter Use and Retrieval Rates Across a Large US Health Care Region

Early Response to COVID-19

Money makes the world go around, The world go around, the world go around, Money makes the world go around, It makes the world go around. —From Cabaret (Fred Ebb and John Kander) “It’s so difficult caring for patients these days! Rules and guidelines, financial and managerial barriers drive doctors crazy.” “Steve, I keep reading about presidential campaign promises in your newspapers. What do you think will actually happen to the US health care system with a new President?” “Mike, I keep reading that the National Health Service (NHS) is changing too—is it really? How long are your waiting lists?” “How can physicians influence what’s happening in our countries? Do we actually know what we want?” We were seeing patients together. “Because we still have 45 million uninsured in the United States, there are people who say that health insurance for everyone needs to be our first priority.” “I would certainly agree with that, Steve! We see universal coverage as a responsibility of society to all its citizens; the marketplace has a role, sure, and you could devise a system that places the market in control. Obviously, there are health care systems other than the NHS model that could be considered. And after all, no other country has followed the United Kingdom in its tax-based, universal, cradle-to-grave, everything covered, open to all, free at the point of care, system—60 years old this year. There must be a message there. Perhaps this election will generate the debate that needs to take place in the United States.” “You’re right—there’s no groundswell in the United States to emulate the NHS! But universal health insurance won’t solve the issue of runaway health care costs any more than your tax-based system has. When I entered medical school in 1964, the Medicare/Medicaid programs were on the …

Health Systems Need to Transform Data Collection to Advance Health Equity.

Health care in the United States is among the most technologically advanced in the world, but it is largely failing to meet the needs of the nation. The US can claim international excellence in important areas of care, such as cancer treatment, and it leads the world in biomedical innovation and building a well-prepared and dedicated clinical workforce. The Affordable Care Act was a major step forward in expanding access to health care in the US. However, Americans are faced with staggering health costs, inadequate access to care, pervasive health inequities, and lagging life expectancy compared with other developed nations. In this article, part of the National Academy of Medicine's Vital Directions for Health and Health Care: Priorities for 2025 initiative, we present a partial road map for transforming the US health care system. We propose bold national goals: affordable and equitable care for all, an additional decade of healthy birthdays after retirement, elimination of racial and ethnic disparities in health, substantial reduction in health care expenditures, and, most important, improved health outcomes. To achieve these goals, we recommend changes to ensure coverage for all, invest in primary care and social determinants of health, create financing to incentivize population health, and improve transparency and accountability. Major systemic transformation of the US health care system is not just required; it is a moral and economic imperative.

The future of health professions education: Emerging trends in the United States.

Health Care After the COVID-19 Pandemic and the Influence of Telemedicine

Amid much controversy in March 2010, Congress passed President Barack Obama's sweeping legislation to fundamentally transform America's health care system in the Patient Protection and Affordable Care Act (PPACA). In Reforming America's Health Care System, health policy experts from the United States, Canada, and Western Europe discuss both what to expect from the recent health reform legislation and alternatives that should still be considered. They offer critical appraisals of numerous aspects of the new law, looking at the individual mandate to buy insurance, the threats to medical innovation, the reduction of choice to consumers, and the complexities of medical malpractice reform. In addition they examine lessons learned from state health reforms, the Canadian government's control of access to care, and the Western European government's oversight of comparative effectiveness. The contributors stress that although government can be a positive piece of the health care puzzle by facilitating competitive markets, it is the marketplace that can provide more choices, better care, higher quality, and cost based on value. Innovation, they argue, comes from the private sector, not government, and there is no reason that the health insurance industry would be an exception. If Congress enacts reforms that remove artificial barriers and constructively open markets to competition, private-sector creativity will generate innovative, low-cost insurance products for tens of millions of consumers and facilitate innovations in medical care that have been the linchpin of improved health care during the past several decades. Such genuine reforms would bring down the cost of insurance, reduce the number of uninsured, increase individual choice, and empower Americans to make value-based decisions for their families.

Assessment of the 12-lead ECG as a screening test for detection of cardiovascular disease in healthy general populations of young people (12-25 Years of Age): a scientific statement from the American Heart Association and the American College of Cardiology.

The most dramatic changes in the British National Health Service since its inception are underway. These changes place new responsibilities on general practice and create new opportunities to expand and develop general practice. Market strategies are important in these changes and could result in a system that adopts aspects of the US health care system. There is disagreement within the United Kingdom about the need for and wisdom of these changes. This paper partially describes these changes for hospitals and general practice. Family physicians in the United States can learn valuable lessons by monitoring the progress of this grand social experiment.