"A marvelous collection of ideas and insights by first-rate scholars. This book lays a foundation for more creative and effective policy-making." - Stephen M. Shortell, Dean and Blue Cross of California Professor of Health Policy and Management, University of California, Berkeley

Health care delivery in the United States is an enormously complex enterprise, and its $1.6 trillion annual expenditures involve a host of competing interests. While arguably the nation offers among the most technologically advanced medical care in the world, the American system consistently under performs relative to its resources. Gaps in financing and service delivery pose major barriers to improving health, reducing disparities, achieving universal insurance coverage, enhancing quality, controlling costs, and meeting the needs of patients and families.

Bringing together twenty-five of the nation's leading experts in health care policy and public health, this book provides a much-needed perspective on how our health care system evolved, why we face the challenges that we do, and why reform is so difficult to achieve. The essays tackle tough issues including: socioeconomic disadvantage, tobacco, obesity, gun violence, insurance gaps, the rationing of services, the power of special interests, medical errors, and the nursing shortage.

Linking the nation's health problems to larger political, cultural, and philosophical contexts, Policy Challenges in Modern Health Care offers a compelling look at where we stand and where we need to be headed.

With the passage of comprehensive health reform, the United States must redouble efforts to address our most vexing health policy issues. The need for innovative, cross-cutting health policy research is more urgent than ever. The Robert Wood Johnson Foundation (RWJF) recently announced the selection of this year’s recipients of the RWJF Investigator Awards in Health Policy Research - scholars who will tackle some of America’s most difficult health concerns and inform policy on these issues. The winning scholars, affiliated with major institutions across the country, will receive awards of up to $335,000 to support 10 innovative and cutting-edge research projects. The award recipients are:

• Co-investigators Joel T. Braslow, M.D., Ph.D., University of California, Los Angeles, and John S. Brekke, Ph.D., University of Southern California
• Cynthia A. Connolly, Ph.D., R.N., P.N.P., University of Pennsylvania
• Jennifer L. Hochschild, Ph.D., Harvard University
• James S. Jackson, Ph.D., University of Michigan
• Aaron S. Kesselheim, M.D., J.D., M.P.H., Harvard University and Brigham and Women’s Hospital
• Miriam J. Laugesen, Ph.D., Columbia University
• Co-investigators Jens Ludwig, Ph.D., University of Chicago, and Greg J. Duncan, Ph.D., University of California, Irvine
• S. V. Subramanian, Ph.D., M.Phil., Harvard University
• Co-investigators Jason Schnittker, Ph.D., University of Pennsylvania, and Christopher Uggen, Ph.D., University of Minnesota
• Co-investigators Robert L. Wears, M.D., University of Florida, and Kathleen M. Sutcliffe, Ph.D., University of Michigan

This prestigious and highly competitive funding program attracts investigators from a wide range of fields including medicine, nursing, public health, economics, sociology, political science, psychology, history, law, ethics, journalism, communications, public and social policy, and others. A national advisory committee of distinguished experts from fields similar to those of the investigators reviews applications and makes funding recommendations to the Foundation. The members of the 2009-2010 national advisory committee (NAC), which includes seven past Investigator Awardees, are:

• Paul D. Cleary, Ph.D., Yale University, NAC Chair
• Sheila Burke, R.N., M.P.A., Harvard University
• Lawrence Casalino, M.D., Ph.D., Weill Cornell Medical College, 1999 Awardee
• Susan Dentzer, Health Affairs
• Judy Feder, Ph.D., Georgetown University
• Bruce G. Link, Ph.D., Columbia University, 1995 Awardee
• Catherine G. McLaughlin, Ph.D., Mathematica Policy Research, Inc.
• Mark A. Peterson, Ph.D., University of California, Los Angeles, 1994 Awardee
• Jill B. Quadagno, Ph.D., Florida State University, 1999 Awardee
• Jeannette Rogowski, Ph.D., University of Medicine and Dentistry of New Jersey
• Sara Rosenbaum, J.D., George Washington University, 2000 Awardee
• Mark J. Schlesinger, Ph.D., Yale University, 1993 Awardee
• Alvin R. Tarlov, M.D., University of Chicago (retired)
• William A. Vega, Ph.D., University of Southern California
• Keith A. Wailoo, Ph.D., Princeton University, 2001 Awardee

RWJF created the Investigator Awards in Health Policy Research program to support talented researchers throughout the stages of their careers whose cross-cutting and bold new ideas promise to contribute meaningfully to improving U.S. health policy. Funded projects produce enduring insights and sophisticated analyses of pressing problems, potential solutions for improving health and health care, and evidence that can inform policymakers, the media, and the public. Since 1992, the Foundation has supported 167 projects involving 216 investigators.

“Through the Investigators’ program, the Foundation invests in ideas and individuals – investments that pay off long after the research grants have ended,” said Lori Melichar, Ph.D., economist and senior program officer in Research and Evaluation at RWJF. “The books and articles resulting from Investigators’ research contribute to the public discourse in health policy. The program also provides the Investigators with opportunities to join the debate on health policy issues, and influence how policymakers think about the challenges of providing and financing health care and improving the health of the nation.”

David Mechanic, Ph.D., leads the RWJF Investigator Awards program, which is headquartered at the Institute for Health, Health Care Policy, and Aging Research at Rutgers, The State University of New Jersey. “This program supports thinking that is creative and crosses disciplinary boundaries in search of knowledge and solutions to emerging problems or vexing issues that are important for improving the nation’s health and health care,” Mechanic says.

A brief description of each new investigator project follows.

Description: Patients as Policy Actors offers groundbreaking accounts of one of the health field's most important developments of the last fifty years--the rise of more consciously patient-centered care and policymaking. The authors in this volume illustrate, from multiple disciplinary perspectives, the unexpected ways that patients can matter as both agents and objects of health care policy yet nonetheless too often remain silent, silenced, misrepresented, or ignored. The volume concludes with a unique epilogue outlining principles for more effectively integrating patient perspectives into a pluralistic conception of policy-making. With the recent enactment of the Patient Protection and Affordable Care Act, patients' and consumers' roles in American health care require more than ever the careful analysis and attention exemplified by this innovative volume.

Drug use represents a significant burden to public health through disease, disability and social problems, and policy makers are becoming increasingly interested in how to develop evidence-based drug policy. It is therefore crucial to strengthen the links between addiction science and drug policy. Drug Policy and the Public Good is collaboratively written by an international group of career scientists to provide an analytical basis on which to build relevant global drug policies, and to inform policy makers who have direct responsibility for public health and social welfare.

Drug Policy and the Public Good presents, in a comprehensive, practical, and readily accessible form, the accumulated scientific knowledge on illicit drugs that has direct relevance to the development of drug policy on local, national, and international levels. The authors describe the conceptual basis for a rational drug policy and present new epidemiological data on the global dimensions of drug misuse. The core of the book is a critical review of the cumulative scientific evidence in five general areas of drug policy: primary prevention programs in schools and other settings; supply reduction approaches, including drug interdiction and legal enforcement; treatment interventions and harm reduction approaches; criminal sanctions and decriminalization; and control of the legal market through prescription drug regimes. The final chapters discuss the current state of drug policy in different parts of the in different parts of the world, and describe the need for a new approach to drug policy that is evidence-based, realistic, and co-ordinated.

The authors describe the conceptual basis for a rational drug policy and present new epidemiological data on the global dimensions of drug misuse. The core of the book is a critical review of the cumulative scientific evidence in five general areas of drug policy: primary prevention programs in schools and other settings; supply reduction approaches, including drug interdiction and legal enforcement; treatment interventions and harm reduction approaches; criminal sanctions and decriminalization; and control of the legal market through prescription drug regimes. The final chapters discuss the current state of drug policy in different parts of the world, and describe the need for a new approach to drug policy that is evidence-based, realistic, and co-ordinated.

Daniel Carpenter describes how the FDA cultivated a reputation for competence and vigilance throughout the last century, and how this organizational image has enabled the agency to regulate an industry as powerful as American pharmaceuticals while resisting efforts to curb its own authority. Carpenter explains how the FDA's reputation and power have played out among committees in Congress, and with drug companies, advocacy groups, the media, research hospitals and universities, and governments in Europe and India. He shows how FDA regulatory power has influenced the way that business, medicine, and science are conducted in the United States and worldwide. Along the way, Carpenter offers new insights into the therapeutic revolution of the 1940s and 1950s; the 1980s AIDS crisis; the advent of oral contraceptives and cancer chemotherapy; the rise of antiregulatory conservatism; and the FDA's waning influence in drug regulation today.

Reputation and Power demonstrates how reputation shapes the power and behavior of government agencies, and sheds new light on how that power is used and contested.

Daniel P. Carpenter is the Allie S. Freed Professor of Government at Harvard University. He is the author of The Forging of Bureaucratic Autonomy: Reputations, Networks, and Policy Innovation in Executive Agencies, 1862-1928 (Princeton).

Endorsements:

"Reputation and Power is by far the most thorough and penetrating study of the most powerful and important regulatory agency in the world--the U.S. Food and Drug Administration--and one of the best studies of any American regulatory agency. The book is essential reading for anyone seriously interested in American politics, public policy, administrative institutions, or health and medicine. This is an extraordinary work."--Paul Quirk, University of British Columbia

In Democracy Remixed, award-winning scholar Cathy J. Cohen offers an authoritative and empirically powerful analysis of the state of black youth in America today. Utilizing the results from the Black Youth Project, a groundbreaking nationwide survey, Cohen focuses on what young Black Americans actually experience and think--and underscores the political repercussions. Featuring their stories from cities across the country, she reveals that black youth want, in large part, what most Americans want--a good job, a fulfilling life, safety, respect, and equality. But while this generation shares much in common with the rest of America, they also believe that equality does not yet exist, at least not in their lives. Many believe that they are treated as second-class citizens. Moreover, for many the future seems bleak when they look at their neighborhoods, their schools, and even their own lives and choices. Through their words, these young people provide a complex and balanced picture of the intersection of opportunity and discrimination in their lives.

The political alienation and hope of black youth is real--and it is grounded in a contradictory reality that must be addressed. Democracy Remixed provides the insight and information necessary to truly transform the future of young Black Americans and American democracy.

New York. London. Paris. Although these cities have similar sociodemographic characteristics, including income inequalities and ethnic diversity, they have vastly different health systems and services. This book compares the three and considers lessons that can be applied to current and future debates about urban health care.

Highlighting the importance of a national policy for city health systems, the authors use well—established indicators and comparable data sources to shed light on urban health policy and practice. Their detailed comparison of the three city health systems and the national policy regimes in which they function provides information about access to health care in the developed world's largest cities.

The authors first review the current literature on comparative analysis of health systems and offer a brief overview of the public health infrastructure in each city. Later chapters illustrate how timely and appropriate disease prevention, primary care, and specialty health care services can help cities control such problems as premature mortality and heart disease.

In providing empirical comparisons of access to care in these three health systems, the authors refute inaccurate claims about health care outside of the United States.

"Rothman and Blumenthal's compelling book, Medical Professionalism in the New Information Age, fills a current gap in the literature on the possible implications of information technology for practicing physicians, health care organizations, and the profession more generally, thereby advancing both policy analysis and clinical practice."—Melissa Goldstein, George Washington University Medical Center

Description:

With computerized health information receiving unprecedented government support, a group of health policy scholars analyze the intricate legal, social, and professional implications of the new technology. These essays explore how Health Information Technology (HIT) may alter relationships between physicians and patients, physicians and other providers, and physicians and their home institutions. Patient use of web-based information may undermine the traditional information monopoly that physicians have long enjoyed. New IT systems may increase physicians’ legal liability and heighten expectations about transparency. Case studies on kidney transplants and maternity practices reveal the unanticipated effects, positive and negative, of patient uses of the new technology. An independent HIT profession may emerge, bringing another organized interest into the medical arena. Taken together, these investigations cast new light on the challenges and opportunities presented by HIT.

About the Editors:

DAVID J. ROTHMAN is president of the Institute on Medicine as a Profession (IMAP) and Bernard Schoenberg Professor of Social Medicine at Columbia College of Physicians & Surgeons. His many books include Strangers at the Bedside and The Pursuit of Perfection with Sheila M. Rothman.