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Purpose -- The purpose of this paper is to present the three critical changes needed to reform the US health care system -- these changes will drive cascades of other beneficial changes. These three changes include the use of transparent market prices, alignment of incentives and systematic assessment and ratings of quality. Design/methodology/approach -- The paper used an analysis based on the literature on the comparison between non-market and market systems. The current US health care system is similar to the Soviet economic system, and the paper proposes moving it gradually to where it can respond to market-based signals. Findings -- The US health care system needs to adopt transparent and real pricing, independent quality assessment of health provider organizations and portable electronic patient records. These changes will lead to continuing cascades of innovation and improvement. Research limitations/implications -- The recommended changes will be opposed by vested interest groups, and so will be easier with regulatory guidance and encouragement. It would also be useful to protect against "regulatory capture" by interested parties during the change process. Practical implications -- Health care in the USA will gradually become better and cheaper. Health organizations will become more transparent. Regulators would have to set up and supervise private quality ratings agencies. Social implications -- Social implications of this paper include greater labor mobility and higher productivity, as well as increased competitiveness of the USA. Originality/value -- In spite of numerous writings on the subject, this issue has not been analyzed in this way. This paper is unique in the way in which it layouts the process of movement to a market-based system for the US health care system. [ABSTRACT FROM AUTHOR]

Purpose The purpose of this paper is to describe factors associated with incarceration as well as the association between recent incarceration and HIV-related sexual risk behaviors, access to insurance, healthcare utilization (emergency department (ED) and hospital use), antiretroviral therapy (ART) prescription, and viral suppression. Design/methodology/approach Using 2009-2010 data from a cross-sectional, nationally representative three-stage sample of HIV-infected adults receiving care in the USA, the authors assessed the demographic characteristics, healthcare utilization, and clinical outcomes of HIV-infected persons who had been recently incarcerated (detention for>24 hours in the past year) using bivariate analyses. The authors used multivariable logistic regression to examine associations of recent incarceration with insurance status as well as clinical and behavioral outcomes. Findings An estimated 22,949 (95 percent confidence interval (CI) 19,062-26,836) or 5.4 percent (CI: 4.7-6.1) of all HIV-infected persons receiving care were recently incarcerated. Factors associated with recent incarceration were age <50 years, being a smoker, having high school diploma or less, being homeless, income at or below the poverty guidelines, having a geometric mean of CD4 count <500 cells/ μL, and using drugs in the past 12 months. Results from multivariable modeling indicated that incarcerated persons were more likely to use ED services, and to have been hospitalized, and less likely to have achieved viral suppression. Originality/value Recent incarceration independently predicted worse health outcomes and greater use of emergency services among HIV-infected adults currently in HIV care. Options to improve the HIV continuum of care, including pre-enrollment for healthcare coverage and discharge planning, may lead to better health outcomes for HIV-infected inmates post-release. [ABSTRACT FROM AUTHOR]

Purpose – The purpose of this paper is to survey current nutrition/foodservice-related healthcare professionals to determine their level of knowledge about dysphagia, and their perceptions of dysphagic patients and their needs. Design/methodology/approach – A data collection instrument in the form of a questionnaire was developed to obtain an idea of the perceptions and knowledge-level of diet/foodservice-related healthcare workers about dysphagia. Subjects included foodservice workers, including food preparers and food deliverers at a large healthcare facility in the Southwestern United States. A total sample size of n=51 surveys was collected and analyzed. Findings – Given the means from this sample group, healthcare foodservice workers are lacking in some areas of knowledge concerning dysphagia patients, and their dietary needs. Education and training seem indicated, as the number of patients suffering from some degree of dysphagia is only going to increase as the US population ages. Originality/value – Millions of Americans currently suffer from at least some degree of dysphagia. This number is expected to increase as the Baby Boomer generation reaches retirement age. The USA will be populated by more elderly people than ever before, and will thus host more individuals suffering from swallowing impairment. This paper adds insights to the subject. [ABSTRACT FROM AUTHOR]