by J.E.B. Johnson, MD Let me preface this comment by stating I am not an actuarial. I hated statistics and am no fan of insurance companies. That said I would like to know why patients and the US government think that health insurance companies should accept unlimited risk? My car insurance has limits, my homeowners insurance has limits, my malpractice insurance has limits.  Why ...

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Many of you are familiar with the famous "invisible gorilla" experiment, wherein an audience, being instructed to watch closely for the number of passes made with a basketball, fails to  see a rather large and deliberate gorilla march slowly across the screen, stop in mid  picture and thump its chest. In fact over 1/2 of those tested failed to notice this obvious action.  The predominant response is one of suspicion and ...

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Comparative effectiveness outcome studies have shown that while percutaneous coronary intervention (PCI) may be more effective than optimal medical therapy (OMT) for treatment of acute coronary syndrome, it is not more effective for treatment of stable ischemic heart disease. Results of the Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation (COURAGE) trial, published in 2007 and 2008 in the NEJM, demonstrated that PCI did not improve survival or prevent myocardial ...

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Perhaps you are just beginning a quality improvement program or project.  Perhaps you have several project improvement projects successfully completed at your healthcare site. No matter what your level of experience, you have encountered staff who are roadblocks to your efforts.  What are you to do?  Ignoring them or doing nothing will imperil your quality efforts eventually.  Let me share some ideas on what to do based upon my own ...

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by Sam Wainwright There's a fascinating blog post over at the New York Times math blog that has the health policy program here at New America scratching our heads, sharpening our No. 2 pencils, and dusting off our calculators. Turns out, German mathematicians have been studying how and why the human brain seems to struggle with comprehending risk. We find it difficult to translate the ...

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The creation of consumer-driven health plans (CDHPs), health insurance policies with high deductibles linked to a savings option and with more financial responsibility shouldered by patients and employees and less by employers, was completely inevitable. The American public likes to have everything, whether consumer electronics or other services, as cheap as possible. With escalating health care expenses rising far more rapidly than wages or inflation, it's not surprising employers ...

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It strikes me that in developing payment reform related, compensation driven cost-containment strategies aimed at constraining the cost of emergency care, policy makers, emergency physicians, and health insurers should adhere to certain principles. The American College of Emergency Physicians should be at the forefront when it comes to establishing these principles, which I hope will be focused on protecting our patients first, and our specialty second. The concept and practice of ...

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Much is being written about the ever increasing cost of health care in the US, especially compared to the rest of the developed world. As a nation, we spend nearly 16% of our GDP on health care.  All estimates predict that this amount will continue increasing unless costs can be controlled now.  Hence the passage of the Affordable Care Act.  Not only was it designed to extend coverage to more ...

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by Benjamin P. Geisler, MD, MPH A recent New York Times article on how to value a life drew almost two-hundred heavy-handed comments. It discussed how different governmental agencies such as the Food and Drug Administration (FDA), the Environmental Protection Agency (EPA) or the Department of Transportation (DoT) place a monetary value on each life saved. In many public policy areas, cost-benefit Analysis (CBA) is being used to assess whether an investment ...

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by John Kaegi We all complain about the cost of health care and health insurance.  Ours is by far the most expensive health care system in the world.  And for the money, our health isn’t so hot either.  On the world stage, the U.S. ranks 37th in health care efficiency (a measure of health outcomes such as infant mortality, incidence of chronic disease, etc.) as reported by the World Health Organization.  America ...

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