NEJM Audio Perspectives

Under the Affordable Care Act, Medicare will launch a Shared Savings Program for groups of health care providers that join forces, with or without hospitals or health plans, to form legal entities that agree to take responsibility for the quality, cost, and overall care of a population of patients. What will these accountable care organizations (ACOs) look like? Who will step forward to form them? What are the best pathways and likely hurdles to achieving ACO status? What are the risks of...

President Barack Obama has argued that healthcare reform is essential to the future economic health of the United States. But the economics of both healthcare and reform are daunting. Is it possible to pay for healthcare coverage for all Americans without moderating our rapidly rising healthcare costs? And what do we know about the best ways of achieving cost savings? In a roundtable discussion moderated by Dr. Atul Gawande, three experts in health economics — Drs. Elliott Fisher, Jonathan...

President Barack Obama has placed US healthcare reform at the top of his domestic agenda, and months of legislative work on the issue have resulted in five bills — three in the House of Representatives and two in the Senate — that proponents believe will move the country in the direction of universal coverage, a fairer insurance system, and slower escalation of health care costs. In part 3 of a symposium co-sponsored by the Journal and the Harvard School of Public Health, health policy...

President Barack Obama has placed US healthcare reform at the top of his domestic agenda, and months of legislative work on the issue have resulted in five bills — three in the House of Representatives and two in the Senate — that proponents believe will move the country in the direction of universal coverage, a fairer insurance system, and slower escalation of health care costs. In part 2 of a symposium co-sponsored by the Journal and the Harvard School of Public Health, health policy...

U.S. primary care is in crisis. Primary care physicians must care for more and more patients, with more and more chronic conditions, in less and less time, for which they are compensated far less than subspecialists. They must absorb increasing volumes of medical information and complete more paperwork than ever, as they try to function in a poorly coordinated health care system. As a result, their ranks are thinning, with practicing physicians burning out and trainees shunning primary...

In this roundtable discussion, moderator Dr. Atul Gawande, surgeon and associate professor at Harvard Medical School and the Harvard School of Public Health, is joined by Deborah Denno, professor of law at Fordham University; Dr. Robert Truog, professor of medical ethics, anesthesiology, and pediatrics at Harvard Medical School; and Dr. David Waisel, associate professor of anesthesia at Harvard Medical School, in a conversation about lethal injection, the current protocol, possible...

In two large randomized trials, researchers examined the effect of annual prostate-specific antigen (PSA) screening on the rate of death from prostate cancer and found that it was small and was offset by false positive diagnoses. Since screening may have benefits in catching cancers early but may also carry risks including that of unnecessary treatment, professional societies have split on the question of whether to recommend regular PSA screening. In a roundtable discussion moderated by...

In an issue of the Journal, Boucek et al. reported on three cases of heart transplantation from infants who were pronounced dead on the basis of cardiac criteria. Moderator Atul Gawande, of Harvard Medical School; George Annas, of the Boston University School of Public Health; Arthur Caplan, of the University of Pennsylvania; and Robert Truog, of Harvard Medical School discuss key ethical aspects of organ donation after cardiac death.