In a push to encourage “personal responsibility,” the Centers for Medicare and Medicaid Services (CMS) has approved work requirements as a condition for receiving Medicaid benefits in four states - Kentucky, Indiana, Arkansas, and most recently New Hampshire, with applications from other states pending. In a new JAMA Viewpoint, Harald Schmidt and Allison Hoffman review the implications and ethics of Medicaid work requirements and other personal responsibility policies. They propose safeguards CMS should consider to minimize risk and protect beneficiaries’ health.
A recent report from the Institute for Clinical and Economic Review (ICER) calls into question the effectiveness and cost-effectiveness of abuse-deterrent formulations at both the individual patient and population levels. It finds limited evidence that these formulations have a real-world impact on opioid abuse, and its economic impact models suggest that any success comes with an eye-popping price tag.
Sen. Bernie Sanders (I., Vt.) last week released his Medicare for All vision: a single-payer health care system that would ensure coverage for all Americans. His quest comes at a time when budget-motivated Republicans are revisiting efforts to curb costs in Medicaid through spending caps. These two efforts seem worlds apart, especially to people across the country who are counting on Congress to fix the cost and coverage challenges they are facing with their health insurance.
Most of the time, scientists generate research questions based on what they think is interesting and important. This approach can obviously yield valuable discoveries, but it also means that scientists don’t always have answers to the questions that urgently plague policymakers. I learned to embrace a different approach, one that aims to work with policymakers and influencers to identify and answer the research questions that they most need answered.
The national conversation over plans to reform health care in America has been focused on who would lose coverage and who would keep it under newly proposed plans, but this masks a different problem that’s just as significant: many Americans who currently have insurance may not be able to get the care they need when they get sick, and they may not even know it.
When we read about racial inequality in pain management, it may be easy to assume that it only happens at other institutions or with other providers. But as physicians dedicated to delivering equitable care, we have to recognize the possibility that we may act with bias unconsciously and in contrast to our personal values. Recognition of our own implicit biases can start with reflecting upon and discussing a particular case at our own institution.
How can state lawmakers decrease non-medical vaccination exemptions without infringing on parental choice? That’s the question that LDI Senior Fellow Alison Buttenheim seeks to answer in her new Governing magazine article.
For 15 consecutive years, nursing has been rated as the most trusted profession in the U.S. Yet, nurses are continuously underrepresented in organizations that make large-scale health care decisions. Merely 37 percent of hospitals have a nurse on their governing board, compared with 75 percent that include a physician. Skills in health care delivery, quality, and responsiveness to the public are crucial to the functioning of a health care board, and are central to the work that nurses do. But although nurses often work the closest with patients and communities served by hospitals, current literature shows they are not seen as influential decision makers by other health care leaders. Why?
Where you end up may depend on where you start. That’s the perspective taken by LDI Senior Fellow Said Ibrahim in the New England Journal of Medicine, as he discusses how shared decision-making tools and increased patient knowledge affect treatment choice. Specifically, Ibrahim looks at elective joint replacement, and examines how increased use of decision aids affects the choice to pursue either conservative management or total joint replacement.