Health affairs
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Fairness in finance is an intrinsic and challenging goal of health systems. Mexico recently devised a structural reform that responds to this challenge. ⋯ This paper analyzes the reform, focusing on financial features, expected benefits, and future challenges. It also highlights aspects of relevance for other countries that are striving to formulate and implement health policies to promote universal social protection and fair financing.
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Greater use of electronic medical records (EMRs) has the potential to improve the quality of medical care and has become a goal of the U. S. administration. ⋯ The adoption rate did not increase from 2001 through 2003. Practices with more physicians and those owned by health maintenance organizations (HMOs) were significantly more likely to use this technology, but use varied little by the characteristics of individual physicians, the practice's scope of services, or the practice's sources of revenue.
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Randomized Controlled Trial
The costs of nonbeneficial treatment in the intensive care setting.
Ethics consultations have been shown to reduce the use of "nonbeneficial treatments," defined as life-sustaining treatments delivered to patients who ultimately did not survive to hospital discharge, when treatment conflicts occurred in the adult intensive care unit (ICU). In this paper we estimated the costs of nonbeneficial treatment using the results from a randomized trial of ethics consultations. We found that ethics consultations were associated with reductions in hospital days and treatment costs among patients who did not survive to hospital discharge. We conclude that consultations resolved conflicts that would have inappropriately prolonged nonbeneficial or unwanted treatments in the ICU instead of focusing on more appropriate comfort care.
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The Food and Drug Administration (FDA) approval of BiDil unleashed a vigorous commentary, mostly critical of the decision. The FDA was soon caught between biologists, who see research and clinical utility in using racial classifications, and social scientists (and many politicians), who fear the adversities of greater discrimination. Analyses rarely addressed the practical factors the FDA had to consider in reaching a decision. Much of the literature simply assigned the question to the domain of racial politics, failing to consider the ethics of professional care, the Hippocratic oath, and the marketplace efficiency in moving drugs quickly to those who might most benefit.
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U. S. citizens spent $5,267 per capita for health care in 2002--53 percent more than any other country. Two possible reasons for the differential are supply constraints that create waiting lists in other countries and the level of malpractice litigation and defensive medicine in the United States. ⋯ S. malpractice claims is estimated at $6.5 billion in 2001, only 0.46 percent of total health spending. The two most important reasons for higher U. S. spending appear to be higher incomes and higher medical care prices.