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Caught between two paradigms Print E-mail
Written by A Country Doctor Writes   
Friday, 20 October 2017 17:27
In the very near future, clinics like ours will be paid according to how well our patients do medically, or at least according to how consistently we provide certain medical tests and interventions. This includes frequency of diabetic blood tests, foot exams, eye exams, prescriptions for heart and kidney protective medications, achievement of pre-set targets for blood pressure, body mass index and immunization rates, and other measurable "quality indicators".
But paychecks for medical providers as well as short term financial viability of clinics like my Federally Qualified Health Center depends, besides Federal grants for being open in the first place, almost entirely on the fixed revenue we receive from every face to face encounter we have with patients.
Last Updated on Friday, 20 October 2017 17:29
What Makes Singapore's Health Care So Cheap? Print E-mail
Written by The Incidental Economist   
Saturday, 07 October 2017 09:27
Singapore's health care system is distinctive, and not just because of the improbability that it's admired by many on both the American left and the right. It spends less of its economy on health care than any country that was included in our recent tournament on best health systems in the world. And it spends far, far less than the United States does. Yet it achieves some outcomes Americans would find remarkable.
Last Updated on Saturday, 07 October 2017 09:32
The Best Healthcare System in the World: Which One Would You Pick? Print E-mail
Written by The Incidental Economist   
Saturday, 23 September 2017 11:41

"Medicare for all," or "single-payer," is becoming a rallying cry for Democrats. This is often accompanied by calls to match the health care coverage of "the rest of the world." But this overlooks a crucial fact: The "rest of the world" is not all alike. The commonality is universal coverage, but wealthy nations have taken varying approaches to it, some relying heavily on the government (as with single-payer); some relying more on private insurers; others in between. Experts don't agree on which is best; a lot depends on perspective. But we thought it would be fun to stage a small tournament.

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Last Updated on Tuesday, 03 October 2017 18:15
The hidden crisis within the health care crisis Print E-mail
Written by Todd J. Albert, MD | KevinMD   
Tuesday, 05 September 2017 00:00

My first year after completing surgical residency was exhilarating and exhausting; an experience most physicians will recall as part of their training. The American medical culture has imagined that the nation's doctors - no matter their workload - simply don't reach physical or emotional exhaustion in their work. But they do, and as we debate the future of healthcare in our country, we need to address this problem and quickly get to solutions, helping ensure that the practitioners closest to tomorrow's patients can always be at their absolute best.

To define the problem, look at the three fundamental factors common to any American doctor's routine...

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Last Updated on Tuesday, 05 September 2017 18:58
Doctors: Are you employees, business owners or entrepreneurs? Print E-mail
Written by FHI's Week in Review   
Monday, 21 August 2017 00:00

Pamela Wible, MD, in an August 17, 2017 KevinMD post, asserts:
Hate your job? You may be in the right profession, but the wrong position for your personality. Want to love your life and career? Step one: discover whether you are an employee, a business owner or an entrepreneur.
This is a great article for physicians and non-physicians. Dr. Wible explains succinctly how to figure out which profile best fits your personality.

Read more in the current issue of Week in Review>>
Will Genetic Engineering Save or Sink Humanity? Print E-mail
Written by FHI News   
Monday, 07 August 2017 00:00

In an 8.6.17 post, MD Whistleblower ponders the ethical dilemma created by the recent announcement that gene editing has been applied to fix diseased genes in viable human embryos:
<We have> learned of an astonishing scientific breakthrough that seems utterly fantastic and futuristic, even though it has actually occurred. Scientists amended the DNA of human embryos to correct a mutation - a genetic defect - that causes a very serious medical disease. This suggests that with additional research and testing that embryos who otherwise might be destined for misery could be rescued...The fact that there is a fortune to be made in the genetics industry can be expected to alter the direction of our ethical compass. And, while the initial roll-out will be discussing how genetic intervention can reverse the course of devastating and fatal diseases, does anyone believe it will stop there? Once the concept has been normalized, other medical conditions will be targeted. The creep will be inexorable. Boundaries will be shattered.
Last Updated on Tuesday, 08 August 2017 18:11
5 steps to create medical quality without trying Print E-mail
Written by Kjell Benson, MD | KevinMD   
Thursday, 27 July 2017 00:00

The need for what we are calling medical "quality" is acute, yet the strategies employed to obtain it are destroying medicine. Patient outcomes are inconsistent, care varies depending on many factors outside of disease state, and the cost of our medical system is not sustainable. But to fix this, most health systems employ non-clinicians to audit charts while checking boxes such as "A1C<8%?" and "DVT prophylaxis ordered within 24 hours?" These non-providers then send threatening letters and cut salaries with "pay-for-performance." Unsurprisingly, such efforts are not working, and only end up creating distorted physician-patient relationships. Yet, obtaining improved quality requires only a few key steps...

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