JERUSALEM (Reuters) - U.S. Secretary of State John Kerry accelerated his Middle East shuttle diplomacy on Friday in the hope of persuading Israel and the Palestinians to resume direct peace negotiations.
After seeing Palestinian President Mahmoud Abbas in Jordan, Kerry flew by helicopter to Jerusalem for evening talks with Israeli Prime Minister Benjamin Netanyahu - a meeting that had been originally expected to take place on Saturday.
A senior State Department official said the three-hour meeting with Netanyahu involved a "detailed and substantive conversation about the way forward". Syria's civil war and Iran were also discussed.
It was the men's second meeting in two days, suggesting a new urgency in Kerry's latest monthly visit to the region. Israeli officials declined to discuss the content of the talks.
Later, Kerry met Israeli President Shimon Peres at his residence in a quiet suburb of Jerusalem. Peres praised Kerry for his determination in trying to revive talks.
"I know this is difficult, there are many problems, but as far as I'm concerned I can see how (among) people, there is a clear majority for the peace process, a two-state solution, and a great expectation that you will do it and that you can do it," he told Kerry.
Direct negotiations between Israel and the Palestinians broke down in late 2010 in a dispute over Israeli settlements in the occupied West Bank and East Jerusalem, territories that the Palestinians seek for a future state.
Abbas has insisted that building in the settlements, viewed as illegal by most world powers, be halted before talks resume. He also wants Israel to recognize the boundary of the West Bank as the basis for the future Palestine's border.
It was unclear whether Kerry would be able to announce a deal on Saturday to restart talks, or whether he will have to return again for follow-up meetings.
MORE TALKS AHEAD
Abbas's spokesman Nabil Abu Rdaineh said Abbas would meet Kerry again in Jordan on Saturday, and that a "clear response" was needed from Israel before talks could resume. A State Department official confirmed the Abbas meeting.
Israel wants to keep settlement blocs under any future peace accord and has rejected Abbas's demands as preconditions. But it has also quietly slowed down housing starts in settlements.
Palestinian and U.S. officials did not immediately comment on the results of the Abbas-Kerry meeting. Zeev Elkin, Israel's deputy foreign minister, placed the peacemaking onus on Abbas.
Asked on Israel Radio whether Kerry's visit - his fifth - could bring a breakthrough, Elkin said: "The only one who knows the answer to that question is not Kerry, nor Netanyahu, but Abu Mazen (Abbas)."
Kerry has divulged little of his plan to bring the sides together, but has said he would not have returned to the region if he did not believe there could be progress.
He is also keen to clinch a peacemaking deal before the United Nations General Assembly, which has already granted de facto recognition to a Palestinian state, convenes in September.
Netanyahu is concerned that the Palestinians, in the absence of direct peace talks, could use the U.N. session as a springboard for further statehood moves circumventing Israel.
State Department officials believe the sides will return to negotiations once there is an agreement on confidence-building measures - for example, partial Israeli amnesty for Palestinian security prisoners - and a formula for fresh talks.
Part of the incentive for the Palestinians to return to talks is a $4 billion economic plan led by former British prime minister Tony Blair, whom Kerry also met in Jordan.
The plan involves investments from large private-sector firms that will boost jobs and spur economic growth in agriculture, construction and tourism.
(Additional reporting by Ali Sawafta; Writing by Dan Williams; Editing by Kevin Liffey)
Supporters of Egypt's Islamist President Mohammed Morsi fill a public square outside the Rabia el-Adawiya Mosque in Cairo, not far from the presidential palace, during a rally in Cairo, Friday, June 28, 2013. Tens of thousands of backers and opponents of Egypt's Islamist president held competing rallies in the capital Friday and new clashes erupted between the two sides in the country's second largest city, Alexandria, in a prelude to massive nationwide protests planned by the opposition this weekend demanding Mohammed Morsi's removal.(AP Photo)
Supporters of Egypt's Islamist President Mohammed Morsi fill a public square outside the Rabia el-Adawiya Mosque in Cairo, not far from the presidential palace, during a rally in Cairo, Friday, June 28, 2013. Tens of thousands of backers and opponents of Egypt's Islamist president held competing rallies in the capital Friday and new clashes erupted between the two sides in the country's second largest city, Alexandria, in a prelude to massive nationwide protests planned by the opposition this weekend demanding Mohammed Morsi's removal.(AP Photo)
Opponents of Egypt's Islamist President Mohammed Morsi chant slogans as fire rages at the Muslim Brotherhood headquarters in Alexandria, Friday, June 28, 2013. Thousands of backers and opponents of Egypt's Islamist president held competing rallies in the capital Friday and new clashes erupted between the two sides in the country's second largest city, Alexandria, in a prelude to massive nationwide protests planned by the opposition this weekend demanding Mohammed Morsi's removal.(AP Photo/Heba Khamis)
Opponents of Egypt's Islamist President Mohammed Morsi chant slogans as fire rages at the Muslim Brotherhood headquarters in Alexandria, Friday, June 28, 2013. Thousands of backers and opponents of Egypt's Islamist president held competing rallies in the capital Friday and new clashes erupted between the two sides in the country's second largest city, Alexandria, in a prelude to massive nationwide protests planned by the opposition this weekend demanding Mohammed Morsi's removal.(AP Photo/Heba Khamis)
Supporters of Egypt's Islamist President Mohammed Morsi hold a rally in Cairo, Friday, June 28, 2013. Thousands of backers and opponents of Egypt's Islamist president held competing rallies in the capital Friday and new clashes erupted between the two sides in the country's second largest city, Alexandria, in a prelude to massive nationwide protests planned by the opposition this weekend demanding Mohammed Morsi's removal. (AP Photo/Manu Brabo)
Opponents of Egypt's Islamist President Mohammed Morsi wane national flags as they demonstrate in Tahrir Square in Cairo, Egypt, Friday, June 28, 2013. Thousands of supporters of Egypt's embattled president are rallying in the nation's capital in a show of support ahead of what are expected to be massive opposition-led protests on June 30 to demand Mohammed Morsi's ouster.(AP Photo/Amr Nabil)
CAIRO (AP) ? The health department says one person has died and at least 85 others were injured in clashes between supporters and opponents of Egypt's President Mohamed Morsi in the Mediterranean city of Alexandria.
Thousands of anti-Morsi protesters marched toward the Muslim Brotherhood headquarters Friday, where up to a 1,000 supporters of the president's political group were deployed. Fighting erupted when someone on the Islamist side fired birdshots on the marchers, according to an Associated Press cameraman at the scene. Later, opposition protesters broke into the headquarters and torched it.
The health department reported one death in the fighting, without elaborating. It was not immediately known which side the victim belonged to.
Backers and opponents of Egypt's Islamist president held competing rallies Friday ahead of massive protests planned Sunday demanding Morsi's removal.
AMMAN, Jordan (AP) ? U.S. Secretary of State John Kerry was meeting Friday with Palestinian President Mahmoud Abbas and planned to return to Jerusalem for more talks with the Israelis as he continues his latest round of Mideast diplomacy in an effort to get both sides back to the negotiating table.
Kerry was using Amman as a base for the talks. He drove to Jerusalem Thursday night for a dinner meeting with Israeli Prime Minister Benjamin Netanyahu that lasted about four hours.
He and his delegation returned to Amman early Friday. Around noon, he drove to a diplomatic area of Amman for a luncheon with Abbas.
"It's good to be back and I look forward to our conversation. We have a lot to talk about, obviously, as you know," Kerry told Abbas.
As reporters and photographers were ushered out of the meeting, Kerry turned to Abbas and said: "We had a good long meeting." It was an apparent reference to his meeting with Netanyahu the night before. "We're going back."
State Department officials have said little about the details of the talks. It was clear from the travel schedule given to the delegation that Kerry was going to go back to Jerusalem, but State Department officials wouldn't confirm the return trip.
It, however, was one of the first things Kerry told Abbas as the two men sat down to talk.
Kerry, who is on a two-week swing through the Mideast and Asia, left Amman on Thursday evening in a convoy of nearly a dozen vehicles for the roughly 90-minute drive to Jerusalem. A Jordanian military helicopter flew over his convoy during the trip, according to a reporter who was allowed to make the trip with Kerry and his delegation.
Netanyahu was about an hour late, apparently telling Kerry that he was delayed because he had been attending a graduation ceremony for Israeli military pilots. They talked mostly one-on-one, but advisers also were present for some of the discussion, which began around 9:30 p.m. local time in a suite at a hotel in Jerusalem and ended around 1:30 a.m. Friday.
The State Department released the dinner menu ? fish ceviche and a main course of red tuna and sea bream over lentils and mushrooms ? but offered no detailed information about their talks. The State Department said only that the two had a "productive, in-depth and wide-ranging conversation" and that Kerry reiterated his commitment to working with all parties to achieve a two-state solution.
There was no readout from the Israelis.
State Department officials say Kerry will continue to try to find common ground between the two sides that would lead to a re-launching of negotiations. On this trip, Kerry is trying to pin down precisely what conditions Abbas and Netanyahu have for resuming talks and perhaps discuss confidence-building measures.
Representatives from the NAACP Legal Defense Fund stand outside the Supreme Court in Washington, Tuesday, June 25, 2013, awaiting a decision in Shelby County v. Holder, a voting rights case in Alabama. The Supreme Court says a key provision of the landmark Voting Rights Act cannot be enforced until Congress comes up with a new way of determining which states and localities require close federal monitoring of elections. (AP Photo/J. Scott Applewhite)
Representatives from the NAACP Legal Defense Fund stand outside the Supreme Court in Washington, Tuesday, June 25, 2013, awaiting a decision in Shelby County v. Holder, a voting rights case in Alabama. The Supreme Court says a key provision of the landmark Voting Rights Act cannot be enforced until Congress comes up with a new way of determining which states and localities require close federal monitoring of elections. (AP Photo/J. Scott Applewhite)
Ryan P. Haygood, director of the NAACP Legal Defense Fund, talks outside the Supreme Court in Washington, Tuesday, June 25, 2013, about the Shelby County v. Holder, a voting rights case in Alabama. Charles White, the national field director for the NAACP is second from right and Sherrilyn Ifill, president of the NAACP Legal Defense Fund is at right. The Supreme Court says a key provision of the landmark Voting Rights Act cannot be enforced until Congress comes up with a new way of determining which states and localities require close federal monitoring of elections. (AP Photo/J. Scott Applewhite)
WASHINGTON (AP) ? A deeply divided Supreme Court on Tuesday halted enforcement of the federal government's most potent tool to stop voting discrimination over the past half century, saying it does not reflect racial progress.
In a 5-4 ruling, the court declared unconstitutional a provision of the landmark Voting Rights Act that determines which states and localities must get Washington's approval for proposed election changes.
President Barack Obama, the nation's first black chief executive, issued a statement saying he was "deeply disappointed" with the ruling.
The decision effectively puts an end to the advance approval requirement that has been used, mainly in the South, to open up polling places to minority voters in the nearly half century since it was first enacted in 1965, unless Congress can come up with a new formula that Chief Justice John Roberts said meets "current conditions" in the United States.
Roberts, writing for a conservative majority, said the law Congress most recently renewed in 2006 relies on 40-year-old data that does not reflect racial progress and changes in U.S. society.
"The coverage formula that Congress reauthorized in 2006 ignores these developments, keeping the focus on decades-old data relevant to decades-old problems, rather than current data reflecting current needs," Roberts said.
Obama was sharply critical of the ruling and called on Congress to reinvigorate the law.
"While today's decision is a setback, it doesn't represent the end of our efforts to end voting discrimination," the president said. "I am calling on Congress to pass legislation to ensure every American has equal access to the polls."
That task eluded Congress in 2006 when lawmakers overwhelmingly renewed the advance approval requirement with no changes in the system by which states and local jurisdictions were chosen for coverage. And Congress did nothing in response to a high court ruling in a similar challenge in 2009 in which the justices raised many of the same concerns.
Tuesday's decision means that a host of state and local laws that have not received Justice Department approval or have not yet been submitted will be able to take effect. Prominent among those are voter identification laws in Alabama and Mississippi.
Going forward, the outcome alters the calculus of passing election-related legislation in the affected states and local jurisdictions. The threat of an objection from Washington has hung over election-related proposals for nearly a half century. At least until Congress acts, that deterrent now is gone.
That prospect has upset civil rights groups which especially worry that changes on the local level might not get the same scrutiny as the actions of state legislatures.
Justice Ruth Bader Ginsburg, joined by her three liberal colleagues, dissented from Tuesday's ruling.
"Hubris is a fit word for today's demolition" of the law, Ginsburg said.
She said no one doubts that voting discrimination still exists. "But the court today terminates the remedy that proved to be best suited to block that discrimination," she said in a dissent that she read aloud in the packed courtroom.
Ginsburg said the law continues to be necessary to protect against what she called subtler, "second-generation" barriers to voting. She identified one such effort as the switch to at-large voting from a district-by-district approach in a city with a sizable black minority. The at-large system allows the majority to "control the election of each city council member, effectively eliminating the potency of the minority's votes," she said.
Justice Clarence Thomas was part of the majority, but wrote separately to say again that he would have struck down the advance approval requirement itself.
Civil rights lawyers condemned the ruling.
"The Supreme Court has effectively gutted one of the nation's most important and effective civil rights laws. Minority voters in places with a record of discrimination are now at greater risk of being disenfranchised than they have been in decades," said Jon Greenbaum, chief counsel for the Lawyer's Committee for Civil Rights Under Law. "Today's decision is a blow to democracy. Jurisdictions will be able to enact policies which prevent minorities from voting, and the only recourse these citizens will have will be expensive and time-consuming litigation."
Sherrilyn Ifill, president of the NAACP Legal Defense and Educational Fund, said, "This is like letting you keep your car, but taking away the keys."
The decision comes five months after Obama started his second term in the White House, re-elected by a diverse coalition of voters.
The high court is in the midst of a broad re-examination of the ongoing necessity of laws and programs aimed at giving racial minorities access to major areas of American life from which they once were systematically excluded. The justices issued a modest ruling Monday that preserved affirmative action in higher education and will take on cases dealing with anti-discrimination sections of a federal housing law and another affirmative action case from Michigan next term.
The court warned of problems with the voting rights law in a similar case heard in 2009. The justices averted a major constitutional ruling at that time, but Congress did nothing to address the issues the court raised. The law's opponents, sensing its vulnerability, filed several new lawsuits.
The latest decision came in a challenge to the advance approval, or preclearance, requirement, which was brought by Shelby County, Ala., a Birmingham suburb.
The lawsuit acknowledged that the measure's strong medicine was appropriate and necessary to counteract decades of state-sponsored discrimination in voting, despite the Fifteenth Amendment's guarantee of the vote for black Americans.
But it asked whether there was any end in sight for a provision that intrudes on states' rights to conduct elections, an issue the court's conservative justices also explored at the argument in February. It was considered an emergency response when first enacted in 1965.
The county noted that the 25-year extension approved in 2006 would keep some places under Washington's oversight until 2031 and seemed not to account for changes that include the elimination of racial disparity in voter registration and turnout or the existence of allegations of race-based discrimination in voting in areas of the country that are not subject to the provision.
The Obama administration and civil rights groups said there is a continuing need for it and pointed to the Justice Department's efforts to block voter ID laws in South Carolina and Texas last year, as well as a redistricting plan in Texas that a federal court found discriminated against the state's large and growing Hispanic population.
Advance approval was put into the law to give federal officials a potent tool to defeat persistent efforts to keep blacks from voting.
The provision was a huge success because it shifted the legal burden and required governments that were covered to demonstrate that their proposed changes would not discriminate. Congress periodically has renewed it over the years. The most recent extension was overwhelmingly approved by a Republican-led Congress and signed by President George W. Bush.
The requirement currently applies to the states of Alabama, Alaska, Arizona, Georgia, Louisiana, Mississippi, South Carolina, Texas and Virginia. It also covers certain counties in California, Florida, New York, North Carolina and South Dakota, and some local jurisdictions in Michigan. Coverage has been triggered by past discrimination not only against blacks, but also against American Indians, Asian-Americans, Alaska Natives and Hispanics.
Towns in New Hampshire that had been covered by the law were freed from the advance approval requirement in March. Supporters of the provision pointed to the ability to bail out of the prior approval provision to argue that the law was flexible enough to accommodate change and that the court should leave the Voting Rights Act intact.
On Monday, the Justice Department announced an agreement that would allow Hanover County, Va., to bail out.
Lowering costs for higher-cost medicare patients through better outpatient care may be limitedPublic release date: 24-Jun-2013 [ | E-mail | Share ]
Contact: Marge Dwyer mhdwyer@hsph.harvard.edu 617-432-8416 The JAMA Network Journals
In an analysis that included a sample of patients in the top portion of Medicare spending, only a small percentage of their costs appeared to be related to preventable emergency department visits and hospitalizations, limiting the ability to lower costs for these patients through better outpatient care, according to a study in the June 26 issue of JAMA. The study is being released early to coincide with its presentation at the AcademyHealth annual research meeting.
"High and increasing health care costs are arguably the single biggest threat to the long-term fiscal solvency of federal and state governments in the United States. One compelling strategy for cost containment is focusing on the small proportion of patients in the Medicare programs who account for the vast majority of health care spending. We know from prior work that Medicare spending is highly concentrated: 10 percent of the Medicare population accounts for more than half of the costs to the program," according to background information in the article.
The biggest sources of spending among high-cost beneficiaries are those related to acute care: emergency department (ED) visits and inpatient hospitalizations. "As a result, many interventions targeting high-cost patients have focused on case management and care coordination, aiming to prevent ED visits and hospitalizations for conditions thought amenable to improvement through high-quality outpatient management programs. The premise behind these and related interventions is that high-quality outpatient care should reduce unnecessary hospitalizations for high-cost patients. However, there are few data on the proportion of inpatient hospitalizations among high-cost patients that are potentially preventable," the authors write.
Karen E. Joynt, M.D., M.P.H., of the Harvard School of Public Health, Boston, and colleagues conducted a study to quantify the preventability of high-cost Medicare patients' acute care spending. The researchers summed standardized costs for each inpatient and outpatient service contained in standard 5 percent Medicare files from 2009 and 2010 across the year for each patient in their sample, and defined those in the top decile (one of ten groups) of spending in 2010 as high-cost patients and those in the top decile in both 2009 and 2010 as persistently high-cost patients. Standard algorithms were used to identify potentially preventable emergency department visits and acute care inpatient hospitalizations. A total of 1,114,469 Medicare fee-for-service beneficiaries 65 years of age or older were included.
The high-cost patient group, which included 10 percent of the patients in this sample, were older, more often male and more often black. This group was responsible for 32.9 percent of ED costs and 79.0 percent of inpatient costs. Within the high-cost group, 42.6 percent of ED visits were deemed to be preventable. These visits were associated with 41 percent of the ED costs within this group. The most common reasons for preventable hospitalization in high-cost patients were congestive heart failure, bacterial pneumonia, and chronic obstructive pulmonary disease.
Within the high-cost group, 9.6 percent of hospital costs were attributable to preventable hospitalization. Within the non-high-cost group, though overall spending was significantly lower, a higher proportion of inpatient costs were potentially preventable (16.8 percent).
"Comparable proportions of ED spending (43.3 percent) and inpatient spending (13.5 percent) were preventable among persistently high-cost patients. Regions with high primary care physician supply had higher preventable spending for high-cost patients," the authors write.
"The biggest drivers of inpatient spending for high-cost patients were catastrophic events such as sepsis, stroke, and myocardial infarction, as well as cancer and expensive orthopedic procedures such as spine surgery and hip replacement. These findings suggest that strategies focused on enhanced outpatient management of chronic disease, while critically important, may not be focused on the biggest and most expensive problems plaguing Medicare's high-cost patients."
The researchers add that their "findings suggest that a complementary approach to saving money on acute care services for high-cost patients may be to additionally focus on reducing per-episode costs for high-cost disease entities through clinical innovation and care delivery redesign."
(JAMA. 2013;309(24):2572-2578; Available pre-embargo to the media at http://media.jamanetwork.com)
Editor's Note: This study was funded by the Rx Foundation and the West Wireless Foundation. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, etc.
Editorial: New Evidence Supports, Challenges, and Informs the Ambitions of Health Reform
Aaron E. Carroll, M.D., M.S., of the Indiana University School of Medicine, Indianapolis, and Austin B. Frakt, Ph.D., of the VA Boston Healthcare System, Boston University Schools of Medicine and Public Health, Boston, comment on the findings of this study in an accompanying editorial.
"These findings certainly do not suggest abandoning efforts to reduce preventable emergency department use and hospitalizations. Joynt et al do not consider the social cost of this utilization. Even though avoiding some emergency department use and hospital admissions might not save much moneyand certainly not enough to declare victory in controlling health spendingpreventing such use when possible would be of substantial benefit to patients, both those who would otherwise use these services and those who have their care delayed because of overburdened emergency department and hospital resources. Even with no cost savings, reducing preventable use of high-intensity and capacity-constrained care would enhance efficiency. Improvements to quality are not always substantial cost savers but still may be worthwhile."
(JAMA. 2013;309(24):2600-2601; Available pre-embargo to the media at http://media.jamanetwork.com)
Editor's Note: The authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest and none were reported.
###
[ | E-mail | Share ]
?
AAAS and EurekAlert! are not responsible for the accuracy of news releases posted to EurekAlert! by contributing institutions or for the use of any information through the EurekAlert! system.
Lowering costs for higher-cost medicare patients through better outpatient care may be limitedPublic release date: 24-Jun-2013 [ | E-mail | Share ]
Contact: Marge Dwyer mhdwyer@hsph.harvard.edu 617-432-8416 The JAMA Network Journals
In an analysis that included a sample of patients in the top portion of Medicare spending, only a small percentage of their costs appeared to be related to preventable emergency department visits and hospitalizations, limiting the ability to lower costs for these patients through better outpatient care, according to a study in the June 26 issue of JAMA. The study is being released early to coincide with its presentation at the AcademyHealth annual research meeting.
"High and increasing health care costs are arguably the single biggest threat to the long-term fiscal solvency of federal and state governments in the United States. One compelling strategy for cost containment is focusing on the small proportion of patients in the Medicare programs who account for the vast majority of health care spending. We know from prior work that Medicare spending is highly concentrated: 10 percent of the Medicare population accounts for more than half of the costs to the program," according to background information in the article.
The biggest sources of spending among high-cost beneficiaries are those related to acute care: emergency department (ED) visits and inpatient hospitalizations. "As a result, many interventions targeting high-cost patients have focused on case management and care coordination, aiming to prevent ED visits and hospitalizations for conditions thought amenable to improvement through high-quality outpatient management programs. The premise behind these and related interventions is that high-quality outpatient care should reduce unnecessary hospitalizations for high-cost patients. However, there are few data on the proportion of inpatient hospitalizations among high-cost patients that are potentially preventable," the authors write.
Karen E. Joynt, M.D., M.P.H., of the Harvard School of Public Health, Boston, and colleagues conducted a study to quantify the preventability of high-cost Medicare patients' acute care spending. The researchers summed standardized costs for each inpatient and outpatient service contained in standard 5 percent Medicare files from 2009 and 2010 across the year for each patient in their sample, and defined those in the top decile (one of ten groups) of spending in 2010 as high-cost patients and those in the top decile in both 2009 and 2010 as persistently high-cost patients. Standard algorithms were used to identify potentially preventable emergency department visits and acute care inpatient hospitalizations. A total of 1,114,469 Medicare fee-for-service beneficiaries 65 years of age or older were included.
The high-cost patient group, which included 10 percent of the patients in this sample, were older, more often male and more often black. This group was responsible for 32.9 percent of ED costs and 79.0 percent of inpatient costs. Within the high-cost group, 42.6 percent of ED visits were deemed to be preventable. These visits were associated with 41 percent of the ED costs within this group. The most common reasons for preventable hospitalization in high-cost patients were congestive heart failure, bacterial pneumonia, and chronic obstructive pulmonary disease.
Within the high-cost group, 9.6 percent of hospital costs were attributable to preventable hospitalization. Within the non-high-cost group, though overall spending was significantly lower, a higher proportion of inpatient costs were potentially preventable (16.8 percent).
"Comparable proportions of ED spending (43.3 percent) and inpatient spending (13.5 percent) were preventable among persistently high-cost patients. Regions with high primary care physician supply had higher preventable spending for high-cost patients," the authors write.
"The biggest drivers of inpatient spending for high-cost patients were catastrophic events such as sepsis, stroke, and myocardial infarction, as well as cancer and expensive orthopedic procedures such as spine surgery and hip replacement. These findings suggest that strategies focused on enhanced outpatient management of chronic disease, while critically important, may not be focused on the biggest and most expensive problems plaguing Medicare's high-cost patients."
The researchers add that their "findings suggest that a complementary approach to saving money on acute care services for high-cost patients may be to additionally focus on reducing per-episode costs for high-cost disease entities through clinical innovation and care delivery redesign."
(JAMA. 2013;309(24):2572-2578; Available pre-embargo to the media at http://media.jamanetwork.com)
Editor's Note: This study was funded by the Rx Foundation and the West Wireless Foundation. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, etc.
Editorial: New Evidence Supports, Challenges, and Informs the Ambitions of Health Reform
Aaron E. Carroll, M.D., M.S., of the Indiana University School of Medicine, Indianapolis, and Austin B. Frakt, Ph.D., of the VA Boston Healthcare System, Boston University Schools of Medicine and Public Health, Boston, comment on the findings of this study in an accompanying editorial.
"These findings certainly do not suggest abandoning efforts to reduce preventable emergency department use and hospitalizations. Joynt et al do not consider the social cost of this utilization. Even though avoiding some emergency department use and hospital admissions might not save much moneyand certainly not enough to declare victory in controlling health spendingpreventing such use when possible would be of substantial benefit to patients, both those who would otherwise use these services and those who have their care delayed because of overburdened emergency department and hospital resources. Even with no cost savings, reducing preventable use of high-intensity and capacity-constrained care would enhance efficiency. Improvements to quality are not always substantial cost savers but still may be worthwhile."
(JAMA. 2013;309(24):2600-2601; Available pre-embargo to the media at http://media.jamanetwork.com)
Editor's Note: The authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest and none were reported.
###
[ | E-mail | Share ]
?
AAAS and EurekAlert! are not responsible for the accuracy of news releases posted to EurekAlert! by contributing institutions or for the use of any information through the EurekAlert! system.
By Phil Stewart WASHINGTON, June 22 (Reuters) - Edward Snowden was in a "safe place" in Hong Kong, a newspaper reported on Saturday, as the United States prepared to seek the extradition of the former U.S. National Security Agency contractor after filing espionage charges against him. The South China Morning Post said Snowden, who has exposed secret U.S. surveillance programs including new details published on Saturday about alleged hacking of Chinese phone companies, was not in police protection in Hong Kong, as had been reported elsewhere. "Contrary to some reports, the former CIA analyst has not been detained, is not under police protection but is in a 'safe place' in Hong Kong," the newspaper said. Hong Kong Police Commissioner Andy Tsang declined to comment other than to say Hong Kong would deal with the case in accordance with the law. Two U.S. sources, speaking on condition of anonymity, said the United States was preparing to seek Snowden's extradition from Hong Kong, which is part of China but has wide-ranging autonomy, including an independent judiciary. The United States charged Snowden with theft of government property, unauthorized communication of national defense information and willful communication of classified communications intelligence to an unauthorized person, according to the criminal complaint made public on Friday. The latter two offenses fall under the U.S. Espionage Act and carry penalties of up to 10 years in prison. America's use of the Espionage Act against Snowden has fueled debate among legal experts about whether that could complicate his extradition, since Hong Kong courts may choose to shield him. Snowden says he leaked the details of the classified U.S. surveillance to expose abusive programs that trampled on citizens' rights. Documents leaked by Snowden revealed that the NSA has access to vast amounts of internet data such as emails, chat rooms and video from large companies such as Facebook and Google, under a government program known as Prism. They also showed that the government had worked through the secret Foreign Intelligence Surveillance Court to gather so-called metadata - such as the time, duration and telephone numbers called - on all calls carried by service providers such as Verizon. On Friday, the Guardian newspaper, citing documents shared by Snowden, said Britain's spy agency GCHQ had tapped fiber-optic cables that carry international phone and internet traffic and is sharing vast quantities of personal information with the NSA.
STEALING DATA The South China Morning Post said on Saturday that Snowden offered new details on U.S. surveillance activities in China. The paper said documents and statements by Snowden show the NSA program had hacked major Chinese telecoms companies to access text messages and targeted China's top Tsinghua University. The NSA program also hacked the Hong Kong headquarters of Pacnet, which has an extensive fiber-optic network, it said. "The NSA does all kinds of things like hack Chinese cellphone companies to steal all of your SMS data," Snowden was quoted by the Post as saying during a June 12 interview. President Barack Obama and his intelligence chiefs have vigorously defended the programs, saying they are regulated by law and that Congress was notified. They say the programs have been used to thwart militant plots and do not target Americans' personal lives. Since making his revelations about massive U.S. surveillance programs, Edward Snowden, 30, has sought legal representation from human rights lawyers as he prepares to fight U.S. attempts to force him home for trial, sources in Hong Kong say. The United States and Hong Kong signed an extradition treaty in 1998, under which scores of Americans have been sent back home to face trial. The United States and Hong Kong have "excellent cooperation" and as a result of agreements, "there is an active extradition relationship between Hong Kong and the United States," a U.S. law enforcement official told Reuters. However, the process can take years, lawyers say, and Snowden's case could be particularly complex. An Icelandic businessman linked to the anti-secrecy group WikiLeaks said on Thursday he had readied a private plane in China to fly Snowden to Iceland if Iceland's government would grant asylum. Iceland refused on Friday to say whether it would grant asylum to Snowden. (Reporting by Phil Stewart; Additional reporting by James Pomfret, Venus Wu and Grace Li in HONG KONG, Tabassum Zakaria and Mark Hosenball in WASHINGTON; Editing by Eric Beech)
![[ Back to EurekAlert! ]](https://lh3.googleusercontent.com/blogger_img_proxy/AEn0k_v6z7JN4UdnrrfvFlFDwXflWXPHgEwF0curoTLee_VM9anFNb-vrBPsC2hZYNexJ5S6J6umfhsHtPgyR-LJC5KBop4trTFdaLmyADgq2yk=s0-d){kind=small}
Public release date: 24-Jun-2013
Share ]