Journal of the American College of Radiology : JACR
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Management of hepatic malignancy is a challenging clinical problem involving several different medical and surgical disciplines. Because of the wide variety of potential therapies, treatment protocols for various malignancies continue to evolve. Consequently, development of appropriate therapeutic algorithms necessitates consideration of medical options, such as systemic chemotherapy; surgical options, such as resection or transplantation; and locoregional therapies, such as thermal ablation and transarterial embolization. ⋯ The ACR Appropriateness Criteria(®) are evidence-based guidelines for specific clinical conditions that are reviewed every 2 years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer-reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances in which evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment.
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The Patient Protection and Affordable Care Act (PPACA) is comprehensive reform and by virtue of its comprehensiveness can be cumbersome to read and understand. This short piece is a succinct and irreverent glance at PPACA. The piece starts with a question and ends with the same question: Will PPACA break the iron triangle?
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Insurance plays an important role in the United States, most importantly in but not limited to medical care. The authors introduce basic economic concepts that make medical care and health insurance different from other goods and services traded in the market. They emphasize that competitive pricing in the marketplace for insurance leads, quite rationally, to risk classification, market segmentation, and market failure. The article serves as a springboard for understanding the basis of the reforms that regulate the health insurance market in the Patient Protection and Affordable Care Act.
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Under the Patient Protection and Affordable Care Act, all states are required to establish health insurance exchanges, marketplaces where individuals and small businesses can purchase health care coverage. In establishing these exchanges, states must address a range of regulatory and design issues to ensure that their exchanges are sustainable and meet the needs of their populations. The issues include the degree of federal involvement in the management of the exchanges, the overall structure and governance of the exchanges, the requirements for insurance plans to be offered on the exchanges, and the design of the exchanges themselves. Each of these issues will play a crucial role in determining the quality of coverage offered to consumers and how effectively they can access that coverage.
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The Patient Protection and Affordable Care Act is a comprehensive and multipronged reform of the US health care system. The legislation makes incremental changes to Medicare, Medicaid, and the market for employer-sponsored health insurance. However, it makes substantial changes to the market for individual and small-group health insurance. The purpose of this article is to introduce the key regulatory reforms in the market for individual and small-group health insurance and explain how these reforms tackle adverse selection and risk classification and improve access to health care for the hitherto uninsured or underinsured population.