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The U.S. Department of Health and Human Services implemented the Healthy People initiative to set national health objectives for four different decades since 1979. This national effort has promoted a shared vision for improving the health of all Americans in a very fragmented health care delivery system. The current Healthy People 2020 initiative being implemented by the Department's Office of Disease Prevention and Health Promotion differs from previous efforts in several important ways. This paper explores one of these changes: implementation of a new communication strategy based in modern information technology. This strategy conceptualized a Healthy People 2020 online space that would be a user-focused, 'one-stop shop' for public health and health care professionals, policymakers, and community members to learn about the objectives, plan interventions, and implement strategies to reach the 2020 objectives. The communication strategy incorporated new digital media, including building a following on LinkedIn and Twitter. At present, membership in the Healthy People LinkedIn group is more than 7700 people, and the Healthy People Twitter account (@gohealthypeople) has nearly 50 000 followers. In addition to the growth in number of users, the success of the communication strategy is also confirmed by the consistently high customer satisfaction rankings the site receives from the American Customer Satisfaction Index E-government Satisfaction Index. New developments in digital communication technology have the potential to advance three principal functions originally conceptualized for Healthy People 2020 online: benchmarking, advocacy, and connecting with others. Several exciting digital tools can be used to implement each of these key Healthy People 2020 functions, including mobile Web site optimization, smartphone/tablet apps, social media, and cloud computing. Ultimately, HHS can conduct research with Healthy People target audiences and stakeholders to inform the types of digital tools that will be most helpful to Healthy People 2020 users. [ABSTRACT FROM AUTHOR]

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This paper gives estimates by industry of cost and price impacts of mandatory workplace health insurance, which is part of the National Health Plan (NHP), a legislative proposal of the previous administration. The NHP proposal insures that most US residents have, at minimum, protection against catastrophic medical expenses. The paper briefly (a) describes major aspects of the workplace proposal; (b) discusses its economic effects, including alternative shifting and incidence situations; (c) presents the methodology of the estimates; and (d) summarizes simulation results. [ABSTRACT FROM AUTHOR]

Background: Several aspects of the opioid epidemic and of public health care organization in the United States (US) make the conduct of economic evaluation and the design of policies to respond to this crisis particularly challenging. Objectives: This commentary offers suggestions for how economic evaluation may address and overcome four key features of the opioid epidemic: 1) its magnitude and geographical distribution, 2) its intersection with multiple epidemics, 3) its rapidly changing dynamics, 4) its multi-sectoral causes and consequences. Results: We first offer pragmatic suggestions to address the difficulties in delivering a coordinated response given the fragmented nature of health care in the US. In view of the broad suite of responses required to address opioid use disorder and its associated comorbidities, we highlight the need for economic evaluations which consider interventions throughout the continuum of care (i.e. primary, secondary and tertiary levels of prevention). We examine how the use of predictive modelling alongside economic evaluation might be adopted to address the rapidly evolving situation affecting distinct populations and geographic areas and encourage investments in epidemic preparedness. Finally, we propose methods to capture the interdependence of various sectors of government affected by the opioid crisis in economic evaluations to ensure optimal levels of investment towards a comprehensive response. Conclusions: The opioid epidemic in the US represents an unprecedented public health challenge, but sound epidemiological modelling and economic analysis can help to guide use of limited resources committed to addressing it in ways that can have greatest impact in limiting its adverse consequences. [ABSTRACT FROM AUTHOR]

This article focuses on medical care in the U.S. In the 1950s, the then Minister of Health, Iain Macleod, described the boundary between health and social care as perhaps the most baffling problem in the whole of the NHS. Against this background, recent policy has tended to transfer a number of local government functions to the NHS. In addition, local authority-led health services would lead to a reduction in the democratic deficit of the NHS, making sure that vital public services are overseen by elected representatives rather than centrally appointed and less open and accountable NHS boards.

Efforts to describe health literacy in the last decade have helped us define the issue and recognize that our public's skills and abilities are not adequate for successfully navigating the growing demands and complexity of healthcare. There have been significant developments in health literacy over the last decade, with milestones of progress. Much of the work done in the 1990s focused on defining health literacy, initially measuring its prevalence and subsequently looking at its associations. Since then, health literacy has grown from an issue of an under-recognized “silent epidemic” to an issue of health policy and reform. Ideas and objectives proposed have actually been adopted in recent years, with significant policy developments. This article recognizes many achievements and milestones while developing recommendations for implementation in the decade ahead. [ABSTRACT FROM AUTHOR]

State-provided health insurance has now spread throughout much of the industrialized world. The United States is a particular exception to this trend. The U.S. uninsured represents one-sixth of its population. The uninsured exemplify those on the margins of the U.S. health care system. Based on qualitative research with 215 chronically ill, uninsured ethnic minorities, I argue that the U.S. system fosters an organized approach of containment toward the uninsured that not only marginalizes them but it keeps the problem of the uninsured in check by discouraging people from using health care services. Respondents viewed the treatment they received as an assault on their dignity and experienced discrimination, depersonalization, and disenfranchisement. They avoided using the health care system whenever possible despite chronic, life-threatening illnesses. I conclude that the uninsured, as a problem of the state, lies at its very heart, with implications for the health and well-being of the uninsured as well as for the governmental systems that attempt to manage and contain them. [ABSTRACT FROM AUTHOR]

Over the last ten years, partly in response to the backlash against restrictions on personal choice created by old forms of 'managed care', health plans in the USA have developed population health management programmes to target healthcare support services based on the level of patient need. Their large transaction processing functions create bases of data, linking primary, secondary, hospital, pharmacy and laboratory data for each individual they serve, giving them a unique capability to view and analyse the landscape of care for an entire population. Sophisticated new risk stratification techniques are used to identify health risk trajectories at the individual level so that at-risk individuals can be targeted with services to help them navigate the health system more efficiently and effectively. Interventions range from complex case management for individuals in the middle of acute episodes, disease management for individuals facing chronic care needs, health coaching for lifestyle-sensitive conditions, and personalised messaging services for primary and secondary prevention. These programmes show some improvement in adherence to recommended care paths, better management of chronic disease and aggregate savings at the population level. [ABSTRACT FROM AUTHOR]

This article presents information on the Cooperative Agreement Projects launched by the U.S. Department of Health and Human Services' (DHHS) Special Projects of National Significance program to fund 27 innovative models of HIV care. The organizations involved in HIV care aim to improve access to care, health and quality of life for traditionally underserved populations living with HIV/AIDS. It explains that the population being served by the projects have the following characteristics: 88.9% lacked private insurance, 72.5% were people of color and 85.7% were unemployed or unable to work due to a disability. It added that 22.1% had a history of sex work.