[Correspondence] The Global Kidney Exchange programme – Authors’ reply

Marta López-Fraga and Beatriz Domínguez-Gil make their point about our Health Policy on the ethics of the Global Kidney Exchange (GKE) programme1 by asking us to imagine that Alyson, an Ohio farmer, is willing to donate a kidney to her daughter but unable to afford the surgery. Medicare pays for kidney transplantation surgery in the USA, even for people younger than 65 years, so there is no way in which GKE could prevent Alyson's daughter from receiving a kidney from her mother. Kidney transp...

[Correspondence] Rebuilding the broken health contract in Chile

Many Chileans think that their country has lost its way. Massive protests highlight the need for a political reform to prioritise universal health care. The uncritical worship of the most extreme version of the free market by the Pinochet dictatorship led to the dismantling of the social contract and privatisation of the social security system. A system of personal retirement accounts was mandatory for new workers whereas the current workforce could opt out from the existing government-manage...

[Editorial] Support for caregivers in the USA

The contest to secure the Democratic party nomination for President of the USA has brought health care to the forefront of public discourse, with much of the discussion dominated by the merits of Medicare for All, a comprehensive single-payer national health-care programme. The questions raised in this debate have brought a welcome focus on specific policy options for addressing the country's myriad health-care challenges. But largely missing has been the issue of social care, particularly th...

[Editorial] Trump’s steady erosion of health insurance protections

43% of US households report that at least one family member has a pre-existing medical condition, according to a survey released by Gallup on Dec 6, 2019. 49% of Americans (156 million people) receive health insurance through employers, and before the 2010 Affordable Care Act (ACA), a change of situation, such as losing or switching a job, would have allowed insurance companies to decline coverage or potentially make people uninsurable because of chronic health conditions. Although Democrats ...

[Series] Primary prevention of ischaemic heart disease: populations, individuals, and health professionals

Ischaemic heart disease has a multifactorial aetiology and can be prevented from developing in populations primordially, and in individuals at high risk by primary prevention. The primordial approach focuses on social determinants of health in populations: political, economic, and social factors, principally unplanned urbanisation, illiteracy, poverty, and working and living conditions. Implementation of the UN Sustainable Development Goals can lead to major improvements in cardiovascular hea...

[Editorial] Prioritising primary care in the USA

Although the USA spends more on health care despite having worse outcomes than other high-income nations, one area where it underinvests is primary care. Research has shown that higher levels of spending on primary care lead to improved patient outcomes and lower overall health-care costs. On July 17, 2019, the Patient-Centered Primary Care Collaborative (PCPCC) issued the first report to look at primary care spending by state, including spending from across different types of payers: commerc...

[Correspondence] Key points to consider in the IMPERIAL trial – Author’s reply

We agree with Jim Reekers that the IMPERIAL trial,1 in both device concept and trial design, as well as in its outcome, was unique and important in the endovascular field. We also wholeheartedly support the use of supervised exercise training in peripheral arterial disease patients as a valuable primary and adjunctive tool to improve symptoms and functional capacity, and we are especially pleased at the decision in 2017 by the US Centers for Medicare & Medicaid Services.