Early Views

  • The Generation of Integration: The Early Experience of Implementing Bundled Care in Ontario, Canada

    Gayathri Embuldeniya, Maritt Kirst, Kevin Walker, Walter P. Wodchis

    Integrated health care models counter fragmented health care delivery and rising system costs by bundling services and encouraging interprofessional and interorganizational collaboration. While research has been conducted on the facilitators and challenges of integration, less is known about how integration is generated. This qualitative study looks at on-the-ground integration strategies in 6 programs in Ontario that each comprised multiple hospital and community partners to implement bundled care. Integration was generated through the successful production of connectivity and consensus. Read more

  • The Health Reformers’ Dilemma

    John E. McDonough

    Ever since the US Supreme Court ruled in 2012 that the expansion of Medicaid under the Affordable Care Act must be optional rather than mandatory for states, health care advocates have worked heart and soul to convince their state governments to adopt the expansion. But there’s a catch. The only politically viable pathway to expansion includes a detested provision, known as the “work requirement,” that obligates many new enrollees to work or else forfeit coverage. What to do? Read more

  • How Equity-Oriented Health Care Affects Health: Key Mechanisms and Implications for Primary Health Care Practice and Policy

    Marilyn Ford-Gilboe, C. Nadine Wathen, Colleen Varcoe, Carol Herbert, Beth E. Jackson, Josée G. Lavoie, Bernadette (Bernie) Pauly, Nancy A. Perrin, Victoria Smye, Bruce Wallace, Sabrina T. Wong, Annette J. Browne (for the EQUIP Research Program)

    Significant attention has been directed toward addressing health inequities at the population health and health system levels, yet little progress has been made in identifying approaches to reduce health inequities through clinical care, particularly in a primary care context. In this study, researchers found that providing more equity-oriented health care in primary care settings—including trauma-informed, culturally safe, and contextually tailored care—predicts improved health outcomes over time for people living in marginalizing conditions. Read more

  • Commentary

    Customer-Ownership in Equity-Oriented Health Care

    Douglas K. Eby

  • The Fires Are Burning

    Joshua M. Sharfstein

    Smoke from California wildfires has impaired air quality across the nation, with increases in particulate matter and carbon monoxide reported as far away as Washington, DC. Exposure to smoke imperils the health of people with asthma and chronic obstructive pulmonary disease—and may lead to more heart attacks. Joshua Sharfstein explains that health systems and health departments have an important role to play in protecting the environment—and the wildfires offer a great opportunity to move forward. Read more

  • Will Disruptive Innovation in Health Care Improve the Health of Populations?

    Sandro Galea

    Health care in the United States is long overdue for an upheaval. At least four health care innovations have been gathering steam—precision medicine, “Big Data,” the Affordable Care Act, and corporate efforts to reshape health care delivery and financing, each promising to change the nature of health care and influence population health. Read more

  • The Myths We Tell Ourselves About the Poor: From the English Poor Law to the Council of Economic Advisers

    Sara Rosenbaum

    The President’s Council of Economic Advisers (CEA) report, released in July, is a reminder of the deep roots of the American myth about poor working-age adults, a myth that can be traced to the English Poor Law, which consigned “able-bodied” adults to local workhouses. While the social welfare reforms of the 20th century have done much to sweep away poor-law mentality, myths persist for centuries. Today, no government program aimed at fostering greater health equity seems to be immune—from reframing the Medicaid narrative as a welfare handout to the CEA report and the refashioning of government assistance. Read more

  • Reflections on the Mental Health Parity and Addiction Equity Act After 10 Years

    Richard G. Frank

    Today marks the 10th anniversary of the Mental Health Parity and Addiction Equity Act. Prior to its enactment on October 3, 2008, consumer groups, providers, and some segments of the health insurance industry worked long and hard to enact legislation that promised coverage for mental illnesses and substance use disorders on a par with other medical care. Richard Frank reflects on the lessons learned over the past 10 years and what we’ll need in the future to meet the needs of all people with mental illness and substance use disorders. Read more