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PubH 7556-001

Health and Health Systems

Spring Semester Term A 2015

Credits: 2

Meeting Days: January 10 – March 14, 2015

Meeting Time: online

Meeting Place: online

Instructor: Jon Christianson PhD

Office Address: Health Policy and Management

420 Delaware St. SE MMC 729

Minneapolis MN 55455

Office Phone: 612/625-3849

Fax: 612/624-2196

E-mail: chris001@umn.edu

Office Hours: By appointment

I. Course Description This two-credit course covers a range of topics designed to provide an overview of the U.S. health care system and the challenges it now faces.

II. Course Prerequisites You must be admitted to the University of Minnesota’s Master in Healthcare Administration Program.

III. Course Goals and Objectives Specific learning objectives are provided for each lesson. The main goal of the course is to provide students with an overall knowledge of the health care system and a context for subsequent courses in the curriculum of health administration.

IV. Methods of Instruction and Work Expectations

This course consists of an in-person introduction and 8 online lessons, with one lesson a week. Lesson activities include lecture, discussion, reading, and writing assignments. You may work ahead if you wish, but note that there are specific due dates throughout the semester. Each lesson is introduced with narrated presentations, in which the instructor discusses significant issues with reference to the session readings.

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For this course, you will:

Complete a total of eight weekly written assignments consisting of four individual and four group assignments.

Complete one session summary pertaining to the session designated for your group.

Work with the same group members throughout the eight-week course.

Work with your group in a private forum to complete group assignments and summaries of challenges. ‒ Note: Although we recognize there are other means of communicating with your group, we ask for evaluation

purposes that you make the private group forum your primary means. ‒ I have access to the private group forum, and although I will not be an active participant in your private

discussions, I may monitor the activity as part of evaluating each person's contributions to group assignments.

Share with your group members the lead role of coordinating and submitting assignments.

Share your group work with the class. If you have any questions about the course, please use the "Course Q&A, Announcements" forum. Email the instructor with private questions that are not relevant to others in the class.

Instructions: Group Summaries

Your group is expected to provide a summary for one of the 8 lessons. You will post your summary for that lesson for the other groups to read and discuss. I will read the summaries and occasionally comment on them after they are posted. Use the private group forum to collaborate and communicate with your group.

The summary contributes up to 40 points (out of 200) towards your final grade. Your summary is intended to be a group effort, with the results reflecting discussion and consensus among group members. Every group member is expected to fully participate and every group member will receive the same grade. The grade will reflect the thoroughness of your work, the quality of your insights based on your reading of the suggested articles, and the quality of the writing.

To complete the group summary assigned to you:

1. There is a list of suggested readings for each week, organized by different subheadings. Focus on 4 different subheadings (your choice) in preparing your summary. If there are fewer than four subheadings under a given topic, organize your summary around the headings that are available.

2. Based on the readings under each subheading, identify and discuss the challenges facing the health care system.

For example, if your group is assigned Lesson 2, it might select “Physician Education” as one of the four

subheadings it addressed. After reading these articles, identify the challenges facing the health care system relating to implementing successful strategies concerning physician education and briefly describe/discuss them. Do the same for each of the other three subheadings you select under Lesson 2.

3. Your task will be to synthesize the content of the articles under each of the 4 subheadings you choose, drawing out the most important challenges, as your group sees them. Clearly, some articles will be more useful than others in this respect. Do not simply summarize or repeat the content of each individual article.

4. Your summary should be fully referenced and footnoted. If you are quoting a source, put the quotes in quotation marks and include the source in your reference list. If you a citing a source, reference the source in the text and include it in your reference list.

5. Use a 10 point font or larger when drafting your summary, keeping the total length to under 4 pages, double-spaced. You may use headings and subheadings, but provide more than a list of bullet points.

6. Read the summaries posted by other groups and engage in online discussions, especially when you feel there are

additional points to be made that would be of interest to classmates.

V. Course Text and Readings

The readings are listed in and available from the weekly lesson plans in the course outline. Some suggested readings are designated by an asterisk, which indicates that the reading has a hot link attached and is a good place to start.

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VI. Course Outline/Weekly Schedule

The U.S. Health Care System and Prospects for Reform

January 10 (in-person) Health System Performance: From Three-Legged Stool to the Triple Aim

Cost and Population Health

Patient Experience

Care Delivery

January 19-25 A Macro View of Physician Supply: Do We Have Enough Physicians Now? Will We Need More in the Future? Group Assignment 1 – January 25 Rethinking Primary Care: From Marcus Welby to Team-based Care? Group 1 Summary – January 19

January 26 – February 1 The Nurse Workforce: “Is There a Nurse in the House?” Individual Assignment 1 – February 1 Long-Term Care: Can This Rubik’s Cube Be Solved? Group 2 Summary – January 26

February 2-8 The Hospital: From Doctors’ Workshop to “Big Med”? Group Assignment 2 – February 8 Group 3 Summary – February 2

February 9-15 Medical Technology and Devices: At the Cutting Edge? Individual Assignment 2 – February 15 Group 4 Summary – February 9

February 16-22 Pharmaceuticals: What Price Progress? Group Assignment 3 – February 22 Group 5 Summary – February 16

Financing

February 23 – March 1 Health Insurance, Uninsurance, and the Private Health Insurance Market: What Works, What Doesn’t and How Might Health Reform Change It? Individual Assignment 3 – March 1 Group 6 Summary – February 23

March 2-8 Medicaid: How Can This “Vast Public Enterprise” Be Sustained? Group Assignment 4 – March 8 Group 7 Summary – March 2

March 9-15 Financing Care for Seniors: Is This Any Way to Run an Insurance Program? Individual Assignment 4 – March15 Saving Medicare from Itself: Politics, Economics, and Intergenerational Conflict Group 8 Summary – March 9

Note: With the exception of the Group Summaries, all assignments are due by midnight of the last day in the session

week. For example, your first group assignment is due prior to midnight, January 25.

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Health System Performance

Session 1 – Classroom Introduction – January 10, 2015 Health System Performance: From Three-Legged Stool to the Triple Aim – Cost and Population Health There is no assignment or group summary pertaining to this material.

Learning Objectives Students should be able to:

1. Discuss the different components of the Triple Aim and the performance of the U.S. health care system relative to:

Cost per capita: components of costs, drivers of cost growth, variation in costs

Population health 2. Compare and contrast different views regarding whether, or under what circumstances, health care expenditures that grow at a

faster rate than the rest of the economy should be regarded with concern. 3. Discuss evidence on geographic variation in health care costs in the United States. 4. Discuss and explain differences between the U.S. and other countries in health care costs and population health

Suggested Readings The Triple Aim

1.* Berwick, D.M., Nolan, T.W., Whittington, J. “The triple aim: Care, health and cost.” Health Affairs 27(3):759-769, 2008. http://content.healthaffairs.org/content/27/3/759.full.pdf+html

2.* Moses, III, H., Matheson, D.H.M., Dorsey, E.R., George, B.P., Sadoff, D., Yoshimura, Y. “The anatomy of health care in the United States.” Journal of the American Medical Association 310(18):1947-1963, 2013. http://jama.jamanetwork.com/issue.aspx?journalid=67&issueid=928805&direction=P

3. Fuchs, V.R. “Critiquing US Health Care.” Journal of the American Medical Association. Published online October 16, 2014. http://jama.jamanetwork.com/solr/searchresults.aspx?q=critiquing%20US%20Health%20Care&fd_JournalID=67&f_JournalDisplayName=JAMA&SearchSourceType=3

Spending on Health Care Trends

1.* The Henry J. Kaiser Family Foundation. “Health care costs. A primer.” May 2012. http://www.kff.org/insurance/upload/7670-03.pdf

2. Barnes, K. “Behind the health spending numbers.” Health Affairs Blog, June 18, 2013. http://healthaffairs.org/blog/2013/06/18/behind-the-health-spending-numbers/

3. Roehrig, C. “U.S. health spending as a share of GDP – Where are we headed?” Altarum Institute, July 16, 2013. http://altarum.org/health-policy-blog/u-s-health-spending-as-a-share-of-gdp-where-are-we-headed

4. Orszag, P. “Economy can’t be all that’s slowing health costs.” Bloomberg, September 24, 2013. http://www.bloomberg.com/news/2013-09-24/economy-can-t-be-all-that-s-slowing-health-costs.html

5. Millman, J. “The end of health care’s historic spending slowdown is near.” The Washington Post. September 3, 2014. http://www.washingtonpost.com/blogs/wonkblog/wp/2014/09/03/the-end-of-health-cares-historic-spending-slowdown-is-near/

6. Carey, M.A. “Health care spending forecast to increase modestly in next decade.” Kaiser Health News, September 3, 2014. http://kaiserhealthnews.org/news/health-costs-inflation-cms-report/

7. Dranove, D., Garthwaite, C., Ody, C. “Health spending slowdown is mostly due to economic factors, not structural change in the health care sector.” Health Affairs 33(8):1399-1406, 2014. http://content.healthaffairs.org/content/33/8/1399.full.pdf+html

Geographic Variation in Health Spending 1.* Rau, J. “Medicare spending variations mostly due to health differences, study concludes.” Kaiser Health News, May 28, 2013.

http://www.kaiserhealthnews.org/Stories/2013/May/28/medicare-state-geographic-variation-costs.aspx 2. Joynt, K.E., Jha, A.K. “The relationship between cost and quality. No free lunch.” Journal of the American Medical Association

307(10):1082-1083, 2012. http://jama.jamanetwork.com/Issue.aspx?journalid=67&issueID=22493&direction=P Views Regarding Health Spending 1.* Pauly, M.V. “The trade-off among quality, quantity, and cost: How to make it—if we must.” Health Affairs 30(4):574-580, 2011.

http://content.healthaffairs.org/content/30/4/574.full.pdf+html 2.* Altman, D., Levitt, L. “We still have a health-care spending problem.” Washington Post, April 21, 2012.

http://articles.washingtonpost.com/2013-04-21/opinions/38717666_1_health-spending-health-costs-health-care-spending 3. RWJF. “Consumer attitudes on health care costs: Insights from focus groups in four U.S. cities.” January 2013.

http://www.rwjf.org/content/dam/farm/reports/issue_briefs/2013/rwjf403428

http://content.healthaffairs.org/content/27/3/759.full.pdf+htmlhttp://jama.jamanetwork.com/issue.aspx?journalid=67&issueid=928805&direction=Phttp://jama.jamanetwork.com/solr/searchresults.aspx?q=critiquing%20US%20Health%20Care&fd_JournalID=67&f_JournalDisplayName=JAMA&SearchSourceType=3http://jama.jamanetwork.com/solr/searchresults.aspx?q=critiquing%20US%20Health%20Care&fd_JournalID=67&f_JournalDisplayName=JAMA&SearchSourceType=3http://www.kff.org/insurance/upload/7670-03.pdfhttp://healthaffairs.org/blog/2013/06/18/behind-the-health-spending-numbers/http://altarum.org/health-policy-blog/u-s-health-spending-as-a-share-of-gdp-where-are-we-headedhttp://www.bloomberg.com/news/2013-09-24/economy-can-t-be-all-that-s-slowing-health-costs.htmlhttp://www.washingtonpost.com/blogs/wonkblog/wp/2014/09/03/the-end-of-health-cares-historic-spending-slowdown-is-near/http://kaiserhealthnews.org/news/health-costs-inflation-cms-report/http://content.healthaffairs.org/content/33/8/1399.full.pdf+htmlhttp://www.kaiserhealthnews.org/Stories/2013/May/28/medicare-state-geographic-variation-costs.aspxhttp://jama.jamanetwork.com/Issue.aspx?journalid=67&issueID=22493&direction=Phttp://content.healthaffairs.org/content/30/4/574.full.pdf+htmlhttp://articles.washingtonpost.com/2013-04-21/opinions/38717666_1_health-spending-health-costs-health-care-spendinghttp://www.rwjf.org/content/dam/farm/reports/issue_briefs/2013/rwjf403428

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4. Douthat, R. “Conservatives and health care costs.” New York Times, May 15, 2013. http://douthat.blogs.nytimes.com/2013/05/15/conservatives-and-health-care-costs/?_r=0

5. Nichols, L. “Seven challenges for continued health care cost control: Will Congress step up to the plate?” Altarum Institute, August 20, 2013. http://altarum.org/health-policy-blog/seven-challenges-for-continued-health-care-cost-control-will-congress-step-up-to-the-plate

Drivers of Growth in Spending 1.* Rao, A. “IOM report focuses on $750 billion in inefficient health care spending.” Kaiser Health News Blog, September 6, 2012.

http://capsules.kaiserhealthnews.org/?p=12818 2.* Appleby, J. “Higher prices charged by hospitals, other providers, drove health spending during downturn.” Kaiser Health News,

May 21, 2012. http://www.kaiserhealthnews.org/Stories/2012/May/21/higher-health-care-prices-hospitals.aspx 3.* Kliff, S. “Over next two decades, obesity could cost us $550 billion.” The Washington Post, September 18, 2012.

http://www.washingtonpost.com/blogs/wonkblog/wp/2012/09/18/over-next-two-decades-obesity-could-cost-us-550-billion/ 4. Acaramenico. “Poll of emergency physicians shows more than half order tests as protection against being sued.” May 26, 2011

http://californiaprevailingwage.wordpress.com/2011/05/26/poll-of-emergency-physicians-shows-more-than-half-order-tests-as-protection-against-being-sued/

5. Porter, E. “Health care’s overlooked cost factor.” New York Times, June 11, 2013. http://www.nytimes.com/2013/06/12/business/examinations-of-health-costs-overlook-mergers.html?pagewanted=all

6. Rosenthal, E. “The $2.7 trillion medical bill.” New York Times, June 1, 2013. http://www.nytimes.com/2013/06/02/health/colonoscopies-explain-why-us-leads-the-world-in-health-expenditures.html?pagewanted=all

7. Gordon, J. “The medical arms race.” Minnesota Medicine, February 2007. http://www.minnesotamedicine.com/PastIssues/PastIssues2007/February2007/FeatureFebruary2007.aspx

8. Fuchs, V.R. “The gross domestic product and health care spending.” New England Journal of Medicine May 22, 2013. http://www.nejm.org/doi/full/10.1056/NEJMp1305298

9. Rosenberg, Y. “Do you really need that test? Doctors warn on 90 treatments.” The Fiscal Times, February 21, 2013. http://www.thefiscaltimes.com/Articles/2013/02/21/Doctors-Warn-on-90-Overused-Medical-Treatments.aspx#page1

10. Pittman, G. “Unnecessary repeat cholesterol tests common: study.” Reuters, July 1, 2013. http://www.reuters.com/article/2013/07/01/us-unnecessary-repeat-cholesterol-idUSBRE96015420130701

11. Rothberg, M.B., Class, J., Bishop, T.F., Frederici, J., Kleppel, R., Lindenauer, P.K. “The cost of defensive medicine on 3 hospital medicine services.” JAMA Internal Medicine. Published online September 15, 2014. http://archinte.jamanetwork.com/solr/searchresults.aspx?q=the%20cost%20of%20defensive%20medicine&fd_JournalID=71&f_JournalDisplayName=JAMA%20Internal%20Medicine&SearchSourceType=3

12. Kliff, S., “How much money do we waste on useless health care?” Vox, September 18, 2014. http://www.vox.com/2014/9/18/6251063/health-care-waste-dartmouth-atlas-sheiner

13. Orszag, P.R. “Patient health doesn’t explain cost differences.” BloombergView, September 30, 2014. http://www.bloombergview.com/articles/2014-09-30/patient-health-doesn-t-explain-cost-differences

14. Cauchon, D. “Health care spending is transferred out of ICU.” USA Today, March 4, 2013. http://www.usatoday.com/story/news/health/2013/03/04/health-care-spending-growth-slows/1963165/

Population Health Trends

1.* Kelly, J. “Boomers live longer, but sicker, than parents.” Pittsburgh Post-Gazette, March 4, 2013. http://www.post-gazette.com/stories/news/health/boomers-live-longer-but-sicker-than-parents-677824/ 2.* Winslow, R. “Americans are living longer, but not necessarily healthier, study shows.” The Wall Street Journal, July 10, 2013.

http://online.wsj.com/article/SB10001424127887324694904578597444105321914.html 3. Gardner, A. “America’s health a mixed bag: Report.” Health, February 16, 2011. http://news.health.com/2011/02/16/americas-

health-a-mixed-bag-report/ 4. US Burden of Disease Collaborators. “The state of US health, 1990-2010. Burden of diseases, injuries, and risk factors.” Journal

of the American Medical Association 310(6):591-608, 2013. http://jama.jamanetwork.com/Issue.aspx?journalid=67&issueID=927436&direction=P

5. Pitman, D. “Gains made, but U.S. still lags in life expectancy.” MedPage Today, July 10, 2013. http://www.medpagetoday.com/PublicHealthPolicy/PublicHealth/40381

Illness-specific Measures 1. Reinberg, S. “U.S. cancer death rate continues to drop.” USA Today, July 8, 2010. http://www.usatoday.com/news/health/2010-

07-08-cancer-deaths_N.htm 2. HealthDay. “Asthma cases continue to rise in U.S., affecting millions.” May 15, 2012.

http://consumer.healthday.com/Article.asp?AID=664789 3. USA Today. “Percentage of severely obese adults skyrockets.” October 1, 2012.

http://www.usatoday.com/story/news/nation/2012/10/01/severely-obese-americans-increasing/1606469/

http://douthat.blogs.nytimes.com/2013/05/15/conservatives-and-health-care-costs/?_r=0http://altarum.org/health-policy-blog/seven-challenges-for-continued-health-care-cost-control-will-congress-step-up-to-the-platehttp://altarum.org/health-policy-blog/seven-challenges-for-continued-health-care-cost-control-will-congress-step-up-to-the-platehttp://capsules.kaiserhealthnews.org/?p=12818http://www.kaiserhealthnews.org/Stories/2012/May/21/higher-health-care-prices-hospitals.aspxhttp://www.washingtonpost.com/blogs/wonkblog/wp/2012/09/18/over-next-two-decades-obesity-could-cost-us-550-billion/http://californiaprevailingwage.wordpress.com/2011/05/26/poll-of-emergency-physicians-shows-more-than-half-order-tests-as-protection-against-being-sued/http://californiaprevailingwage.wordpress.com/2011/05/26/poll-of-emergency-physicians-shows-more-than-half-order-tests-as-protection-against-being-sued/http://www.nytimes.com/2013/06/12/business/examinations-of-health-costs-overlook-mergers.html?pagewanted=allhttp://www.nytimes.com/2013/06/02/health/colonoscopies-explain-why-us-leads-the-world-in-health-expenditures.html?pagewanted=allhttp://www.nytimes.com/2013/06/02/health/colonoscopies-explain-why-us-leads-the-world-in-health-expenditures.html?pagewanted=allhttp://www.minnesotamedicine.com/PastIssues/PastIssues2007/February2007/FeatureFebruary2007.aspxhttp://www.nejm.org/doi/full/10.1056/NEJMp1305298http://www.thefiscaltimes.com/Articles/2013/02/21/Doctors-Warn-on-90-Overused-Medical-Treatments.aspx#page1http://www.reuters.com/article/2013/07/01/us-unnecessary-repeat-cholesterol-idUSBRE96015420130701http://archinte.jamanetwork.com/solr/searchresults.aspx?q=the%20cost%20of%20defensive%20medicine&fd_JournalID=71&f_JournalDisplayName=JAMA%20Internal%20Medicine&SearchSourceType=3http://archinte.jamanetwork.com/solr/searchresults.aspx?q=the%20cost%20of%20defensive%20medicine&fd_JournalID=71&f_JournalDisplayName=JAMA%20Internal%20Medicine&SearchSourceType=3http://www.vox.com/2014/9/18/6251063/health-care-waste-dartmouth-atlas-sheinerhttp://www.bloombergview.com/articles/2014-09-30/patient-health-doesn-t-explain-cost-differenceshttp://www.usatoday.com/story/news/health/2013/03/04/health-care-spending-growth-slows/1963165/http://www.post-gazette.com/stories/news/health/boomers-live-longer-but-sicker-than-parents-677824/http://online.wsj.com/article/SB10001424127887324694904578597444105321914.htmlhttp://news.health.com/2011/02/16/americas-health-a-mixed-bag-report/http://news.health.com/2011/02/16/americas-health-a-mixed-bag-report/http://jama.jamanetwork.com/Issue.aspx?journalid=67&issueID=927436&direction=Phttp://www.medpagetoday.com/PublicHealthPolicy/PublicHealth/40381http://www.usatoday.com/news/health/2010-07-08-cancer-deaths_N.htmhttp://www.usatoday.com/news/health/2010-07-08-cancer-deaths_N.htmhttp://consumer.healthday.com/Article.asp?AID=664789http://www.usatoday.com/story/news/nation/2012/10/01/severely-obese-americans-increasing/1606469/

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4. Reuters. “U.S. cholesterol levels decline: Study.” October 16, 2012. http://www.reuters.com/article/2012/10/16/health-cholesterol-idUSL3E8LG7C120121016

5. Reinberg, S. “Nearly 30 percent of Americans have high blood pressure: CDC.” WebMD News from HealthDay, April 4, 2013. http://www.webmd.com/hypertension-high-blood-pressure/news/20130404/nearly-30-percent-of-americans-have-high-blood-pressure-cdc

6. Preidt, R. “U.S. stroke deaths fell 30 percent over past decade.” MedlinePlus, December 3, 2013. http://www.nlm.nih.gov/medlineplus/news/fullstory_143067.html

Disparities 1.* HealthDay News. “Health disparities persist in U.S., report shows.” January 13, 2011. http://health.usnews.com/health-

news/family-health/heart/articles/2011/01/13/health-disparities-persist-in-us-report-shows 2. Kaiser Health News. “Race plays role in diagnosis and treatment.” July 24, 2009. http://www.kaiserhealthnews.org/daily-

reports/2009/july/24/racial-disparities.aspx?referrer=search 3. Tavernise, S. “The health toll of immigration.” New York Times, May 18, 2013. http://www.nytimes.com/2013/05/19/health/the-

health-toll-of-immigration.html?pagewanted=all 4. Goodell, S., Escarce, J.J. “Racial and ethnic disparities in access to and quality of health care.” Policy Brief 12, The Synthesis

Project, Robert Wood Johnson Foundation, September 2007. http://www.rwjf.org/en/research-publications/find-rwjf-research/2007/09/racial-and-ethnic-disparities-in-access-to-and-quality-of-health.html

5. Warshawsky, M.J., Biggs, A.G. “Income inequality and rising health-care costs.” The Wall Street Journal, October 6, 2014. http://search.proquest.com/docview/1610678693/fulltext/13F7506088E64D26PQ/1?accountid=14586

International Comparisons 1.* Fuchs, V.R. “How and why US health care differs from that in other OECD countries.” Journal of the American Medical

Association 309(1):33-34, 2013. http://jama.jamanetwork.com/Issue.aspx?journalid=67&issueID=926163&direction=P 2. Baker, S. “Study: US leads in healthcare spending, but ranks last in health.” The Hill’s Healthcare Blog, May 12, 2011.

http://thehill.com/blogs/healthwatch/public-global-health/160845-study-us-leads-in-healthcare-spending-but-ranks-last-in- health- 3. Fox, M. “Survey shows Americans pay a lot more for health care." NationalJournal, March 25, 2012.

http://www.nationaljournal.com/healthcare/survey-shows-americans-pay-a-lot-more-for-health-care-20120304 4. Laugesen, M.J., Glied, S.A. “Higher fees paid to U.S. physicians drive higher spending for physician services compared to other

countries.” Health Affairs 30(9):1647-1656, 2011. http://content.healthaffairs.org/content/30/9/1647.full.pdf+html 5. Goodwin, J. “Americans have worse health than English peers, study finds.” US News, March 9, 2011.

http://health.usnews.com/health-news/family-health/boomer-health/articles/2011/03/09/americans-have-worse-health-than-english-peers-study-finds

6. Heavey, S. “Obesity, lack of insurance cited in U.S. health gap.” Reuters, January 9, 2013. http://www.reuters.com/article/2013/01/09/us-usa-health-ranking-idUSBRE9080ZN20130109

7. Goldhill, D. “Other nations don’t compare to U.S. health care.” Bloomberg, June 20, 2013. http://www.bloomberg.com/news/2013-06-20/what-the-world-can-t-tell-us-about-health-care.html

8. Porter, E. “Health care’s overlooked cost factor.” The New York Times, June 11, 2013. http://www.nytimes.com/2013/06/12/business/examinations-of-health-costs-overlook-mergers.html?_r=0

9. Price, Waterhouse, Coopers. “Medical cost trend: Behind the numbers 2014.” June, 2013. http://pwchealth.com/cgi-local/hregister.cgi/reg/medical-cost-trend-behind-the-numbers-2014.pdf

Further Readings 1. Wayne, A. “Health cost growth slows further even as economy rebounds.” Bloomberg, June 18, 2013.

http://www.bloomberg.com/news/2013-06-18/health-cost-growth-slows-further-even-as-economy-rebounds.html 2. Goldhill, D. “Focus on health-care costs causes more spending.” Bloomberg, January 1, 2013.

http://www.bloomberg.com/news/2013-01-01/focus-on-health-care-costs-causes-more-spending.html 3. Kaiser Family Foundation. “Assessing the effects of the economy on the recent slowdown in health spending.” April 2013.

http://kff.org/health-costs/issue-brief/assessing-the-effects-of-the-economy-on-the-recent-slowdown-in-health-spending-2/ 4. Steuerle, G. “A slower rate of health cost growth? What happens when an irresistible force meets an increasingly immovable

object.” Altarum Institute Health Policy Forum, May 10, 2013. http://www.altarum.org/forum/post/slower-rate-health-cost-growth-what-happens-when-irresistible-force-meets-increasingly

5. Samuelson, R.J. “Is the health-care spending slowdown for real?” The Washington Post, May 19, 2013. http://articles.washingtonpost.com/2013-05-19/opinions/39376698_1_affordable-care-act-affordable-health-coverage-health-affairs

6. Klein, E. “One way Obamacare may already be working.” Bloomberg, May 29, 2013. Available at: http://www.bloomberg.com/news/2013-05-29/one-way-obamacare-may-already-be-working.html

7. Eligon, J. “An oil boom takes a toll on health care.” The New York Times, January 27, 2013. http://www.nytimes.com/2013/01/28/us/boom-in-north-dakota-weighs-heavily-on-health-care.html?_r=0&gwh=BE712B27B95AE737019CF8BBC3FD40D7

http://www.reuters.com/article/2012/10/16/health-cholesterol-idUSL3E8LG7C120121016http://www.reuters.com/article/2012/10/16/health-cholesterol-idUSL3E8LG7C120121016http://www.webmd.com/hypertension-high-blood-pressure/news/20130404/nearly-30-percent-of-americans-have-high-blood-pressure-cdchttp://www.webmd.com/hypertension-high-blood-pressure/news/20130404/nearly-30-percent-of-americans-have-high-blood-pressure-cdchttp://www.nlm.nih.gov/medlineplus/news/fullstory_143067.htmlhttp://health.usnews.com/health-news/family-health/heart/articles/2011/01/13/health-disparities-persist-in-us-report-showshttp://health.usnews.com/health-news/family-health/heart/articles/2011/01/13/health-disparities-persist-in-us-report-showshttp://www.kaiserhealthnews.org/daily-reports/2009/july/24/racial-disparities.aspx?referrer=searchhttp://www.kaiserhealthnews.org/daily-reports/2009/july/24/racial-disparities.aspx?referrer=searchhttp://www.nytimes.com/2013/05/19/health/the-health-toll-of-immigration.html?pagewanted=allhttp://www.nytimes.com/2013/05/19/health/the-health-toll-of-immigration.html?pagewanted=allhttp://www.rwjf.org/en/research-publications/find-rwjf-research/2007/09/racial-and-ethnic-disparities-in-access-to-and-quality-of-health.htmlhttp://www.rwjf.org/en/research-publications/find-rwjf-research/2007/09/racial-and-ethnic-disparities-in-access-to-and-quality-of-health.htmlhttp://search.proquest.com/docview/1610678693/fulltext/13F7506088E64D26PQ/1?accountid=14586http://jama.jamanetwork.com/Issue.aspx?journalid=67&issueID=926163&direction=Phttp://thehill.com/blogs/healthwatch/public-global-health/160845-study-us-leads-in-healthcare-spending-but-ranks-last-in-%20health-http://www.nationaljournal.com/healthcare/survey-shows-americans-pay-a-lot-more-for-health-care-20120304http://content.healthaffairs.org/content/30/9/1647.full.pdf+htmlhttp://health.usnews.com/health-news/family-health/boomer-health/articles/2011/03/09/americans-have-worse-health-than-english-peers-study-findshttp://health.usnews.com/health-news/family-health/boomer-health/articles/2011/03/09/americans-have-worse-health-than-english-peers-study-findshttp://www.reuters.com/article/2013/01/09/us-usa-health-ranking-idUSBRE9080ZN20130109http://www.bloomberg.com/news/2013-06-20/what-the-world-can-t-tell-us-about-health-care.htmlhttp://www.nytimes.com/2013/06/12/business/examinations-of-health-costs-overlook-mergers.html?_r=0http://pwchealth.com/cgi-local/hregister.cgi/reg/medical-cost-trend-behind-the-numbers-2014.pdfhttp://pwchealth.com/cgi-local/hregister.cgi/reg/medical-cost-trend-behind-the-numbers-2014.pdfhttp://www.bloomberg.com/news/2013-06-18/health-cost-growth-slows-further-even-as-economy-rebounds.htmlhttp://www.bloomberg.com/news/2013-01-01/focus-on-health-care-costs-causes-more-spending.htmlhttp://kff.org/health-costs/issue-brief/assessing-the-effects-of-the-economy-on-the-recent-slowdown-in-health-spending-2/http://www.altarum.org/forum/post/slower-rate-health-cost-growth-what-happens-when-irresistible-force-meets-increasinglyhttp://www.altarum.org/forum/post/slower-rate-health-cost-growth-what-happens-when-irresistible-force-meets-increasinglyhttp://articles.washingtonpost.com/2013-05-19/opinions/39376698_1_affordable-care-act-affordable-health-coverage-health-affairshttp://articles.washingtonpost.com/2013-05-19/opinions/39376698_1_affordable-care-act-affordable-health-coverage-health-affairshttp://www.bloomberg.com/news/2013-05-29/one-way-obamacare-may-already-be-working.htmlhttp://www.nytimes.com/2013/01/28/us/boom-in-north-dakota-weighs-heavily-on-health-care.html?_r=0&gwh=BE712B27B95AE737019CF8BBC3FD40D7http://www.nytimes.com/2013/01/28/us/boom-in-north-dakota-weighs-heavily-on-health-care.html?_r=0&gwh=BE712B27B95AE737019CF8BBC3FD40D7

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8. Philipson, T., Eber, M., Lakdawalla, D.N., Corral, M., Conti, R., Goldman, D.P. “An analysis of whether higher health care spending in the United States versus Europe is ‘worth it’ in the case of cancer.” Health Affairs 31(4):667-675, 2012. http://content.healthaffairs.org/content/31/4/667.full.pdf+html

9. Lawrence, B.R. “Cutting U.S. health-care costs doesn’t have to be harmful.” The Washington Post online, July 26, 2012. http://www.washingtonpost.com/opinions/cutting-us-health-care-costs-doesnt-have-to-be-painful/2012/07/26/gJQA1ZzJCX_story.html

10. Ledger, K. “Healthiest state?” Minnesota Medicine, May 2012. http://www.minnesotamedicine.com/PastIssues/May2012/HealthiestState.aspx

11. Goldsmith, J. “Barking up the wrong tree: Affordability, not cost growth, is the policy challenge.” Health Affairs Blog, May 7, 2012. http://healthaffairs.org/blog/2012/05/07/barking-up-the-wrong-tree-affordability-not-cost-growth-is-the-policy-challenge/

12. Healy, M. “Obesity in U.S. projected to grow, though pace slows: CDC study.” LA Times online, May 7, 2012. http://articles.latimes.com/2012/may/07/news/la-heb-obesity-projection-20120507

13. Kenney, G.M., McMorrow, S., Zuckerman, S., Goin, D.E. “A decade of health care access declines for adults holds implications for changes in the Affordable Care Act.” Health Affairs 31(5):899-908, 2012. http://content.healthaffairs.org/content/31/5/899.full.pdf+html

14. Lowrey, A. “In hopeful sign, health spending is flattening out.” New York times, April 28, 2012, p.A.1. http://www.nytimes.com/2012/04/29/health/policy/in-hopeful-sign-health-spending-is-flattening-out.html?pagewanted=all

15. Mahoney, D. “Uncontrolled hypertension deemed pervasive in U.S. adults.” Internal Medicine News, September 4, 2012. http://www.internalmedicinenews.com/single-view/uncontrolled-hypertension-deemed-pervasive-in-us-adults/e84cc5f65b0596965e8e9b606b653355.html

16. Bipartisan Policy Center. “What is driving U.S. health care spending?” September 2012. http://bipartisanpolicy.org/sites/default/files/BPC%20Health%20Care%20Cost%20Drivers%20Brief%20Sept%202012.pdf

17. Carroll, A. “The ‘iron triangle’ on health care: Access, cost, and quality.” JAMA Forum, October 3, 2012. http://newsatjama.jama.com/2012/10/03/jama-forum-the-iron-triangle-of-health-care-access-cost-and-quality/

18. Detsky, A.S. “How to control health care costs.” Journal of General Internal Medicine 27(9):1095-1096, 2012. http://link.springer.com/content/pdf/10.1007%2Fs11606-012-2119-0.pdf

19. National Institute for Health Care Management. “U.S. health care spending: The big picture.” NIHCM Foundation Data Brief, May 2012. http://www.nihcm.org/images/stories/Data_Brief_1_-_Big_Picture_FINAL.pdf

20. Reinhardt, U.E., “Is U.S. health spending finally under control.” New York Times online, January 20, 2012. http://economix.blogs.nytimes.com/2012/01/20/is-u-s-health-spending-finally-under-control/

21. Roehrig, C., Turner, A., Hughes-Cromwick, P., Miller, G. “When the cost curve bent – Pre-recession moderation in health care.” New England Journal of Medicine 367(7):590-593, 2012. http://www.nejm.org/doi/pdf/10.1056/NEJMp1205958

22. Stein, R. “A dire sign of the obesity epidemic: Teen diabetes soaring, study finds.” NPR, May 21, 2012. http://www.npr.org/blogs/health/2012/05/21/153030283/a-dire-sign-of-the-obesity-epidemic-teen-diabetes-soaring-study-finds

23. The Economist. “An incurable disease.” September 29, 2012. http://www.economist.com/node/21563714 24. Wang, S.S. “Revealing the unexpected dangers of obesity.” The Wall Street Journal, October 29, 2012.

http://www.nytimes.com/2012/09/23/health/new-system-for-patients-to-report-medical-mistakes.html?_r=0 25. Roehrig, C.S., Rousseau, D.M. “The growth in cost per case explains far more of U.S. health spending increases than rising

disease prevalence.” Health Affairs 30(9):1657-1663, 2011. http://content.healthaffairs.org/content/30/9/1657.full.pdf+html 26. Rovner, J. “You really are paying a lot more for health care.” NPR, May 11, 2011.

http://www.npr.org/blogs/health/2011/05/11/136213104/you-really-are-paying-a-lot-more-for-health-care 27. Reinberg, S.. “Aging population could send cancer costs soaring.” January 12, 2011. http://news.health.com/2011/01/12/aging-

population-could-send-cancer-costs-soaring/ 28. Gardner, A. “U.S. found to be losing ground in life expectancy.” HealthDay, June 15, 2011. http://health.usnews.com/health-

news/family-health/heart/articles/2011/06/15/us-found-to-be-losing-ground-in-life-expectancy 29. Gawande, A. “The cost conundrum: What a Texas town can teach us about health care.” The New Yorker, June 1, 2009.

http://go.galegroup.com/ps/retrieve.do?sgHitCountType=None&sort=DA-SORT&inPS=true&prodId=PROF&userGroupName=mnaumntwin&tabID=T003&searchId=R1&resultListType=RESULT_LIST&contentSegment=&searchType=AdvancedSearchForm&currentPosition=1&contentSet=GALE%7CA201451685&&docId=GALE|A201451685&docType=GALE&role=&docLevel=FULLTEXT

30. Escarce, J.J. “Racial and ethnic disparities in access to and quality of health care.” Research Synthesis Report No. 12. Robert Wood Johnson Foundation, September 7, 2007. http://www.rwjf.org/en/research-publications/find-rwjf-research/2007/09/racial-and-ethnic-disparities-in-access-to-and-quality-of-health.html

31. Banks, J., Marmot, M., Oldfield, Z., Smith J.P. “Disease and disadvantage in the United States and in England.” JAMA 2006;295(17):2037-2045. http://jama.jamanetwork.com/Issue.aspx?journalid=67&issueID=5022&direction=P

32. Kennedy, K., White House touts slow increase in health care costs.” USA Today, July 29, 2013. http://www.usatoday.com/story/news/politics/2013/07/29/administration-lowered-premiums-white-house/2596453/

http://content.healthaffairs.org/content/31/4/667.full.pdf+htmlhttp://www.washingtonpost.com/opinions/cutting-us-health-care-costs-doesnt-have-to-be-painful/2012/07/26/gJQA1ZzJCX_story.htmlhttp://www.washingtonpost.com/opinions/cutting-us-health-care-costs-doesnt-have-to-be-painful/2012/07/26/gJQA1ZzJCX_story.htmlhttp://www.minnesotamedicine.com/PastIssues/May2012/HealthiestState.aspxhttp://healthaffairs.org/blog/2012/05/07/barking-up-the-wrong-tree-affordability-not-cost-growth-is-the-policy-challenge/http://articles.latimes.com/2012/may/07/news/la-heb-obesity-projection-20120507http://content.healthaffairs.org/content/31/5/899.full.pdf+htmlhttp://www.nytimes.com/2012/04/29/health/policy/in-hopeful-sign-health-spending-is-flattening-out.html?pagewanted=allhttp://www.internalmedicinenews.com/single-view/uncontrolled-hypertension-deemed-pervasive-in-us-adults/e84cc5f65b0596965e8e9b606b653355.htmlhttp://www.internalmedicinenews.com/single-view/uncontrolled-hypertension-deemed-pervasive-in-us-adults/e84cc5f65b0596965e8e9b606b653355.htmlhttp://bipartisanpolicy.org/sites/default/files/BPC%20Health%20Care%20Cost%20Drivers%20Brief%20Sept%202012.pdfhttp://newsatjama.jama.com/2012/10/03/jama-forum-the-iron-triangle-of-health-care-access-cost-and-quality/http://link.springer.com/content/pdf/10.1007%2Fs11606-012-2119-0.pdfhttp://www.nihcm.org/images/stories/Data_Brief_1_-_Big_Picture_FINAL.pdfhttp://economix.blogs.nytimes.com/2012/01/20/is-u-s-health-spending-finally-under-control/http://www.nejm.org/doi/pdf/10.1056/NEJMp1205958http://www.npr.org/blogs/health/2012/05/21/153030283/a-dire-sign-of-the-obesity-epidemic-teen-diabetes-soaring-study-findshttp://www.economist.com/node/21563714http://www.nytimes.com/2012/09/23/health/new-system-for-patients-to-report-medical-mistakes.html?_r=0http://content.healthaffairs.org/content/30/9/1657.full.pdf+htmlhttp://www.npr.org/blogs/health/2011/05/11/136213104/you-really-are-paying-a-lot-more-for-health-carehttp://news.health.com/2011/01/12/aging-population-could-send-cancer-costs-soaring/http://news.health.com/2011/01/12/aging-population-could-send-cancer-costs-soaring/http://health.usnews.com/health-news/family-health/heart/articles/2011/06/15/us-found-to-be-losing-ground-in-life-expectancyhttp://health.usnews.com/health-news/family-health/heart/articles/2011/06/15/us-found-to-be-losing-ground-in-life-expectancyhttp://go.galegroup.com/ps/retrieve.do?sgHitCountType=None&sort=DA-SORT&inPS=true&prodId=PROF&userGroupName=mnaumntwin&tabID=T003&searchId=R1&resultListType=RESULT_LIST&contentSegment=&searchType=AdvancedSearchForm&currentPosition=1&contentSet=GALE%7CA201451685&&docId=GALE|A201451685&docType=GALE&role=&docLevel=FULLTEXThttp://go.galegroup.com/ps/retrieve.do?sgHitCountType=None&sort=DA-SORT&inPS=true&prodId=PROF&userGroupName=mnaumntwin&tabID=T003&searchId=R1&resultListType=RESULT_LIST&contentSegment=&searchType=AdvancedSearchForm&currentPosition=1&contentSet=GALE%7CA201451685&&docId=GALE|A201451685&docType=GALE&role=&docLevel=FULLTEXThttp://go.galegroup.com/ps/retrieve.do?sgHitCountType=None&sort=DA-SORT&inPS=true&prodId=PROF&userGroupName=mnaumntwin&tabID=T003&searchId=R1&resultListType=RESULT_LIST&contentSegment=&searchType=AdvancedSearchForm&currentPosition=1&contentSet=GALE%7CA201451685&&docId=GALE|A201451685&docType=GALE&role=&docLevel=FULLTEXThttp://go.galegroup.com/ps/retrieve.do?sgHitCountType=None&sort=DA-SORT&inPS=true&prodId=PROF&userGroupName=mnaumntwin&tabID=T003&searchId=R1&resultListType=RESULT_LIST&contentSegment=&searchType=AdvancedSearchForm&currentPosition=1&contentSet=GALE%7CA201451685&&docId=GALE|A201451685&docType=GALE&role=&docLevel=FULLTEXThttp://www.rwjf.org/en/research-publications/find-rwjf-research/2007/09/racial-and-ethnic-disparities-in-access-to-and-quality-of-health.htmlhttp://www.rwjf.org/en/research-publications/find-rwjf-research/2007/09/racial-and-ethnic-disparities-in-access-to-and-quality-of-health.htmlhttp://jama.jamanetwork.com/Issue.aspx?journalid=67&issueID=5022&direction=Phttp://www.usatoday.com/story/news/politics/2013/07/29/administration-lowered-premiums-white-house/2596453/

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Health System Performance: From Three-Legged Stool to the Triple Aim – Patient Experience Learning Objectives Students should be able to:

1. Discuss issues and evidence relating to access to care and deficiencies on the quality of health care in the United States 2. Discuss the evidence regarding prevalence of medical errors in the U.S. health care system and their sources. 3. Use terminology related to “medical errors” appropriately. 4. Discuss basic approaches being used in hospitals and other providers to reduce medical errors. 5. Discuss how poor communication and care coordination can affect patient outcomes.

Suggested Readings Patient Safety and Medical Errors: Concepts, Terminology, and Impact Overview 1.* Leape, L. “Error in medicine.” Journal of the American Medical Association 272(23):1851-1857, 1994 (Posted on Moodle) 2.* Boodman, S.G. “Doctors’ diagnostic errors are often not mentioned but can take a serious toll.” Kaiser Health News, May 6,

2013. http://www.kaiserhealthnews.org/stories/2013/may/07/doctor-errors-misdiagnosis-more-common-than-known-serious-impact.aspx

3.* Allen,, M. “We’re still not tracking patient harm.” Propublica, July 17, 2014. http://www.propublica.org/article/were-still-not-tracking-patient-harm

4. Van Den Bos, J., Rustagi, K., Gray, T., Halford, M., Ziemkiewicz, E., Shreve, J. “The $17.1 billion problem: The annual cost of measurable medical errors.” Health Affairs 30(4):596-603, 2011. http://content.healthaffairs.org/content/30/4/596.full.pdf+html

5. Young, J. “Hospital errors occur 10 times more than reported, study finds.” Bloomberg.com, April 6, 2011. http://www.bloomberg.com/news/2011-04-07/hospital-errors-occur-10-times-more-than-reported-study-finds.html

6. Weber, T., Ornstein, C., Allen, M. “Why can’t medicine seem to fix simple mistakes? ProPublica, July 20, 2012. http://www.propublica.org/article/why-cant-medicine-seem-to-fix-simple-mistakes

7. Southwick, F.S. “Losing my leg to a medical error.” The New York Times, February 19, 2013. http://www.nytimes.com/2013/02/20/opinion/losing-my-leg-to-a-medical-error.html?smid=pl-share&_r=0

8. Zimlichman, E., Henderson, D., Tamir, O., et al. “Health care-associated infections. A meta-analysis of costs and financial impact on the US health care system.” JAMA Internal Medicine, September 2, 2013. http://archinte.jamanetwork.com/article.aspx?articleID=1733452

9. Brown, E. “Senator: Hospitals reducing treatment errors, but problems remain.” The Los Angeles Times, April 25, 2014. http://www.latimes.com/local/lanow/la-me-ln-boxer-hospital-errors-20140425-story.html

10. Millman, J. “Hospitals are cutting down on their deadly mistakes, HHS says.” The Washington Post, May 7, 2014. http://search.proquest.com/docview/1521893302/fulltext/E15539BC35254636PQ/1?accountid=14586

11. Tavernise, S. “Infections at hospitals are falling, C.D.C. says.” The New York Times, March 26, 2014. http://search.proquest.com/docview/1510343620/fulltext/B9D98808BC034F5APQ/2?accountid=14586

12. Begley, S. “Hospital ratings show sharp differences in safety, chance of dying.” Reuters, March 27, 2014. http://www.reuters.com/article/2014/03/27/us-hospitals-ratings-idUSBREA2Q0NC20140327

13. Reinberg, S. “1 in 5 U.S. patients injured by medical care.” HealthDay, May 27, 2014. http://consumer.healthday.com/general-health-information-16/injury-health-news-413/1-in-5-medicare-patients-injured-because-of-their-medical-care-688223.html

14. Starmer, A.J., Spector, N.D., Srivastava, R., et al. “Changes in medical errors after implementation of a handoff program.” New England Journal of Medicine 371(19):1803-1812. http://www.nejm.org/doi/pdf/10.1056/NEJMsa1405556

Causes of Medical Errors 1.* Volpp, K.G.M., Grande, D. “Residents’ suggestions for reducing errors in teaching hospitals.” New England Journal of Medicine

348(9):851-855, 2003. http://www.nejm.org/doi/pdf/10.1056/NEJMsb021667 2.* Couse-Baker, R. “Even a doctor can’t keep his father safe in the hospital.” Cognoscenti, April 5, 2013.

http://cognoscenti.wbur.org/2013/04/05/medical-errors-ashish-jha 3. Sun, L.H. “’Alarm fatigue’ leads hospital caregivers to ignore beeps, posing risks for patients.” Bangor Daily News, July 23, 2013.

http://bangordailynews.com/2013/07/08/health/alarm-fatigue-leads-hospital-caregivers-to-ignore-beeps-posing-risks-for-patients/ 4. Richtel, M. “As doctors use more devices, potential for distraction grows.” New York Times, December 15, 2011, p. A.1.

http://www.nytimes.com/2011/12/15/health/as-doctors-use-more-devices-potential-for-distraction-grows.html?pagewanted=all&_r=0

5. Robertson, J. “Digital health records’ risks emerge as deaths blamed on systems.” Bloomberg, June 25, 2013. http://www.bloomberg.com/news/2013-06-25/digital-health-records-risks-emerge-as-deaths-blamed-on-systems.html

6. Smith, K. “For doctors, too much information.” Politico, March 5, 2013. http://www.politico.com/story/2013/03/electronic-alert-glut-overloads-doctors-88394.html

7. Welch, J.R. “As she lay dying: How I fought to stop medical errors from killing my mom.” Health Affairs 31(12):2817-2820, 2012. http://content.healthaffairs.org/content/31/12/2817.full.pdf+html

http://www.kaiserhealthnews.org/stories/2013/may/07/doctor-errors-misdiagnosis-more-common-than-known-serious-impact.aspxhttp://www.kaiserhealthnews.org/stories/2013/may/07/doctor-errors-misdiagnosis-more-common-than-known-serious-impact.aspxhttp://www.propublica.org/article/were-still-not-tracking-patient-harmhttp://www.propublica.org/article/were-still-not-tracking-patient-harmhttp://content.healthaffairs.org/content/30/4/596.full.pdf+htmlhttp://www.bloomberg.com/news/2011-04-07/hospital-errors-occur-10-times-more-than-reported-study-finds.htmlhttp://www.propublica.org/article/why-cant-medicine-seem-to-fix-simple-mistakeshttp://www.nytimes.com/2013/02/20/opinion/losing-my-leg-to-a-medical-error.html?smid=pl-share&_r=0http://archinte.jamanetwork.com/article.aspx?articleID=1733452http://www.latimes.com/local/lanow/la-me-ln-boxer-hospital-errors-20140425-story.htmlhttp://search.proquest.com/docview/1521893302/fulltext/E15539BC35254636PQ/1?accountid=14586http://search.proquest.com/docview/1510343620/fulltext/B9D98808BC034F5APQ/2?accountid=14586http://www.reuters.com/article/2014/03/27/us-hospitals-ratings-idUSBREA2Q0NC20140327http://consumer.healthday.com/general-health-information-16/injury-health-news-413/1-in-5-medicare-patients-injured-because-of-their-medical-care-688223.htmlhttp://consumer.healthday.com/general-health-information-16/injury-health-news-413/1-in-5-medicare-patients-injured-because-of-their-medical-care-688223.htmlhttp://www.nejm.org/doi/pdf/10.1056/NEJMsa1405556http://www.nejm.org/doi/pdf/10.1056/NEJMsb021667http://cognoscenti.wbur.org/2013/04/05/medical-errors-ashish-jhahttp://bangordailynews.com/2013/07/08/health/alarm-fatigue-leads-hospital-caregivers-to-ignore-beeps-posing-risks-for-patients/http://www.nytimes.com/2011/12/15/health/as-doctors-use-more-devices-potential-for-distraction-grows.html?pagewanted=all&_r=0http://www.nytimes.com/2011/12/15/health/as-doctors-use-more-devices-potential-for-distraction-grows.html?pagewanted=all&_r=0http://www.bloomberg.com/news/2013-06-25/digital-health-records-risks-emerge-as-deaths-blamed-on-systems.htmlhttp://www.politico.com/story/2013/03/electronic-alert-glut-overloads-doctors-88394.htmlhttp://www.politico.com/story/2013/03/electronic-alert-glut-overloads-doctors-88394.htmlhttp://content.healthaffairs.org/content/31/12/2817.full.pdf+html

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8. Sun, L.H. “Hospital antibiotic use can put patients at risk, study says.” The Washington Post, March 4, 2014. http://search.proquest.com/docview/1504030034/fulltext/BF4E6C58E6474034PQ/1?accountid=14586

Proposals and Interventions Aimed at Reducing Reduce Medical Errors 1.* Gawande, T. “The Checklist.” New Yorker, 83(39):86-95, December 10, 2007.

http://www.newyorker.com/reporting/2007/12/10/071210fa_fact_gawande 2.* Shaw, G. “Researchers: CPOE averted 17.4 million medication errors in one year.” FierceHealthIT, February 22, 2013.

http://www.fiercehealthit.com/story/researchers-cpoe-averted-174-million-medication-errors-one-year/2013-02-22 3.* Shekelle, P.G., Pronovost, P.J., Wachter, R.M., et al. “The top patient safety strategies that can be encouraged for adoption

now.” Annals of Internal Medicine 158(5-Part 2):365-368, 2013. http://annals.org/issue.aspx?journalid=90&issueID=926462&direction=P

4. Millenson, M.L. “Analysis: Is a new federal patient safety effort doing enough to curb medical errors?” Kaiser Health News, February 22, 2012. http://www.kaiserhealthnews.org/stories/2012/february/23/millenson-hens.aspx

5. Hartocollis, A. “With money at risk, hospitals push staff to wash hands.” The New York Times, May 28, 2013. http://www.nytimes.com/2013/05/29/nyregion/hospitals-struggle-to-get-workers-to-wash-their-hands.html?_r=0

6. Ofri, D. “Ashamed to admit it: Owning up to medical error.” Health Affairs 29(8):1549-1551, 2010. http://content.healthaffairs.org/content/31/12/2817.full.pdf+html

7. Clark, C. “It’s impossible to know what $1B in federal quality spending buys.” HealthLeaders Media, February 20, 2014. http://www.healthleadersmedia.com/page-1/QUA-301234/Its-Impossible-to-Know-What-1B-in-Federal-Quality-Spending-Buys##

Care Coordination and Communication Issues 1.* Schoen, C., Osborn, R., Squires, D., Doty, M., Pierson, R., Applebaum, S. “New 2011 survey of patients with complex care

needs in eleven countries finds that care is often poorly coordinated.” Health Affairs 30(12):2437-2448, 2011. http://content.healthaffairs.org/content/30/12/2437.full.pdf+html

2. Pham, H.H., Grossman, J.M., Cohen, G., Bodenheimer, T. “Hospitalists and care transitions: The divorce of inpatient and outpatient care.” Health Affairs 27(5):1315-1327, 2008. http://content.healthaffairs.org/content/27/5/1315.full.pdf+html

3. Levinson, W., Pizzo, P.A. “Patient-physician communication. It’s about time.” Journal of the American Medical Association 305(17):1802-1803, 2011. http://jama.jamanetwork.com/Issue.aspx?journalid=67&issueID=20327&direction=P

How Patients Experience the Health Care System 1.* Jauhar, S. “Referral system turns patients into commodities.” The New York Times, May 26, 2009, p.D.5.

http://www.nytimes.com/2009/05/26/health/26essa.html?scp=12&sq=health%20care&st=cse 2. Blendon, R.J., Buhr, T., Cassidy, E.F., Perez, D.J., Sussman, T., Benson, J.M., et al. “Disparities in physician care: Experiences

and perceptions of a multi-ethnic America. Health Affairs 27(2):507-517, 2008. http://content.healthaffairs.org/content/27/2/507.full.pdf+html

3. Dimick, J., Ruhter, J., Sarrazin, M.V., Birkmeyer, J.D. “Black patients more likely than Whites to undergo surgery at low-quality hospitals in segregated regions.” Health Affairs 32(6):1046-1053, 2013. http://content.healthaffairs.org/content/32/6/1046.full.pdf+html

4. Colwill, J.M. “A case of ‘medical homelessness’.” Health Affairs 29(5):1067-1070, 2010. http://content.healthaffairs.org/content/29/5/1067.full.pdf+html

5. Mayer, M.L. “On being a ‘difficult’ patient.” Health Affairs 27(5):1416-1421, 2008. http://content.healthaffairs.org/content/27/5/1416.full.pdf+html

6. Hiltzik, M. “The U.S. healthcare system: Worst in the developed world.” The Los Angeles Times, June 17, 2014. http://www.latimes.com/business/hiltzik/la-fi-mh-the-us-healthcare-system-20140617-column.html

Access to Care 1.* Galewitz, P. “Health care increasingly out of reach for millions of Americans.” Kaiser Health News, May 7, 2012.

http://www.kaiserhealthnews.org/stories/2012/may/07/health-affairs-care-increasingly-out-of-reach-for-millions.aspx 2. Pecquet, J. “Report: Americans still struggling with medical debt.” The Hill, March 7, 2012.

http://thehill.com/blogs/healthwatch/health-insurance/214759-report-americans-still-struggling-with-medical-debt 3. Kenney, G.M., McMorrow, S., Zuckerman, S., Goin, D.E. “A decade of health care access declines for adults hold implications

for changes in the Affordable Care Act.” Health Affairs 31(5):899-908, 2012. http://content.healthaffairs.org/content/31/5/899.full.pdf+html

4. Rosenthal, E. “The health care waiting game.” The New York Times, July 5, 2014. http://search.proquest.com/docview/1543264717/fulltext/FADD4A64271D46B6PQ/1?accountid=14586

Quality of Care Not Enough?

1. Maugh, T.H. “Nearly 70,000 Americans die needlessly each year because they are not given optimal heart failure therapy.” June 6, 2011. http://www.latimes.com/health/boostershots/la-heb-heart-failure-06062011,0,4047246.story?track=rss

2. Reuters. “Cardiac arrest survival improving in U.S. hospitals: Study.” July 16, 2012. http://www.reuters.com/article/2012/07/17/us-heart-idUSBRE86G01F20120717

3. HealthDay. “Many lacked preventive care before health reform law: U.S. report.” June 14, 2012. http://consumer.healthday.com/Article.asp?AID=665762

http://search.proquest.com/docview/1504030034/fulltext/BF4E6C58E6474034PQ/1?accountid=14586http://www.newyorker.com/reporting/2007/12/10/071210fa_fact_gawandehttp://www.fiercehealthit.com/story/researchers-cpoe-averted-174-million-medication-errors-one-year/2013-02-22http://annals.org/issue.aspx?journalid=90&issueID=926462&direction=Phttp://www.kaiserhealthnews.org/stories/2012/february/23/millenson-hens.aspxhttp://www.nytimes.com/2013/05/29/nyregion/hospitals-struggle-to-get-workers-to-wash-their-hands.html?_r=0http://content.healthaffairs.org/content/31/12/2817.full.pdf+htmlhttp://www.healthleadersmedia.com/page-1/QUA-301234/Its-Impossible-to-Know-What-1B-in-Federal-Quality-Spending-Buyshttp://content.healthaffairs.org/content/30/12/2437.full.pdf+htmlhttp://content.healthaffairs.org/content/27/5/1315.full.pdf+htmlhttp://jama.jamanetwork.com/Issue.aspx?journalid=67&issueID=20327&direction=Phttp://www.nytimes.com/2009/05/26/health/26essa.html?scp=12&sq=health%20care&st=csehttp://content.healthaffairs.org/content/27/2/507.full.pdf+htmlhttp://content.healthaffairs.org/content/32/6/1046.full.pdf+htmlhttp://content.healthaffairs.org/content/29/5/1067.full.pdf+htmlhttp://content.healthaffairs.org/content/27/5/1416.full.pdf+htmlhttp://www.latimes.com/business/hiltzik/la-fi-mh-the-us-healthcare-system-20140617-column.htmlhttp://www.kaiserhealthnews.org/stories/2012/may/07/health-affairs-care-increasingly-out-of-reach-for-millions.aspxhttp://thehill.com/blogs/healthwatch/health-insurance/214759-report-americans-still-struggling-with-medical-debthttp://content.healthaffairs.org/content/31/5/899.full.pdf+htmlhttp://search.proquest.com/docview/1543264717/fulltext/FADD4A64271D46B6PQ/1?accountid=14586http://www.latimes.com/health/boostershots/la-heb-heart-failure-06062011,0,4047246.story?track=rsshttp://www.reuters.com/article/2012/07/17/us-heart-idUSBRE86G01F20120717http://consumer.healthday.com/Article.asp?AID=665762

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4. Mohammed, K.A., Bullard, K.M., Saaddine, J.B., Cowie, C.C., Imperatore, G., Gregg, E.W. “Achievement of goals in U.S. diabetes care, 1999-2010.” The New England Journal of Medicine, 2013;368(17):1613-1624. http://www.nejm.org/doi/pdf/10.1056/NEJMsa1213829

5. Weintraub, K. “1 and 20 adult outpatients misdiagnosed, study reports.” The Boston Globe, April 16, 2014. http://search.proquest.com/docview/1517862010/fulltext/C2F1E953A7794EAAPQ/1?accountid=14586

Too Much Care? 1.* PR Newswire. “U.S. physician groups identify commonly used tests or procedures they say are often not necessary.” April 4,

2012. http://www.prnewswire.com/news-releases/us-physician-groups-identify-commonly-used-tests-or-procedures-they-say-are-often-not-necessary-146046345.html

2. Abelson, R., Creswell, J. “Hospital chain inquiry cited unnecessary cardiac work.” New York Times online, August 6, 2012. http://www.nytimes.com/2012/08/07/business/hospital-chain-internal-reports-found-dubious-cardiac-work.html?pagewanted=all

3. Brownlee, S., Saini, V., Cassel, C. “When less is more: Issues of overuse health care.” Health Affairs, April 25, 2014. http://healthaffairs.org/blog/2014/04/25/when-less-is-more-issues-of-overuse-in-health-care/

4. Chassin, M.R. “Improving the quality of health care: What’s taking so long?” Health Affairs 32(10):1761-1765, 2013. http://content.healthaffairs.org/content/32/10/1761.full.pdf+html

Further Readings 1. Commins, J. “Diagnostic errors common, costly, and harmful.” HealthLeaders Media, April 23, 2013.

http://www.healthleadersmedia.com/page-1/QUA-291407/Diagnostic-Errors-Common-Costly-and-Harmful## 2. Kennedy, K. “HHS: Hospitals ignoring requirements to report errors.” USA Today online, July 20, 2012.

http://www.usatoday.com/news/health/story/2012-07-19/hospitals-preventable-errors-report/56343348/1 3. Lerner, M. “In new safety test, not all Minnesota hospitals earn A: National report card rates 38 state hospitals for patient safety.”

Star Tribune, June 7, 2012, p. B3. http://www.startribune.com/lifestyle/health/157309745.html 4. O’Connell, K. “Two arms, two choices: If only I’d known then what I know now.” Health Affairs 31(8):1895-1899, 2012.

http://content.healthaffairs.org/content/31/8/1895.full.pdf+html 5. Welch, H.G. “Testing what we think we know.” New York Times online, August 19, 2012.

http://www.nytimes.com/2012/08/20/opinion/testing-standard-medical-practices.html 6. Pryor, D., Hendrich, A., Henkel, R.J., Beckmann, J.K., Tersigni, A.R. “The quality ‘journey’ at Ascension Health: How we’ve

prevented at least 1,500 avoidable deaths a year — and aim to do even better.” Health Affairs 30(4):604-611, 2011. http://content.healthaffairs.org/content/30/4/604.full.pdf+html

7. Crosby, J. “Getting it right (or left); Wrong-site surgeries continue to plague hospitals, but a new campaign hopes to ensure everyone takes a “timeout” before surgery.” Star Tribune, June 20, 2011, p. D.1. http://www.highbeam.com/doc/1G1-259321876.html

8. McCoy, J. “7 medical error disclosure deterrents.” HealthLeaders Media, February 9, 2011. http://www.healthleadersmedia.com/content/PHY-260817/7-Medical-Error-Disclosure-Deterrents.html

9. Moisse, K. “HHS announces partnership for patients to save lives, money.” abc News, April 12, 2011. http://abcnews.go.com/Health/Wellness/hospital-safety-government-industry-team-reduce-errors/story?id=13355460

10. Terry, T. “Electronic prescriptions have as many errors as written prescriptions.” FierceHealthIT, June 30, 2011. http://www.fiercehealthit.com/story/prescription-errors-equal-whether-written-or-electronic/2011-06-30

11. Metzger, J., Welebob, E., Bates, D.W., Lipsitz, S., Classen, D.C. “Mixed results in the safety performance of computerized physician order entry.” Health Affairs 29(4):655-663, 2010. http://content.healthaffairs.org/content/29/4/655.full.pdf+html

12. Szabo, L. “Studies: Surgeons could save lives, $20B by using checklist.” USA Today, January 14, 2009. http://www.usatoday.com/news/health/2009-01-14-surgery-checklist_N.htm

13. Garbutt, J., Waterman, A.D., Kapp, J.M., Dunagan, W.C., Levinson, W., Fraser, V., Gallagher, T.H. “Lost opportunities: How physicians communicate about medical errors.” Health Affairs 27(1):246-255, 2008. http://content.healthaffairs.org/content/27/1/246.full.pdf+html

14. Koppel, R., Wetterneck, T., Telles, J.L., Karsh, B-T. “Workarounds to barcode medication administration systems: Their occurrences, causes, and threats to patient safety.” Journal of the American Medical Informatics Association 15(4):408-423, 2008. http://www.sciencedirect.com/science/journal/10675027/15/4

15. Buerhaus, P.I. “Is hospital patient care becoming safer? A conversation with Lucian Leape.” Health Affairs – Web Exclusive 26(6):w687-w696, published online October 9, 2007. http://content.healthaffairs.org/content/26/6/w687.full.pdf+html

16. Leape, L. “Reporting of adverse events.” New England Journal of Medicine 347(20):1633-1638, 2002. http://www.nejm.org/doi/pdf/10.1056/NEJMNEJMhpr011493

17. Kaiser Health News. “Race Plays Role in Diagnosis and Treatment.” July 24, 2009. http://www.kaiserhealthnews.org/daily-reports/2009/july/24/racial-disparities.aspx?referrer=search

18. Ofri, D. “My near miss.” The New York Times, May 28, 2013. http://www.nytimes.com/2013/05/29/opinion/addressing-medical-errors.html

19. Johnson, C.K. “Poor infection control at many surgery centers.” MSNBC, June 8, 2010. http://www.msnbc.msn.com/id/37577363

http://www.nejm.org/doi/pdf/10.1056/NEJMsa1213829http://search.proquest.com/docview/1517862010/fulltext/C2F1E953A7794EAAPQ/1?accountid=14586http://www.prnewswire.com/news-releases/us-physician-groups-identify-commonly-used-tests-or-procedures-they-say-are-often-not-necessary-146046345.htmlhttp://www.prnewswire.com/news-releases/us-physician-groups-identify-commonly-used-tests-or-procedures-they-say-are-often-not-necessary-146046345.htmlhttp://www.nytimes.com/2012/08/07/business/hospital-chain-internal-reports-found-dubious-cardiac-work.html?pagewanted=allhttp://healthaffairs.org/blog/2014/04/25/when-less-is-more-issues-of-overuse-in-health-care/http://content.healthaffairs.org/content/32/10/1761.full.pdf+htmlhttp://www.healthleadersmedia.com/page-1/QUA-291407/Diagnostic-Errors-Common-Costly-and-Harmfulhttp://www.usatoday.com/news/health/story/2012-07-19/hospitals-preventable-errors-report/56343348/1http://www.startribune.com/lifestyle/health/157309745.htmlhttp://content.healthaffairs.org/content/31/8/1895.full.pdf+htmlhttp://www.nytimes.com/2012/08/20/opinion/testing-standard-medical-practices.htmlhttp://content.healthaffairs.org/content/30/4/604.full.pdf+htmlhttp://www.highbeam.com/doc/1G1-259321876.htmlhttp://www.highbeam.com/doc/1G1-259321876.htmlhttp://www.healthleadersmedia.com/content/PHY-260817/7-Medical-Error-Disclosure-Deterrents.htmlhttp://abcnews.go.com/Health/Wellness/hospital-safety-government-industry-team-reduce-errors/story?id=13355460http://www.fiercehealthit.com/story/prescription-errors-equal-whether-written-or-electronic/2011-06-30http://content.healthaffairs.org/content/29/4/655.full.pdf+htmlhttp://www.usatoday.com/news/health/2009-01-14-surgery-checklist_N.htmhttp://content.healthaffairs.org/content/27/1/246.full.pdf+htmlhttp://www.sciencedirect.com/science/journal/10675027/15/4http://content.healthaffairs.org/content/26/6/w687.full.pdf+htmlhttp://www.nejm.org/doi/pdf/10.1056/NEJMNEJMhpr011493http://www.kaiserhealthnews.org/daily-reports/2009/july/24/racial-disparities.aspx?referrer=searchhttp://www.kaiserhealthnews.org/daily-reports/2009/july/24/racial-disparities.aspx?referrer=searchhttp://www.nytimes.com/2013/05/29/opinion/addressing-medical-errors.htmlhttp://www.nytimes.com/2013/05/29/opinion/addressing-medical-errors.htmlhttp://www.msnbc.msn.com/id/37577363

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20. Sittig, D.F., Singh, H. “Defining health information technology—related errors.” Archives of Internal Medicine 171(14):1281-1284, 2011. http://archinte.jamanetwork.com/Issue.aspx?journalid=71&issueID=22519&direction=P

21. Harris, G. “U.S. inaction lets look-alike tubes kill patients.” The New York Times, August 20, 2010. http://www.nytimes.com/2010/08/21/health/policy/21tubes.html?pagewanted=all

22. Schiff, G.D. “Medical error. A 60-year-old man with delayed care for a renal mass.” Journal of the American Medical Association 305(18):1890-1898, 2011. http://jama.jamanetwork.com/Issue.aspx?journalid=67&issueID=20328&direction=P

23. Ledger, K. “Safety first. How anesthesiologists launched the patient-safety movement.” Minnesota Medicine, March 2011. http://www.minnesotamedicine.com/PastIssues/PastIssues2011/March2011/SafetyFirst.aspxes

24. Drolet, B.C., Khokhar, M.T., Fischer, S.A. “The 2011 duty-hour requirement — a survey of residence program directors.” The New England Journal of Medicine 368(8):694-697, 2013. http://www.nejm.org/doi/pdf/10.1056/NEJMp1214483

25. HealthDay. “Fewer U.S. patients getting weight counseling from doctors.” U.S. News, January 10, 2013. http://health.usnews.com/health-news/news/articles/2013/01/10/fewer-us-patients-getting-weight-counseling-from-doctors

26. Roy, A. “The Commonwealth Fund rags on U.S. health care.” National Review, June 27, 2010. http://www.nationalreview.com/agenda/230340/commonwealth-fund-rags-u-s-health-care/avik-roy#!

27. Hiatt, K. “9 warning signs of bad care.” US News, February 26, 2013. http://health.usnews.com/health-news/best-nursing-homes/articles/2013/02/26/9-warning-signs-of-bad-care

Care Delivery

Lesson 2 – January 19-25, 2015 A Macro View of Physician Supply: Do We Have Enough Physicians Now? Will We Need More in the Future? Group Assignment 1

Learning Objectives Students should be able to:

1. Explain the limitations of the present medical education system in expanding physician supply. 2. Discuss ongoing changes in the way that physicians organize and practice medicine. 3. Discuss the points of controversy regarding the prediction of future shortages or surpluses in physician supply in America. 4. Discuss the public policy issues regarding expanding physician supply.

Suggested Readings Physician Education

1.* Saxton, J. “The medical education of physicians.” Background Paper No. 73, National Health Policy Forum. February 17, 2010. http://www.nhpf.org/library/background-papers/BP73_MedicalEducation_02-17-10.pdf

2.* Iglehart, J.K. “The residency mismatch.” The New England Journal of Medicine 369(4):297-299, 2013. http://www.nejm.org/doi/full/10.1056/NEJMp1306445

3.* Wilensky, G. “The challenges of reforming graduate medical education payments.” JAMA Forum, October 2, 2014. http://newsatjama.jama.com/2014/10/02/jama-forum-the-challenges-of-reforming-graduate-medical-education-payments/

4.* Reinhardt, U.E. “The teaching of future doctors doesn’t necessarily deserve your tax dollars.” The New York Times, August 22, 2014. http://www.nytimes.com/2014/08/23/upshot/the-teaching-of-future-doctors-doesnt-necessarily-deserve-your-tax-dollars.html?_r=0

5.* Ofri, D. “The third year of medical school turns students from altruistic to bitter.” Slate, June 4, 2013. http://www.slate.com/articles/health_and_science/medical_examiner/2013/06/medical_school_dark_side_the_third_year_makes_students_less_empathetic.html

6. Dower, C. “Graduate medical education. A debate continues over the size and scope of federal subsidies to support residency training of the nation’s physicians.” Health Affairs Policy Brief, August 16, 2012. http://healthaffairs.org/healthpolicybriefs/brief_pdfs/healthpolicybrief_73.pdf

7. Iglehart, J.K. “Financing graduate medical education – mounting pressure for reform.” New England Journal of Medicine 366(17):1562-1563, 2012. http://www.nejm.org/doi/pdf/10.1056/NEJMp1114236

8. Cohen, J. “New med school aims to train primary care docs.” Kaiser Health News, April 2, 2013. http://www.kaiserhealthnews.org/stories/2013/april/02/quinnipiac-medical-school-primary-care.aspx

9. Sack, K. “Summer of work exposes medical students to system’s ills.” The New York Times, September 9, 2009. http://www.nytimes.com/2009/09/09/health/policy/09medschool.html?_r=0

10. Crosson, F.J., Leu, J., Roemer, B.M., Ross, M.N. “Gaps in residency training should be addressed to better prepare doctors for a twenty-first century delivery system.” Health Affairs 30(11):2142-2148, 2011. http://content.healthaffairs.org/content/30/11/2142.full.pdf+html

http://archinte.jamanetwork.com/Issue.aspx?journalid=71&issueID=22519&direction=Phttp://www.nytimes.com/2010/08/21/health/policy/21tubes.html?pagewanted=allhttp://jama.jamanetwork.com/Issue.aspx?journalid=67&issueID=20328&direction=Phttp://www.minnesotamedicine.com/PastIssues/PastIssues2011/March2011/SafetyFirst.aspxeshttp://www.nejm.org/doi/pdf/10.1056/NEJMp1214483http://health.usnews.com/health-news/news/articles/2013/01/10/fewer-us-patients-getting-weight-counseling-from-doctorshttp://www.nationalreview.com/agenda/230340/commonwealth-fund-rags-u-s-health-care/avik-royhttp://health.usnews.com/health-news/best-nursing-homes/articles/2013/02/26/9-warning-signs-of-bad-carehttp://health.usnews.com/health-news/best-nursing-homes/articles/2013/02/26/9-warning-signs-of-bad-carehttp://www.nhpf.org/library/background-papers/BP73_MedicalEducation_02-17-10.pdfhttp://www.nejm.org/doi/full/10.1056/NEJMp1306445http://newsatjama.jama.com/2014/10/02/jama-forum-the-challenges-of-reforming-graduate-medical-education-payments/http://www.nytimes.com/2014/08/23/upshot/the-teaching-of-future-doctors-doesnt-necessarily-deserve-your-tax-dollars.html?_r=0http://www.nytimes.com/2014/08/23/upshot/the-teaching-of-future-doctors-doesnt-necessarily-deserve-your-tax-dollars.html?_r=0http://www.slate.com/articles/health_and_science/medical_examiner/2013/06/medical_school_dark_side_the_third_year_makes_students_less_empathetic.htmlhttp://www.slate.com/articles/health_and_science/medical_examiner/2013/06/medical_school_dark_side_the_third_year_makes_students_less_empathetic.htmlhttp://healthaffairs.org/healthpolicybriefs/brief_pdfs/healthpolicybrief_73.pdfhttp://www.nejm.org/doi/pdf/10.1056/NEJMp1114236http://www.kaiserhealthnews.org/stories/2013/april/02/quinnipiac-medical-school-primary-care.aspxhttp://www.nytimes.com/2009/09/09/health/policy/09medschool.html?_r=0http://content.healthaffairs.org/content/30/11/2142.full.pdf+html

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11. Hartman, B. “The 3 year medical school: Is shorter good enough?” MedPage Today, September 16, 2013. http://www.medpagetoday.com/PublicHealthPolicy/MedicalEducation/41651

12. Hoekzema, G. “Graduate education for primary care physicians.” Health Affairs 33(6):1102, 2014. http://content.healthaffairs.org/content/33/6/1102.1.full.pdf+html

13. Shannon, S.C., Buser, B.R., Hahn, M.B. “Graduate medical education: The authors reply.” Health Affairs 33(6):1102, 2014, http://content.healthaffairs.org/content/33/6/1102.2.full.pdf+html

14. Chandra, A., Khullar, D., Wilensky, G.R. “The economics of graduate medical education.” The New England Journal of Medicine 370:2357-2360, 2014. http://www.nejm.org/doi/pdf/10.1056/NEJMp1402468

15. Chen, P.W. “Are med school grads prepared to practice medicine?” The New York Times, April 24, 2014. http://www.lexisnexis.com/lnacui2api/api/version1/getDocCui?lni=5C26-84H1-DY2M-W3KW&csi=379740&hl=t&hv=t&hnsd=f&hns=t&hgn=t&oc=00240&perma=true

16. Wickline, S. “Biggest match day yet.” MedPage Today, March 21, 2014. http://www.medpagetoday.com/PublicHealthPolicy/GeneralProfessionalIssues/44866

17. Garg, M., Drolet, B.C., Tammaro, D., Fischer, S.A. “Resident duty hours: A survey of internal medicine program directors.” Journal of General Internal Medicine 29(10):1349-1354, 2014. http://download.springer.com/static/pdf/986/art%253A10.1007%252Fs11606-014-2912-z.pdf?auth66=1414697673_3e554a5e7a9e73ff8f3b982debc8b51c&ext=.pdf

Physician Concerns 1.* Goodnough, A. “New law’s demands on doctors have many seeking a network.” The New York Times, March 2, 2014.

http://search.proquest.com/docview/1503511347/fulltext/FF55492CC4D94464PQ/1?accountid=14586 2.* Pollack, A. “Cost of treatment may influence doctors.” The New York Times, April 17, 2014.

http://www.nytimes.com/2014/04/18/business/treatment-cost-could-influence-doctors-advice.html 3. Cortez, M.F. “Pay gap for women doctors increases to $50,000 a year.” Bloomberg, September 2, 2013.

http://www.bloomberg.com/news/2013-09-02/pay-gap-for-women-doctors-increases-to-50-000-a-year.html 4. Bornstein, D. “Medicine’s search for meaning.” The New York Times, September 18, 2013.

http://opinionator.blogs.nytimes.com/2013/09/18/medicines-search-for-meaning/ 5. Pearl, R. “Medicine is an art, not a science: Medical myth or reality.” Forbes, June 12, 2014.

http://www.forbes.com/sites/robertpearl/2014/06/12/medicine-is-an-art-not-a-science-medical-myth-or-reality/ 6. Pho, K. “Doctors are not overpaid: Column.” USA Today, July 2, 2014.

http://www.usatoday.com/story/opinion/2014/07/02/doctors-salaries-health-care-costs-physician-column/12113999/ 7. Rosenthal, E. “Medicine’s top earners are not the M.D.s.” The New York Times, May 17, 2014.

http://www.nytimes.com/2014/05/18/sunday-review/doctors-salaries-are-not-the-big-cost.html?_r=0 8. Tobey, P. “Doctors still make good money.” The Washington Post, April 18, 2014.

http://www.washingtonpost.com/news/morning-mix/wp/2014/04/18/doctors-still-make-good-money/ 9. Blendon, R.J., Benson, J.M., Hero, J.O. “Public trust in physicians — U.S. medicine in international perspective.” New England

Journal of Medicine 371(17):1570-1572, 2014. http://www.nejm.org/doi/pdf/10.1056/NEJMp1407373 Challenges to Traditional Physician Practice

1.* Ringel, S.P. “Practicing medicine versus pushing paper. A neurologist reflects on the realities of his workday after a patient asks why doctors complain about payers’ bureaucratic oversight.” Health Affairs 30(6):1200-1202, 2011. http://content.healthaffairs.org/content/30/6/1200.full.pdf+html

2.* Gamble, M. “68% of graduating physicians want sign-on bonus, 29% want hospital practice.” Becker’s Hospital Review, August 16, 2012. http://www.beckershospitalreview.com/hospital-physician-relationships/68-of-graduating-physicians-want-sign-on-bonus-29-want-hospital-practice.html

3.* Bernstein, L. “How many patients should your doctor see each day?” The Washington Post May 22, 2014. http://search.proquest.com/docview/1527270597/fulltext/FC95ED13FDFF42E4PQ/1?accountid=14586

4. Morra, D., Nicholson, S., Levinson, W., Gans, D.N., Hammons, T., Casalino, L.P. “US Physician practices versus Canadians: Spending nearly four times as much money interacting with payers.” Health Affairs 30(8):1443-1450, 2011. http://content.healthaffairs.org/content/30/8/1443.full.pdf+html

5. Yeh, C. “’Nothing is broken’: For an injured doctor, quality-focused care misses the mark.” Health Affairs 33(6):1094-1097, 2014. http://content.healthaffairs.org/content/33/6.toc

6. Reschovsky, J. “Does location determine medical practice patterns?” Virtual Mentor 16(2):138-141, 2014. http://virtualmentor.ama-assn.org/2014/02/pdf/oped1-1402.pdf

7. Hethcock, B. “Physician turnover rises as hospitals employ more docs.” Dallas Business Journal, March 17, 2014. http://www.bizjournals.com/dallas/news/2014/03/17/physician-turnover-rises-as-hospitals-employ-more.html?page=all

8. Bastian, L.A. “Evolution of hospital medicine and the impact of residents’ career choices.” Journal of General Internal Medicine 29(7):971-972, 2014. http://link.springer.com/journal/11606/29/7/page/1

9. Beck, M. “AMA urges overhaul of electronic medical records.” Wall Street Journal, September 16, 2014. http://online.wsj.com/articles/ama-urges-overhaul-of-electronic-records-1410840063

http://www.medpagetoday.com/PublicHealthPolicy/MedicalEducation/41651http://content.healthaffairs.org/content/33/6/1102.1.full.pdf+htmlhttp://content.healthaffairs.org/content/33/6/1102.2.full.pdf+htmlhttp://www.nejm.org/doi/pdf/10.1056/NEJMp1402468http://www.lexisnexis.com/lnacui2api/api/version1/getDocCui?lni=5C26-84H1-DY2M-W3KW&csi=379740&hl=t&hv=t&hnsd=f&hns=t&hgn=t&oc=00240&perma=truehttp://www.lexisnexis.com/lnacui2api/api/version1/getDocCui?lni=5C26-84H1-DY2M-W3KW&csi=379740&hl=t&hv=t&hnsd=f&hns=t&hgn=t&oc=00240&perma=truehttp://www.medpagetoday.com/PublicHealthPolicy/GeneralProfessionalIssues/44866http://download.springer.com/static/pdf/986/art%253A10.1007%252Fs11606-014-2912-z.pdf?auth66=1414697673_3e554a5e7a9e73ff8f3b982debc8b51c&ext=.pdfhttp://download.springer.com/static/pdf/986/art%253A10.1007%252Fs11606-014-2912-z.pdf?auth66=1414697673_3e554a5e7a9e73ff8f3b982debc8b51c&ext=.pdfhttp://search.proquest.com/docview/1503511347/fulltext/FF55492CC4D94464PQ/1?accountid=14586http://www.nytimes.com/2014/04/18/business/treatment-cost-could-influence-doctors-advice.htmlhttp://www.bloomberg.com/news/2013-09-02/pay-gap-for-women-doctors-increases-to-50-000-a-year.htmlhttp://opinionator.blogs.nytimes.com/2013/09/18/medicines-search-for-meaning/http://www.forbes.com/sites/robertpearl/2014/06/12/medicine-is-an-art-not-a-science-medical-myth-or-reality/http://www.usatoday.com/story/opinion/2014/07/02/doctors-salaries-health-care-costs-physician-column/12113999/http://www.nytimes.com/2014/05/18/sunday-review/doctors-salaries-are-not-the-big-cost.html?_r=0http://www.washingtonpost.com/news/morning-mix/wp/2014/04/18/doctors-still-make-good-money/http://www.nejm.org/doi/pdf/10.1056/NEJMp1407373http://content.healthaffairs.org/content/30/6/1200.full.pdf+htmlhttp://www.beckershospitalreview.com/hospital-physician-relationships/68-of-graduating-physicians-want-sign-on-bonus-29-want-hospital-practice.htmlhttp://www.beckershospitalreview.com/hospital-physician-relationships/68-of-graduating-physicians-want-sign-on-bonus-29-want-hospital-practice.htmlhttp://search.proquest.com/docview/1527270597/fulltext/FC95ED13FDFF42E4PQ/1?accountid=14586http://content.healthaffairs.org/content/30/8/1443.full.pdf+htmlhttp://content.healthaffairs.org/content/33/6.tochttp://virtualmentor.ama-assn.org/2014/02/pdf/oped1-1402.pdfhttp://www.bizjournals.com/dallas/news/2014/03/17/physician-turnover-rises-as-hospitals-employ-more.html?page=allhttp://link.springer.com/journal/11606/29/7/page/1http://online.wsj.com/articles/ama-urges-overhaul-of-electronic-records-1410840063

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10. Kravitz, R.L. “Physician incomes in the twenty-first century: Time for a new social contract.” Journal of General Internal Medicine 29(11):1425-1426, 2014. http://download.springer.com/static/pdf/383/art%253A10.1007%252Fs11606-014-3012-9.pdf?auth66=1414697546_e0d9409c0b62fd00923606c4b03a3dce&ext=.pdf

Physician Supply Projections 1.* KaiserEDU.org. “Primary care shortage; Background brief.”

http://www.wcl.american.edu/secle/materials/Fall_2012/Next_Steps_in_Health_Reform/TAB%2012.Background-Brief.pdf 2.* Gordon, E. “Primary care shortage? Not for the insured, study shows.” Kaiser Health News, April 8, 2014.

http://capsules.kaiserhealthnews.org/index.php/2014/04/primary-care-shortage-not-for-the-insured-study-shows/ 3. Iglehart, J.K. “Grassroots activism and the pursuit of an expanded physician supply.” New England Journal of Medicine

358(16):1741-1749, 2008. http://www.nejm.org/doi/pdf/10.1056/NEJMhpr0800058 4. Dunn, L. “What will the physician workforce look like in 2030?” Becker’s Hospital Review, May 13, 2013.

http://www.beckershospitalreview.com/hospital-physician-relationships/what-will-the-physician-workforce-look-like-in-2030.html 5. Preidt, R. “Primary care doctors still in short supply in U.S.” MedlinePlus, June 14, 2013.

http://www.nlm.nih.gov/medlineplus/news/fullstory_137836.html 6. Sadick, B. “In search of more primary-care doctors.” The Wall Street Journal, November 17, 2013.

http://online.wsj.com/news/articles/SB10001424052702303902404579151510997182566 7. Krasselt, K., O’Donnell, J. “Supply won’t meet growing demand for primary care.” USA Today, June 30, 2014.

http://www.usatoday.com/story/news/politics/2014/06/29/primary-care-shortage-health/11101265/ 8. Punke, H. “5 things to know about provider dispersion in the US.” Becker’s Hospital Review, May 22, 2014.

http://www.beckershospitalreview.com/hospital-physician-relationships/5-things-to-know-about-provider-dispersion-in-the-us.html Options for Increasing Physician Supply 1.* Pardes, H., Miller, E.D. “We can’t afford to train fewer doctors.” New York Times, July 12, 2011, p. A.13.

http://online.wsj.com/article/SB10001424052702303544604576434470768158908.html 2.* Caramenico, A. “Med school enrollment growth won’t ease doc shortage.” FierceHealthcare, May 3, 2013.

http://www.fiercehealthcare.com/story/med-school-enrollment-growth-wont-ease-doc-shortage/2013-05-03 3.* McAllester, M. “America is stealing the world’s doctors.” New York Times online, March 7, 2012.

http://www.nytimes.com/2012/03/11/magazine/america-is-stealing-foreign-doctors.html?pagewanted=all 4. Editorial. “An Rx for the doctor shortage.” Los Angeles Times, April 21, 2013. http://articles.latimes.com/2013/apr/21/opinion/la-

ed-medical-professionals-20130421 5. Sanders, B. “Primary physician shortage calls for intervention.” Politico, May 7, 2013.

http://www.politico.com/story/2013/05/doctors-physician-shortage-calls-for-intervention-91024.html 6. Gold, J. “Immigrant docs help ease California’s primary care shortage.” Kaiser Health News, April 4, 2013.

http://www.kaiserhealthnews.org/stories/2013/april/04/california-doctors-primary-care-latin-america.aspx 7. Torrey, E.F., Torrey, B.B. “The US distribution of physicians from lower income countries.” PLoS One 7(3):1-4, 2012.

http://www.plosone.org/article/info:doi/10.1371/journal.pone.0033076 8. Association of American Medical Colleges. “Medical school enrollment continues to climb with new diversity gains.” October 24,

2012. https://www.aamc.org/newsroom/newsreleases/310002/121023.html 9. Rampell, C. “Path to United States practice is long slog to foreign doctors.” The New York Times, August 11, 2013.

http://www.nytimes.com/2013/08/12/business/economy/long-slog-for-foreign-doctors-to-practice-in-us.html Public Policy Issues and Concerns About Physician Supply 1.* Goozner, M. “More doctors on the way, higher costs to follow.” The Fiscal Times, May 4, 2012.

http://www.thefiscaltimes.com/Articles/2012/05/04/More-Doctors-on-the-Way-Higher-Costs-to-Follow.aspx#page1 2.* Reinhardt, U.E. “Health-care reform and the ‘doctor shortage’.” New York Times online, August 17, 2012.

http://economix.blogs.nytimes.com/2012/08/17/health-care-reform-and-the-doctor-shortage/ 3.* Reinhardt, U.E. “From physician glut to physician shortage.” The New York Times, August 31, 2012.

http://economix.blogs.nytimes.com/2012/08/31/from-physician-glut-to-physician-shortage/ 4. Lowrey, A., Pear, R. “Doctor shortage likely to worsen with health law.” New York Times, July 29, 2012, p. A.1.

http://www.nytimes.com/2012/07/29/health/policy/too-few-doctors-in-many-us-communities.html 5. Davis, K.L. “Demand for doctors soaring as cuts loom.” Politico, March 5, 2013. http://www.politico.com/story/2013/03/demand-

for-doctors-soaring-as-cuts-loom-88390.html 6. Ubel, P. “How much money should a cardiologist make?” Forbes, December 7, 2012.

http://www.forbes.com/sites/peterubel/2012/12/07/how-much-money-should-a-cardiologist-make/ 7. Robertson, K. “Legislation would speed up education for doctors.” Sacramento Business Journal, March 12, 2014.

http://www.bizjournals.com/sacramento/news/2014/03/12/calif-legis-education-doctors-accelerate.html 8. Kennedy, K. “Obama budget will seek record funding for new doctors.” USA Today, February 27, 2014.

http://www.usatoday.com/story/news/nation/2014/02/27/new-budget-proposes-record-funding-for-new-doctors/5836317/

http://download.springer.com/static/pdf/383/art%253A10.1007%252Fs11606-014-3012-9.pdf?auth66=1414697546_e0d9409c0b62fd00923606c4b03a3dce&ext=.pdfhttp://download.springer.com/static/pdf/383/art%253A10.1007%252Fs11606-014-3012-9.pdf?auth66=1414697546_e0d9409c0b62fd00923606c4b03a3dce&ext=.pdfhttp://www.wcl.american.edu/secle/materials/Fall_2012/Next_Steps_in_Health_Reform/TAB%2012.Background-Brief.pdfhttp://capsules.kaiserhealthnews.org/index.php/2014/04/primary-care-shortage-not-for-the-insured-study-shows/http://www.nejm.org/doi/pdf/10.1056/NEJMhpr0800058http://www.beckershospitalreview.com/hospital-physician-relationships/what-will-the-physician-workforce-look-like-in-2030.htmlhttp://www.nlm.nih.gov/medlineplus/news/fullstory_137836.htmlhttp://online.wsj.com/news/articles/SB10001424052702303902404579151510997182566http://www.usatoday.com/story/news/politics/2014/06/29/primary-care-shortage-health/11101265/http://www.beckershospitalreview.com/hospital-physician-relationships/5-things-to-know-about-provider-dispersion-in-the-us.htmlhttp://online.wsj.com/article/SB10001424052702303544604576434470768158908.htmlhttp://www.fiercehealthcare.com/story/med-school-enrollment-growth-wont-ease-doc-shortage/2013-05-03http://www.nytimes.com/2012/03/11/magazine/america-is-stealing-foreign-doctors.html?pagewanted=allhttp://articles.latimes.com/2013/apr/21/opinion/la-ed-medical-professionals-20130421http://articles.latimes.com/2013/apr/21/opinion/la-ed-medical-professionals-20130421http://www.politico.com/story/2013/05/doctors-physician-shortage-calls-for-intervention-91024.htmlhttp://www.kaiserhealthnews.org/stories/2013/april/04/california-doctors-primary-care-latin-america.aspxhttp://www.plosone.org/article/info:doi/10.1371/journal.pone.0033076https://www.aamc.org/newsroom/newsreleases/310002/121023.htmlhttp://www.nytimes.com/2013/08/12/business/economy/long-slog-for-foreign-doctors-to-practice-in-us.htmlhttp://www.thefiscaltimes.com/Articles/2012/05/04/More-Doctors-on-the-Way-Higher-Costs-to-Follow.aspx#page1http://economix.blogs.nytimes.com/2012/08/17/health-care-reform-and-the-doctor-shortage/http://economix.blogs.nytimes.com/2012/08/31/from-physician-glut-to-physician-shortage/http://www.nytimes.com/2012/07/29/health/policy/too-few-doctors-in-many-us-communities.htmlhttp://www.politico.com/story/2013/03/demand-for-doctors-soaring-as-cuts-loom-88390.htmlhttp://www.politico.com/story/2013/03/demand-for-doctors-soaring-as-cuts-loom-88390.htmlhttp://www.forbes.com/sites/peterubel/2012/12/07/how-much-money-should-a-cardiologist-make/http://www.bizjournals.com/sacramento/news/2014/03/12/calif-legis-education-doctors-accelerate.htmlhttp://www.usatoday.com/story/news/nation/2014/02/27/new-budget-proposes-record-funding-for-new-doctors/5836317/

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Further Readings 1. Conover, C. “Are U.S. doctors paid too much?” Forbes, May 28, 2013.

http://www.forbes.com/sites/theapothecary/2013/05/28/are-u-s-doctors-paid-too-much/ 2. C