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Le problème de la médecine fondée sur des données probantes (EBM)

SEATTLE – Chaque système de soins de santé doit trouver un compromis entre la couverture, la qualité et le coût. Bien souvent, on y parvient en se concentrant sur un ou deux paramètres au détriment des autres. Les systèmes européens par exemple ont tendance à se concentrer sur la couverture et sur l'assurance d'un accès universel aux soins. En revanche aux États-Unis, la qualité semble être primordiale.

Mais quel que soit le point de vue de chacun sur les priorités du système, il est clair que les États-Unis peuvent encore améliorer leur système dans ces trois domaines. Heureusement, des efforts sont en cours pour répondre à chacun de ces besoins. Et les efforts des États-Unis ont des implications pour d'autres pays.

Le Patient Protection and Affordable Care Act américain, ou loi sur la protection des malades et les soins abordables, (la loi historique maintenant largement connue sous le nom de « Obamacare ») vise à élargir la couverture, tandis que les organismes responsables des soins, comme Kaiser Permanente, tentent de limiter les coûts en faisant correspondre les intérêts des fournisseurs et des payeurs. Cependant, les efforts pour améliorer la qualité par l'application de la médecine fondée sur les données probantes(EBM) risquent d'ignorer ce que nous savons sur la cognition et sur l'expertise humaine et peuvent saper le rôle vital joué par le jugement d'expert d'un médecin.

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