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Kaiser Daily Health Policy Report
HHS Secretary Leavitt Discusses Medicaid, Other Issues in Interview
Lawmakers Call for CMS To Investigate Possible Discrimination by Specialty Hospitals
One-Third of the Estimated 8.4M Uninsured Children Go Without Medical Care for Entire Year, Despite Eligibility for Public Health Insurance, Report Says
Magazine Examines Hospital Infections, Profiles Pennsylvania Group's Efforts
Massachusetts Employers, Workers To See Minimum 10% Increase in Insurance Premiums in 2006
California Insurance Commissioner To Issue Report on Health Savings Accounts, Association Health Plans
New York Bill Would Allow District Attorneys To Prosecute Medicaid Fraud
The Latest Reports in Health Policy
Health Affairs Features Interview With World Bank Official
Prescription Drugs
23 Drug Companies Agree to New Guidelines on Advertising
[Aug 03, 2005]
The Pharmaceutical Research and Manufacturers of America on Tuesday released the final version of voluntary guidelines for direct-to-consumer prescription drug advertisements, but critics called the guidelines inadequate, USA Today reports (Schmit, USA Today, 8/3). The guidelines, released in draft form in July, seek to eliminate "misleading advertising that can lead to unnecessary prescriptions," according to the Baltimore Sun. Since PhRMA approved the final version of the guidelines on Friday, 23 pharmaceutical companies -- such as Johnson & Johnson, Merck and Schering-Plough -- have agreed to follow them (Rockoff, Baltimore Sun, 8/3). Other pharmaceutical companies that have agreed to follow the guidelines include Eli Lilly, Pfizer and GlaxoSmithKline (Corbett Dooren, Dow Jones/Wall Street Journal, 8/3). Under the guidelines, the pharmaceutical companies have agreed to: - Restrict DTC ads for erectile dysfunction and similar medication to television programs "reasonably expected" to attract an 80% adult audience;
- Spend an appropriate amount of time, not specified in the guidelines, to educate physicians about new medications before the launch of DTC ads for the treatments;
- Submit TV ads to FDA before they air -- a practice that many companies currently follow -- but the companies do not have to wait for agency approval before they begin to air the ads;
- End the use of "reminder" TV ads that name medications but do not provide details on their uses or safety risks (USA Today, 8/3);
- Include in DTC ads clear language on the safety risks and benefits of medications;
- Make claims about medications in DTC ads only when they are supported by substantial medical evidence (Richwine, Reuters/Houston Chronicle, 8/2);
- Indicate when medications require a prescription and are not available over the counter;
- Remain consistent with label requirements established by FDA; and
- Update DTC ad campaigns to highlight "new and reliable information" on the safety risks and benefits of medications (CQ HealthBeat, 8/2).
PhRMA also plans to establish a telephone hot line and monitoring office to address complaints about DTC prescription drug ads and issue reports to the public. In addition, PhRMA plans to establish an independent review board to monitor the telephone calls and make recommendations. The guidelines will take effect on Jan. 1, 2006, but most pharmaceutical companies have said they will begin to follow them immediately, according to PhRMA President Billy Tauzin ( Dow Jones/Wall Street Journal, 8/3). Weldon Comments
William Weldon, CEO of J&J and chair of the PhRMA board, released the guidelines on Tuesday at a news conference in Dallas. Weldon said that the guidelines "go well beyond what is mandated under regulations," adding, "This is an important step in the transformation of our industry" (Silverman, Newark Star-Ledger, 8/3). Weldon said, "We will use advertising not only to promote new medicines but also to educate consumers about health and disease" (Japsen, Chicago Tribune, 8/3). He added, "While direct-to-consumer advertising has drawn fire from some quarters, and some of this is well-deserved, it is a powerful tool for informing consumers" (Higgins, Washington Times, 8/3). Tauzin Comments
Tauzin said, "This is a code designed to take campaigns to sell products into a realm where they are more educational, more balanced, more complete, more determined to make sure that doctors and patients have a responsible dialogue" (Reuters/Houston Chronicle, 8/2). He added, "We are in a free-speech area. Voluntary codes tend to be the best way to handle these things. So what we've done is set up a good, strong voluntary code" (Alonso-Zaldivar, Los Angeles Times, 8/3). Although PhRMA will not revoke membership from pharmaceutical companies that do not follow the guidelines, Tauzin said, "We will have a healthy discussion with companies that sign up with the code of conduct and do not follow it" (Washington Times, 8/3). Reaction From Pharmaceutical Companies
Eli Lilly officials on Tuesday said that the company will limit ads for the ED medication Cialis to TV programs that likely will not attract children and will not air such ads during major sporting events. Pfizer Vice Chair Karen Katen said that the company will limit ads for the ED medication Viagra to appropriate audiences (Dow Jones/Wall Street Journal, 8/3). "We would not be on the Super Bowl," she added (Henderson, Boston Globe, 8/3). GSK officials said that the company will "comply as soon as possible" with the guidelines (Ginsberg, Philadelphia Inquirer, 8/3). Takeda Pharmaceuticals North America officials said that the company will delay TV ads for the new insomnia treatment Rozerem and take time to educate physicians about the medication. "The last thing we want to do is drive patients into physicians' offices asking them about a new product that physicians aren't necessarily going to have all of the recent information on," Takeda spokesperson Matt Kuhn said (Chicago Tribune, 8/3). Frist, Grassley Reaction
Senate Majority Leader Bill Frist (R-Tenn.) called the guidelines an "important first step" but said that they should have "gone further." According to the Sun, Frist had proposed a requirement that pharmaceutical companies wait two years before they launch DTC ad campaigns for new medications (Baltimore Sun, 8/3). Frist said, "I hope individual pharmaceutical manufacturers will seriously consider such a measure" (Boston Globe, 8/3). Senate Finance Committee Chair Chuck Grassley (R-Iowa) said that the guidelines do not "deliver a single guarantee for consumers," adding, "It doesn't make sense to rely on drug companies to police themselves" (Philadelphia Inquirer, 8/3). Grassley said that FDA "needs to stop dragging its feet and start exercising its authority to closely monitor the marketing of pharmaceuticals." Additional Reaction
Scott Gottlieb, chief deputy FDA commissioner, said that the agency supports the guidelines, adding, "I think the industry itself, issuing principles like it did today, is an important step. Clearly they're expressing a willingness to try to police themselves" (Saul, New York Times, 8/3). American College of Physicians President C. Anderson Hedberg said, "The fact that drug companies are giving the ads to the FDA for approval is a very good step." Linda Golodner, president of the National Consumers League, said, "We are encouraged that PhRMA has come up with these principles and that some of them call for the basic information we have been calling for over the years. But I am not quite sure how the accountability is going to work" (Washington Times, 8/3). American Medical Association Trustee Edward Langston called the guidelines a "good first step." John Kamp, director of the Coalition for Healthcare Communication, praised the provision in the guidelines on reminder ads (Newark Star-Ledger, 8/3). Marc Scheineson, a former FDA attorney who currently represents pharmaceutical companies, called the guidelines "a platform on which you can build," adding, "You have to start somewhere with principles that can get industry consensus and compliance" (Los Angeles Times, 8/30. Criticism
According to the Washington Times, critics of the pharmaceutical industry "argued that the guidelines are voluntary, and they expect marginal enforcement of the rules" (Washington Times, 8/3). They also said that the guidelines "merely duplicate what is already required" by FDA and only seek to avoid additional restrictions imposed by Congress, the San Francisco Chronicle reports. Sidney Wolfe, director of the Health Research Group at Public Citizen, said, "It's a frantic, desperate attempt to make their image improve and fend off legislation" (Tansey, San Francisco Chronicle, 8/3). He added that the "guidelines are a meaningless attempt to fool people into believing the guidelines are stronger than they really area" (Philadelphia Inquirer, 8/3). Wolfe said, "PhRMA's latest campaign of industry self-regulation via the guidelines ... is both dangerous and, like previous industry efforts, doomed to failure, since selling drugs will always trump obeying the law" (New York Times, 8/3). Wolfe also recommended a "significant increase" in FDA enforcement against DTC prescription drug ads that "make false claims," CQ HealthBeat reports (CQ HealthBeat, 8/2). Other Criticism
Rob Schneider, director of the prescription drug reform effort at Consumers Union, said that the guidelines "fall short" (Baltimore Sun, 8/3). He added, "Presubmission of broadcast ads could be a good thing. But the problem has been a lack of resources at the FDA. If drug makers are serious, they will hold ads until the FDA has had the chance to actually review them" (Dow Jones/Wall Street Journal, 8/3). According to the Inquirer, Grassley has proposed legislation that would require FDA to approve DTC prescription drug ads before they air (Philadelphia Inquirer, 8/3). Implications, FDA Review
According to the Los Angeles Times, "It was not clear ... whether the industry's relatively modest steps would be enough to hold off growing complaints by some lawmakers, consumers and physicians" about DTC prescription drug ads (Los Angeles Times, 8/3). Frist said that he will "continue to evaluate whether legislative remedies are necessary to put patient safety first and help control prescription drug costs" (San Francisco Chronicle, 8/3). Meanwhile, an FDA spokesperson "confirmed a report" in the Wall Street Journal on Tuesday that the agency "plans to review its advertising policies" (Newark Star-Ledger, 8/3). The Wall Street Journal reported that FDA plans to announce a review of DTC prescription drug ads in response to agency research on concerns raised by physicians and consumers (Kaiser Daily Health Policy Report, 8/2). FDA spokesperson Suzanne Trevino said, "We expect to solicit comments from consumers, from experts on advertising and health care professionals on this important topic." She did not indicate when FDA will begin the review (Webb Pressler, Washington Post, 8/3). According to the AP/Las Vegas Sun, an FDA review of DTC prescription drug ads "could lead to tougher regulations" (Agovino, AP/Las Vegas Sun, 8/2). Frist also has requested a study of the issue by the Government Accountability Office (Webb Pressler, Washington Post, 8/3).
 The guidelines are available online. Note: You must have Adobe Acrobat Reader to view the guidelines. Post Column
The guidelines are a "credible first step in solving" some of the problems related to DTC prescription drug ads, but they will do little to "curb the growth in unnecessary spending," columnist Steven Pearlstein writes in a Post opinion piece. According to Pearlstein, what is "needed ... is some sort of test that would limit or eliminate advertising for drugs ... that offe[r] little or no advantage over cheaper generics." Drug advertising seeks to "artificially create the impression in the minds of consumers" that a product is a solution to "some widespread, unmet medical need," Pearlstein writes, concluding that "that ruse would quickly be exposed if drug companies had to put their products through a reasonable and independently administered cost-benefit analysis before marketing them directly to the public" (Pearlstein, Washington Post, 8/3). Pearlstein is scheduled to answer questions about the guidelines in a Washingtonpost.com online chat Wednesday at 11 a.m. ET. A transcript of the discussion will be available online. Broadcast Coverage
APM's "Marketplace" on Tuesday reported on the guidelines. The segment includes comments from John Abramson, physician and author of the book "Overdosing America"; Bruce Lehman, president and CEO at medical marketing agency Lehman Millet; and Tauzin (Palmer, "Marketplace," APM, 8/2).
 The complete segment is available online in RealPlayer.
Administration News
HHS Secretary Leavitt Discusses Medicaid, Other Issues in Interview
[Aug 03, 2005]
HHS Secretary Mike Leavitt on Tuesday discussed various health topics in an interview with Associated Press editors and reporters. The topics are highlighted below.
- Medicaid: Leavitt said that the commission he appointed to recommend ways to cut $10 billion from Medicaid over five years would "likely look" at proposals from the National Governors Association and determine that they "are pretty well thought-out ideas," the AP/Las Vegas Sun reports. "What the governors have basically proposed is a series of things that have been talked about for 10 years," Leavitt said. He said the governors' proposal to increase copayments and deductibles would make beneficiaries more conscious of the cost of health care. Leavitt added, "If we weren't talking about a budget here, we'd be talking about this as reforms because this is what the governors want" (Freking, AP/Las Vegas Sun [1], 8/2).
- Avian flu: Leavitt said that it is "in some ways an absolute certainty" that an avian flu pandemic or other flu pandemic eventually will occur in the U.S. (Freking, AP/Boston Globe, 8/3). Leavitt said, "I believe that we are at a greater risk of a pandemic than we've been for decades," adding that he has had three recent meetings with President Bush to discuss the matter. Leavitt said the Bush administration is developing a domestic surveillance system in hospital emergency departments to give health officials an early warning if a flu pandemic or other health threat arises, adding that a quarantine in such an event is possible (Freking, AP/Las Vegas Sun [2], 8/2). He said the government's goal is to deliver vaccine within 12 hours of any decision to make vaccine available, but exercises have revealed that "the distribution systems are not adequate to put medicines in the hands of people fast enough." Leavitt said, "We're looking at having more points of distribution, for example. We're experimenting with having the postal service being able to deliver them because they walk those routes every day." He added that firehouses also are being considered as distribution points. Leavitt said the government would like to obtain 20 million doses of avian flu vaccine and 20 million doses of Tamiflu, an antiviral medication. It would take four to six months to produce the vaccine, and capacity is too low to produce both an avian flu and pandemic flu vaccine, he said. Leavitt added that it remains unknown how much vaccine is necessary to induce a response in humans (AP/Boston Globe, 8/3).
- Stem cell research: Leavitt said he does not believe Bush would change his position on expanding federal funding for stem cell research. "It's a moral decision with him," he said, adding, "I've seen no wavering on his part at all." Leavitt said he is "very comfortable with the president's decision."
- Drug advertising: Leavitt said that HHS will continue to monitor pharmaceutical companies' direct-to-consumer advertising "very carefully," despite voluntary guidelines that the industry announced on Tuesday. "We have the authority already to enforce limits when people are misleading, and we will use it," he said (AP/Las Vegas Sun [2], 8/3).
Capitol Hill Watch
Lawmakers Call for CMS To Investigate Possible Discrimination by Specialty Hospitals
[Aug 03, 2005]
CMS should investigate whether physician-owned specialty hospitals are racially discriminatory, three Democratic members of the House Ways and Means Committee wrote in a July 28 letter to CMS Administrator Mark McClellan, CQ HealthBeat reports. Reps. John Lewis (D-Ga.), Charles Rangel (D-N.Y.) and Pete Stark (D-Calif.) cited data from a May 2005 analysis by the Medicare Payment Advisory Commission that was prepared for the Senate Finance Committee. According to the analysis, 92.1% of patients discharged from cardiac specialty hospitals in 2002 were white, 3.6% were black, 1.7% were Latino and 2.6% were classified as "other." Discharged cardiac patients from community hospitals were 85.2% white, 9.6% black, 2.2% Latino and 3.1% "other." The lawmakers wrote that the data suggest "possible discrimination based on ethnic or racial factors may be prevalent in the physician-owned specialty hospital industry." They said CMS should continue its current moratorium on providing Medicare and Medicaid payments for new physician-owned specialty hospitals "until this analysis is complete and these questions are satisfactorily answered and resolved." CMS spokesperson Gary Karr said the agency would "respond appropriately" to the letter after fully reviewing it and added that the agency is reviewing eligibility criteria for facilities to qualify for CMS reimbursement. The moratorium, which was created by the 2003 Medicare law, was scheduled to expire on June 8, but administrative steps taken by CMS likely will extend it through at least the end of 2005. The moratorium was established because of complaints that specialty hospitals "skim off the most profitable patients from traditional hospitals," CQ HealthBeat reports. Randy Fenninger, a lobbyist for the American Surgical Hospital Association, said accusations of racism were "bogus," adding, "A hospital that is in downtown Dallas is going to have a different ethnic mix than a hospital in suburban Dallas" (CQ HealthBeat, 8/1).
Coverage & Access
One-Third of the Estimated 8.4M Uninsured Children Go Without Medical Care for Entire Year, Despite Eligibility for Public Health Insurance, Report Says
[Aug 03, 2005]
The number of uninsured U.S. children decreased by about two million to 8.4 million between 1998 and 2003, and 70% of the uninsured qualified for public health insurance programs such as Medicaid or SCHIP but were not enrolled, according to a study released on Tuesday by the Robert Wood Johnson Foundation, CQ HealthBeat reports. According to the report, released as part of the sixth annual RWJF Covering Kids and Families Back to School Campaign, 20% of Latino children lacked health insurance, compared with 9% of black children and 6% of white children (CQ HealthBeat, 8/2). For the report, analysts from the Urban Institute and the State Health Access Data Assistance Center at the University of Minnesota examined recent surveys conducted by CDC and the U.S. Census Bureau. The report found that almost one-third of uninsured children received no medical treatment for a one-year period between 2002 and 2003. Latino children accounted for 41.4% of the uninsured children who received no medical treatment for the one-year period, black children accounted for 29% and white children accounted for 25.7%, according to the report. The report also found significant differences among states in the rates of uninsured children who received no medical treatment for the one-year period. Arizona had the highest rate at 47.1%, followed by Nevada at 43%, Oklahoma at 41.7%, Texas at 40.5%, New Mexico at 40.3% and Georgia at 37.8% (Johnson, AP/Las Vegas Sun, 8/2). States with larger immigrant populations appeared to have the highest rates, according to the report (Keim, AP/Arizona Daily Star, 8/3). In addition, the report found that only six states had rates less than 20%: Maryland at 14.8%, Massachusetts at 15%, Rhode Island at 17.4%, Pennsylvania at 18.5%, New Jersey at 18.9% and Maine at 19.9% (AP/Las Vegas Sun, 8/2). Reaction
Risa Lavizzo-Mourey, president and chief executive of the Robert Wood Johnson Foundation, said, "Inequality in health care is just plain unacceptable in our great country." U.S. Surgeon General Richard Carmona said, "The number of uninsured children continues to be in the millions," adding, "No child should go without health care" (Dvorak, Washington Post, 8/3). Elaine Arkin, manager of the RWJF campaign, added, "These are obviously working families. A lot of times both parents work, they may have two jobs, so they think their children are not eligible" (AP/Las Vegas Sun, 8/2).
The report is available online. Note: You will need Adobe Acrobat Reader to view the report.
 A HealthCast of the RWJF event is available online at kaisernetwork.org.
CBS' "Early Show" on Tuesday included an interview with Carmona about the number of uninsured children and the RWJF campaign (Syler, "Early Show," CBS, 8/2). The complete segment is available online in Windows Media. Related CBS coverage is available online.
Magazine Examines Hospital Infections, Profiles Pennsylvania Group's Efforts
[Aug 03, 2005]
Governing Magazine in its August issue examined hospital infection rates and one group's efforts to address them. According to the magazine, about two million U.S. residents -- or 5% of all U.S. hospital patients -- contract a hospital-acquired infection each year, and about 90,000 of these patients die. Since 1975, the infection rate has risen 36%, the magazine reports. Providers attribute the increase to factors such as advances in medicine and technology as older patients are treated for underlying diseases. However, researchers and some hospitals have shown that simple measures such as hand-washing by hospital personnel can save the lives of as many as 30,000 patients each year, and a number of states are considering measures to require hospitals to report infection rates, the magazine reports. The article profiles efforts by the Pennsylvania Health Care Cost Containment Council to collect hospital infection data from facilities in Pennsylvania, the only state that is "on the verge of implementing a fully functional" data-collection system, the magazine reports (Buntin, Governing Magazine, August 2005).
Health Care Marketplace
Massachusetts Employers, Workers To See Minimum 10% Increase in Insurance Premiums in 2006
[Aug 03, 2005]
Many Massachusetts companies and their workers likely will see increases in their health insurance premiums of 10% or more beginning in 2006, according to the state's largest insurers, the Boston Globe reports. Blue Cross and Blue Shield of Massachusetts, the state's largest health insurer with 2.75 million members, said it expects to increase premiums 10% to 14% for employers with more than 50 workers. According to the Globe, 2006 will mark the sixth consecutive year in which health insurance premiums have increased by 10% or more. Insurers attribute the double-digit increases to rising prescription drug costs, an aging population and increasing hospital expenses. According to industry experts, the continuing increases in premiums mean both employers and workers will have to absorb more costs. And with some employers expected to offer health plans that would require workers to pay higher out-of-pocket costs, experts say some state residents might be unable to afford coverage, resulting in an increase in the uninsured rate. "As prices go up, some at the margin won't be able to afford to cover their families," Michael Doonan, executive director of the nonpartisan research group Massachusetts Health Policy Forum, said. Doonan added that Medicaid enrollment also will increase. Andre Mayer, senior vice president for research at Associated Industries of Massachusetts, said that the continued increases in health costs will mean reduced take-home pay for most workers. "The overall costs of health benefits ultimately tend to come out of wages," Mayer said (Krasner, Boston Globe, 8/2).
State Watch
California Insurance Commissioner To Issue Report on Health Savings Accounts, Association Health Plans
[Aug 03, 2005]
California Insurance Commissioner John Garamendi on Wednesday plans to issue a report that criticizes health savings accounts and other "consumer-driven" health plans as contributors to increased health care costs, the Los Angeles Times reports. The 74-page report, prepared by Garamendi's staff members, examines health care costs and the increased number of uninsured residents in California. The report calls consumer-driven health plans, which offer limited benefits to reduce costs, "symptoms of a worsening situation, not solutions." In addition, the report states that consumer-driven health plans "put the entire health system at risk" because they attract healthy individuals from traditional HMOs or PPOs, a situation that makes the plans more costly in the long term. As a result, the number of uninsured individuals, as well as the number enrolled in public health insurance programs, could increase, the report said. The report also found that health insurance premiums increased by 61% in California between 2000 and 2004. Garamendi, who supports a universal health coverage system, said that the state health care system could face a "complete breakdown" and that the report could prompt legislation to establish minimum coverage requirements for all health plans. According to Garamendi, the state must ensure that residents have access to affordable and effective health coverage to reduce the number enrolled in public health insurance programs. "The extraordinary run-up in costs is pricing out an increasingly large part of the population who can't get insurance," Garamendi said, adding, "We think there should be a basic health care program that everyone can participate in." Garamendi plans to hold several hearings -- with the first scheduled for next month in San Francisco -- to examine consumer-driven health plans. Criticism of AHPs
The report also criticizes a bill (HR 525) passed last month by the House that would allow small businesses to form association health plans across state lines and would exempt the plans from a number of state laws that regulate health plans and require them to cover certain benefits. According to the report, AHPs would "operate across state borders, free from any state's oversight." Reaction
White House spokesperson Trent Duffy rejected the criticism of consumer-driven health plans and AHPs, both of which President Bush supports. He said that Bush is "very focused on innovative solutions" to address the issue of health care costs. Peter Lee, president of the Pacific Business Group on Health, questioned the potential for a universal health coverage system. "There's no question that universal coverage is one of the solutions we need," he said, adding, "The question is how to get there. ... This is where universal care efforts, for 25 years, have always run ashore" (Vrana, Los Angeles Times, 8/3).
Medicaid
New York Bill Would Allow District Attorneys To Prosecute Medicaid Fraud
[Aug 03, 2005]
Under a bill to be introduced on Wednesday by New York state Sen. Dean Skelos (R), prosecutions of Medicaid fraud cases under certain circumstances would be handed from the state attorney general's Medicaid Fraud Control Unit to county district attorneys, the New York Times reports (Luo, New York Times, 8/3). New York state's recent focus on Medicaid comes in response to a Times series published last month about fraud and abuse in the $44.5 billion state program. New York Gov. George Pataki (R) established an independent inspector general as part of a proposal to improve efforts by the state Department of Health and other agencies to address fraud and abuse in Medicaid (Kaiser Daily Health Policy Report, 7/21). Skelos' bill would enact a 60-day deadline for MFCU prosecutors to file complaints or initiate grand jury proceedings on cases referred to them by the state health department. If action is not taken, MFCU would be required to give the evidence over to the district attorney in the county in which the alleged fraud occurred. As an incentive for DAs to accept the cases, 10% of any money recovered would go to the county, and 10% would go to a "special fund" in the DA's office for cases involving theft from state programs, the Times reports. Thomas Dunham, a spokesperson for Skelos, said the bill was created because "[w]e don't feel the attorney general's office has been aggressive in any way, shape or form" in "trying to figure out how to get more prosecutions and get more money back in the system." Darren Dopp, a spokesperson for state Attorney General Eliot Spitzer (D), who is a gubernatorial candidate, said Skelos was "playing cheap political games" with his proposal. Some DAs "expressed reservations" about Skelos' proposal, the Times reports. Brooklyn DA Charles Hynes said that "the way to fix this thing is to respond to what [Spitzer] has been saying: 'Give me the authority to hire additional staff'" (New York Times, 8/3).
The Latest Reports in Health Policy
Health Affairs Features Interview With World Bank Official
[Aug 03, 2005]
"Ideas Versus Money: A Conversation With Jean-Louis Sarbib," Health Affairs: In a Health Affairs Web exclusive, Philip Musgrove -- a health economist, former World Bank employee and one of the editors of the Disease Control Priorities Project -- interviews World Bank Senior Vice President Jean-Louis Sarbib about the World Bank's accomplishments in the global health realm, the lessons it has learned and what challenges lie ahead (Musgrove, Health Affairs, 8/2).
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