Basic Health Access

Academic leaders truly believe that they are excelling in their exclusive areas of education, research, and patient care. This may be a matter of their exclusive perspective as they lay their claims regarding Educating the next generation of physicians Conducting cutting-edge research Offering world-class patient care (AAMC Exec Darrell Kirch, MD) Exclusive is an appropriate descriptive term. The exclusive origins and exclusive training experiences of the academic leaders are matched by decades of immersions in exclusive academic environments. The pathway to academic leadership flows through institutions, foundations, corporations, and associations - each with their own exclusive designs. There is a filtering process that selects for exclusive and results in exclusive. Exclusive perspectives cloud a more global perspective - necessary for evaluation and treatment of the health care needs of an entire nation - the exclusive doing well and most of the nation not...

Election outcomes may well be about demographic changes such as population migrations. The visible wealthiest may be Republican, but the highly educated and professionals have significant Democrat populations. Changes in demographics may work against the Democrats. In the previous election, major demographic changes in areas such as race/ethnicity were thought to contribute to Democrat gains. Since these were expected to continue, there were fewer worries about the future elections. There are, of course, many ways to look at demographics. State migration patterns have been changing - perhaps not enough to impact elections with larger margins of victory, but enough to impact close elections such as in 2016. Migrations For Jobs or for Lower Cost of Living   Young college educated persons tend to move to areas with concentrations of populations - Blue Cities and States. Blue people in need of less grueling winters can leave cold Blue States for the So...

It ain't easy being Swiss Cheezy as Data Breaches reach all time highs. New reports indicate 57 data breaches in November of 2016 with about 500,000 records exposed.  More records were exposed in June (11 million) and in August (8.8 million). Average delay in reporting has been about 135 days. Inside jobs in businesses and in health care entities are more evident in the data breaches. HITECH to ACA to MACRA has been high profit for software corporations, consultants, and criminal organizations while it has slashed productivity, revenue generation, and morale in the team members to deliver the care. Overprediction and Underperformance A ten year review of the literature indicates that the predicted savings from EHR and digitalization has never materialized. The costs were known to be substantial over a decade ago. The cost consequences to team members and to people and to health organizations were minimized. The changes benefited those that already had health in...

Family medicine leadership supports a coalition that claims that it can cut costs and improve quality by a movement to value based payment. This coalition wants to convince the incoming government to continue to support continued innovations and transitions to value based payments. This would be a continuation of the last decade of experimentation. "While not fully scaled, the new payment models have made great progress in promoting transparency, reducing cost and improving quality," said the letter. "Many organizations are nearing the tipping point for realizing permanent change."  As has been common in these experimentations, the efforts have involved more concentrated organizations, practices, businesses, and locations - those least associationed with family physicians and basic health access needs. In the 34 years since Prospective Payment and DRGs the dominant focus has been on cost cutting. This period, The Era of Cost Cutting, continues to dominate thin...

Many articles have focused upon different perspectives regarding the reasons for the election results. The red counties have been identified as having lower education levels. There are many more differences in demographics and other characteristics. Perhaps the most common ground is that these are counties that have been left behind by a number of designs or that feel that they have been left behind or likely both. The 2700+ red counties are the same or similar to the 2621 lowest physician concentration counties that I have studied. While it is true that education statistical differences exist such as only 27% of bachelors degrees found in these counties with 40% of the population, there are a number of other demographic, policy, political, and other differences. These are important to understand regarding why voters saw red and voted red. The bigger question is whether the red party will address the needs  of those who turned the tide. Newer articles (Economist) have...