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1. Achieving a high-performance health care system with universal access: what the United States can learn from other countries

Author

Robert B. Doherty, P. Preston Reynolds, Ralston Jf, Jack Ginsburg, David A. Fleming, Levine Js, David C. Dale, Purtle Mw, Nichols Pm, McLean Rm, Stubbs Jw, Cutler C, Mark Liebow, Weaver Km, Molly Cooke, Freeman Bp, Gluckman Ra, Musana Ka, and Senkeeto N

Subjects
Economic growth, HRHIS, Government, Medical Assistance, Quality Assurance, Health Care, business.industry, Universal design, Health Policy, Public policy, General Medicine, Health Care Costs, Health Services Accessibility, United States, Health Care Reform, Physicians, Health care, Internal Medicine, Medicine, Position paper, Health care reform, business, Delivery of Health Care, Health policy
Abstract

This position paper concerns improving health care in the United States. Unlike previous highly focused policy papers by the American College of Physicians, this article takes a comprehensive approach to improving access, quality, and efficiency of care. The first part describes health care in the United States. The second compares it with health care in other countries. The concluding section proposes lessons that the United States can learn from these countries and recommendations for achieving a high-performance health care system in the United States. The articles are based on a position paper developed by the American College of Physicians' Health and Public Policy Committee. This policy paper (not included in this article) also provides a detailed analysis of health care systems in 12 other industrialized countries. Although we can learn much from other health systems, the College recognizes that our political and social culture, demographics, and form of government will shape any solution for the United States. This caution notwithstanding, we have identified several approaches that have worked well for countries like ours and could probably be adapted to the unique circumstances in the United States.

Published
2007

2. Achieving a high-performance health care system with universal access: what the United States can learn from other countries.

Author

Ginsburg JA, Doherty RB, Ralston JF Jr., Senkeeto N, Cooke M, Cutler C, Fleming DA, Freeman BP, Gluckman RA, Liebow M, McLean RM, Musana KA, Nichols PM, Purtle MW, Reynolds PP, Weaver KM, Dale DC, Levine JS, Stubbs JW, and American College of Physicians

Abstract

This position paper concerns improving health care in the United States. Unlike previous highly focused policy papers by the American College of Physicians, this article takes a comprehensive approach to improving access, quality, and efficiency of care. The first part describes health care in the United States. The second compares it with health care in other countries. The concluding section proposes lessons that the United States can learn from these countries and recommendations for achieving a high-performance health care system in the United States. The articles are based on a position paper developed by the American College of Physicians' Health and Public Policy Committee. This policy paper (not included in this article) also provides a detailed analysis of health care systems in 12 other industrialized countries. Although we can learn much from other health systems, the College recognizes that our political and social culture, demographics, and form of government will shape any solution for the United States. This caution notwithstanding, we have identified several approaches that have worked well for countries like ours and could probably be adapted to the unique circumstances in the United States. [ABSTRACT FROM AUTHOR]

Published
2008

3. Acute Cytomegalovirus Illness in an Immunocompetent Adult Causing Intravascular Hemolysis and Suspected Hemophagocytic Lymphohistiocytosis.

Author

Elliott RP, Freeman BP, Meier JL, and El-Herte R

Abstract

Background: Primary cytomegalovirus (CMV) infection of the immunocompetent host usually produces little-to-no illness. Occasionally, the infection results in mononucleosis syndrome, protracted fever, hepatitis, tissue-invasive disease, or Guillain-Barré syndrome. Hemolytic anemia and hemophagocytic lymphohistiocytosis (HLH) are rare complications that have not been reported to co-occur. Having hemolytic anemia in conjunction with more common findings of fever and hepatitis complicates the diagnosis of HLH. Case Presentation . A 34-year-old male with previously good health presented with a prolonged febrile illness, jaundice, and anemia. An extensive work-up during hospitalization revealed intravascular hemolytic anemia, leukopenia, hepatosplenomegaly, and biopsy evidence of extensive lymphohistiocytic infiltration of the liver with microgranulomata and sinusoidal hemophagocytosis. Soluble CD25 level was mildly elevated at 1200.3 pg/mL and the HScore calculation (fever, bicytopenia, hepatosplenomegaly, aspartate aminotransaminase 99 IU/L, ferritin 1570 ng/mL, fibrinogen 488 mg/dL, and triglycerides 173 mg/dL) suggested a moderate probability of reactive HLH. Primary CMV infection was diagnosed based on CMV IgM positivity, low CMV IgG avidity index, and low-grade CMV DNAemia. The CMV antigen was not detected in the liver biopsy, and the bone marrow biopsy was unremarkable. The illness began to improve before he received oral valganciclovir for 5 days, and he was in good health 10 months later., Conclusion: Acute CMV illness in an immunocompetent adult can present with hemolytic anemia and clinicopathologic abnormalities consistent with a form fruste of HLH. The illness is likely due to an excessive or unbalanced immune response that may self-correct., Competing Interests: All of the authors report no conflicts of interest., (Copyright © 2022 Ross P. Elliott et al.)

Published
2022
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