Viewpoints: Budget Advice For Safety-Net Hospitals; An Abortion Case, The High Court And Free Speech
A selection of opinions on health care from around the country.
JAMA:
Global Budgets For Safety-Net Hospitals
Investing in outpatient and community-based services can improve health and lower cost in the United States. Opportunities include enhancing primary care, expanding evidence-based behavioral health services, improving the coordination of care for patients with complex health needs, and linking patients to critical social resources. Yet because there is limited direct reimbursement for such efforts, major expansions depend on capturing savings. As a committee of the National Academy of Medicine recently noted: “In terms of sustainability, interventions that improve health and quality of care or reduce utilization and cost are only feasible to maintain if the provider is paid in such a way that profits (revenues minus costs) are higher with the intervention than without. (Joshua M. Sharfstein, Sule Gerovich and David Chin, 11/14)
USA Today:
Supreme Court Abortion Case Could Promote Free Speech By Both Sides
As a supporter of both free speech and free contraception, I may have two dogs inthe fight that the Supreme Court recently agreed to settle. But I think one side is going to make the other wish he’d never gotten into the quarrel. The case, National Institute of Family and Life Advocates v. Becerra, is a challenge to California’s Reproductive FACT Act. The law forces the state’s 200 or so pro-life crisis pregnancy centers to post notices about free or low-cost abortion and contraceptive services available elsewhere. (Melinda Henneberger, 11/16)
JAMA:
Prepregnancy Obesity And Severe Maternal Morbidity
There is an obesity pandemic in the United States. In 1991, approximately 12% of the US population was obese, and no single state had an obesity rate greater than 15%. In 2014, the obesity rate was 38%, and no single state had an obesity rate less than 20%. ... In 2014, approximately 50% of all pregnant women in the United States were overweight or obese. Obese pregnant women are at increased risk of pregnancy complications. Maternal-related pregnancy complications (diabetes, preeclampsia, and cesarean delivery) and fetal or neonatal complications (preterm birth, macrosomia, fetal growth restriction, and stillbirth) are more common in obese pregnant women. Further, some evidence suggests that the recent increase in maternal mortality in the United States is related to maternal obesity. (Aaron B. Caughey, 11/14)
Los Angeles Times:
In Landmark Ruling, Court Orders Paint Companies To Pay To Clean Lead Paint Out Of California Homes
In a ruling that could set a precedent for lawsuits over the effects of climate change, a panel of appeals judges on Tuesday found three paint manufacturers responsible for the health hazards of lead paint in California homes and upheld an order that they pay to abate the dangers. The companies — ConAgra, NL Industries and Sherwin-Williams — had been ordered by a trial court in 2014 to pay a combined $1.15 billion for a lead paint abatement program in 10 counties and cities covering homes built before 1978, when lead paint in homes was outlawed. (Michael Hiltzik, 11/15)
JAMA:
The Greatest Gift: How A Patient’s Death Taught Me To Be A Physician
The package was in plain brown paper wrapping. The note enclosed read, “Thanks for everything you did for my father. It meant more than you can ever imagine.” I teared up, remembering the day I helped the father of a colleague die peacefully. When I opened the wrapping and saw the picture of two saplings planted side by side and a certificate saying that the family planted one in my honor next to the one in their father’s, the single tear turned to a river. Although I never thought that a patient’s death would be one of the best clinical experiences of my then young career, that day increased my love for practicing medicine significantly. (Lawrence I. Kaplan, 11/14)
JAMA:
The Las Vegas Shootings—Underscoring Key Features Of The Firearm Epidemic
Mass shootings draw widespread media attention. The Las Vegas shooting has been followed, as are most such events, by survivor interviews and video clips, commentators discussing the political challenges of gun legislation in the country, and the range of potential actions that could be taken to mitigate the human cost of firearms in the United States. Yet beyond the focus on fatalities, the Las Vegas event also highlights several issues that mandate attention in public and academic conversations around this issue. We summarize them here. (James M. Shultz, Siri Thoresen and Sandro Galea, 11/14)
