Category: Medical Quality

A calculator, a stethoscope, and a stack of money rest on a table.

Why Our Health Care Is Incomplete: Review of “Exposed” (Part II)

Daniel Aaron 2 Comments

By: Daniel Aaron

Just last month, Professor Christopher T. Robertson, at the University of Arizona College of Law, released his new book about health care, entitled Exposed: Why Our Health Insurance Is Incomplete and What Can Be Done About It. Part II of this book review offers an analytical discussion of “cost exposure,” the main subject of his book with a focus on solutions. Read Part I here.

Baby solutions

Prof. Robertson writes two chapters on solutions. In the first, titled “Fixes We Could Try,” he offers reforms, from mild to moderate, that would make cost exposure less harmful. The chapter largely retains the analytical nature of the prior chapters, but it comes across like a chapter he might have rather not written. This is evident in the following chapter’s title, “What We Must Do.” It’s also evident because some of the proposals do not seem fully considered, and in some ways appear more controversial than the more comprehensive solution offered later. Read More

A calculator, a stethoscope, and a stack of money rest on a table.

Why Our Health Care Is Incomplete: Review of “Exposed” (Part I)

Daniel Aaron Leave a comment

By: Daniel Aaron

Just last month, Professor Christopher T. Robertson, at the University of Arizona College of Law, released his new book about health care, entitled Exposed: Why Our Health Insurance Is Incomplete and What Can Be Done About It. This book review will offer an analytical discussion of “cost exposure,” the main subject of his book.

What is cost exposure in health care?

Cost exposure is payments people make related to their medical care. There are many ways patients pay – here are a few common ones.

  • Deductible – Patient is responsible for the first, say, $5,000 of their medical care; after this point, the health insurance kicks in. Resets each year.
  • Copay – Patient pays a specific amount, say $25, when having an episode of care.
  • Coinsurance – Patient pays a specified percentage, say 20%, of care.

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Improving the Mindset on NHS Complaint Handling

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By John Tingle

History has not served the NHS (National Health Service) complaints system well

History has not served the NHS complaints system well. There have been many reports about NHS complaints going back well over two and a half decades, saying the same or similar things about the system. Many have argued and continue to argue that the NHS complaints system needs to be much more responsive, simpler in operation and less defensive. It is fair comment to argue today that the NHS complaints system is still plagued with endemic and systemic problems. The NHS has never been able to gets its health care complaints system right.

Two contemporary reports, one published in 2018 and the other in 2020, give support to the view that the NHS needs to do much more to improve how patient complaints are handled. Read More

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Patient Satisfaction in the NHS in England with the Emergency Room

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By John Tingle

The Accident and Emergency (A&E), the Emergency Room, is the bellwether NHS speciality from which all the other clinical specialities appear to be judged. Long reported delays and missed targets in the A&E (Emergency Room) lead to a public, media clamoring that the NHS is a failing public service. The independent regulator of health and social care in England, the CQC (Care Quality Commission) recently published findings from a national survey of more than 50,000 people who received urgent and emergency care from 132 NHS trusts (hospitals).The survey looked at people’s experiences, from decision to attend, to leave, using Type 1 (major A&E) and Type 3 (urgent care centers, minor injury units, urgent treatment centers) urgent and emergency care services.

Survey Results

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Care Quality Commission Annual Assessment of Health and Social Care

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By John Tingle

The independent regulator for health and social care in England, the Quality Care Commission (CQC) has recently published its annual report on the real-time state of health and social care in England. It analyses trends, shares examples of outstanding, good, and poor health care care practices. It provides a true, unabashed account of issues facing the National Health Service (NHS) and health care delivery.

A Health System Stretched

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The FDA’s NEST Initiative and Women’s Health

Alexandra Slessarev Leave a comment

The history of medical device regulation in the United States has been shaped by the prominent failure of individual devices, many of which were indicated for women.

The Dalkon Shield intrauterine device infamously ushered in the 1976 amendments to the Federal Food, Drug, and Cosmetics Act, establishing the first pre-market notification and approval process for medical devices in the United States. Similarly, a series of failures among devices designed for women’s health—including the power morcellator, the Essure System, and pelvic mesh—has recently invigorated the FDA’s focus on its post-market regime. Read More

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Report: Maternal Mental Health Must be a Top Priority

Rebecca Friedman Leave a comment

The U.S. Preventive Services Task Force (USPSTF), published recommendations recently urging clinicians to refer pregnant and postpartum women to counseling if they are at risk of depression.

The recommendations respond to the prevalence of perinatal depression, which is considered to be the most common pregnancy complication. Perinatal depression, affects up to one in seven women and can develop at any time after a woman becomes pregnant, immediately following the brith of a child, or even up to a year after.

Among the many concerning potential consequences of maternal depression are premature births and low birth weights, as well as neglect and inattentiveness from mothers after the baby is born, which can subject infants to risk of additional problems, according to Karina Davidson, a USPSTF member who helped write the recent recommendations. Read More

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Update on the Future Direction of Patient Safety in the National Health Service

John Tingle Leave a comment

Matt Hancock, the Secretary of State for Health and Social Care on February 6 gave a wide-ranging speech on the future direction of patient safety in the NHS. The speech is important as it gives key insights into government priorities for patient safety policy development in the NHS.He stated that we all trust nurses and doctors more than any other profession. He spoke about the importance of a “just culture” in the NHS and openness, honesty, and trustworthiness. Read More

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Repayment for Training as an Optimal Solution to Medical Brain Drain

Mark Satta Leave a comment

In an earlier post I offered two arguments for why wealthy nations have a moral obligation to address medical professional brain drain from resource-scarce developing nations. But once one acknowledges that wealthy nations have this obligation, a question remains as to what the best way to fulfill that obligation is.

Some have suggested that the solution is for wealthy nations to train an ample amount of doctors in their home countries so that they no longer need to take talent from developing nations to make up for the gap. This idea has intuitive appeal. After all, it allows more medical doctors to be trained in wealthy nations like the U.S. and results in more doctors being trained overall (assuming that developing nations would continue to train the same amount of doctors under such a model). Read More

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Machine Learning in Medicine: Addressing Ethical Challenges

Alex Pearlman Leave a comment

Machine learning in medicine is accelerating at an incredible rate, bringing a new era of ethical and regulatory challenges to the clinic.

In a new paper published in PLOS Medicine, Effy Vayena, Alessandro Blasimme, and I. Glenn Cohen spell out these ethical challenges and offer suggestions for how Institutional Review Boards (IRBs), medical practitioners, and developers can ethically deploy machine learning in medicine (MLm). Read More