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Purpose: The purpose of this paper is to identify the primary executive leadership skills required to promote the effectiveness of Medicare Shared Savings Program Accountable Care Organizations (MSSP ACOs) and to create a new substantive theory describing these skills. The author identifies that MSSP ACO is a relatively new value-based care delivery (VBCD) structure in the USA that links clinicians' compensation to their clinical outcomes. The research question concerns what primary executive leadership skills are essential in the VBCD era. Design/methodology/approach: This single, embedded, exploratory case study is based on interviews, a focus group discussion and archival record data of MSSP ACO executives in the Northeast, Midwest, South and West of the USA. Findings: The findings represented seven major categories or the primary executive leadership skills required to succeed in the VBCD environment. Each category or skill included five subcategories or concepts supporting the leadership skills essential for reaching VBCD goals. The categories and subcategories gave rise to a new substantive theory – the Accountable Healthcare Leadership Theory of Five Ps: promoting partnership between providers, patients and payers. Research limitations/implications: The empirical generalizability of the results was limited by its essence as a single, embedded, exploratory case study of 18 MSSP ACO executives in 4 regions of the USA. The strength of this study, however, lies in its potential for making analytic generalizations for identifying theoretically meaningful leadership skills essential for success in the VBCD era. Originality/value: The author has developed and validated a new theory describing the primary executive leadership skills required to succeed in the VBCD environment. [ABSTRACT FROM AUTHOR]

In the unprecedented disruption and social isolation of the COVID-19 pandemic, families around the world are faced with questions of how their children can thrive in these conditions. On top of the ubiquitous challenges for all children, this public health crisis imparts unique difficulties for children with special health needs. We identify children with Autism Spectrum Disorder (ASD) as being particularly vulnerable to negative impacts of the COVID-19 pandemic. In this paper, we examine why children with ASD are uniquely vulnerable, recommend strategies to mitigate these stressors for children with ASD and their parents, explore the potential challenges of reintegration into society as conditions improve, and examine the obligations of healthcare and community stakeholders to support these families. [ABSTRACT FROM AUTHOR]

Coordinating care for hospitalized patients requires the use of multiple sources of information. Using a macroergonomic framework (i.e. the work system model), we conducted interviews and observations of care managers involved in care coordination across transitions of care. When information is distributed across multiple health IT applications, care managers experience a range of challenges, including organizational barriers, technology design problems, skills and knowledge issues, and task performance demands (i.e. issues related to individual information processing and management and sharing of information). These challenges can be used as a checklist to evaluate the proposed IT infrastructure that will allow the integration of multiple health IT applications and, therefore, support coordination across transitions of care. [ABSTRACT FROM AUTHOR]

This paper hypothesizes the extent of access to health care by disposed people, particularly in the US. The disposed are people 'thrown away' as used-up commodities. This paper briefly examines the theoretical idea of disposability. It then presents the basic results of new research showing that a sample of Americans sees that people in several different occupations are equally liable to be disposed. The section that follows proposes that the access these disposed people have to the US health-care system is minimal overall and is not likely to improve. Because this total grouping has not previously been studied as a whole, these hypothetical findings are partly based on subsets of the disposed: the poor; those without health insurance; and the unemployed. [ABSTRACT FROM AUTHOR]

This paper examines the grid of sentiment that structures medical travel to India. In contrast to studies that render emotion as ancillary, the paper argues that affect is fundamental to medical travel's ability to ease the linked somatic, emotional, financial, and political injuries of being ill 'back home'. The ethnographic approach follows the scenes of medical travel within the Indian corporate hospital room, based on observations and interviews among foreign patients, caregivers, and hospital staff in Mumbai, New Delhi, Chennai, and Bangalore. Foreign patients conveyed diverse sentiments about their journey to India ranging from betrayal to gratitude, and their expressions of risk, healthcare costs, and cultural difference help sustain India's popularity as a medical travel destination. However, although the affective dimensions of medical travel promise a remedy for foreign patients, they also reveal the fault lines of market medicine in India. [ABSTRACT FROM AUTHOR]

This study provides an insight into the difficulties companies encounter in transposing basic science into commercially viable healthcare technologies, focusing on the issue of establishing a dominant supply model within a highly regulated market. The core issue is how to scale-up customised scientific processes into products able to supply wider and possibly mass markets. In tracing the development of approaches to scaling-up, the paper highlights the influence regulatory regimes have on high technology regulated products and services. The paper details the implications of two contrasting supply initiatives towards operationalising tissue engineering, based on differences in regulatory regimes between Europe and the USA. [ABSTRACT FROM AUTHOR]

Healthcare currently consumes 17% of the U.S. Gross Domestic Product and is expected to reach 20% within the coming decade. Confronted with such high costs, sharp demand, and limited capacity, many hospitals now are vying for shorter lengths of stay and are transferring services from inpatient to outpatient facilities. This paper seeks to develop a methodology for constructing effective outpatient appointment scheduling systems. The objective of these appointment systems is to minimize the average total cost function describing total costs incurred by patient waiting and by staff idle time and overtime. In the paper, we will establish that the average total cost function exhibits a unimodal curve. The lowest point of the curve essentially means the lowest average total cost. We will next develop a simulation-based heuristic algorithm for finding an outpatient schedule near the lowest point. In the paper, we present numerical examples using the heuristic based upon a set of predetermined unit costs. Specifically, we find the near optimal interappointment times for schedules, where there are two and three patients in each block, respectively. The current work does not consider possible no shows and walk-ins. Future work will undertake these issues. [ABSTRACT FROM AUTHOR]

The article discusses the challenges and opportunities of incorporating electronic data capture (EDC) with electronic medical records (EMR) in the U.S. It mentions that EDC allows users to review and analyze data in real time while EMR allows users to perform the same for patient care data since they are both focused on collecting patient data. It notes that the convergence of the two systems has the possibility to improve the management of clinical research data.

In this paper we propose an empirically implementable measure of aggregate-level efficiency along the lines of Debreu’s (1951) coefficient of resource utilization but restricted to the production side. The efficiency measure is based on directional distance functions, which allows the overall measure of efficiency to be decomposed into measures of technical and “structural” efficiency. The latter measure, which captures inefficiencies associated with the organization of production within an industry, is further decomposed into measures of scale and mix efficiency. The measures developed in the paper are illustrated using U.S. hospital data. The illustration sheds light on the efficacy of certificate of need (CON) regulations. [ABSTRACT FROM AUTHOR]

Many Western governments have sought to encourage people to adopt more active lifestyles, as a way of reducing the growing costs of a seemingly infinite demand for health care. In this regard, sport, exercise and physical activity are often seen as equivalent tools to achieve the same goal. The central object of this paper is to subject such claims to a critical examination. More specifically, the paper seeks to examine: (i) the assumptions underlying what is one of the stated objectives of government sport programmes in Britain and the United States, namely to improve the nation's health; (ii) some of the key social differences between sport and physical activity, (iii) some of the health consequences of these social differences and (iv) some of the health implications for public policy designed to encourage greater participation in sport. It is argued that, while the health benefits of physical activity are clear, the health arguments in favour of competitive sport, and especially contact sport, are not persuasive and that public health policy should focus on promoting regular, moderate-intensity physical activity rather than competitive sport. [ABSTRACT FROM AUTHOR]

Studies to advance the potential health benefits of berries continue to increase as was evident at the sixth biennial meeting of the Berry Health Benefits Symposium (BHBS). The two and a half-day symposium was held on October 13-15, 2015, in Madison, Wisconsin, United States. The 2015 BHBS featured new and emerging research further bolstering the positive biological effects of berry consumption on human health, performance, and disease prevention. The papers presented at the 2015 BHBS consisted of invited papers from an international group of leading berry researchers, as well as poster abstracts. Oral sessions were organized around themes including heart health, cancer prevention, gut health/gut microflora, brain aging, metabolism, and berry compositional chemistry. These thematic health areas, while not exhaustive, encompass the more prominent research success stories on berries, the vast majority of which are backed by published animal and human studies. Similar to the past meetings, the research findings at the 2015 BHBS primarily focused on blackberries, blueberries, black raspberries, cranberries, red raspberries, and strawberries. However, research on other berry fruits, including chokeberry (aronia berry), cloudberry, blue honeysuckle berry, bilberry, jamun berry, and elderberry, was also featured as was data on major classes of berry polyphenols/phytochemicals including anthocyanins and other flavonoids and their in vivo derived metabolites. The BHBS continues to be a leading forum for interactions between scientists and berry industry stakeholders. The cluster of papers in this issue represents a snapshot of presentations at the 2015 BHBS which support the positive biological effects of berries on human health and diseases. [ABSTRACT FROM AUTHOR]

The article focuses on studies completed by the U.S. National Bureau of Economic Research (NBER) since its formation in September 2003. According to the authors, NBER has conducted studies on Social Security reforms and sustainability. The Bureau has also analyzed changes in the financial resources of retirees in the country, including increases in retirement savings and rising medical spending in the private sector. Effects of changing demographic trends were also analyzed by NBER.

Health spending as a percentage of gross domestic product in the U.S. economy is growing, from 5% in 1960 to about 16% in the current period, and it is predicted to grow to as much as 30% in 2050. Then why is the supply of health care in the United States so insensitive to steeply rising prices? This paper conducts an econometric study to show that high health-care costs have an adverse impact on labor productivity, causing a negative production externality in all industries. So, can the rising cost of health-care affect the U.S. comparative advantage? The paper seeks answers to these questions in a general equilibrium model and finds that the labor productivity shock is responsible for the sluggish or declining supply of health care. Consumers are able to afford less health care due to a possible decline in real wages. U.S. comparative advantage becomes a nonissue, provided that the equilibrium is stable in spite of a negatively sloped health-care supply curve. Negative externality, leading to market failure, may be addressed in two alternative ways. ( JEL F11, I11, I12, I18) [ABSTRACT FROM AUTHOR]

This policy commentary addresses a significant access to care issue that faces methadone maintenance patients seeking residential treatment in the United States. Methadone maintenance therapy (MMT) has demonstrated strong efficacy in the outpatient treatment of opiate dependence. However, many opiate dependent patients are also in need of more intensive interventions, such as residential care. Many publically-funded residential treatment programs explicitly decline to admit MMT patients, contending that methadone raises both clinical and administrative problems in treatment. Although advocates within the field believe that this issue is a violation of the American’s with Disabilities Act (ADA) in the United States, no lawsuits have been brought forth, and there is no legal precedent or public policy to inform the debate. The present paper provides an overview of this problem and discusses factors that may contribute to the problem, including an abstinence-oriented philosophy and treatment program operational concerns. The paper also draws parallels between methadone and other medical conditions and analyzes the problem in the context of disabilities encompassed in the ADA. Finally, recommendations on strategies for increasing access to residential care for MMT patients are provided. [ABSTRACT FROM AUTHOR]

The article offers a review of various articles related to family medicine. It notes the move of the American public to become a model of medical care that occupies with the patient where they can direct their care with their chosen providers. It mentions the vitality of critical thinking to assist all clinicians in the processes of decision-makings. The move of physicians towards a structured interview for training posts is also cited.

Introduction: The use of human samples in genomic research has increased ethical debate about informed consent (IC) requirements and the information that subjects should receive regarding the results of the research. However, there are no quantitative data regarding researchers' attitudes about these issues. Methods: We present the results of a survey of 104 US and 100 Spanish researchers who had published genomic epidemiology studies in 61 journals during 2006. Results: Researchers preferred a broader IC than the IC they had actually obtained in their published papers. US authors were more likely than their Spanish colleagues to support obtaining a broad IC, covering either any future research project or any projects related to a group of diseases (67.6% vs 43%; adjusted OR = 4.84, 95% CI, 2.32 to 10.12). A slight majority of researchers (55.8%) supported informing participants about individual genomic results only if the reliability and clinical validity of the information had been established. Men were more likely than women to believe that patients should be informed of research results even if these conditions were not met (adjusted OR = 2.89, 95% CI = 1.46 to 5.72). Conclusions: This study provides evidence of a wide range of views among scientists regarding some controversial ethical issues related to genomic research, suggesting the need for more study, debate and education. In the interim, journals might consider including the investigators' policies regarding these ethical issues in the papers they publish in the field of genomic epidemiology. [ABSTRACT FROM AUTHOR]

Recent years have witnessed an increasing attention to the vast and alarming health disparities in the United States. This paper explores provider factors in health disparities, considering the role of medical education in training health care providers to practice culturally responsive health care toward a diminution of health inequalities. The paper begins with a description of culturally responsive care along with an overview of the key elements of a comprehensive curriculum for health care providers in this arena. Next, the paper explores the key contributions from the field of psychology to collaborative instruction of health care providers in the areas of attitudes/awareness, knowledge and skills components of culturally responsive care. Finally, the paper concludes with a description of collaborative teaching from a family medicine residency program where a 33-h ‘cultural medicine curriculum within the curriculum’ is delivered over the course of 3 years. [ABSTRACT FROM AUTHOR]

On October 2, 1919, President Woodrow Wilson suffered a stroke that paralyzed the left half of his body. Wilson's stroke forced the American public to confront stroke, and laypeople came to identify stroke as a nervous disorder, rather than a condition rooted solely in psychological phenomena. His medical care was overseen by Cary Grayson, his personal internist, and Francis X. Dercum, a remarkably accomplished neurologist from Philadelphia. Dercum was very involved in the treatment of the President, from the day of the stroke until years later. While the medical records have been destroyed, some basic facts of Wilson's treatment and rehabilitation can be inferred from the literature. Although Woodrow Wilson was an exceptional patient, his care, albeit administered by some of the most famous physicians of the era, was typical of the time. Therefore, this paper's approach to Wilson's 1919 stroke contextualizes the President's case into the larger scheme of early twentieth-century neurology. [ABSTRACT FROM AUTHOR]

Background: Studies on differences between immigrant and non-immigrant groups in health care utilization vary with respect to the extent and direction of differences in use. Therefore, our study aimed to provide a systematic overview of the existing research on differences in primary care utilization between immigrant groups and the majority population. Methods: For this review PubMed, PsycInfo, Cinahl, Sociofile, Web of Science and Current Contents were consulted. Study selection and quality assessment was performed using a predefined protocol by 2 reviewers independently of each other. Only original, quantitative, peer-reviewed papers were taken into account. To account for this hierarchical structure, logistic multilevel analyses were performed to examine the extent to which differences are found across countries and immigrant groups. Differences in primary care use were related to study characteristics, strength of the primary care system and methodological quality. Results: A total of 37 studies from 7 countries met all inclusion criteria. Remarkably, studies performed within the US more often reported a significant lower use among immigrant groups as compared to the majority population than the other countries. As studies scored higher on methodological quality, the likelihood of reporting significant differences increased. Adjustment for health status and use of culture-/language-adjusted procedures during the data collection were negatively related to reporting significant differences in the studies. Conclusion: Our review underlined the need for careful design in studies of differences in health care use between immigrant groups and the majority population. The results from studies concerning differences between immigrant and the majority population in primary health care use performed within the US might be interpreted as a reflection of a weaker primary care system in the US compared to Europe and Canada. [ABSTRACT FROM AUTHOR]

The article reflects on the significance of leadership in nursing in the U.S. Due to the turbulent days in the healthcare industry and the increasing demand for stronger accountability and delivery of nursing and healthcare services, the author believes that there is a serious need to invest in bespoke leadership experience in order to provide quality services among nursing practitioners in the industry.

Fraud and abuse have led to significant additional expense in the health care system of the United States. This paper aims to provide a comprehensive survey of the statistical methods applied to health care fraud detection, with focuses on classifying fraudulent behaviors, identifying the major sources and characteristics of the data based on which fraud detection has been conducted, discussing the key steps in data preprocessing, as well as summarizing, categorizing, and comparing statistical fraud detection methods. Based on this survey, some discussion is provided about what has been lacking or under-addressed in the existing research, with the purpose of pinpointing some future research directions. [ABSTRACT FROM AUTHOR]

Three complementary and overlapping foci for interprofessional education (IPE) - preparing individuals for collaborative practice; learning to work in teams; and developing services to improve care - have been presented previously as a threefold classification derived from a systematic review (Barr et al., 2005). This paper adds discussion of a fourth: improving the quality of life in communities. The fourth focus is less often found in the literature and is described more fully in this paper. It embodies six approaches to interprofessional learning, discussed in the paper, that are thought to be particularly relevant to the work of Pathways into Health with American Indian and Alaska Native tribes, and more widely wherever collaborative learning and practice are invoked to improve quality of community life. [ABSTRACT FROM AUTHOR]

Approximately 200 million people in the United States have an addiction disorder that significantly disrupts employment, family relationships, financial stability, and personal health. As a result, addiction has become one of the most critical health care challenges presently facing the American health care system. Research in the last five years has provided substantial evidence that addiction is a neurobiological condition rooted in genetic factors. During the addiction process neurologic changes occur that are responsible for tolerance, craving, and relapse. It appears that once addiction becomes chronic, the brain enters an addicted state that may be irreversible without pharmaceutical intervention. Such alterations in neurochemistry-rather than poor volitional control-account for why addiction is characterized by a chronic, relapsing-remitting course. This paper discusses (a) the neurobiological factors underlying the addiction process, (b) available pharmaceutical treatment, and (c) how recent research regarding the neurobiology of addiction affects occupational therapy's role in addiction rehabilitation. A case study follows that illustrates how occupational therapists can contribute to addiction intervention. [ABSTRACT FROM AUTHOR]

The mission of the Veterans Health Administration's (VHA) quality enhancement research initiative (QUERI) is to enhance the quality of VHA health care by implementing clinical research findings into routine care. This paper presents lessons that QUERI investigators have learned through their initial attempts to pursue the QUERI mission. The lessons in this paper represent those that were common across multiple QUERI projects and were mutually agreed on as having substantial impact on the success of implementation. While the lessons are consistent with commonly recognized ingredients of successful implementation efforts, the examples highlight the fact that, even with a thorough knowledge of the literature and thoughtful planning, unexpected circumstances arise during implementation efforts that require flexibility and adaptability. The findings stress the importance of utilizing formative evaluation techniques to identify barriers to successful implementation and strategies to address these barriers. [ABSTRACT FROM AUTHOR]

Few studies have examined the impact of government support and policies on immigrant services within ethnic enclaves. This paper seeks to address this gap and examines the structure and challenges of ethnic community based organizations (CBOs) that serve low income immigrant populations and the impact of government support and policies on these CBOs. The study utilized case study and ethnographic methodologies and examined 2 Chinese and 2 Vietnamese CBOs in the San Francisco Bay Area. The findings show that ethnic CBOs critically depend on government fiscal support for survival. In exchange for fiscal support, ethnic CBOs represent public assistance and legitimacy interests for government in immigrant communities. However, culturally proficient and community leadership resources of ethnic CBOs can serve as bargaining chips to secure government funding, reduce compliance to government demands, and advance immigrant community interests. Nevertheless, in times of government fiscal crisis, ethnic CBOs and immigrant services tend to be most vulnerable to budget cuts due to lack of political voice. In sum, government-community collaboration through ethnic CBOs has a central role to play in facilitating and strengthening health and human services for rapidly growing, culturally diverse immigrant populations. These collaborative efforts in immigrant services are vital to cultivating healthy immigrant human capital and multicultural communities across the United States. [ABSTRACT FROM AUTHOR]

Spirituality is an important part of African-American culture and is often cited as an explanation for the more-aggressive treatment preferences of some African Americans at the end of life. This paper reviews the literature on spiritual beliefs that may influence the treatment decisions of African Americans.Medline 1966 to February 2003, Psych Info 1872 to February 2003, and CINAHL 1982 to February 2003 were searched for studies exploring spiritual beliefs that may influence the treatment preferences of African Americans. All candidate papers were examined for quality, and data were extracted on study population, design, analysis, and results to identify recurrent themes. Forty studies met inclusion criteria.Recurrent themes describing spiritual beliefs that may influence the treatment preferences of African Americans throughout the course of illness include the following: spiritual beliefs and practices are a source of comfort, coping, and support and are the most effective way to influence healing; God is responsible for physical and spiritual health; and the doctor is God's instrument.Spiritual beliefs specifically addressing treatment preferences at the end of life include: only God has power to decide life and death, there are religious prohibitions against physician-assisted death or advance directives limiting life-sustaining treatments, and divine intervention and miracles occur.For some African Americans, spiritual beliefs are important in understanding and coping with illness and may provide a framework within which treatment decisions are made. Given the growing ethnic diversity of the United States, some understanding of the complexities of culture and spirituality is essential for healthcare providers. [ABSTRACT FROM AUTHOR]

The 2nd American Samueli Institute symposium was held January 22-25, 2004. The focus of this meeting was an exposition of optimal healing environments (OHE) in American health care. Fifty-five (55) invited guests participated; most had written one of the papers in this Supplement. The conduct of the meeting revolved around small group discussions and two plenary sessions. The ensuing dialogue refined and organized the definitions, components, and research protocols associated with creating and implementing an OHE. This Supplement contains both the invited papers and an abstract of the plenary session discussions. [ABSTRACT FROM AUTHOR]

This paper examines the effects of conversions between For-Profit and Not-For-Profit forms on quality of medical care in California hospitals. The sample includes elderly patients treated in California's private hospitals from 1990 to 1998 for Acute Myocardial Infarction and Congestive Heart Failure. The results suggest that converted hospitals have experienced quality changes before conversion and that ignoring these changes may bias the estimates of conversion effects. Both conversions are found to have some adverse consequences: Hospitals that converted to FP form show an increase in AMI mortality rates, while those converted to NFP status indicate an increase in CHF mortality outcomes. [ABSTRACT FROM AUTHOR]

In all aspects of health and mental health care-the emergency room, the outpatient clinic, inpatient facilities, rehab centers, nursing homes, and hospices-social workers interact with patients from many different cultures. This paper will introduce an assessment tool for health care professionals to advance understanding of culturally diverse patients and their families. [ABSTRACT FROM AUTHOR]

Mandatory reporting of child abuse and neglect has its origins in the USA, where model statutes for laws designed to introduce this process were first drafted in the early 1960s. Indeed, every state and the District of Columbia passed a child abuse reporting law between 1963 and 1967. Some 10 years later, in 1977, New South Wales was the first Australian state to pass comparable legislation. Mandatory reporting of suspected cases of child abuse and neglect is now in place in all Australian states and territories, with the exception of Western Australia. The question considered in this paper is: ‘What evidence is there that children are abused and neglected less in jurisdictions where mandatory reporting exists by comparison with jurisdictions where it does not exist?’ This question is examined by way of a comparison between two states, New South Wales and Western Australia. This paper also raises questions about the cost of mandatory reporting and the extent to which it diverts financial resources away from support services for families. There is also a question about the new New South Wales child protection legislation that extends mandatory reporting and possible negative consequences for ordinary families. The final question is about the role assigned to health care and education professionals under this legislation. [ABSTRACT FROM AUTHOR]

‘Scraps’: hidden nursing information and its influence on the delivery of care What nurses commonly describe as ‘scraps’ are defined as the personalized recordings of information that is routinely made on any available piece of paper (hence scraps) or in small notebooks. The use of scraps is common in practice and has been noted in research from across the globe. Drawing on an empirical study it is argued that scraps are a unique combination of personal and professional knowledge that informs the delivery of care. The overall aim of the study was to discover how nurses define and communicate information about patients and the delivery of care to each other on an elderly care unit. The processes by which information was constructed and the organizational structure and interactions that influenced this were also identified. The research design was an ethnographic one that involved: observations of formal nursing end of shift reports (23 handovers) and informal interactions between nurses (146 hours); interviews (n + 34) with registered nurses, student nurses and nursing auxiliaries; and analysis of written records. Data were collected from five acute elderly care wards at a district general hospital in the south of England. A grounded theory analysis was undertaken which revealed that scraps may have a significant role in the communication of information and the delivery of care. Therefore a categorization of scraps within three main themes was undertaken. First, the analysis revealed the processes involved in the construction of scraps. Second, the content and role of scraps in influencing the delivery of care was exposed. Finally, the potentially confidential nature of scraps and consequent problems of storage and disposal was recognized. The findings are discussed in relation to a suggested model of the interrelationship between paperwork, scraps, handovers and the delivery of nursing care. It is concluded that scraps are significant... [ABSTRACT FROM AUTHOR]

The article offers a perspective on the main concepts of algorithmic fairness and how their application can improve the design of machine learning or artificial intelligence algorithms. Topics discussed include the increasing use of machine learning algorithms in decision making, interaction of algorithms with the existing ethical conflicts such as disparities and discrimination, and the impact of algorithm on health care in the U.S.

The article reports on the adoption of artificial intelligence in health care based on evidence gathered from online job postings in the U.S. from January 1, 2015 to December 31, 2018. Topics discussed include impact of artificial intelligence on healthcare transformation, the fraction of jobs requiring artificial intelligence skills according to an industry classification system code, and the possible impact of artificial intelligence adoption on healthcare employment.

Tax-preferred health savings devices such as Flexible Spending Accounts (FSAs) and Health Savings Accounts (HSAs) offer employees potentially valuable financial instruments for directing pre-tax earnings to eligible medical expenses. Despite their increasing popularity as an employee benefit, however, there is little causal evidence around individual demand for these accounts. This paper seeks to address this gap in the literature, reporting on a randomized controlled field experiment conducted with over 11,000 U. S federal employees in 2017 in order to evaluate the effectiveness of targeted messages designed to increase FSA contributions. Our results suggest that the provision of basic information about FSAs delivered via an emailed employee newsletter did not affect the likelihood of contribution or the contribution level. The addition of statements about the absolute returns or relative returns offered by the accounts similarly had no significant effects, and these null effects are observed despite relatively high email open rates. We discuss explanations for the null results and the policy implications of findings from what appears to be the first health economics experiment analyzing tax incentives around health care savings. [ABSTRACT FROM AUTHOR]

This paper is part of the American College of Physicians' policy framework to achieve a vision for a better health care system, where everyone has coverage for and access to the care they need, at a cost they and the country can afford. Currently, the United States is the only wealthy industrialized country that has not achieved universal health coverage. The nation's existing health care system is in efficient, unaffordable, unsustainable, and inaccessible to many. Part 1 of this paper discusses why the United States needs to do better in addressing coverage and cost. Part 2 presents 2 potential approaches, a single-payer model and a public choice model, to achieve universal coverage. Part 3 describes how an emphasis on value-based care can reduce costs. [ABSTRACT FROM AUTHOR]

Copyright of Revista Ciencias de la Salud is the property of Colegio Mayor de Nuestra Senora del Rosario and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Cognitive behavioral therapy for schizophrenia spectrum disorders is an evidence-based treatment that is recommended by United States schizophrenia treatment guidelines. Based on recent estimates, only 0.3% of individuals with a primary psychotic disorder are able to access this treatment in the United States. Stepped care interventions have shown promise as an applied treatment delivery model in other settings and for other psychotherapeutic interventions. The current paper describes how the stepped care model can be applied to CBT for psychosis in the US to increase access to the intervention in community mental health settings by leveraging the multidisciplinary team. [ABSTRACT FROM AUTHOR]

Advanced practice providers (APPs) have come to play an increasingly significant role in the United States healthcare system in the past five decades, particularly in primary care. The first portion of this paper will explore the utilization of APPs in specific patient populations: pediatrics, obstetrics, geriatrics, and psychiatry. After a brief discussion of the demand for these specialties, the authors will outline the educational preparation and competencies that nurse practitioners and physician assistants must achieve before working with these special populations. Finally, the authors will discuss the current and future roles of APPs in pediatric, obstetric, geriatric, and psychiatric populations. Simulated patient interactions and scenarios have become integrated into clinical education for many health care providers. Although traditionally utilized only in emergency medicine education, medical simulation has grown to become a staple of training in nearly every area of medicine. Healthcare providers of all levels can benefit from both individual and team-based training designed to improve everything from patient communication to procedural competence. The flexible nature of simulation training allows for customized teaching that is directly relevant to a specific specialty. The second half of this paper will demonstrate simulation's versatilite applications in the specialty areas of urgent care, pediatrics, mental health, geriatrics, and obstetrics. [ABSTRACT FROM AUTHOR]

The outbreak of COVID-19 has raised concerns about the availability of health care facilities globally. Disruptive innovations in health care may impact a new system that provides a continuum of treatment tailored to each patient's specific requirements. In light of this evolution, this study aimed to visualize global research output on disruptive innovation in health care between 2001 to 2021 as indexed in the Scopus database. The dataset was extracted on January 10, 2022, and 204 records were identified for data analysis. Various bibliometric indicators were used to identify publication trends. VOSviewer visualization software was also used to analyze data. The findings revealed the increasing pattern of publication growth with slight fluctuation over time. M. Friebe was the most prolific author having contributed four publications. The Harvard Medical School was the most productive institution with eight publications and the United States was the most productive country with 84 publications on disruptive innovation in health care. Furthermore, human, health care, and disruptive innovation were the top keywords in this field. These findings are expected to be useful to academics and administrators all across the world. This study also gives readers insight into this domain and will allow them to begin their research by selecting a topic of their choice. [ABSTRACT FROM AUTHOR]

Academic leadership in undergraduate and graduate medical education requires a specific set of leadership and managerial skills that are unique to academic leadership positions. While leadership development training programs exist for traditional leadership roles such as department chairs, executives, and deans, there are fewer models of leadership training specifically geared for academic leadership positions such as program and clerkship directors, and designated institutional officials. There are academic programs at the national level, but there is sparse literature on the specific decisions required to create such programs locally. With growing regulatory and accreditation requirements as well as the challenges of balancing the clinical and educational missions, effective leadership is needed across the spectrum of academic medicine. To meet this need for the military health care system in the United States, we used Kern's six-step framework for curriculum development to create a 1-week academic leadership course. This paper describes the process of development, implementation, outcomes, and lessons learned following the initial 3 years of courses. Specific discussions regarding who to train, which faculty to use, content, and other elements of course design are reviewed. The course and process outlined in the paper offer a model for other organizations desiring to establish an academic leadership course. [ABSTRACT FROM AUTHOR]

The article reports on the announcement of Vision Care Section of the American Public Health Association in the U.S. of its awards program for 1987. The association solicits nominations in the three categories of awards including distinguished achievement, outstanding student and outstanding paper or project. The distinguished achievement award is the highest honor bestowed by the Vision Care Section, designed to recognize the leaders in vision care and public health. The outstanding student award provides recognition to a student who has demonstrated the ability in the promotion of vision care in the public health field. The paper or project award is designed to recognize an individual, institution, or group that have significantly contributed to the advancement of vision care.

Is the hospital industry a relative pauper, as the industry itself contends, or an aggressive bill-collecting bully with vastly inflated prices, as some of its critic insist? This paper explores some of the issues at the center of the struggle over hospital billing. In addition, it describes attempts by one sector of the industry--hospital audit firms hired by plan administrators to augment third-party claims administration--to audit hospital bills on behalf of their client plans. [ABSTRACT FROM AUTHOR]