Emergency departments (EDs) nationwide are busy places. In some locales they are overcrowded. In places like Los Angeles and other dense, urban areas with high poverty, they are over-capacity to such an extent that they can grind to a halt for all but the highest priority cases. In years past, it was not unheard of for… Read More »
Smoking cessation is not innovative or trendy or even particularly exciting, but as a primary care doctor, in most cases helping a patient quit smoking is the best thing that I can do to help that patient over their lifetime. Without question. And for that reason, I always make it a priority to talk about it… Read More »
Republican Congressional leaders are currently debating how to repeal the Affordable Care Act (ACA) as part of the budget reconciliation process. Much of the debate over the ACA has focused on the individual mandate (and here) and the affordability (here and here) of coverage in the state-based marketplaces. The House version of the legislation, however,… Read More »
I once saw a breast cancer so advanced that the tumor had eroded through the woman’s chest wall. This wasn’t in a foreign country with little access to healthcare – it was in the city where I attended medical school: New Haven, Connecticut. The patient worked a full-time job and raised a family, but did… Read More »
The unintended pregnancy rate (reflecting pregnancies that are unwanted or mistimed) for women in the U.S. has hovered at around 50% for the last 35 years. Only recently has that rate dropped to 45%, but the burden continues to fall most heavily on poor, undereducated women, women from racial or ethnic minority backgrounds, and young women. Much talk… Read More »
With the mania of the presidential election in full tilt and the election just days away, it’s hard to have a rational public discussion about health care. Supporters of the two presidential candidates have drawn a deep and divisive line (or rather a tectonic fissure) in the sand about health care reform. This is due, in great part, to the bombastic, and ultimately… Read More »
Expanding health insurance coverage may improve health care access [PDF] and reduce financial stress [PDF]. Ideally, having health insurance and the resultant access to care should improve health outcomes and well-being, although the evidence is complicated and mixed. One thing is sure: expanded insurance coverage typically leads to more utilization – a concern for policymakers and administrators because… Read More »
A small section of the Affordable Care Act (ACA) packs a potentially big punch: State Innovation Waivers allow states to ask the federal government for authority to change parts of the ACA, namely the individual and employer mandates, establishment of state exchanges, and financial help to purchase insurance. These waivers can be used by states… Read More »
President Obama’s Affordable Care Act (ACA) included provisions to gradually reduce the Medicare part D “doughnut hole” – a much-maligned gap in coverage that was an economizing feature of President Bush’s legislation. So, how have these changes affected drug use and spending by seniors? A new article in Medical Care provides insights. Under the standard part D benefit… Read More »
In 2013, there were 10.7 million people enrolled [PDF] in both Medicare and Medicaid. Dual eligibility depends on age, income, and disability. Dually enrolled beneficiaries are also responsible for a large share of program costs overall; 31% of Medicare fee-for-services spending for 18% of beneficiaries [PDF] who are dually enrolled. Given the additional health challenges [PDF] faced by dual eligibles, this… Read More »
In a new Medical Care article published ahead of print, Cheryl R. Clark, MD, ScD, and colleagues, of Brigham and Women’s Hospital and Harvard, provide pre-ACA implementation estimates of income-based disparities in delayed or forgone care due to cost by race/ethnicity, by state-level Medicaid expansion status. Reforms can be unevenly implemented even if they address the primary causes of… Read More »
Nearly halfway through the primaries, the Democratic primary contest between Hillary Clinton and Bernie Sanders continues. And perhaps nothing sets these candidates further apart in the progressiveness of their agenda than their approaches to health care. In this post, let’s take a look at the vastly different approaches to health care proposed by candidates Clinton and Sanders, with a particular focus on primary care.
Who treats Medicaid patients? And is the quality of care provided by these individuals the same as you might expect from a clinician who takes only private insurance? An article in the April 2016 issue of Medical Care sought to answer these questions.
Although more than 92% of physicians reported seeing at least one Medicaid patient in 2011, the median proportion of Medicaid patients, for both PCPs and specialists, was less than 6%. This suggests that a small group of providers is responsible for seeing the majority of patients with Medicaid coverage…
As a current medical student, this research struck a nerve, particularly because of the emphasis on IMGs and medical school ranking. … What is more important to me is to understand what I, as a future primary care provider, can do. How do I ensure that people with Medicaid coverage get timely and appropriate referrals to specialty care? How can I expand my provider network to better equip them with the tools they need to ensure their long-term, lasting health?
The presidential primaries are in full swing and health care is an issue for both parties. The candidates have left themselves plenty of wiggle room, but there is enough information in the public domain to make some predictions about what the different approaches (and they are different) would mean for the health care system. This… Read More »
The major goal of the Affordable Care Act was to expand health insurance coverage. The Department of Health and Human Services will tell you that the Affordable Care Act is working: more Americans are insured. About 16.4 million people gained insurance in the past five years. What do these numbers mean for racial and ethnic minorities who… Read More »
Increased use of recommended clinical preventive services among adults, such as colorectal and breast cancer screening and influenza vaccination, may save up to 100,000 lives per year and vastly improve life expectancy among the US population. Despite these benefits, recommended preventive services have been underused. In this post, I focus on colorectal cancer screening among adults… Read More »
Emergency department (ED) use has been increasing in the US for several decades, and some estimate that about half of all outpatient ED visits are potentially avoidable (also referred to as primary-care sensitive, or PCS). ED visits are expensive and may signify issues with access to, and quality of, care. Thus, reducing ED use is… Read More »