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Health reforms as examples of multilevel interventions in cancer care.

Authors
  • Flood, Ann B1
  • Fennell, Mary L
  • Devers, Kelly J
  • 1 Department of Community and Family Medicine, and The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth Medical School, Hanover, NH 03755, USA. [email protected]
Type
Published Article
Journal
Journal of the National Cancer Institute. Monographs
Publication Date
May 01, 2012
Volume
2012
Issue
44
Pages
80–85
Identifiers
DOI: 10.1093/jncimonographs/lgs012
PMID: 22623600
Source
Medline
License
Unknown

Abstract

To increase access and improve system quality and efficiency, President Obama signed the Patient Protection and Affordable Care Act with sweeping changes to the nation's health-care system. Although not intended to be specific to cancer, the act's implementation will profoundly impact cancer care. Its components will influence multiple levels of the health-care environment including states, communities, health-care organizations, and individuals seeking care. To illustrate these influences, two reforms are considered: 1) accountable care organizations and 2) insurance-based reforms to gather evidence about effectiveness. We discuss these reforms using three facets of multilevel interventions: 1) their intended and unintended consequences, 2) the importance of timing, and 3) their implications for cancer. The success of complex health reforms requires understanding the scientific basis and evidence for carrying out such multilevel interventions. Conversely and equally important, successful implementation of multilevel interventions depends on understanding the political setting and goals of health-care reform.

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