Viewpoints: The case for doctors making house calls; the measles threat; the VA's value

The New York Times' Taking Note: When Courts Consider Evidence, Abortion Supporters Win
At a time when burdensome restrictions enacted in Republican-led states are threatening women's access to abortion care, it is all the more vital that courts scrutinize phony claims that new laws actually protect women's health and safety (Dorothy J. Samuels, 6/4). 

Los Angeles Times: Want Better Healthcare? Have Doctors Make House Calls.
I make house calls. Remember those? When a doctor came to your door with a black bag? You might think of this as a quaint vestige of prewar life, or a luxury for the exceptionally wealthy with their concierge doctors. But home care medicine, as it's now called, is extremely efficient and effective in modern America. Indeed, it often makes more medical and financial sense than a trip to the doctor's office (Mindy Fain, 6/4).

Bloomberg: When No One Is Safe From Measles
Chalk up another demerit for the antivaccine movement: So far, 2014 is shaping up as the worst year for confirmed cases of the measles since it was declared eliminated as an endemic disease in 2000 in the U.S. Most of the news and media coverage of the outbreak has focused on the fact that 69 percent of the 288 people sickened so far hadn't been vaccinated against measles. This, of course, shouldn't be a surprise. People who don't get immunized are prone to getting sick. What's more noteworthy is that 10 percent of those who've fallen ill had been vaccinated and another 20 percent may have been but weren't sure (Lisa Beyer, 6/4).

Raleigh News & Observer: NC Senate Budget Mangles A Hard-Won Plan To Reform Medicaid
The North Carolina Medical Society's immediate response to the recent Senate budget proposal was concern for the harm it would cause our state's aged, blind and disabled residents who would no longer be eligible for Medicaid benefits. The Senate's budget proposal offers no real solution to the big challenges we're facing in Medicaid. In fact, it makes Medicaid worse, not better (Robert W. Seligson, 6/4).

The New England Journal Of Medicine: Restoring Trust In VA Health Care
To some observers, the VA's problems confirm that government cannot manage health care. To others, they tell a simple story of insufficient funding: the VA needs more money to care for the large number of veterans returning from the wars in Iraq and Afghanistan and for aging Vietnam veterans. Unfortunately, neither narrative adequately captures the challenges facing this organization or provides guidance on how we might address them. Inadequate numbers of primary care providers, aged facilities, overly complicated scheduling processes, and other difficult challenges have thwarted the VA's efforts to meet soaring demand for services. ... So how can the VA turn the ship around? We propose a few first steps (Drs. Kenneth W. Kizer, and Ashish K. Jha, 6/4).

The New England Journal Of Medicine: Improving Health Care For Veterans -; A Watershed Moment For The VA
[A]ccess to care, particularly to outpatient appointments, has been an enduring problem for the VA, as documented in multiple reports from the OIG and the Government Accountability Office (GAO). ... Beyond access to care, health system performance should be evaluated on the basis of health outcomes, the quality and safety of the care delivered, patient satisfaction, and costs. In many of these domains, the VA has kept pace with or surpassed private-sector health systems. ... In the 1990s, VA health care, facing a similar crisis of confidence and bipartisan calls for privatization, was transformed into a more technologically advanced, decentralized, and quality-oriented system. Now it needs to protect the best elements of its infrastructure, built around longitudinal, holistic care of each veteran, while embarking on another round of reform (Dr. Dave A. Chokshi, 6/4).

The New England Journal Of Medicine: My Hidden VA List
Nowhere else than at the VA have I felt as much that I was a part of something greater than myself. We "care for him who shall have borne the battle" in a system that, for all its woes, remains a singular presence in the confused patchwork of medical care that is American medicine. Enter the VA medical system and you know that your critical medical data are available to every provider at every VA hospital in the country in ways unimaginable in the private sector; you know that care delivered in the VA system often meets or exceeds the quality standards of the private sector. You know, moreover, that you and the person sitting next to you in the waiting room will get the same level of care, because there is no mysterious and fickle insurer to reckon with at the end of the appointment (Dr. Dena E. Rifkin, 6/4).

The New England Journal Of Medicine: Learning from Big Health Care Data 
Two key "learning" applications of big health care data that hold the promise of improving patient care are the generation of new knowledge about the effectiveness of treatments and the prediction of outcomes. Both these functions exceed the bounds of most computer applications currently used in health care, which tend to offer physicians such tools as context-sensitive warning messages, reminders, suggestions for economical prescribing, and results of mandated quality-improvement activities (Dr. Sebastian Schneeweiss, 6/5).