The following guest post is written by Candace Littell, Health Policy Advisor at Candace Littell, LLC. Candace Littell is a consultant with 30 years experience in healthcare policy and reimbursement. She serves as an advisor to corporate clients, healthcare providers, associations and related organizations.

President Obama’s 2011 HHS budget builds on the American Recovery and Reinvestment Act (AARA) investment in federally qualified health centers (FQHCs), providing an additional $290 million for further expansions.  With this increase, the administration estimates that health centers will be able to serve more than 20 million individuals in FY 2011.

Combined with other AARA provisions, this is good news for some of our nation’s “safety net” providers, including FQHCs, as well as public and nonprofit hospitals that treat many low income patients.  But there’s also a growing hole in the safety net as free medical clinics struggle to survive the current economic recession.

In a recently released research brief on safety net providers by the Robert Wood Johnson Foundation’s Center for Studying Health System Change^[1], the authors note, “while many FQHCs have benefitted from both the recent ARRA funding and federal expansion grants over the past 10 years, many free clinics without FQHC status were facing more serious financial strains than safety net hospitals and FQHCs.”  The report goes on to quote one FQHC executive as saying, “FQHCs got money, and free clinics are worried about keeping their doors open…There’s a big have and have-nots disparity.”

FQHCs include community health centers, public housing centers and some outpatient programs.  These providers receive federal payments for qualified services and are eligible for stimulus funds and federal expansion grants.  In contrast, free clinics do not receive federal payments and they are not eligible for funding available to FQHCs.  Instead, they depend primarily on private philanthropy and a team of volunteer physicians to provide care to the uninsured.

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It could not escape notice this week that the Virginia state Senate passed legislation that would make it illegal for any government body to require individuals to purchase health insurance.  The bill is expected to be passed by the state’s House of Delegates and then signed into law by Governor Bob McDonnell.

Virginia is one of the first states to take such action, but it almost certainly won’t be the last.  According to the American Legislative Exchange Council, legislative measures or proposed constitutional amendments have been filed in 35 states to challenge the idea of health insurance mandates.

This is a significant problem for the future of health reform.  One of the most popular components of the health reform bills that have passed both houses of Congress is the provision that removes pre-existing health conditions as a barrier to purchasing health coverage.  Even in our fractious society, there is virtual unanimity around the idea that having an illness shouldn’t leave individuals and families without health insurance and subject to financial ruin.

But we can’t enact that essential reform unless we also take steps to ensure that there is an individual responsibility to have health coverage.  Just as our property insurance system would collapse if individuals could wait until their house is on fire to buy a homeowners’ policy, so would our health insurance system be unsustainable if the healthiest among us could opt out until we became ill and needed an insurance plan to cover their expenses.

Understandably, lawmakers, in a challenging political environment, would love to pass laws making insurance companies issue policies to all comers, but they’re reluctant to impose health insurance mandates on their constituents. This, however, is a case where you genuinely can’t have the dessert without the vegetables.

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Human beings have a fundamental right to health, which must be equally distributed to all. To be able to provide the prevention, care, treatment and rehabilitative services needed for its population, Rwanda has embarked on an ambitious journey to transform its socio-economic situation by changing its economy from an agriculture-based to a knowledge-based economy. In this context, Rwanda has identified the use of science and technology as a key tool for achieving our socio-economic transformation and reaching the MGDs. Although a high tech strategy may appear inappropriate for the health system of a developing country, this is is not applicable to Rwanda because our health sector ICT plan is integrated into two master plans: our health sector strategic plan and our national ICT plan. We know that e-Health is vital in order to create an effective and sustainable health system, as it will help us solve challenges in our health system, such as the lack of infrastructure and the shortage of professionals (since roads are still a problem in some remote areas, sending information, plans, and reports by ICT saves time and money).

Another reason why ICT for E-Health should be developed is because the right to health cannot be separated from the right to information, and the use of new information and communication technologies is the most accurate and timely way to provide information.

A good flow of information concerns four categories in the health sector: the patients, the policy makers, the care providers and the program managers. When it comes to patients, they need to be educated on their health needs and on how, when, and where to seek proper care. Also, once on treatment, patients should know why it is important to go for timely medical follow up appointments and be compliant to treatment, since it not only aids their recovery, but also helps to avoid dangerous resistances to epidemic diseases like HIV. Patients would be informed of these things by making ICT tools available to health professional at all level: community health workers would use phones, while central and district managers, health centres, district hospitals and referral hospitals would use web-based tools. For policy makers and program managers, ICT is important because it helps to design health policies and programs that are informed by evidence and based on accurate information. In general, the use of ICT has proven to be the more effective, secure, rapid and accurate way to serve patients and program managers. This is why the Government of Rwanda has put ICT as a top priority for its health development and recognizes that there is an urgent need to build e-Health capacity.

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The following guest post by Dr. Peggy Polaneczky, a New York-based physician, was recently featured on the Better Health blog.The original post can be found on Dr. Polaneczky’s The Blog that Ate Manhattan: Food, Considerations & Second Opinions blog.

First off, I need to address those who think they’re being brilliantly funny comparing Apple’s new product name to a feminine hygiene product – making comments like “Does it come with wings?” and “It’s light and easy to use, but can you swim with it?” (these are the cleaner comments I’ve seen), or calling for the next generation ITampon.

Since when did the word “Pad” become unusable in public discourse? And where were these folks when IBM came out with their Think Pad? It’s stupid, 12-year old funny and just plain dumb. Grow up, ladies and gents.

Now, on to more serious matters.

Is the IPad, as some are suggesting, the next big thing in Medicine? Dana Blakenhorn at ZDNet thinks so, calling medicine the IPad’s “Sweet Spot”-

It’s what your doctor has been dreaming of ever ince the PC revolution began. Imagine this in a flip-up case, in every examination room at your clinic. The nurse sets up the chart, the doctor walks in with a stylus and examines you, and when he’s done the chart goes into the file and the prescription is waiting at the desk for you, printed clearly, along with your Coordination of Care Record. Hand the nurse your credit card and you’re off.

On January 23, the Boston Globe reported that Lawrence DuBuske, M.D., Harvard Medical School Instructor, Asthma and Allergy Specialist and lecturer/consultant to pharmaceutical companies would resign his posts at Harvard and Brigham at the end of the month because remaining there would require he cease his work with industry. Failing to do so would be a violation of the Harvard/Partner’s conflict of interest policy.

If the article is accurate and he followed through on those plans, he’s gone now.

I know how carefully industry vets their speakers and consultants. That should come as no surprise. Any event planner, organization or company engaging a speaker or consultant wants just that – an expert.

I have no way of knowing how carefully Harvard Medical School vets its instructors or Brigham vets its clinicians, but I imagine both to be tailored to assure that only the best and only the experts are hired. Surely, were I a student at Harvard or a patient at Brigham, I’d want just that – and expert.

I’ve not met Dr. DuBuske, but ‘on paper’ he seems to be just that—an expert. He’s ‘passed muster’ more than once to gain – and retain – positions at elite institutions. The fact that he has associated with major, respected institutions is a credit to his qualifications.

In addition, he has achieved Fellow status in five major clinical societies: the American College of Physicians, the American Academy of Allergy, Asthma and Immunology, the American College of Allergy, Asthma and Immunology, the American College of Rheumatology and the American College of Chest Physicians. I’ll forego mentioning those organizations in which he is only a member, his European affiliations and all the awards except one – 2004 Distinguished Fellow of the American College of Allergy, Asthma and Immunology.

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