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US healthcare

William Cayley: Comprehensiveness, diversity, and primary care

6 Dec, 16 | by BMJ

bill_cayley_2As medicine continues to grow in complexity and diversity, it is fair to ponder what roles may be best suited for the medical workforce of the future. A recent opinion piece argued that since we have no models permitting “any single physician to simultaneously and effectively serve the many patient subpopulations that exist,” we need to recruit, educate, and sustain a “diverse” health and healthcare workforce.

While I agree wholeheartedly that our workforce of the future needs caregivers who are technically skilled and adept at interdisciplinary collaboration, we also need to balance the increasing degree of specialization and compartmentalization in healthcare with a genuine appreciation for the breadth and generalism of primary care and family medicine. more…

Vineet Chopra et al: Motivational interviewing for healthcare providers

30 Nov, 16 | by BMJ

Improving patient safety through behavioral change is something that all healthcare providers strive to achieve. Supported by a three year grant, we are involved in a new way of doing this by using motivational interviewing (MI) among staff to improve patient outcomes.

A technique typically used by clinicians for patients, MI aims to empower and guide individuals towards health behavior change. Research studies have shown that MI achieves superior results compared to traditional patient education interventions for health behaviors including tobacco use, physical inactivity, and weight gain/obesity. more…

John J Park and Rifat Atun: Will global health be Trumped?

30 Nov, 16 | by BMJ

Donald Trump’s election as the 45th President of the United States (US) has left many in the global health community startled. What lies ahead for the future of global health and sustainable development, especially for millions of vulnerable people largely dependent on US assistance for health?

When Donald Trump famously announced: “I am not running to be President of the World. I’m running to be President of the United States,” he was probably not considering the fact that as the new US President, he would have tremendous influence on global health. [1] His responsibilities as President will include, among others, appointing the heads of the US Agency for International Development (USAID), Department of Health and Human Services (HHS), Centers for Disease Control and Prevention (CDC), and National Institutes of Health (NIH). Collectively, these organizations account for a large proportion the US Government’s $10 billion overseas assistance for health each year. [2] more…

The consequences of repealing and replacing Obamacare: A troublesome paradox

22 Nov, 16 | by BMJ

evan_goldsteinTo the approval of millions of Americans, President-elect Donald J Trump campaigned on directing the US Congress to repeal the Affordable Care Act (ACA or Obamacare). As the dust settles from Mr Trump’s surprising victory on 8 November, the Republican Party finds itself with looming control of all three branches of the US federal government.

Paul Ryan, the US speaker of the House of Representatives, is ready to oblige Mr Trump’s promise to repeal the ACA, having made a similar promise in his A Better Way plan, the presumptive blueprint for the Republican Party—and soon Americanpolitical agenda. more…

The Affordable Care Act: Lessons learnt and unintended consequences

16 Nov, 16 | by BMJ

junaid_nabiThe Affordable Care Act (ACA), colloquially called “Obamacare,” has drastically changed the American healthcare landscape: providing a safety net to millions of uninsured people, creating more robust mechanisms for improving the quality of healthcare delivery, and essentially changing the way that hospitals operate.

Although the effect of the ACA upon the number of uninsured people and quality improvement strategies has been thoroughly studied and found to have led to its desired outcome, the ACA has led to a situation that was not predicted more…

William Seligman and Mataroria Lyndon: Making American healthcare great again?

9 Nov, 16 | by BMJ

donald_trump2After eighteen months of breakneck campaigning, there are few who would have predicted the results we saw in the United States presidential election last night. Donald J. Trump, described by President Barack Obama as the “single least qualified candidate for the presidency in the history of the United States,” swept to victory winning traditional conservative states and flipping liberal strongholds. What’s more, the Republican Party now has majorities in both houses of Congress—the Senate and the House of Representatives. Last week, we discussed what we thought might happen given any number of presidential and congressional scenarios. Never did we think we’d be writing again today to discuss the implications of a Trump White House, Republican-majority Senate, and Republican-majority House. But here we are and what does this mean for healthcare in America?

William Seligman: What’s going to happen to US health policy after the presidential election?

31 Oct, 16 | by BMJ

william_seligmanWhether it’s the razzmatazz, scandal, or fear generated by the forthcoming US presidential election, it’s fair to say that people are talking about it worldwide and watching closely as 8 November approaches. The outcome of this election will, I think, have implications worldwide particularly on account of the candidates’ views on immigration, trade, and foreign affairs. The outcome of this election will also shape health policy in the US now and perhaps also for the next generation. The Affordable Care Act (“Obamacare”) was passed in 2010 and has reformed the US healthcare system and health industry. Key provisions under Obamacare included: 1) removal of ineligibility for health insurance on the basis of pre-existing conditions 2) a requirement for all persons to buy health insurance 3) expansion in safety net coverage for low-income Americans and 4) reform of the medical care delivery system. Despite being passed six years ago, its fate is still uncertain. [1] With so much at stake, what is likely to happen? Well, it turns out that what happens really depends on more than just the Clinton vs Trump showdown but also on what happens in elections across the US for the Senate and House of Representatives. In this blog, I discuss the most likely election results (based on current polling [2] [3]) and their impact on US health policy based on the candidates’ and parties’ stated health agenda: more…

No waiving goodbye to Medicaid expansion: What does the rejection of Ohio’s Medicaid waiver proposal mean for other states?

27 Oct, 16 | by BMJ

evan_goldsteinSince the enactment of the Affordable Care Act (ACA, or Obamacare), the number of uninsured individuals in the United States decreased from 49 million in 2010 to 29 million in 2015. While the American press and political debate remain focused on the shortcomings of the ACA’s Health Insurance Marketplace, relatively little attention is paid to the status of the expanded Medicaid program—the ACA’s mechanism for providing health insurance at no or little cost for Americans on low incomes.

Such disregard is worrisome considering that, under the ACA, upwards of 11-15 million of the newly insured Americans have gained health insurance coverage through Medicaid expansion more…

Neel Sharma: Lessons from the Bronx

26 Oct, 16 | by BMJ

I have just relocated to the Bronx in New York. At 29 I made it my mission to work and live abroad. I realised there comes a point when simply obtaining knowledge from books, online, or during conferences serves a limited purpose in medicine and in life in general. The only way to really learn is through experience. And by being a nomad I can admit to learning more than I ever could have imagined.

During recent faculty discussions, it was emphasised how patient management in the region is troublesome—for no particular fault of the patients I might add. But it is well known that the region suffers from socio economic issues that are worlds apart from the gentrified neighbouring borough of Manhattan. more…

William Cayley: Numerical minimal change disease

14 Oct, 16 | by BMJ

bill_cayley_2What difference makes a difference?

We often encourage patients to make small behavioral changes, in the hope that even one step in the right direction is at least small progress. However, when it comes to medical care, and testing in particular, I think we forget that some changes are not really changes at all.

As we continue to think collectively about overdiagnosis, we also need to look at the impact of “minimal change disease.” more…

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