Health affairs
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This paper presents a framework for universal health insurance that builds on the current U. S. mixed private-public system by expanding group coverage through private markets and publicly sponsored insurance. ⋯ The paper estimates coverage and costs, and assesses the approach. Our findings indicate that the framework could reach near-universal coverage with little net increase in national health spending.
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Efforts to improve the quality and costs of U. S. health care have focused largely on fostering physician adherence to evidence-based guidelines, ignoring the role of clinical judgment in more discretionary settings. ⋯ Physicians in high-spending regions see patients back more frequently and are more likely to recommend screening tests of unproven benefit and discretionary interventions compared with physicians in low-spending regions; however, both appear equally likely to recommend guideline-supported interventions. Greater attention should be paid to the local factors that influence physicians' clinical judgment in discretionary settings.
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Historical Article
The long road to health reform requires bipartisan leadership.
The United States appears headed toward another national debate about health system reform. Worry about access and health system deficiencies has reached critical mass, and polls indicate that health care leads the domestic agenda for the 2008 elections. This debate, like previous debates, will succeed or fail in Congress. We highlight key elements of recent sagas in health legislation and offer advice to the next president and Congress for improving the likelihood of a successful outcome in 2009-10: (1) make health reform a top legislative priority; (2) be leaders, not partisans; and (3) develop broad policy consensus but leave the policy details to Congress.
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This paper examines the introduction of a prioritized list of fifty-six health conditions in Chile, for which access to treatment is guaranteed. This is an important health reform issue, and the discussion of Chile's rich and complex approach may benefit other countries. ⋯ The dominant criteria were high burden of disease and social preferences. Cost-effectiveness was introduced after the fact to identify effective treatments at a cost that the country could afford.