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In this randomized trial of financial incentives in smokers, both reward-based and deposit-based incentive programs were more effective than usual care in achieving smoking cessation. Reward programs were much more commonly accepted than deposit-based programs. Financial incentives have been shown to promote a variety of health behaviors. 1 – 8 For example, in a randomized, clinical trial involving 878 General Electric employees, a bundle of incentives worth $750 for smoking cessation nearly tripled quit rates, from 5.0% to 14.7%, 8 and led to a program adapted by General Electric for its U.S. employees. 9 Although incentive programs are increasingly used by governments, employers, and insurers to motivate changes in health behavior, 10 , 11 their design is usually based on the traditional economic assumption that the size of the incentive determines its effectiveness. In contrast, behavioral economic theory suggests that incentives . . .

Can American health insurance survive? In The Transformation of American Health Insurance, Troyen A. Brennan traces the historical evolution of public and private health insurance in the United States from the first Blue Cross plans in the late 1930s to reforms under the Biden administration. In analyzing this evolution, he finds long-term trends that form the basis for his central argument: that employer-sponsored insurance is becoming unsustainably expensive, and Medicare for All will emerge as the sole source of health insurance over the next two decades. After thirty years of leadership in health care and academia, Brennan argues that Medicare for All could act as a single-payer program or become a government-regulated program of competing health plans, like today's Medicare Advantage. The choice between these two options will depend on how private insurers adapt and behave in today's changing health policy environment. This critical evolution in the system of financing health care is important to employers, health insurance executives, government officials, and health care providers who are grappling with difficult strategic choices. It is equally important to all Americans as they face an inscrutable health insurance system and wonder what the future might hold for them regarding affordable coverage.

Significant disparities exist in cardiovascular outcomes based on race/ethnicity and gender. Rates of evidence-based medication use and long-term medication adherence also appear to be lower in racial subgroups and women but have been subject to little attention. Our objective was to evaluate the effect of race/ethnicity and gender on adherence to statin therapy for primary or secondary prevention. Studies were identified through a systematic search of MEDLINE, EMBASE, ClinicalTrials.gov, and the Cochrane Database of Systematic Reviews (through April 1, 2010) and manual examination of references in selected articles. Studies reporting on adherence to statins by men and women or patients of white and nonwhite race were included. Information on study design, adherence measurement, duration, geographic location, sample size, and patient demographics was extracted using a standardized protocol. From 3,022 potentially relevant publications, 53 studies were included. Compared with men, women had a 10% greater odds of nonadherence (odds ratio 1.10, 95% confidence interval [CI], 1.07-1.13). Nonwhite race patients had a 53% greater odds of nonadherence than white race patients (odds ratio 1.53, 95% CI 1.25-1.87). There was significant heterogeneity in the pooled estimate for gender (I2 0.95, P value for heterogeneity <.001) and race (I2 0.98, P value for heterogeneity <.001). The overall results remained unchanged in those subgroups that had significantly less heterogeneity. Among patients prescribed statins, women and nonwhite patients are at increased risk for nonadherence. Further research is needed to identify interventions best suited to improve adherence in these populations.

Frivolous lawsuits have been cited as a major contributor to the high costs of the malpractice system in the United States. In this national study of 1452 closed claims, physician reviewers found no evidence of medical errors in 37 percent. Most claims, however, did not result in payment to the plaintiffs. Claims not associated with errors accounted for only 13 to 16 percent of the total costs. In this national study of 1452 closed claims, physician reviewers found no evidence of medical errors in 37 percent. Most claims, however, did not result in payment to the plaintiffs. Claims not associated with errors accounted for only 13 to 16 percent of the total costs. The debate over medical malpractice litigation continues unabated in the United States 1 and other countries. 2 – 4 Advocates of tort reform, including members of the Bush administration, lament the burden of “frivolous” malpractice lawsuits and cite them as a driving force behind rising health care costs. 5 , 6 (A frivolous claim is one that “present[s] no rational argument based upon the evidence or law in support of the claim.” 7 ) Plaintiffs' attorneys refute this charge, countering that contingency fees and the prevalence of medical errors make the pursuit of meritless lawsuits bad business and unnecessary. 8 , 9 Previous research has established that the . . .

This study compared characteristics of patients with retained sponges or instruments after surgery, identified through a large malpractice insurer, and control patients who underwent the same types of surgery but did not have retained foreign objects. Independent predictors of the retention of a foreign body included emergency surgery, an unplanned change in procedure, and higher body-mass index. Counts of instruments and sponges were less likely to have been performed for patients with retained foreign bodies than for controls, although in the majority of cases, such counts were performed and were recorded as being correct. Independent predictors included emergency surgery and an unplanned change in procedure. Error in medicine is common and may cause harm. 1 However, isolating the factors underlying specific types of errors has proved to be a formidable task. The types of errors that occur vary widely because of the extreme complexity and heterogeneity of the tasks involved in medical care. Furthermore, many of the most devastating errors happen too infrequently for observational or single-institution studies to identify the risk factors and patterns of causation. As a result, studies of error to date have generally measured only the frequency and outcomes of specific types of errors, not the roles of particular contributing factors. One . . .

The growing prevalence of obesity among adults and children has prompted legal initiatives designed to combat this public health problem. The authors describe litigation and legislation that target obesity and discuss the potential for public health law to reduce obesity in the United States. The authors describe litigation and legislation that target obesity and discuss the potential for public health law to reduce obesity in the United States. The law is now firmly established as a powerful instrument of public health. 1 Some of the most important public health victories in the United States in the past century — declining lead exposure, reduced rates of smoking, improvements in workplace and motor vehicle safety, and increased vaccination rates — are the result of new legislation, heightened regulatory enforcement, litigation, or a combination of the three. 2 – 4 With each victory, confidence mounts in the capacity of legal tools to be used in combating serious health threats. One of the newest targets of public health law is obesity. 5 The past few years . . .

Biosimilars present a key opportunity to contain the growing cost of biologic drug spending and to make essential medications more affordable. However, the lackluster performance of the US biosimilar market in its first decade was met with disappointment and concern for its future viability. To evaluate the evolution of the biosimilar market, we reviewed key distinctions in medication classes and the financial stakeholders involved in each. Within this context, we examined recent evidence that suggests that the maturing postapproval biosimilar marketplace is flourishing. The entry of biosimilars for adalimumab offers a case study demonstrating these recent market and policy dynamics. Building on recent gains, policy makers could take additional steps to accelerate biosimilar adoption through both payment and regulatory policy levers.

BackgroundOne-quarter of U.S. patients do not have a primary care provider or do not have complete access to one. Work and personal responsibilities also compete with finding convenient, accessible care. Telehealth services facilitate patients’ access to care, but whether patients are satisfied with telehealth is unclear.ObjectiveWe assessed patients’ satisfaction with and preference for telehealth visits in a telehealth program at CVS MinuteClinics.DesignCross-sectional patient satisfaction survey.ParticipantsPatients were aged ≥18 years, presented at a MinuteClinic offering telehealth in January–September 2014, had symptoms suitable for telehealth consultation, and agreed to a telehealth visit when the on-site practitioner was busy.Main MeasuresPatients reported their age, gender, and whether they had health insurance and/or a primary care provider. Patients rated their satisfaction with seeing diagnostic images, hearing and seeing the remote practitioner, the assisting on-site nurse’s capability, quality of care, convenience, and overall understanding. Patients ranked telehealth visits compared to traditional ones: better (defined as preferring telehealth), just as good (defined as liking telehealth), or worse. Predictors of preferring or liking telehealth were assessed via multivariate logistic regression.Key resultsIn total, 1734 (54 %) of 3303 patients completed the survey: 70 % were women, and 41 % had no usual place of care. Between 94 and 99 % reported being “very satisfied” with all telehealth attributes. One-third preferred a telehealth visit to a traditional in-person visit. An additional 57 % liked telehealth. Lack of medical insurance increased the odds of preferring telehealth (OR = 0.83, 95 % CI, 0.72–0.97). Predictors of liking telehealth were female gender (OR = 1.68, 1.04–2.72) and being very satisfied with their overall understanding of telehealth (OR = 2.76, 1.84–4.15), quality of care received (OR = 2.34, 1.42–3.87), and telehealth’s convenience (OR = 2.87, 1.09–7.94)ConclusionsPatients reported high satisfaction with their telehealth experience. Convenience and perceived quality of care were important to patients, suggesting that telehealth may facilitate access to care.

A substantial threat to the overall health of the American public is nonadherence to medications used to treat diabetes, as well as physicians' failure to initiate patients' use of those medications. To address this problem, we evaluated an integrated, pharmacy-based program to improve patients' adherence and physicians' initiation rates. The study included 5,123 patients with diabetes in the intervention group and 24,124 matched patients with diabetes in the control group. The intervention consisted of outreach from both mail-order and retail pharmacists who had specific information from the pharmacy benefit management company on patients' adherence to medications and use of concomitant therapies. The interventions improved patients' medication adherence rates by 2.1 percent and increased physicians' initiation rates by 38 percent, compared to the control group. The benefits were greater in patients who received counseling in the retail setting than in those who received phone calls from pharmacists based in mail-order pharmacies. This suggests that the in-person interaction between the retail pharmacist and patient contributed to improved behavior. The interventions were cost-effective, with a return on investment of approximately $3 for every $1 spent. These findings highlight the central role that pharmacists can play in promoting the appropriate initiation of and adherence to therapy for chronic diseases. Adapted from the source document.

Pressure mounts on physicians and hospitals to disclose adverse outcomes of care to patients. Although such transparency diverges from traditional risk management strategy, recent commentary has suggested that disclosure will actually reduce providers' liability exposure. We tested this theory by modeling the litigation consequences of disclosure. We found that forecasts of reduced litigation volume or cost do not withstand close scrutiny. A policy question more pressing than whether moving toward routine disclosure will expand litigation is the question of how large such an expansion might be.