Subject(s)
Civil Rights , Community Participation , Physicians , Political Activism , Public Policy , Publishing , Systemic Racism , Humans , Black or African American , Civil Rights/history , Civil Rights/legislation & jurisprudence , Community Participation/history , Community Participation/legislation & jurisprudence , Editorial Policies , History, 20th Century , Hospitals/history , Medicare/economics , Medicare/history , Periodicals as Topic/history , Physicians/economics , Physicians/history , Physicians/legislation & jurisprudence , Public Policy/history , Public Policy/legislation & jurisprudence , Publishing/history , Social Determinants of Health/economics , Social Determinants of Health/ethnology , Social Determinants of Health/history , Social Determinants of Health/legislation & jurisprudence , Sociological Factors , Systemic Racism/ethnology , Systemic Racism/history , United States , WhiteABSTRACT
One of the heroes in American history, Associate Supreme Court Justice Thurgood Marshall (1908-1993) sought legal remedies against racial discrimination in education and health care. As director of the Legal Defense Fund (LDF) of NAACP from 1940 to 1961, his success in integrating law schools in Texas led to the first black medical student admitted to a state medical school in the South. Representing doctors and dentists needing a facility to perform surgery, the LDF brought cases before the courts in North Carolina that moved the country toward justice in health care. His ultimate legal victory came in 1954, Brown v. Board of Education of Topeka, the decision that declared racial segregation in public schools unconstitutional. In 1964, the LDF under Jack Greenberg, Marshall's successor as director, won Simkins v. Moses H. Cone Memorial Hospital, a decision that held that hospitals accepting federal funds had to admit black patients. The two decisions laid the judicial foundation for the laws and administrative acts that changed America's racial history, the Civil Rights Act of 1964 and the Social Security Act Amendments of 1965 that established Medicare and Medicaid. His achievements came during the hottest period of the American civil rights movement of the 1950s and 1960s. Well past the middle of the twentieth century, black Americans were denied access to the full resources of American medicine, locked in a "separate-but-equal" system woefully inadequate in every respect. In abolishing segregation, Marshall initiated the long overdue remedy of the unjust legacies of slavery and Jim Crow.
Subject(s)
Black or African American , Delivery of Health Care , Education , Human Rights , Lawyers , Supreme Court Decisions , Aged , Humans , Black or African American/education , Black or African American/history , Black or African American/legislation & jurisprudence , Civil Rights/history , Civil Rights/legislation & jurisprudence , Delivery of Health Care/ethnology , Delivery of Health Care/legislation & jurisprudence , Education/history , Education/legislation & jurisprudence , Education, Medical/history , Education, Medical/legislation & jurisprudence , Educational Status , History, 20th Century , Human Rights/history , Human Rights/legislation & jurisprudence , Medicare/history , Medicare/legislation & jurisprudence , Racial Groups , Supreme Court Decisions/history , United States , Lawyers/historyABSTRACT
AIMS: To evaluate temporal trends in racial/ethnic groups in rates of serious hypoglycemia among higher risk patients dually enrolled in Veterans Health Administration and Medicare fee-for-service and assess the relationship(s) between hypoglycemia rates, insulin/secretagogues and comorbid conditions. METHODS: Retrospective observational serial cross-sectional design. Patients were ≥65â¯years receiving insulin and/or secretagogues. The primary outcome was the annual (period prevalence) rates (2004-2015), per 1000 patient years, of serious hypoglycemic events, defined as hypoglycemic-related emergency department visits or hospitalizations. RESULTS: Subjects were 77-83% White, 7-10% Black, 4-5% Hispanic, <2% women; 38-58% were ≥75â¯years old; 72-75% had ≥1 comorbidity. In 2004-2015, rates declined from 63.2 to 33.6(-46.9%) in Blacks; 29.7 to 20.3 (-31.6%) in Whites; and 41.8 to 29.6 (-29.3%) in Hispanics. The Black-White rate differences narrowed regardless of insulin use, hemoglobin A1c level, and frequency and various combinations of comorbid conditions. Among insulin users, the Black-White contrast decreased from 34.7 (98.5 vs. 63.8) in 2004 to 13.2 (43.6 vs. 30.4) in 2015; in non-insulin users, the contrast was 25.7 (44.1 vs. 18.4) in 2004 and 10.1 (18.9 vs. 8.8) in 2015. CONCLUSION: Marked declines in serious hypoglycemia events occurred across race, medications, and comorbidities, suggesting significant changes in clinical practice.
Subject(s)
Diabetes Mellitus, Type 2/ethnology , Health Status Disparities , Hypoglycemia/ethnology , Racial Groups/statistics & numerical data , Veterans/statistics & numerical data , Aged , Aged, 80 and over , Blood Glucose/drug effects , Blood Glucose/metabolism , Comorbidity , Cross-Sectional Studies , Diabetes Mellitus, Type 2/drug therapy , Diabetes Mellitus, Type 2/epidemiology , Ethnicity/statistics & numerical data , Female , Glycated Hemoglobin/drug effects , Glycated Hemoglobin/metabolism , History, 20th Century , History, 21st Century , Humans , Hypoglycemia/chemically induced , Hypoglycemia/epidemiology , Hypoglycemia/pathology , Insulin/therapeutic use , Male , Medicare/history , Medicare/statistics & numerical data , Medicare/trends , Retrospective Studies , Severity of Illness Index , United States/epidemiology , United States Department of Veterans Affairs/history , United States Department of Veterans Affairs/statistics & numerical data , United States Department of Veterans Affairs/trends , Veterans Health/ethnology , Veterans Health/statistics & numerical dataABSTRACT
INTRODUCTION: The first successful kidney transplant in humans was performed in 1954. In the following 25 years, the biomedical, ethical, and social implications of kidney transplantation were widely discussed by both healthcare professionals and the public. Issues relating to race, however, were not commonly addressed, representing a "blind spot" regarding racial disparities in access and health outcomes. METHODS: Through primary sources in the medical literature and lay press, this paper explores the racial dynamics of kidney transplantation in the 1950-1970s in the United States as the procedure grew from an experimental procedure to the standard of care for patients in end-stage renal disease (ESRD). RESULTS & DISCUSSION: An extensive search of the medical literature found very few papers about ESRD, dialysis, or renal transplant that mentioned the race of the patients before 1975. While the search did not reveal whether race was explicitly used in determining patient access to dialysis or transplant, the scant data that exist show that African-Americans disproportionately developed ESRD and were underrepresented in these early treatment populations. Transplant outcome data in the United States failed to include race demographics until the late 1970s. The Social Security Act of 1972 (PL 92-603) extended Medicare coverage to almost all Americans with ESRD and led to a rapid increase in both dialysis and kidney transplantation for African-Americans in ESRD, but disparities persist today.
Subject(s)
Black or African American/statistics & numerical data , Healthcare Disparities/history , Kidney Failure, Chronic/ethnology , Kidney Transplantation/history , Black or African American/history , Dialysis , Health Services Accessibility/history , Healthcare Disparities/ethnology , History, 20th Century , Humans , Kidney Failure, Chronic/history , Kidney Failure, Chronic/surgery , Medicare/history , Medicare/legislation & jurisprudence , United StatesABSTRACT
Medicare, a federally funded insurance program in the United States, is a complex program about which many physicians may not receive formal training or education. Plastic surgeons, residents, and advanced practitioners may benefit from at least a basic understanding of Medicare, its components, reimbursement methods, and upcoming health care trends. Medicare consists of Parts A through D, each responsible for a different form of insurance coverage. Medicare pays hospitals, physicians, and graduate medical education. Since the introduction of Medicare, several reforms and programs have been introduced, particularly in recent years with the implementation of the Affordable Care Act. Many of these changes are moving reimbursement systems away from the traditional fee-for-service model toward quality-of-care programs. The aim of this review is to provide a brief history of Medicare, explain the basics of coverage and relevant reforms, and describe how federal insurance programs relate to plastic surgery both at academic institutions and in a community practice environment.
Subject(s)
Medicare/history , Surgery, Plastic/history , Health Care Reform/economics , Health Care Reform/history , Health Care Reform/organization & administration , History, 20th Century , History, 21st Century , Humans , Insurance Coverage/history , Insurance Coverage/organization & administration , Medicare/organization & administration , Patient Protection and Affordable Care Act/history , Surgery, Plastic/economics , Surgery, Plastic/education , United StatesSubject(s)
Coronary Artery Bypass/economics , Medicare/economics , Myocardial Infarction/economics , Reimbursement Mechanisms , Centers for Medicare and Medicaid Services, U.S. , Health Expenditures , History, 20th Century , History, 21st Century , Medicare/history , Patient Care Bundles , Reimbursement Mechanisms/history , United StatesSubject(s)
Ethnicity/history , Health Policy/history , Health Status Disparities , Hospitals/history , Medicaid/history , Medicare/history , Ethnicity/legislation & jurisprudence , Health Policy/economics , Health Policy/legislation & jurisprudence , History, 20th Century , History, 21st Century , Humans , Medicaid/economics , Medicaid/legislation & jurisprudence , Medicare/economics , Medicare/legislation & jurisprudence , United StatesABSTRACT
Our work with older adults, particularly those with limited incomes, has provided significant insight into the complexities of Medicare and the U.S. healthcare system. This article provides a brief history and overview of Medicare; describes the array of insurance choices Medicare beneficiaries face; and considers the effect of income, race, and health literacy on an individual's ability to navigate Medicare. We discuss how health is more than healthcare service delivery and that it takes community efforts to ensure that older adults not only understand their insurance, but also have access to other important resources that influence their health such as safe, affordable housing; food security; and transportation.
Subject(s)
Health Literacy , Health Resources/economics , Health Services Accessibility , Medicare/organization & administration , Medicare/standards , Aged , Healthcare Disparities/economics , History, 20th Century , History, 21st Century , Humans , Income , Medicare/history , North Carolina , Racial Groups , United StatesSubject(s)
Health Policy , Human Rights , Medicare , Single-Payer System , Universal Health Insurance , Cost Savings , History, 20th Century , Income , Medicare/economics , Medicare/history , Medicare/legislation & jurisprudence , Moral Obligations , Public Opinion , Single-Payer System/economics , Single-Payer System/history , Taxes , United States , Universal Health Insurance/legislation & jurisprudenceSubject(s)
Insurance, Health, Reimbursement/economics , Insurance, Health, Reimbursement/legislation & jurisprudence , Medicare/economics , Medicare/legislation & jurisprudence , Centers for Medicare and Medicaid Services, U.S./economics , Centers for Medicare and Medicaid Services, U.S./legislation & jurisprudence , Children's Health Insurance Program/economics , Children's Health Insurance Program/legislation & jurisprudence , History, 20th Century , Humans , Insurance Claim Review , Liability, Legal , Medicaid/economics , Medicaid/legislation & jurisprudence , Medicare/history , United StatesABSTRACT
The British Journal of Hospital Medicine is 50 years old. This article takes a look back at articles published during the year of its inception from the British Medical Journal, the Lancet and the Journal of the American Medical Association.
Subject(s)
Periodicals as Topic/history , Abortion, Induced/history , Acetaminophen/history , Acetaminophen/toxicity , Adrenocortical Adenoma/history , Allopurinol/history , Allopurinol/therapeutic use , Analgesics/history , Analgesics/toxicity , Antineoplastic Agents/history , Antineoplastic Agents/therapeutic use , Attitude of Health Personnel , Attitude to Health , Bird Fancier's Lung/history , Celiac Disease/complications , Celiac Disease/history , Chemical and Drug Induced Liver Injury/etiology , Chemical and Drug Induced Liver Injury/history , Dermatitis Herpetiformis/complications , Dermatitis Herpetiformis/history , Drug Discovery/history , Gout/drug therapy , Gout/history , Gout Suppressants/history , Gout Suppressants/therapeutic use , Graft Rejection/history , Graft Rejection/immunology , Granulomatous Disease, Chronic/history , History, 20th Century , Humans , Medicare/history , Publishing/history , United Kingdom , United StatesSubject(s)
National Health Insurance, United States , Single-Payer System , History, 20th Century , History, 21st Century , Insurance Coverage , Medically Uninsured , Medicare/history , National Health Insurance, United States/history , National Health Insurance, United States/legislation & jurisprudence , Single-Payer System/history , Single-Payer System/legislation & jurisprudence , United StatesSubject(s)
Biomedical Research/history , Nephrology/history , Societies, Medical/history , Biomedical Research/trends , Education, Medical/history , Forecasting , History, 20th Century , History, 21st Century , Humans , Medicare/history , Nephrology/education , Nephrology/trends , Societies, Medical/trends , United StatesSubject(s)
Medicare/economics , Reimbursement Mechanisms , Health Care Reform , History, 20th Century , History, 21st Century , Length of Stay/trends , Medicare/history , Medicare/legislation & jurisprudence , Patient Protection and Affordable Care Act , Prospective Payment System , Reimbursement Mechanisms/history , United StatesABSTRACT
Fifty years of Medicare have led to enormous improvements in care of older adults in the United States. Policy changes in Medicare and Medicaid have undergirded the care of older adults and the workforce and professional development of nurses and advanced practice nurses. Reflecting on the decades of change in these 50 years and the context in which these changes occurred can prepare health care providers for future strategies to address needs of the rapidly growing older adult population.