Health affairs
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Physicians complain about the growth of managed care structures and strategies and their effects on treatment autonomy and medical professionalism. Organizational changes and a competitive marketplace make the traditional view less relevant today. New concepts of professionalism are needed that recognize constraints and include patient advocacy within a framework of procedural justice, responsibility for population health, new patient partnerships, and participation in an evidence-based culture. Such changes require more focused efforts in medical education to support the new professionalism.
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Medicare and Medicaid need new organizational structures. At the start of a new administration, the Health Care Financing Administration (HCFA) should be replaced by separate agencies to administer Medicare (a Federal Health Programs Administration) and Medicaid plus other state grant programs (a State Health Programs Administration). A new Medicare management agency should have different centers for beneficiary services, provider payments, health plans, prescription drugs, and program development/special populations. The future Department of Health and Human Services (HHS) should have an assistant secretary for prevention and health care quality, and a new Congress should establish a Joint Health Committee.
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The argument that prescription drugs are cost-effective has been made both by the pharmaceutical industry to support rising drug prices and expenditures, and by advocates of expanded drug coverage for elderly and low-income persons. A new database of 228 published cost-utility analyses sheds light on the issue. ⋯ Cost-utility analyses funded by the drug industry tend to report more favorable results than do those funded by nonindustry sources. Cost-effectiveness analysis can help policymakers to determine whether drugs and other interventions offer value for money.