Health affairs
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International medical graduates (IMGs) represent a large proportion of the population entering graduate medical education (GME) programs. Many of these internationally trained physicians go on to practice medicine in the United States. ⋯ More detailed longitudinal analyses are required to better understand the interwoven issues of physician supply, consumers' needs, and the role of IMGs in the U. S. health care system.
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Almost 60,000 Indian physicians practice in the United States, United Kingdom, Canada, and Australia--a workforce equal to 10 percent of the physicians in India and the largest émigré physician workforce in the world. I traveled to India to interview leaders in medical education, health policy, and public health, to better characterize and understand Indian physician emigration. A changing political and policy environment in India is raising new questions about what might be done to keep more of India's physicians at home.
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Paramedics provide life-saving emergency medical care to patients in the out-of-hospital setting, but only selected emergency interventions have proved to be safe or effective. Endotracheal intubation (the insertion of an emergency breathing tube into the trachea) is an important and high-profile procedure performed by paramedics. ⋯ These findings indicate frequent errors associated with this life-saving technique. These events might be emblematic of larger issues in the structure and delivery of out-of-hospital emergency care.
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Growth in national health spending is projected to slow in 2005 to 7.4 percent, from a peak of 9.1 percent in 2002. Private health insurance premiums are projected to slow to 6.6 percent in 2005, with a rebound expected in 2007. The introduction of Medicare Part D drug coverage in 2006 produces a dramatic shift in spending across payers but has little net effect on aggregate spending growth. Health spending is expected to consistently outpace gross domestic product (GDP) over the coming decade, accounting for 20 percent of GDP by 2015.
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Congress adopted legislation in 1984 to encourage pharmaceutical companies to develop new drugs, while simultaneously allowing competitors to bring cheaper generic versions to market. More than twenty years later, Congress may be faced with a similar balancing act for biologics. ⋯ It should also evaluate the patent law, which is yielding increasingly narrow patents. If additional measures are not adopted in light of the intersection of these factors, then any legislation allowing for "follow-on" biologics could stifle development of new medicines from biotechnology.