by Allan Joseph
In a few weeks, my institution is hosting the AMA’s Northeast-region meeting for medical students who are interested in policy and advocacy, among other topics. I’ve been asked to give a presentation on the policy problems of the future, and ways for the attendees to prepare for those problems and to help shape their solutions.
I thought I’d take an informal poll to help guide my talk. So what do you see as the biggest healthcare policy problem of the next 1 year, 5 years, 10 years, and/or 25 years? What can medical students do to prepare for them, and how should physicians shape the solutions?
Send me your answers to any or all of those questions via email, on Twitter, or in the comments below.
Thanks!
_____________________________
Allan Joseph is a second-year medical student at the Warren Alpert Medical School of Brown University, where he is pursuing an MD/MPH. You can follow him on Twitter @allanmjoseph.
project millennial 
The most important healthcare issues:
1. Decoupling health insurance from employment.
2. Decoupling health insurance from health care.
3. Getting healthcare providers to wash their hands.
4. Eliminating pets that pass on zoonoses.
5. Encouraging medical and dental tourism to Cuba, Brazil, Mexico and Costa Rica, etc.
-Healthcare/insurance coverage gap (especially in states that refuse to expand medicaid or implement healthcare law)
-Rising cost of care/Insurance company profits/reimbursements for physicians
-Women’s health/reproductive health policies
-Funding for expansion of inpatient psychiatric care
-Vaccination requirements
underinsurance and high deductible plans for people who can’t cover those deductibles
– Disjointed care between acute and non-acute settings, especially in elderly
– Re-designing long term care and community based care
– Sociodemographic disparities in care
– Revisiting pay-for-performance reimbursement models
Others have a lot of the big ones, but high-cost specialty drugs, and a physician’s responsibility to help patients navigate the detailed and tricky insurance formularies/preauthorization requirements that will result. Also concern about the viability of insurance companies as drug costs rise (look at Massachusetts Medicaid plans and the huge financial hit they took with hep C drugs).
In addition to the above:
1. Cost of care as well as consequences of reducing costs (such as job loss and income reduction).
2. Public resistance to evidence regarding efficiency/efficacy of care.
3. Loss of effective antibiotics.
Responses are harder than listing problems, but might include more and better organized reserach into treatment quality, adherence to the results of that research (not necessarily to the point of “cookbook medicine”, but in that direction), and stronger communication with patients and families about the purpose and efficacy of treatments.
There’s already a lot of good ones that have been listed, but I would also add minority health issues, like reducing health disparities/improving cultural competency in the healthcare setting/culturally sensitive interventions. Also, the aging population.