Category Archive: NEJM

The Inevitable Math behind Entitlement Reform

The projected growth in Medicare and Medicaid spending, which exceeds projected aggregate economic growth, is pushing policymakers to seriously consider further entitlement reform. At some point, Americans will probably be unwilling to pay higher taxes…

Evaluation of Medicare’s Bundled Payments Initiative for Medical Conditions

Episode-based payment holds promise for improving the quality and efficiency of care. The Center for Medicare and Medicaid Innovation (CMMI) launched the Bundled Payments for Care Improvement (BPCI) initiative in 2013. BPCI is a voluntary program, and …

Parenteral Opioid Shortage — Treating Pain during the Opioid-Overdose Epidemic

The opioid-overdose epidemic now causes more than 30,000 deaths per year in the United States. In response to the increasing death toll, many measures have recently been implemented, including reclassification of hydrocodone as a Schedule II opioid and…

Radical Changes for Reproductive Health Care — Proposed Regulations for Title X

On June 1, 2018, the Department of Health and Human Services (HHS) proposed new regulations for the Title X Family Planning Program. If enacted, these regulations will radically alter the mix of health care providers and the range, quality, and effecti…

A Remembrance of Life before Roe v. Wade

We chatted as the dialysis shift began. She was a young nursing student whose name and face I still remember five decades later, but I will just call her “Jane Roe.” She was from the Virgin Islands and had come to New York for nursing school. She was n…

Medicaid’s Path to Value-Based Reform

The Centers for Medicare and Medicaid Services (CMS) has led the national effort to shift the U.S. health care system toward a focus on value. Prominent Medicare value-based payment models such as accountable care organizations (ACOs) and bundled payme…

A Parallel Universe of Clinical Trials

A recent clinical trial of a herpes simplex virus vaccine allegedly violated fundamental scientific, regulatory, and ethical safeguards. This case opens a window into a parallel universe that spurns the current system of clinical trial oversight in the…

Fractional-Dose Yellow Fever Vaccination — Advancing the Evidence Base

In 2016, a global shortage of yellow fever vaccine occurred as a result of major yellow fever outbreaks in Angola and the Democratic Republic of Congo (DRC). By October, 7136 cases and 493 deaths were reported in the two countries. Reactive vaccination…

Behind Schedule — Reconciling Federal and State Marijuana Policy

The long-standing chasm between federal and state marijuana policy recently widened when U.S. Attorney General Jeff Sessions rescinded Obama-era guidance indicating that the Justice Department would not make it a priority to prosecute federal marijuana…

Moving Addiction Care to the Mainstream — Improving the Quality of Buprenorphine Treatment

More than 40,000 Americans died from opioid overdoses in 2016 — more than the number killed in motor vehicle accidents. The stunning increase in overdose deaths since the 1990s has revealed a pervasive lack of capability to meet the need for treatment …

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