Health Policy Report

Employer-Sponsored Health Insurance in the United States–Origins and Implications

by D. Blumenthal, NEJM, July 6 2006, Vol 355 (1)

Employer-sponsored health insurance has become one of the main pillars of the US health care system, covering more than 62 percent of the non-elderly population as of 2004. In this light, the increasingly unsustainable cost of this system poses a growing threat to the health of our population. Historical conditions and public policy through the decades have contributed to the building of this "uniquely American institution." Thus a system seeded back in President Roosevelt's term is now showing complicated implications on the future of our health care system.

Perspective

Primary Care–Will It Survive?

by T. Bodenheimer, NEJM, August 31 2006, Vol 355 (9)

Decreasing patient satisfaction, increasing physician frustration, a broken reimbursement system, and a myriad of other major and minor problems haunting primary care are deterring medical students in the US from entering the field. The trend of losing primary care physicians does not bode well for an aging population with increasing chronic illnesses, whose treatment often extensively involve primary care physicians. So apart from the foreign doctors lured away from their native countries—which are often in critical needs of physicians—who will save primary care in the US?

Special Article

Gradient of Disability across the Socioeconomic Spectrum in the United States

by M. Minkler et al., NEJM, August 17 2006, Vol 355 (7)

Using Census 2000 Supplementary Survey results, Minkler et al. examines how the prevalence of chronic health condition, illness, disability, and death varies with socioeconomic differences. The study finds that for Americans between the ages of 55 and 84 years, the degree of their disabilities relates inversely to their social classes not only in extreme poverty but also extending to middle and upper classes. Furthermore, the rate of health improvements also follows that the most prosperous groups had the greatest advancements during the past two decades.

Free-Standing Perspective

Immigrant Health

Within the heated topic of immigration lie the challenges of immigrant health care and how the government can accommodate the many unique needs of such a large immigrant population. The greatest issues facing immigrants today are access to health care and increasing regular care and screenings for the immigrant population without compromising immigration status. Through various initiatives to increase enrollment in government health care programs such as Medicaid and SCHIP and efforts to reduce language and cultural barriers through targeted outreach programs, many states are steadily improving health care access and coverage for those who are foreign-born and live in the United States.

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Pathways Through Medicine

Careers in Medicine: Underserved Communities

9th in Series

Dr. James O' Connell shares his experiences and insights in leading the Boston Health Care for the Homeless Program. He mentions specific challenges in serving populations with no set day-to-day schedules and whose unique needs are completely neglected by the health care system. Comparing himself to an anachronistic "Old Country Doctor," Dr. O'Connell also tells his own story, which ironically contains twists and turns not found in the stories of more traditional physicians.

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Advice to the Next Generation

• What are some things to look for when choosing a medical school?
• Other than "helping people," what are some other aspects of a doctor's job?

» Other Questions and Answers