Healthcare Reforms



The aim is to find ideas to cope with rising costs, access to good healthcare and how to limit future increases.

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Health care costs rank at the top of national and international concerns in both developed and developing economies. In the U.S., President Obama is working to keep the debate moving forward as he attempts to fulfill campaign promises. Traction toward solutions is getting international attention. What can be done to make access to safe, innovative and effective first rate health care available to patients everywhere at affordable prices?

Our discussion and debate on this Knol is focuses on the high cost of health care in North America and Western Europe. The cost of drugs may receive some mention here, but this is an issue that merits a separate Knol:  High Priced Prescription Drugs

For a collection of knols dealing with issues of healthcare

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Water Lillies



Ramping up public attention in a highly publicized press event, President Obama paraded a coalition of health care executives in front of the cameras on Monday, May 11 2009, calling it “a historic day, a watershed event,” according to coverage in the NY Times. The visible group included doctors as well as hospitals, insurance and drug company executives, who say they’ll voluntarily reduce costs by some $2 trillion during the next decade. The president said the reductions “will help us take the next and most important step — comprehensive health care reform.”

The United States spends 16% of its GDP ($2.2 trillion in 2007, $8,300 per person) on health care. Hospital and Physician/Clinical Services accounted for 50% of health care costs and drugs accounted for 10%. Persons on medicare spent upto 30% of their budget on out of pockets health costs (co-payments, OTC, generics) according to AARP ( The Congress Budget Office estimates the 2009 healthcare bill at $2.5 trillion(18% of GDP). The contributory factors are fancy new medical technology, high priced new drugs, high malpractise insurance for doctors, fear of lawsuits resulting in a variety of tests, procedures and overprescription.

The increasing and high cost of health care makes headlines in new and old media at regular intervals. The health care cost includes insurance premiums, visits to doctors,  offices, clinics and hospitals, diagnostic and laboratory tests, medical devices, implants, surgery, hospital stay, medical transport, home care, medical nursing homes, etc. Hospitals are shifting their service focus to high income procedures like cardiac care and neurosurgery.
Many emergency rooms have closed or are schedule to close because in large cities the ER often serves as a non-emergency clinic for the uninsured. Many recognized medical specialties like Ob Gyn (obstetrics and gynecology) are under compensated (paid a limited fixed amount which varies by state and insurance, irrespective of complications or actual time and expense involved in service delivery). Ob Gyn specialists — and many other specialists — are encountering spiralling malpractice insurance premiums against the bleak backdrop of reduced payments for services.On the other hand demand for life style surgery and treatment like
plastic surgery, botox injections has grown.

Growing Medical tourism is a recent trend to cut costs and waiting lines for surgery.
US Economic and Healthcare crisis. Possible solutions and role of Medical Tourism

The current debate is how to provide adequate insurance to 46 million uninsured persons and provide access for all to quality care and if required high cost diagnostic tests and new medical devices. The issues are limited to high cost of new technology: devices, diagnostic tests and hospitalization. Since for most of European and Asian healthcare companies, the USA is the major market, any reform of the current system will have global impact. Providing coverage to millions of uninsured patients will expand the healthcare market and increase demand, which will be partly offset by lower prices. It can be win-win situation for all parties involved. It seems everyone wants reforms and no one wants to pay.

A government insurance scheme for low income, poor and uninsured persons, ability to negotiate deep discounts from the healthcare industry and providers, digital patient records to avoid duplication of tests and procedures, family doctor as a gatekeeper of health before going to experts and payments to doctors based on positive health outcome are expected to reduce overall costs.

Dustin Chambers ( recommends market oriented solution and easy entry of foreign doctors.

According to an Associated Press report that appeared in many newspapers on 9 May 2009, the U.S. Senate is privately debating the following three-prong approach (quoted exactly):

  • Create a plan that resembles Medicare, administered by the Health and Human Services Department
  • Adopt a Medicare-like plan, but pick an outside party to run it. That way, government officials would not directly control the day-to-day operations
  • Leave it up to individual states to set up a public insurance plan for their residents
The AP report says that the Senate will debate these approaches in a closed meeting soon, noting that the creation of a public plan by government is an extremely contentious idea for overhaul of a system that is experiencing runaway costs for America’s uninsured. A global issue? Most certainly.
Health care Cost Range

The basis for the following numbers is undergoing development and will be included in an update to this Knol

Typical Patient Costs

  • Consultation Visit   $100-350
  • Laboratory Tests     $100-500
  • Special lab tests     $300-1000   
  • Genetic tests          $300-500
  • Vaccine                 $100-500
  • Drugs                   $ 300-10000


Cancer Detection, Imaging & Radiotherapy

Diagnostic Procedures/Tests

  •   X Ray                    $100
  • Cone Beam X Ray $400
  • ECG                      $100
  • EEG                      $100
  • Ultrasound              $100-500
  • MRI                       $600-3500
  • CT Scan                 $1600-3000
  • PET/SPECT          $1500-3000
  • Biopsy                  $300-500
  • Genomic Analysis  $400   

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  •   Surgery                  $5000-10000
  • Laser/robotic           $3500-10000
  • Organ Transplant     $250,000

Nursing Care/Home care

(under development)

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Endurance Heart Rate/Beat j0438742.jpg


Obama on Healthcare Reform at American Medical Association

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Thanks are due to Mr. Jean-Antoine de Mandato (PDP, Geneva) for providing office facilities and administrative support.

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Healthcare Reforms in USA


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Health Care Reform 2009
A source for health care policy news, opinion, and commentary.

January 6, 2010

Sounding Board
graphicComparative Effectiveness and Health Care Spending — Implications for Reform
The authors argue that health care costs can be reduced without a negative effect on quality by reducing spending on interventions that are not cost-effective. Free Full Text

Online FirstJanuary 6, 2010 (DOI: 10.1056/NEJMsb0911104)

graphicRanking 37th — Measuring the Performance of the U.S. Health Care System
The U.S. health care system has been ranked 37th in the world. Drs. Christopher Murray and Julio Frenk ask why we spend so much to get so little. Free Full Text

Online FirstJanuary 6, 2010 (DOI: 10.1056/NEJMp0910064)

Health Care Reform and the Need for Comparative-Effectiveness Research

Online OnlyJanuary 6, 2010 (DOI: 10.1056/NEJMp0912651)

Patient-Centered Medical Homes in Ontario

Online OnlyJanuary 6, 2010 (DOI: 10.1056/NEJMp0911519)

Nearing Negotiations — Reconciling Key Differences between House and Senate Reform Measures

Online OnlyJanuary 6, 2010 (DOI: 10.1056/NEJMp0912964)

Googling Ourselves — What Physicians Can Learnfrom Online Rating Sites

graphicEnsuring the Fiscal Sustainabilityof Health Care Reform

Published Online December 9, 2009 (DOI: 10.1056/NEJMp0910194)

graphicPayment Reform — The Need to Harmonize Approaches in Medicare and the Private Sector

Published Online December 9, 2009 (DOI: 10.1056/NEJMp0910459)


Rallying the Caucus — The Democrats’ Struggle for Unity on Reform
. Free Full Text

Online OnlyDecember 16, 2009 (DOI: 10.1056/NEJMp0912352)

Uncomfortable Arithmetic — Whom to Cover versus What to Cover
Free Full Text

Online FirstDecember 16, 2009 (DOI: 10.1056/NEJMp0911074)

Ending End-of-Life Phobia — A Prescription for Enlightened Health Care Reform
Free Full Text

Online OnlyDecember 16, 2009 (DOI: 10.1056/NEJMp0909740)

Leveling the Field — Ensuring Equity through National Health Care Reform
 Free Full Text

Published Online December 2, 2009 (DOI: 10.1056/NEJMp0909323)


 On Mammography — More Agreement Than Disagreement

 November 25, 2009 (DOI: 10.1056/NEJMp0911288)

Screening Mammography and the “R” Word

 November 25, 2009 (DOI: 10.1056/NEJMp0911447)

Cervical-Cancer Screening — New Guidelines and the Balance between Benefits and Harms

 November 25, 2009 (DOI: 10.1056/NEJMp0911380)

 A Difficult Balance — Pain Management, Drug Safety, and the FDA


Health Care Reform — A Republican View
Senator Chuck Grassley (R-IA)  Free Full Text

Online FirstNovember 18, 2009 (DOI: 10.1056/NEJMp0911111)

graphic The Consequences of “No”
Dr. Arthur Kellermann and Lawrence Lewin  Free Full Text

Online FirstNovember 18, 2009 (DOI: 10.1056/NEJMp0910138)

Industry Influence on Comparative-Effectiveness Research Funded through Health Care Reform
Drs. Harry Selker and Alastair Wood make a case for the independence of the scientific process. Free Full Text

Online FirstNovember 18, 2009 (DOI: 10.1056/NEJMp0910747)

graphic Lobbying, Campaign Contributions, and Health Care Reform
Free Full Text

Online OnlyNovember 18, 2009 (DOI: 10.1056/NEJMp0910879)

The Supreme Court, Process Patents, and Medical Innovation
Dr. Aaron Kesselheim Free Full Text

Online FirstNovember 18, 2009 (DOI: 10.1056/NEJMp0909658)

graphic Medicaid and National Health Care Reform
Sara Rosenbaum examines Medicaid  Free Full Text

Published Online October 14, 2009 (DOI: 10.1056/NEJMp0909449)

Massachusetts Health Care Reform — Near-Universal Coverage at What Cost?

Published Online October 21, 2009 (DOI: 10.1056/NEJMp0909295)

Getting to the Real Issues in Health Care Reform

NEJM • November 11, 2009

Paul B. Ginsburg, Ph.D.

No issue has dominated the health care reform debate as much as whether the U.S. government should offer a health insurance plan to compete with private insurers — the so-called public option..(More…)

— Separating Promising from Unpromising Approaches

NEJM • November 11, 2009

Peter S. Hussey, Ph.D., Christine Eibner, Ph.D., M. Susan Ridgely, J.D., and Elizabeth A. McGlynn, Ph.D.

High U.S. health care spending has been characterized not only as a barrier to affordable insurance but also as the preeminent long-term threat to the economy and the competitiveness of American business. . (More…)

graphicThe American Public and the Next Phase of the Health Care Reform Debate

Online OnlyNovember 4, 2009 (DOI: 10.1056/NEJMp0906394)

Compromises and Controversies — Moving Forward on Reform

Online OnlyNovember 4, 2009 (DOI: 10.1056/NEJMp0910493)



Online FirstNovember 2, 2009 (DOI: 10.1056/NEJMp0910479)

Doctors, Patients, and the Need for Health Care Reform

Published Online October 21, 2009 (DOI: 10.1056/NEJMp0910001)

Litigation amidst Reform — The Boston Medical Center Case
In July the Boston Medical Center filed suit in Massachusetts state court challenging the state’s Medicaid reimbursement formula. Wendy Parmet writes that this case raises critical questions about the Massachusetts model of health care reform as well as litigation’s role in health care reform debates.
Free Full Text
Payment Reform for Safety-Net Institutions — Improving Quality and Outcomes
Drs. C. Jason Wang, Kathleen Conroy, and Barry Zuckerman argue that safety-net institutions should be reimbursed more per patient under any pay-for-quality scheme that is implemented. Free Full Text

Books and Monographs                                                                                                                

Healthcare Reforms


June 3, 2009 (10.1056/NEJMp0904131)

A Strategy for Health Care Reform — Toward a Value-Based System

Michael E. Porter, Ph.D.


John K. Iglehart Finding Money for Health Care Reform — Rooting Out Waste, Fraud, and Abuse. N Engl J Med 361:229-231, 2009. Published Online June 10, 2009 (DOI: 10.1056/NEJMp0904854)

Iglehart J. K. Building Momentum as Democrats Forge Health Care Reform. New Eng J Med,  360:2385-2387, 2009.

Inouye, SK., Brown, CJ., Tineti, ME. Medicare Nonpayment, Hospital Falls, and Unintended Consequences. New Eng J Med,  360:2390-2393, 2009.

Reforming Health Care.  Washington Post Editorial 27 April, 2009.

Agency for Healthcare Research and Quality

Centers for Medicare and Medicaid Services, Office of the Actuary, National Health Statistics Group, 2006 National Health Care Expenditures Data, January 2008.

Catlin, A., C. Cowan, M. Hartman, et. al.  2008.  National Health Spending in 2006: A Year of Change for Prescription Drugs, Health Affairs, 27(1): 14-29.

Kaiser Family Foundation and Health Research and Educational Trust. Employer Health Benefits 2006 Annual Survey. August 2007.
 Kaiser Family Foundation, 
Medicare Chart Book, 2005.
Altman, D. and L. Levitt. February 23, 2003. 
The Sad History of Health Care Cost Containment As Told in One Chart. Health Affairs Web Exclusive.

Maggon K.; R&D paradigm shift and billion dollar biologics. In Handbook of Pharmaceutical Biotechnology. Gad, S. C. Ed.; John Wiley, New York. May (2007).

US Economic and Healthcare crisis. Possible solutions and role of Medical Tourism

A Primer on the Details of Health Care Reform

Krishan Maggon 

Krishan Maggon Knols


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