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In This Issue of JAMA |

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JAMA. 2013;310(18):1883-1885. doi:10.1001/jama.2013.5403.
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Published online

Edited by Joshua Sharfstein, MD; Phil B. Fontanarosa, MD, MBA; and Howard Bauchner, MD

An Exploration: Critical Issues in US Health Care

This week’s cover reflects the collective contribution of many prominent individuals whose writing appears in this issue. Their analysis and investigation provides a framework to discuss the complex challenges currently faced by those in medicine, public health, and social policy in the effort to create an effective and caring health care system in the United States. Image: Cassio Lynm, MA, CMI

SPECIAL COMMUNICATION

Health care in the United States comprises a complex array of interrelationships among those who receive, provide, and finance care. To describe and document the current anatomy and historical trends of health care in the United States, Moses and colleagues analyzed publicly available data (primarily from 1980 to 2011) relating to the source and use of funds; the people receiving and organizations providing care; and the resulting value created and health outcomes. A number of the authors’ findings contradict common assumptions about health care in the United States, and highlight conflicting expectations of patients, physicians, and policy makers.

Reduction in the use of inpatient care combined with incentives in the Affordable Care Act are contributing to significant consolidation in the hospital industry. In an analysis of 2010 data from 306 hospital referral regions, Cutler and Morton found that the typical region has between 3 and 5 consolidated health systems, which encompass 60% of hospitals and often include ownership of physician practices and post–acute care clinical services. The authors discuss potential benefits and harms of consolidation for consumers and consider strategies to mitigate harms.

Measurement of health care quality and patient safety is evolving; however, the best measures are not clear and a number of challenges exist. Panzer and colleagues discuss these challenges to quality measurement, including diverse purposes for quality measurement, the limited availability of meaningful clinical measures to determine quality, and limitations associated with reliance on claims data to assess quality. The authors describe recent development of a national quality strategy and conclude with recommendations for achieving an efficient and properly focused health care quality measurement system.

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