- N Engl J Med 2022; 387:775-777
For patients with rare diseases, connecting virtually with specialists across state lines can be the only option for excellent care. So why are state-licensing restrictions being enforced more aggressively than ever?
- N Engl J Med 2022; 387:292-294
Primary care practices are increasingly taking on accountability for total health care spending for a defined population. Such arrangements could have implications for clinicians and patients.
- N Engl J Med 2022; 386:2452-2453
By strategically directing necessary production-line work in medical practices away from the professionals with the most clinical expertise, we can preserve physicians’ skills for the nuanced work of problem solving, medical decision making, and relationship building.
- N Engl J Med 2022; 386:2449-2451
Policymakers often use economic evaluations to weigh the costs and benefits of health policies. Some Covid-related policies and interventions are similarly amenable to assessment.
- N Engl J Med 2022; 386:2164-2167
The financial burden associated with orally administered anticancer drugs can be overwhelming for Medicare beneficiaries. Policies adding an out-of-pocket spending cap to Part D have been proposed, and Congress could permit price negotiation for anticancer drugs.
- N Engl J Med 2022; 386:2064-2066
A decade after preexposure prophylaxis against HIV became available, less than a quarter of people in the United States who could benefit from PrEP are taking it. The failure is, in part, a perverse outcome of a system that relies on high drug prices to fund HIV prevention.
- N Engl J Med 2022; 386:1969-1971
A case that would otherwise have set off an avalanche of investigations and therapeutics, family meetings, and consultations was quietly referred for charity hospice care, though Ms. M.’s immigration status made acceptance even by a hospice agency precarious.
- N Engl J Med 2022; 386:e54
Although the Covid pandemic drew renewed attention to problems in U.S. nursing homes, the underlying issues with long-term care are long-standing. Susan Mitchell moderates a Perspective Roundtable about shortcomings and possible solutions.
- N Engl J Med 2022; 386:1869-1871
More than 30 years after the Nursing Home Reform Act, the United States still fails to protect nursing home residents and provide them with high-quality care. The Covid-19 pandemic’s devastating effect on nursing homes reminds us that further reforms are sorely needed.
- N Engl J Med 2022; 386:1850-1854
Drawing on peer review and professionalism, some quality-improvement efforts tap into physicians’ intrinsic motivations for giving their patients the best possible care. How can we scale up such promising approaches and create and sustain a spirit of inquiry?
- N Engl J Med 2022; 386:1759-1763
Proliferating measures of health care quality may distract clinicians from what matters to individual patients and from larger public health problems. Has the quality-improvement movement gone astray by ignoring the complexity of both high-quality care and physicians’ motivations?
- N Engl J Med 2022; 386:1663-1667
Decades into the quality improvement movement in U.S. health care, the fix for the system has become a massive, cumbersome, time-consuming, demoralizing system in its own right — and we don’t even know whether it is improving care.
- N Engl J Med 2022; 386:1297-1301
Although immunotherapy development has improved overall survival among patients with common cancers and has led to important therapeutic advances, rapid expansion of the checkpoint inhibitor class of drugs has been expensive and largely uncoordinated.
- N Engl J Med 2022; 386:1293-1295
The Choosing Wisely initiative was a public relations win for the medical profession in 2012: doctors were stepping up to address low value and high costs in medicine. Today, it’s clear that making lists and publicizing them are not sufficient to reduce low-value care.
- N Engl J Med 2022; 386:1104-1106
Existing laws could be used to help make many drugs more affordable. One gives the government a royalty-free license to use patented inventions that were discovered using federal funding; the other gives the government immunity from being sued for patent infringement.
- N Engl J Med 2022; 386:901-904
The debate regarding step therapy reflects a tension between two important policy goals: safeguarding patients’ access to high-quality care and constraining spending on prescription drugs, including by limiting the overuse of costly medications with uncertain efficacy.
- N Engl J Med 2022; 386:709-711
Since the 1980s, policymakers and private health insurers have implemented various interventions aimed at “bending the cost curve.” But the long-term growth of health care expenditures as a share of the GDP has continued, with negative implications for American workers.
- N Engl J Med 2022; 386:405-408
Although public health practitioners and researchers focus primarily on improving health, economists view health as but one important component of what people may value. This insight is a key aspect of economics’ utility for informing public health policy.
- N Engl J Med 2021; 385:2501-2504
A new AAMC report reaffirms a persistent gender pay gap in U.S. medicine. As we strive to achieve salary equity, we should reflect on components of the compensation calculus that reward the way male physicians have lived and engaged professionally for generations.