Monday 14 January 2019

Could the American Health System Become the Best in the World?

Josep M. Picas



The title of this paper is the same as one recently published in the "Perspective" section of The New England Journal of Medicine (NEJM), "From Last to First. Could the U.S. Health Care System Become Best in the World?" This article seemed to me to be an interesting example of introspection and critical analysis, and at the same time an excellent formulation of future challenges. I must confess that I feel admiration and envy for these types of approaches and advances that we frequently observe in the Anglo-Saxon environment.

In summary, the article is based on a report from the Common-wealth Fund which compares health expen-diture and results across several countries of the world with a high economic level. It’s said that in the United States, despite offering a high level of ad-vanced, specialized technical treatment, the results, from the populations’ point of view, leaves much to be desired. The authors attribute the causes of the problems to several factors:
  • Deficiencies in accessibility in its various nuances (linked to the subject of coverage).
  • Necessary commitment to primary care (expose their hope in the Medical Home).
  • Administrative inefficiency (linked to payment systems).
  • Inequity in the provision of services (associated, among others, with the necessary commitment to increase the financing of social services).

They end the article with the proposal to overcome these challenges and place their hopes on maintaining and improving their health laws despite of the existing threats.

But the aspect that more reflection provokes is that this article appears in a moment of maximum confusion. In particular, if we want to predict how the American health system will evolve, as in many other fields, it will suffer from the actions of the current presidency. In any case, it seems to me of interest to comment that the various attempts at repeal & replace the so-called Obamacare have failed until now, even with the opposition of prominent Republican senators. Many of these attempts relate to the level of coverage and to insurance aspects, but not so much to the organizational model.

At this level, it should be noted that the number of ACOs (accountable care organizations, probably the paradigm of integrated health systems) has continued to rise and their two best-known programs have expanded their success: Medicare Shared Savings recently communicated a total savings of 652 million dollars in 2016 (for example, the Cleveland Clinic ACO has saved 42.2 million, of which 19.9 million will be returned) and the other program, Bundled Payments ), continues to move forward with nuances, especially by introducing concepts related to value payment, led, among others, by Michael Porter.

Success has impacted most global health systems, for example in New Zealand (see "Developing accoun-table care systems, Lessons from Canterbury, New Zealand"). And perhaps the most surprising case is Germany, where, after the success-ful and little-known Gesundes Kinzigtal, OptiMedis AG is expan-ding by applying the model in the Netherlands and even in the United Kingdom.

In order to finish and emphasize this approach to "wanting to be" despite unfavourable environments, two recent documents are advisable for people who may be interested. In one of them, from the National Academies: Global Health and the Future Role of the United States, a large number of authors are positioned in the face of health globalization, and in another, published by NEJM Catalyst under the title The New Marketplace of Health Care: Impacts and Incentives of Payment Reform brings together a collection of articles and expert conversations that lead the reform of the payment system along with clinical practitioners, among many other relevant professionals.

A final comment is that, sadly, our country is not mentioned in this article of the NEJM and that the detail of our involvement in Global Health is insignificant (0.12% of GDP and 25th place among 28 countries, when the average is in 0.41% and the UN target is 0.7%). Maybe someday someone would have to pose some questions.


27 comments:

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  3. Hello Am From The UK , I want to write a little testimony about the good work of doctor Oyagu who cured me from Hsv 1 and 2 for just 2 weeks with his herbal medicine, I never believe I can be normal again and have a good life like others I always regretted the day I got diagnose with the virus, I was lost of hope when my doctor told me there is no cure for it but I keep thinking and thinking about my future, if I can have kids of my own well I am so grateful for my helper who get me cured with his herbal medicine, I go online in search of anything that can help me because I can’t deal with it forever so I found this doc Oyagu email on a blog of someone who was cured by him I quickly contact him for help and explain all my pain to him, he told me not to worry about it there is cure for real, I never believe until he send me the herbal medicine when I order for it and I have it within 4 days that is how I took the medicine for 2 week and the following week I go for test just to confirm I was 100% cured from this sickness what a miracle in my life I am so happy right now, you can also get in contact with him if you have such sickness through email address oyaguherbalhome@gmail. com or text him on what's app, phone number +2348101755322 Dr Oyagu also has remedy to others disease like COLD SORES,HIV/AIDS,DIABETES.CANCER,HIGH BLOOD PRESSURE AND MANY MORE. I oblige everyone to contact this powerful herbalist Dr Oyagu and be free from suffering.

    ReplyDelete
  4. I Want To Appreciate Dr.OYAGU for his great deeds, I Was Diagnosed With type 2 Herpes Virus Last year,And i Was Looking For Solution To Be Cured Luckily I Saw Testimonies On How Dr.OYAGU Cure Herpes Virus I Decided To Contact Dr.OYAGU I Contacted Him He Prepared A Herbal Medicine Portion And Sent It To Me,I Started The Herbal Medicine For My Health.He Gave Me Step By Step Instructions On How To Apply It, When I Applied It As Instructed, I Was Cured Of This Deadly Herpes Within 2 weeks, I Am Now Herpes Negative.My Brother And Sister I No That There Are So Many People That Have The Same Herpes Virus Please contact Dr OYAGU To Help You Too,And Help Me To Thank Dr.OYAGU For Cure Me, I’m Cured By Dr. OYAGU Herbal Medicine,His Contact Email:oyaguherbalhome@gmail.com
    Or Cell Whatsapp Number +2348101755322 thank you

    ReplyDelete
  5. I Want To Appreciate Dr.OYAGU for his great deeds, I Was Diagnosed With type 2 Herpes Virus Last year,And i Was Looking For Solution To Be Cured Luckily I Saw Testimonies On How Dr.OYAGU Cure Herpes Virus I Decided To Contact Dr.OYAGU I Contacted Him He Prepared A Herbal Medicine Portion And Sent It To Me,I Started The Herbal Medicine For My Health.He Gave Me Step By Step Instructions On How To Apply It, When I Applied It As Instructed, I Was Cured Of This Deadly Herpes Within 2 weeks, I Am Now Herpes Negative.My Brother And Sister I No That There Are So Many People That Have The Same Herpes Virus Please contact Dr OYAGU To Help You Too,And Help Me To Thank Dr.OYAGU For Cure Me, I’m Cured By Dr. OYAGU Herbal Medicine,His Contact Email:oyaguherbalhome@gmail.com
    Or Cell Whatsapp Number +2348101755322 thank you

    ReplyDelete

  6. Hello Am From The UK , I want to write a little testimony about the good work of doctor Oyagu who cured me from Hsv 1 and 2 for just 2 weeks with his herbal medicine, I never believe I can be normal again and have a good life like others I always regretted the day I got diagnose with the virus, I was lost of hope when my doctor told me there is no cure for it but I keep thinking and thinking about my future, if I can have kids of my own well I am so grateful for my helper who get me cured with his herbal medicine, I go online in search of anything that can help me because I can’t deal with it forever so I found this doc Oyagu email on a blog of someone who was cured by him I quickly contact him for help and explain all my pain to him, he told me not to worry about it there is cure for real, I never believe until he send me the herbal medicine when I order for it and I have it within 4 days that is how I took the medicine for 2 week and the following week I go for test just to confirm I was 100% cured from this sickness what a miracle in my life I am so happy right now, you can also get in contact with him if you have such sickness through email address oyaguherbalhome@gmail. com or text him on what's app, phone number +2348101755322 Dr Oyagu also has remedy to others disease like COLD SORES,HIV/AIDS,DIABETES.CANCER,HIGH BLOOD PRESSURE AND MANY MORE. I oblige everyone to contact this powerful herbalist Dr Oyagu and be free from suffering.

    ReplyDelete
  7. i m 'here to testify about the great work of Dr Isibor. I have been suffering from (HERPES) disease for the past 5 years and had constant pain, especially in my knees. During the first year,I had faith in God that i would be healed someday.This disease started circulating all over my body and i have been taking treatment from my doctor, few weeks ago i came across a testimony of one lady on the internet testifying about a Man called Dr Isibor on how he cured her from Herpes Simplex Virus. And she also gave the email address of this man and advise anybody to contact him for help for any kind of sickness that he would be of help, so I emailed him telling him about my (HERPES Virus) he told me not to worry that i was going to be cured!! Well i never believed it,, after all the procedures and remedy given to me by this man few weeks later i started experiencing changes all over me as Dr Isibor assured me that i will be cured,after some time i went to my doctor to confirmed if i have be finally healed behold it was TRUE, So friends my advise is if you have such sickness or any other at all you can contact Dr isibor via email:drisiborspellhome@gmail.com or you can call or whatsApp his mobile number  +2348110493039

    ReplyDelete

  8. Hello Am From The UK , I want to write a little testimony about the good work of doctor Oyagu who cured me from Hsv 1 and 2 for just 2 weeks with his herbal medicine, I never believe I can be normal again and have a good life like others I always regretted the day I got diagnose with the virus, I was lost of hope when my doctor told me there is no cure for it but I keep thinking and thinking about my future, if I can have kids of my own well I am so grateful for my helper who get me cured with his herbal medicine, I go online in search of anything that can help me because I can’t deal with it forever so I found this doc Oyagu email on a blog of someone who was cured by him I quickly contact him for help and explain all my pain to him, he told me not to worry about it there is cure for real, I never believe until he send me the herbal medicine when I order for it and I have it within 4 days that is how I took the medicine for 2 week and the following week I go for test just to confirm I was 100% cured from this sickness what a miracle in my life I am so happy right now, you can also get in contact with him if you have such sickness through email address oyaguherbalhome@gmail. com or text him on what's app, phone number +2348101755322 Dr Oyagu also has remedy to others disease like COLD SORES,HIV/AIDS,DIABETES.CANCER,HIGH BLOOD PRESSURE AND MANY MORE. I oblige everyone to contact this powerful herbalist Dr Oyagu and be free from suffering.

    ReplyDelete
  9. Am very glad to share this testimony with everyone for the marvelous work Dr Isibor has done for my life, 5months ago i was diagnosed with herpes virus and ever since then i have been very unhappy, i was so down broken everyday, until one day when i came across a shocking testimony about how Dr  Isibor   cured someone of his herpes virus, without wasting much time i contacted him immediately on his email address: drisiborspellhome@gmail.com and after i explain myself to him about how terrible i have been, and he assure me that he will help me to cure my herpes virus,after he has prepared the herbal medicine he sent it to me and when i have received it and started using it i was totally cure within 2weeks, i am forever grateful to  Dr Isibor  for helping me out with his herpes prescription that cured my virus. contact his email address:drisiborspellhome@gmail.com   or you can call or whatsApp his Mobile number:+2348110493039 

    ReplyDelete
  10. Joy and happiness is all i can see around ever since i came in contact with this great man. i complained bitterly to him about me having herpes only for him to tell me it’s a minor stuff. He told me he has cured thousands of people but i did not believe until he sent me the herbal medicine and i took it as instructed by this great man, only to go to the hospital after two weeks for another test and i was confirmed negative. For the first time in four years i was getting that result. i want to use this medium to thank this great man. His name is Dr Oyagu, i came in contact with his email through a friend in USA and ever since then my live has been full with laughter and great peace of mind. i urge you all with herpes or HSV to contact him if you are willing to give him a chance. you can contact him through this email oyaguherbalhome@gmail.com or you can also WhatsApp him +2348101755322
    He also cured my friend with HIV and ever since then i strongly believe he can do all things. Don't be deceived thinking he does not work, i believe if you can get in contact with this man all your troubles will be over. i have done my part in spreading the good news. Contact him through his email and you will be the next to testify of his great work.


    ReplyDelete


  11. i already gave up on ever getting cured of HSV2 because i have try many treatment none of them work out for me i have go to different hospital they always tell me same thing there is no cure for herpes when i came across a post about Dr oyagu, in the net from a lady called Rebecca i contacted him and he reassured me with him herbal medicine which i took according to the way he instructed, that how i was cured. I doubted at first because i have been to a whole lot of reputable doctors, tried a lot of medicines but none was able to cure me. so i decided to listen to him and he commenced treatment, and under two weeks i was totally free from Herpes. i want to say a very big thank you to DR oyagu for what he has done in my life. feel free to leave him a message on email oyaguherbalhome@gmail.com and also WhatsApp him +2348101755322..
    He can still be able to help you with this herbs medicine:
    1...ALS CURE/DIABETES CURE/EPILESY/HPV CURE/LUPUS/HEPATITIS/CANCER/GOUT

    ReplyDelete

  12. i already gave up on ever getting cured of HSV2 because i have try many treatment none of them work out for me i have go to different hospital they always tell me same thing there is no cure for herpes when i came across a post about Dr oyagu, in the net from a lady called Rebecca i contacted him and he reassured me with him herbal medicine which i took according to the way he instructed, that how i was cured. I doubted at first because i have been to a whole lot of reputable doctors, tried a lot of medicines but none was able to cure me. so i decided to listen to him and he commenced treatment, and under two weeks i was totally free from Herpes. i want to say a very big thank you to DR oyagu for what he has done in my life. feel free to leave him a message on email oyaguherbalhome@gmail.com and also WhatsApp him +2348101755322..
    He can still be able to help you with this herbs medicine:
    1...ALS CURE/DIABETES CURE/EPILESY/HPV CURE/LUPUS/HEPATITIS/CANCER/GOUT

    ReplyDelete
  13. I'm 40 years old female I tested genital herpes (HSV1-2) positive in 2002. I was having bad outbreaks. EXTREMELY PAINFUL. I have try different kinds of drugs and treatment by the medical doctors all to know was avail. Six months ago I was desperately online searching for a helpful remedies for genital herpes (HSV1-2) cure, which i come across some helpful remedies on how Dr OYAGU have help so many people in curing genital herpes (HSV1-2) with the help of herbal treatment because I too believe there is someone somewhere in the world who can cure herpes completely. As of the past 2 months, however, I've been following his herpes protocol Via oyaguherbalhome@gmail.com or +2348101755322 and it stopped all outbreaks completely! To my greatest surprise I was cured completely by following the protocol of his herbal medicine . Don't be discouraged by the medical doctors. There is a cure for HSV with the help of herbs and roots by a herbalist Dr call Dr OYAGU he is so kind and truthful with his herbal treatment, kindly contact him for more information Via oyaguherbalhome@gmail.com or WhatsApp DR on +2348101755322you will be lucky as i am today

    ReplyDelete
  14. I never believe in herbs until my sister told me about Dr Agbomian for helping her curing her Herpes and i decide to email him and he send me the herbal medicine through DHL courier delivery service and he told me how to drink it and i drink it for just 8days and i was healed and now i am now Herpes negative now all thanks to Dr Agbomian thanks to him God Bless You Forever you need his help you can reach him on his email dragbomianherbalcured77@gmail.com or whatsapp +2347040843115

    ReplyDelete

  15. Hello Am From The UK , I want to write a little testimony about the good work of doctor Oyagu who cured me from Hsv 1 and 2 for just 2 weeks with his herbal medicine, I never believe I can be normal again and have a good life like others I always regretted the day I got diagnose with the virus, I was lost of hope when my doctor told me there is no cure for it but I keep thinking and thinking about my future, if I can have kids of my own well I am so grateful for my helper who get me cured with his herbal medicine, I go online in search of anything that can help me because I can’t deal with it forever so I found this doc Oyagu email on a blog of someone who was cured by him I quickly contact him for help and explain all my pain to him, he told me not to worry about it there is cure for real, I never believe until he send me the herbal medicine when I order for it and I have it within 4 days that is how I took the medicine for 2 week and the following week I go for test just to confirm I was 100% cured from this sickness what a miracle in my life I am so happy right now, you can also get in contact with him if you have such sickness through email address oyaguherbalhome@gmail.com or text him on what's app, phone number +2348101755322 Dr Oyagu also has remedy to others disease like COLD SORES,HIV/AIDS,DIABETES.CANCER,HIGH BLOOD PRESSURE AND MANY MORE. I oblige everyone to contact this powerful herbalist Dr Oyagu and be free from suffering.

    ReplyDelete
  16. I Want To Appreciate Dr.OYAGU for his great deeds, I Was Diagnosed With type 2 Herpes Virus Last year,And i Was Looking For Solution To Be Cured Luckily I Saw Testimonies On How Dr.OYAGU Cure Herpes Virus I Decided To Contact Dr.OYAGU I Contacted Him He Prepared A Herbal Medicine Portion And Sent It To Me,I Started The Herbal Medicine For My Health.He Gave Me Step By Step Instructions On How To Apply It, When I Applied It As Instructed, I Was Cured Of This Deadly Herpes Within 2 weeks, I Am Now Herpes Negative.My Brother And Sister I No That There Are So Many People That Have The Same Herpes Virus Please contact Dr OYAGU To Help You Too,And Help Me To Thank Dr.OYAGU For Cure Me, I’m Cured By Dr. OYAGU Herbal Medicine,His Contact Email:oyaguherbalhome@gmail.com
    Or Cell Whatsapp Number +2348101755322 thank you

    ReplyDelete
  17. I never believed in life that I will be cured from herpes virus on till I found this great herbalist doctor called Dr Lucky with his herbs. my doctors said Herpes virus do not have medical cure because the virus is capable of hiding within the human cells, it remains protected from your immune system. Herpes isn’t a special virus – your immune system has the tools to fight it back. Cure your Herpes virus with affordable price. My doctor said there is no cure until i meet Dr Lucky This same doctor also cured my Aunty from hiv, as soon as i heard she had hepatitis, i quickly refer her to DR Lucky and she was cured too after drinking his herbs. I have referred more than 6 person to DR Lucky and they were all cured from their various illness. If you have this herpes virus I don’t think there is any need wasting money and time on medical treatment quickly contact this herbal doctor via email him; drluckyherbalcure@gmail.com Or whatsapp number; +2348154637647

    ReplyDelete
  18. I already gave up on ever getting cured of HSV2 because i have try many treatment none of them work out for me i have be going to different hospital they always tell me same thing there is no cure for herpes when i came across a post about Dr oyagu, in the net from a lady called Rebecca i contacted him and he reassured me with his herbal medicine which i took according to the way he instructed, that how i was cured. I doubted at first because i have been to a whole lot of reputable doctors, tried a lot of medicines but none was able to cure me. so i decided to listen to him and he commenced treatment, and under two weeks i was totally free from Herpes. i want to say a very big thank you to DR oyagu for what he has done in my life. feel free to leave him a message on email oyaguherbalhome@gmail.com and also WhatsApp him +2348101755322.. He can still be able to help you with this herbs medicine: 1...ALS CURE/DIABETES CURE/EPILESY/HPV CURE/LUPUS/HEPATITIS/CANCER/GOUT

    ReplyDelete
  19. I found out, that taking herbal treatment is the best to get rid of hpv as soon as i feel the symptoms of hpv is appearing, i took the healing process by contacting Dr onokun for natural treatment it works wonders, amazingly ever since I had the herbal treatment i have not feel these horrible disease anymore and my doc told me the virus is gone, i am glad i finally got cured out from this horrible disease. every hpv or herpes patients should also get in touch with this herbalist Dr to get ride of these disease forever his email address; dronokunherbalcure@gmail.com 

    ReplyDelete
  20. i was cured of HERPES VIRUS by a great herbal doctor called DR Lucky with the use of different combination of Africa herbs. it is still like a dream to me. There is no word suitable enough to qualify your significant in my life dear doctor. you too can contact him for any kind of cure on his Email 📧 (drluckyherbalcure@gmail.com) or Whatsapp him; (+2348154637647

    ReplyDelete
  21. Hello Am From The UK , I want to write a little testimony about the good work of doctor Oyagu who cured me from Hsv 1 and 2 for just 2 weeks with his herbal medicine, I never believe I can be normal again and have a good life like others I always regretted the day I got diagnose with the virus, I was lost of hope when my doctor told me there is no cure for it but I keep thinking and thinking about my future, if I can have kids of my own well I am so grateful for my helper who get me cured with his herbal medicine, I go online in search of anything that can help me because I can’t deal with it forever so I found this doc Oyagu email on a blog of someone who was cured by him I quickly contact him for help and explain all my pain to him, he told me not to worry about it there is cure for real, I never believe until he send me the herbal medicine when I order for it and I have it within 4 days that is how I took the medicine for 2 week and the following week I go for test just to confirm I was 100% cured from this sickness what a miracle in my life I am so happy right now, you can also get in contact with him if you have such sickness through email address oyaguherbalhome@gmail.com or text him on what's app, phone number +2348101755322 Dr Oyagu also has remedy to others disease like COLD SORES,HIV/AIDS,DIABETES.CANCER,HIGH BLOOD PRESSURE AND MANY MORE. I oblige everyone to contact this powerful herbalist Dr Oyagu and be free from suffering.

    ReplyDelete
  22. I Want To Appreciate Dr.OYAGU for his great deeds, I Was Diagnosed With type 2 Herpes Virus Last year,And i Was Looking For Solution To Be Cured Luckily I Saw Testimonies On How Dr.OYAGU Cure Herpes Virus I Decided To Contact Dr.OYAGU I Contacted Him He Prepared A Herbal Medicine Portion And Sent It To Me,I Started The Herbal Medicine For My Health.He Gave Me Step By Step Instructions On How To Apply It, When I Applied It As Instructed, I Was Cured Of This Deadly Herpes Within 2 weeks, I Am Now Herpes Negative.My Brother And Sister I No That There Are So Many People That Have The Same Herpes Virus Please contact Dr OYAGU To Help You Too,And Help Me To Thank Dr.OYAGU For Cure Me, I’m Cured By Dr. OYAGU Herbal Medicine,His Contact Email:oyaguherbalhome@gmail.com
    Or Cell Whatsapp Number +2348101755322 thank you

    ReplyDelete

  23. Hello Am From The UK , I want to write a little testimony about the good work of doctor Oyagu who cured me from Hsv 1 and 2 for just 2 weeks with his herbal medicine, I never believe I can be normal again and have a good life like others I always regretted the day I got diagnose with the virus, I was lost of hope when my doctor told me there is no cure for it but I keep thinking and thinking about my future, if I can have kids of my own well I am so grateful for my helper who get me cured with his herbal medicine, I go online in search of anything that can help me because I can’t deal with it forever so I found this doc Oyagu email on a blog of someone who was cured by him I quickly contact him for help and explain all my pain to him, he told me not to worry about it there is cure for real, I never believe until he send me the herbal medicine when I order for it and I have it within 4 days that is how I took the medicine for 2 week and the following week I go for test just to confirm I was 100% cured from this sickness what a miracle in my life I am so happy right now, you can also get in contact with him if you have such sickness through email address oyaguherbalhome@gmail.com or text him on what's app, phone number +2348101755322 Dr Oyagu also has remedy to others disease like COLD SORES,HIV/AIDS,DIABETES.CANCER,HIGH BLOOD PRESSURE AND MANY MORE. I oblige everyone to contact this powerful herbalist Dr Oyagu and be free from suffering.

    ReplyDelete
  24. Battling with any health related issues or infection is not the end of your life, why not contact a herbal practitioner for cure dr Maggi has herbal remedies and permanent solution for all your health related problems.I recommend him to you today only because i have also used his herbal medicine and it worked perfectly on my health problem, you can actually save yourself from giving your hard earned money to Scammers if only you can contact dr Maggi today for genuine and Permanent cure herbal products . Pls help share this post to save yourself and your love ones.Dr Maggi is specialize in these areas,Permanent herbal supplements for anxiety and depression,HIV/AIDS, Diabetes, Epilepsy, Blood, Cancer, HPV, ALS, herpes etc. Email: drmaggiherbalhome@gmail.com also call or whatsApp him on +19179796387

    ReplyDelete
  25. Battling with any health related issues or infection is not the end of your life, why not contact a herbal practitioner for cure dr Maggi has herbal remedies and permanent solution for all your health related problems.I recommend him to you today only because i have also used his herbal medicine and it worked perfectly on my health problem, you can actually save yourself from giving your hard earned money to Scammers if only you can contact dr Maggi today for genuine and Permanent cure herbal products . Pls help share this post to save yourself and your love ones.Dr Maggi is specialize in these areas,Permanent herbal supplements for anxiety and depression,HIV/AIDS, Diabetes, Epilepsy, Blood, Cancer, HPV, ALS, herpes etc. Email: drmaggiherbalhome@gmail.com also call or whatsApp him on +19179796387

    ReplyDelete
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