scholarly journals Disparities in Emergent Colectomy for Colorectal Cancer Contribute to Inequalities in Postoperative Morbidity and Mortality in The US Health Care System

2019 ◽  
Vol 109 (2) ◽  
pp. 102-107 ◽  
Author(s):  
F. Schlottmann ◽  
P. D. Strassle ◽  
A. L. Cairns ◽  
F. A. M. Herbella ◽  
A. Fichera ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Health Care ◽  
Health Care System ◽  
Private Insurance ◽  
The United States ◽  
Socioeconomic Disparities ◽  
Wound Complications ◽  
Colorectal Cancer Surgery ◽  
The Us ◽  
Care System

Background and Aims: Colorectal cancer is the third most common cancer among both men and women in the United States. We aimed to determine racial and socioeconomic disparities in emergent colectomy rates for colorectal cancer in the US Health Care system. Material and Methods: We performed a retrospective analysis of the National Inpatient Sample including adult patients (⩾18 years) diagnosed with colorectal cancer, and who underwent colorectal resection while admitted between 2008 and 2015. Multivariable logistic and linear regression were used to assess the association between emergent admissions, compared to elective admissions, and postoperative outcomes. Results: A total of 141,641 hospitalizations were included: 93,775 (66%) were elective admissions and 47,866 (34%) were emergent admissions. Black patients were more likely to undergo emergent colectomy, compared to white patients (42% vs 32%, p < 0.0001). Medicaid and Medicare patients were also more likely to have an emergent colectomy, compared to private insurance (47% and 36% vs 25%, respectively, p < 0.0001), as were patients with low household income, compared to highest (38% vs 31%, p < 0.0001). Emergent procedures were less likely to be laparoscopic (19% vs 38%, p < 0.0001). Patients undergoing emergent colectomy were significantly more likely to have postoperative venous thromboembolism, wound complications, infection, bleeding, cardiac failure, renal failure, respiratory failure, shock, and inpatient mortality. Conclusion: There are significant racial and socioeconomic disparities in emergent colectomy rates for colorectal cancer. Efforts to reduce this disparity in colorectal cancer surgery patients should be prioritized to improve outcomes.

scholarly journals All-Payer Rate Setting: A Framework for a More Efficient Health Care System

2017 ◽  
Vol 24 ◽  
pp. 81
Author(s):  
Eric Flanagan
Keyword(s):  
Health Care ◽  
Health Care System ◽  
Health Care Services ◽  
Health Care Systems ◽  
Private Insurance ◽  
The United States ◽  
Insurance Companies ◽  
Cost Shifting ◽  
The Us ◽  
Care System

The United States is unique among countries with health care systems that rely primarily on private insurance companies because there are generally no regulations that mandate a standard fee schedule for health care services. The prevalence of multiple private and public insurers is known as a multi-payer system. Other countries that have multiple payers set prices unilaterally, as is the case in Japan, or through negotiations between payers and providers, as is the case in Germany. The outcome is a uniform set of prices that applies to all payers within a single hospital. This framework is known as all-payer rate setting. This paper explains how all-payer rate setting regulation can mitigate several problems plaguing the US health care system. Examples include cost shifting, price discrimination, and provider market leverage. The paper then analyzes how these problems negatively affect the US health care system. Finally, the benefits of all-payer rate setting are explained, followed by the downsides (or tradeoffs) of such a system.

scholarly journals The United States: A system built on fragmentation

2019 ◽  
Vol 29 (Supplement_4) ◽  
Author(s):  
H. Jarman
Keyword(s):  
Public Health ◽  
United States ◽  
Health Care ◽  
Health Care System ◽  
The United States ◽  
Universal Health Care ◽  
Local Public Health ◽  
The Us ◽  
Universal Health ◽  
Care System

Abstract Background The United States is effectively a laboratory for ways to produce public goods, such as public health, on the cheap. Its c. 90,000 governments compete for residents, businesses, taxes, development, and jobs while also trying to compensate for the lack of universal health care coverage. They all have structural incentives to provide services as cheaply as possible. The effects are diverse and poorly mapped. They can mean innovation in organizational forms, a different and typically less expensive skill mix among the workers, poor quality, or simple under provision. The exact mix can often be hard to identify. It can also mean extreme responsiveness to funding from higher levels of government such as the states or federal government. Methods A comparative historical analysis (CHA) based on government documents, law, and secondary sources. Results The distinctively expansive scope of US public health actions is largely due to the country’s failure to establish a universal health care system, and the diversity of US public health tasks reflects local adaptation of tens of thousands of governments. This means that public health in the United States retains much of the activity it had in, for example, the UK before the establishment of the US. In particular, and even in states that accepted the Medicaid expansion in the Affordable Care Act (ACA), local public health departments provide a substantial amount of direct care and fill in for gaps in health care provision. Conclusions The US public health system is highly fragmented like the governments that run it, and therefore diverse. Reflecting the failures of the US health care system, it carries out many more tasks that in other countries are seen as health, especially primary, care.

scholarly journals Beyond the Market: The Role of Constitutions in Health Care System Convergence in the United States of America and the United Kingdom

2014 ◽  
Vol 42 (4) ◽  
pp. 455-474 ◽  
Author(s):  
Jamie Fletcher ◽  
Jane Marriott
Keyword(s):  
United States ◽  
Health Care ◽  
United Kingdom ◽  
Health Care System ◽  
United States Of America ◽  
The United States ◽  
The United Kingdom ◽  
Health And Social Care ◽  
The Us ◽  
Care System

Two narratives have emerged to describe recent health care reforms in the United States of America (US) and the United Kingdom (UK). One narrative speaks of revolution, that the adoptions of the Affordable Care Act 2010 (ACA) in the US, and the Health and Social Care Act 2012 (HSCA) in the UK, have resulted in fundamental, large-scale philosophical, political and legal change in the jurisdictions’ respective health care systems. The other narrative evokes evolution, identifying each new legislative scheme as a natural development of existing governance structures. Policymakers in both the US and UK face the problem of a health care system which, as traditionally envisaged, cannot offer universal access to health care at a reasonable, or politically acceptable, price

scholarly journals Examining the Role of Family History of US Enslavement in Health Care System Distrust Today

2021 ◽  
Vol 31 (3) ◽  
pp. 417-424
Author(s):  
Lorraine T. Dean ◽  
Genee S. Smith
Keyword(s):  
Health Care ◽  
African American ◽  
Family History ◽  
African Americans ◽  
Health Care System ◽  
The United States ◽  
Black African ◽  
The Us ◽  
History Of ◽  
Care System

Objective: Black/African American people have long reported high, albeit warranted, distrust of the US health care system (HCS); however, Blacks/African Americans are not a homogenous racial/ethnic group. Little in­formation is available on how the subgroup of Black Americans whose families suffered under US chattel slavery, here called De­scendants of Africans Enslaved in the United States (DAEUS), view health care institu­tions. We compared knowledge of unethical treatment and HCS distrust among DAEUS and non-DAEUS.Design and Setting: A cross-sectional random-digit dialing survey was adminis­tered in 2005 to Blacks/African Americans, aged 21-75 years, from the University of Pennsylvania Clinical Practices in Philadel­phia, Penn.Participants: Blacks/African Americans self-reported a family history of persons enslaved in the US (DAEUS) or no family history of persons enslaved in the US (non- DAEUS).Main Outcome Measures: HCS distrust was measured by a validated scale assessing perceptions of unethical experimentation and active or passive discrimination.Methods: We compared responses to the HCS distrust scale using Fisher’s exact and t-tests.Results: Of 89 respondents, 57% self-re­ported being DAEUS. A greater percentage of DAEUS reported knowledge of unethical treatment than non-DAEUS (56% vs 21%; P<.001), were significantly more likely to express distrust, and to endorse the pres­ence of covert (eg, insurance-based) than overt forms (eg, race-based) of discrimina­tion by the HCS.Conclusions: DAEUS express greater HCS distrust than non-DAEUS, patterned by awareness of unethical treatment and passive discrimination. Understanding how long-term exposure to US institutions influ­ences health is critical to resolving dispari­ties for all Black/African American groups. Rectifying past injustices through repara­tive institutional measures may improve DAEUS’ trust and engagement with the US HCS.Ethn Dis. 2021:31(3):417-424; doi:10.18865/ed.31.3.417

Revisiting ‘The Clinic’: ethical and policy challenges in US community health centers

2014 ◽  
Vol 9 (4) ◽  
pp. 425-434 ◽  
Author(s):  
Nancy Berlinger ◽  
Michael K. Gusmano ◽  
Eva Turbiner
Keyword(s):  
Health Care ◽  
Health Care System ◽  
Community Health Centers ◽  
Safety Net ◽  
The United States ◽  
Health Centers ◽  
Poor People ◽  
Ethical Challenges ◽  
The Us ◽  
Care System

AbstractWhere 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.

EMPLOYMENT AND REMUNERATION OF PHYSICIANS COMPARED TO THE HEALTH INSURANCE SYSTEM IN THE USA

2021 ◽  
Vol 564 (3) ◽  
pp. 14-21
Author(s):  
Hanna Karaszewska
Keyword(s):  
Health Care ◽  
American Literature ◽  
Health Care System ◽  
Private Insurance ◽  
Health Care Expenditures ◽  
Labor Costs ◽  
The Us ◽  
The Usa ◽  
Care System

The last decade has brought a sharp rise in healthcare costs in the US. This was not accompanied by an improvement in the indicators of the quality of healthcare. The health care system in the US, based in the same amount on private insurance as public funding, proved to be ineffective. This fact is mainly attributed to the growing costs of administering the complex system and high prices of medicines. And although the share of labor costs, including the remuneration of doctors in general health care expenditures, is relatively small (20%), there is an urgent need to look for pro-efficiency solutions also in this area. However, they must be accompanied by fuses that ensure adequate quality of health services and their availability. The article presents the mechanisms of employing doctors and their remuneration as an important element of systemic solutions in health care in the USA. It also features some characteristics of the pay relation. The article uses mainly secondary sources, including OECD statistical data. The results of reports published in American literature by various bodies and institutions, including Medscape and Doximity – the most popular American portals associating doctors, were also used. The information collected during unstructured interviews with participants of the health care system (doctors, hospital directors) during their stay in the USA was used as auxiliary.

scholarly journals The impact of the 2006 Massachusetts health care reform law on spine surgery patient payer-mix status and age

2017 ◽  
Vol 27 (6) ◽  
pp. 694-699 ◽  
Author(s):  
Nicolas W. Villelli ◽  
Hong Yan ◽  
Jian Zou ◽  
Nicholas M. Barbaro
Keyword(s):  
Health Care ◽  
New York ◽  
Health Care Reform ◽  
Health Care System ◽  
Spine Surgery ◽  
Private Insurance ◽  
New York State ◽  
Before And After ◽  
The Impact ◽  
Care System

OBJECTIVESeveral similarities exist between the Massachusetts health care reform law of 2006 and the Affordable Care Act (ACA). The authors’ prior neurosurgical research showed a decrease in uninsured surgeries without a significant change in surgical volume after the Massachusetts reform. An analysis of the payer-mix status and the age of spine surgery patients, before and after the policy, should provide insight into the future impact of the ACA on spine surgery in the US.METHODSUsing the Massachusetts State Inpatient Database and spine ICD-9-CM procedure codes, the authors obtained demographic information on patients undergoing spine surgery between 2001 and 2012. Payer-mix status was assigned as Medicare, Medicaid, private insurance, uninsured, or other, which included government-funded programs and workers’ compensation. A comparison of the payer-mix status and patient age, both before and after the policy, was performed. The New York State data were used as a control.RESULTSThe authors analyzed 81,821 spine surgeries performed in Massachusetts and 248,757 in New York. After 2008, there was a decrease in uninsured and private insurance spine surgeries, with a subsequent increase in the Medicare and “other” categories for Massachusetts. Medicaid case numbers did not change. This correlated to an increase in surgeries performed in the age group of patients 65–84 years old, with a decrease in surgeries for those 18–44 years old. New York showed an increase in all insurance categories and all adult age groups.CONCLUSIONSAfter the Massachusetts reform, spine surgery decreased in private insurance and uninsured categories, with the majority of these surgeries transitioning to Medicare. Moreover, individuals who were younger than 65 years did not show an increase in spine surgeries, despite having greater access to health insurance. In a health care system that requires insurance, the decrease in private insurance is primarily due to an increasing elderly population. The Massachusetts model continues to show that this type of policy is not causing extreme shifts in the payer mix, and suggests that spine surgery will continue to thrive in the current US health care system.

Should Screening Programs Be Perfect?

PEDIATRICS ◽  
1983 ◽  
Vol 71 (2) ◽  
pp. 301-301
Author(s):  
PHILIP R. WYATT
Keyword(s):  
United States ◽  
Health Care ◽  
Early Detection ◽  
New England ◽  
Health Care System ◽  
The United States ◽  
Neonatal Hypothyroidism ◽  
Screening Programs ◽  
Care System

To the Editor.— The report of the New England Regional Screening Program1 on neonatal hypothyroidism is a stunning illustration of the vulnerability of screening programs. It is unfortunate that this experience will probably be used as an argument to minimize the input of screening programs in the health care system in the United States. The report illustrates that, in addition to the 2% of the screened population that eluded the program, 14 infants with hypothyroidism escaped the full benefits of early detection and treatment.

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