Health affairs
-
U. S. citizens spent $5,267 per capita for health care in 2002--53 percent more than any other country. Two possible reasons for the differential are supply constraints that create waiting lists in other countries and the level of malpractice litigation and defensive medicine in the United States. ⋯ S. malpractice claims is estimated at $6.5 billion in 2001, only 0.46 percent of total health spending. The two most important reasons for higher U. S. spending appear to be higher incomes and higher medical care prices.
-
This study builds on earlier work by assessing the long-term impact of a public hospital performance report on both consumers and hospitals. In doing so, we shed light on the relative importance of alternative assumptions about what stimulates quality improvements. ⋯ An earlier investigation indicated that hospitals included in the public report believed that the report would affect their public image. Indeed, consumer surveys suggest that inclusion did affect hospitals' reputations.
-
The Food and Drug Administration (FDA) approval of BiDil unleashed a vigorous commentary, mostly critical of the decision. The FDA was soon caught between biologists, who see research and clinical utility in using racial classifications, and social scientists (and many politicians), who fear the adversities of greater discrimination. Analyses rarely addressed the practical factors the FDA had to consider in reaching a decision. Much of the literature simply assigned the question to the domain of racial politics, failing to consider the ethics of professional care, the Hippocratic oath, and the marketplace efficiency in moving drugs quickly to those who might most benefit.
-
Americans have reached consensus that (1) people have a right to refuse life-sustaining medical interventions, and (2) interventions that can be terminated include artificial nutrition and hydration. The one unresolved issue is how to decide for mentally incompetent patients. Only about 20 percent of Americans have completed living wills, and data show that family members are poor at predicting patients' wishes for life-sustaining care. But despite court cases and national consensus that these are private and not legislative matters, the Schiavo case is unlikely to change practices except to increase the number of Americans who complete living wills.
-
Within the past decade, complementary and alternative medicine (CAM) has penetrated mainstream U. S. health care. Major medical journals are publishing research on the efficacy of specific CAM therapies, physicians are attending oversubscribed continuing medical education courses on CAM, and hospitals are offering CAM services, sometimes through outpatient integrative medicine clinics. This paper presents factors behind the growth of CAM, analyzes its relationship with conventional medicine, and suggests how the integration of CAM and conventional medicine can be more effectively guided.