The Commonwealth Fund Commission on a High Performance Health System believes the government should facilitate communities' efforts to improve care for patients with multiple chronic conditions, through improved primary care, payment reform, and better information.

Gaining prompt access to primary care is a growing concern for all American adults. In Massachusetts, average wait times for new patients to obtain an internal-medicine appointment rose by 82% in the 2 years after health insurance coverage was expanded; ...

The belief that cost should be no object in health care has limited efforts to control medical spending; elected officials generally insist that cutting services that yield no value will be sufficient. But eliminating such waste would merely postpone the reckoning.

Waste in U.S. health care — spending on interventions that don't benefit patients — amounts to at least 30% of health care spending and is a major driver of cost increases. So the ethical debate about cost containment is shifting focus from rationing to waste avoidance.

Primary care physicians, long in the doldrums over their incomes and challenging work–life balance, may be heartened by recent steps taken by policymakers and payers signaling the increased recognition of the foundational role they could play in a ...

In recent decades, biomarkers have become essential in diagnosing disease and assessing patients' responses to therapy. The increasing quantitative rigor and efficiency of these tests have led to the possibility of “personalized medicine.” Despite such ...

Though bereaved persons often have depressive symptoms, grief typically runs its course within 2 to 6 months and requires no treatment. But the new edition of the Diagnostic and Statistical Manual of Mental Disorders may define bereavement as a depressive disorder.

The primary care doctor is a rapidly evolving species — and could become an endangered one. As we grapple with making health care more widely available and reducing its cost, it's hard to say how primary care physicians will fit into emerging delivery models.

In its fifth edition, the Diagnostic and Statistical Manual of Mental Disorders should correct a categorization scheme based on clinical appearance, which offers no way of making sense of mental disorders and fosters a diagnostic method reliant on symptom checklists.

The political seas roiled by the Affordable Care Act (ACA) have grown more volatile in the 2 years since its passage. Whether it is the constitutionality of the insurance mandate, the economic feasibility of the Medicaid expansion, or controversy over the ...

In December, 2011, Washington State's Health Care Authority announced its intention to stop paying for emergency department (ED) visits by Medicaid beneficiaries “when those visits are not necessary for that place of service.”¹ To identify unnecessary ...

Human immunodeficiency virus and hepatitis B virus exact a high toll worldwide. Both can lead to chronic disease, cancer, and death, and neither can be eradicated with the use of current therapies. Coinfection with the two viruses represents a major global health problem.

Between 2000 and 2008, measles control improved markedly worldwide, but with poorer countries focused on polio eradication and some richer countries falling prey to opposition to vaccination, the measles genie seems to have slipped out of the bottle in recent years.

Since the spending targets in Medicare's new accountable care organization (ACO) programs are being set on the basis of national, rather than local, rates of spending growth, ACOs could gain or lose financially without altering their delivery of care.

The Food and Drug Administration has added information to statin labels regarding an effect on diabetes, noting reported increases in glycated hemoglobin and fasting serum glucose levels but adding that it believes that the cardiovascular benefits outweigh the risks.

Osteoporosis, a disease characterized by reduced bone mass and increased skeletal fragility, affects 10 million Americans; another 34 million are at risk for it. Bisphosphonates are widely prescribed for osteoporosis; more than 150 million prescriptions ...

In the 21st century, osteoporosis, a disease once considered an inevitable consequence of aging, is both diagnosable and treatable. Large, randomized, controlled trials have shown that bisphosphonate therapy for 3 to 4 years is effective in reducing the ...

Although the media and the U.S. public focused primarily on the minimum-coverage requirement, or individual mandate, during the recent oral arguments in the challenges to the Affordable Care Act (ACA) before the Supreme Court, the most important issue ...

To accelerate the pace and spread of scientific discovery, we must look beyond translation and integrate clinical research with medical practice, creating a patient-centered, science-driven health care enterprise. But there are barriers to doing so.

Paternalism in discussing resuscitation status has given way to an approach in which patients may be asked to choose from a bewildering array of medical options, but physicians-in-training are rarely taught how to lead such conversations confidently and effectively.