Enhancing the effectiveness of the U.S. Army's participation in medical diplomacy: implications from a case study in Trinidad.

Medical diplomacy is a complex, yet increasingly important strategy of the U.S. government. In this article, we present a unique program that was jointly developed by the U.S. Army Reserves 807 th Medical Deployment Support Command and the Trinidad Ministry of Health to address the large backlog of untreated cataracts in Trinidad and Tobago. This partnership evolved over time, but began with a commitment to help address a critical public health issue as determined by the host country, with investment in both local capacity and attention towards sustainability. The 807 th Medical Deployment Support Command utilized its connection to the military and civilian worlds, bringing in outside expertise and a long-term university partner allowing for sustainability without protracted U.S. government support. This program resulted in multiple positive outcomes, including building a strong partnership with a key U.S. interest; enhancing the legitimacy of the Trinidadian government through the development of a sustainable cataract program; and providing a platform for the United States to be seen by the Trinidadian public in a very positive light. This new model for medical diplomacy may have significant benefit for both the host country and U.S. government, and deserves further evaluation in other contexts.

Extending U.S. Medicare to Mexico: Why It's Important to Consider and What Can Be Done.

There is a lack of hard data on the exact number of Medicare-eligible retirees residing in Mexico, but it is at least in the tens of thousands and is certainly rising as the baby boom generation reaches retirement. Because Medicare does not cover health services received outside the United States, these retirees must travel to the United States for health care or purchase alternative coverage for health services received in Mexico. There are several arguments for extending Medicare to Mexico-that is, allowing Medicare-eligible beneficiaries to receive their Medicare benefits in Mexico. Medicare-eligible retirees living in Mexico would certainly benefit, and Mexico might benefit from improved quality of care and an expanded health economy. Moreover, American taxpayers might benefit from a reduced total cost of Medicare: To the extent that extending Medicare to Mexico induces Medicare beneficiaries to substitute higher-cost U.S. health care services with lower-cost Mexican services, overall Medicare expenditures might be reduced. The authors outline four options for how this policy change might be implemented and describe a conceptual model that could be used to assess the effects of each option.

Improving Access to Medicines for Non-Communicable Diseases in the Developing World.

Non-communicable diseases (NCDs) now account for the majority of global morbidity and mortality and are increasingly affecting developing countries whose under-resourced health care systems also have to handle a high burden of infectious disease. To counter the global devastation caused by NCDs, the United Nations General Assembly decided to "set a new global agenda" and convened a high-level meeting on NCDs in September 2011. In connection with this meeting, the authors of this article took a first step toward developing a policy research agenda for improving access to NCD medicines in developing countries, a step that the research-based pharmaceutical industry, in particular, can carry forward as part of broader global efforts to combat NCD. The authors provide a framework for understanding the obstacles to access for NCD medicines, review specific issues to be confronted within each obstacle in the developing world, identify promising ideas for improving access to NCD medicines, and point to several highly promising areas for the research-based pharmaceutical industry to focus on as it develops its NCD policy research program in close collaboration with other key stakeholders.

Building a more resilient haitian state

Ce rapport évalue les plans et politiques passés et actuels visant à améliorer la prestation de services publics en Haïti et, en s'appuyant sur cette évaluation, il fournit des recommandations sur la façon dont ces plans et politiques pourraient être améliorées. Le rapport met l'accent sur l'établissement de priorités pour les années à venir et propose des mesures qui pourraient produire des améliorations palpables dans la fourniture de services publics pendant cette période. Il est destiné au gouvernement d'Haïti pour l'élaboration de plans détaillés pour les réformes politiques et institutionnelles, ainsi qu'à la communauté internationale dans sa détermination de la façon de soutenir les efforts du gouvernement.