More than two in five primary care doctors in the United States report being burned out, one of the highest rates among 10 countries surveyed by the Commonwealth Fund. Researchers say the causes are varied, ranging from excessive administrative burden to the high number of patients physicians see each week. Whatever the reason, doctors experiencing burnout are more likely to say they plan to stop seeing patients in the near future. Easing paperwork requirements and strengthening team-based care are seen as key to keeping physicians in the field and ensuring people get timely primary care.
Primary care is under strain across the U.S. — especially in rural communities. In a Commonwealth Fund brief, Celli Horstman and Arnav Shah examine the barriers more than 60 million rural Americans face in accessing primary care, including persistent workforce shortages and below-average telehealth use. Amidst these challenges, a number of communities are coming up with creative ways to expand access to primary care. New federal investments like the Rural Health Transformation Program, which allocates $50 billion for states, may also bolster these efforts, the researchers say.
Keeping Coverage Choice While Losing the Complexity
The Affordable Care Act has been successful in increasing health coverage and improving access to care. Selecting a health plan, though, remains a frustrating experience for many: one-third of people say they don’t understand what their plan covers or what their costs will be. In a Commonwealth Fund brief, health policy experts Jeanne M. Lambrew and Christen Linke Young discuss an array of options for simplifying plan choices that could lead to greater satisfaction and more affordable coverage. At the same time, they warn against proposals that could further complicate health choices, undermine consumer protections, and raise costs.
In the 10 years leading up to passage of the Orphan Drug Act in 1983, there were 34 orphan drugs on the market. Since then, how many drugs have been approved through the law’s pathway?
400
600
800
1,000
Scroll down to see if you got it right.
Work Requirements May Worsen Mental Health Care
Starting in 2027, states are required to implement work requirements for adults covered through Medicaid eligibility expansions. Some enrollees are exempted from the requirements, including people with behavioral health conditions. On To the Point, the Kennedy Forum’s Nathaniel Counts says it will be important for states to take a thoughtful approach in implementing the exemptions so that people don’t experience coverage gaps. In particular, states will need to determine how to categorize behavioral health conditions as “disabling,” a process that could use claims and administrative data as well as self-attestation.
For the more than 27 million people in the U.S. who don’t speak English or have limited proficiency, a recent executive order by the Trump administration making English the official language for all federal operations will likely impact communication about their health care coverage, including reduced translation and interpreter services. The directive could make it harder for many people to understand their health care options and choose the coverage that’s right for them. The Commonwealth Fund’s Avni Gupta and colleagues examined who may be most affected by the change based on their health care coverage.
In late October, North Dakota’s Medicaid program began reimbursing community paramedics and emergency medical technicians for conducting health assessments, providing chronic disease education, and vaccinating patients in their homes based on a referral from a physician or midlevel provider. In partnership with the Bassett Research Institute, Commonwealth Fund researchers explored how community paramedicine programs offering similar supports have improved health outcomes in rural communities by helping people manage their conditions and avoid the need for emergency and acute care.
QUIZ: Answer
The answer is C. Since the Orphan Drug Act’s passage, the Food and Drug Administration has approved nearly 800 drugs.
Since its enactment 40 years ago, the Orphan Drug Act has incentivized the development of new drug therapies for rare diseases with no existing treatment. But a Commonwealth Fund brief exploring the law’s legacy finds that patient advocates, drug manufacturers, and policymakers continue to grapple with many of the challenges the law was intended to address. According to pharmaceutical policy expert Kristi Martin, some of the problems “stem from drug manufacturers’ attempts to exploit loopholes in the law’s incentives for orphan drug development in order to maximize profits.” Read the brief to learn more about the law’s impact to date, its shortcomings, and potential reforms.
Affordable, quality health care. For everyone.
The Commonwealth Fund, 1 East 75th Street, New York, NY 10021
