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What's up (or down and out) in US healthcare
  1. H BAUCHER, US Editor

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    It is always difficult to summarise trends in US healthcare. But it's worth a shot—in no particular order:

    • Cost is up. Healthcare expenditures are once again increasing by 6–8% or more annually

    • The number of uninsured Americans remains embarrassingly high—45 million—or 1 in 6 US citizens

    • A new programme has been developed: the State Child Health Insurance Program, which should reduce the number of children without insurance. There is growing consensus that all children should have health insurance. Unfortunately, there is no movement to ensure that all their parents, or for that matter, all citizens, should have health insurance

    • Oral antibiotic use is down

    • Immunisation rates are up, as well as the number of vaccines, and more are coming

    • President Bush has announced that biomedical research will be spared any budgetary cuts

    • Our National Institutes of Health have already enjoyed significant increases in budget over the past few years. The current budget is $20 billion. It is likely to reach $30 billion in 2–4 years. Hopefully, we will spend the money wisely

    • Although the genome project has been widely championed in the popular press, it is less clear when there will be direct benefit for patients

    • Although the US experimented with staff model health maintenance organisations and true managed care for a few years, it appears the experiment is over. Many plans

    are once again allowing patients ready access to specialists and emergency room care

    • The cost of prescription drugs continues to increase dramatically. In the coming months, Congress will debate various plans to provide pharmacy benefits for the elderly, but whether a plan emerges and what form it will take is uncertain

    • The cost of Medicare, our healthcare plan for the elderly, continues to increase dramatically, in part because of pharmacy costs. It is not clear if these increases can be contained

    • The health of most Americans is good, but large socioeconomic and ethnic disparities in care and health status still exist

    • Our love affair with technology and specialty care continues

    • Medical errors are alive and well and have become a national priority

    • Learning from the rest of the world, once again we have recognised the importance of breast feeding. Initiation rates are up, and duration is longer in selected groups

    • The promise of information technology—computers in the healthcare work place—is finally beginning to be realised

    • Every new President brings their own new health agenda. Beyond providing prescription benefits for the elderly and increasing the budget for the NIH, the priorities of President Bush are not yet clear.

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