Lessons from Hemophilia

Patients with genetic diseases have long presented a therapeutic and financial challenge to the health-care system.1 With the advent of cryoprecipitates of plasma that contain concentrated factor VIII, physicians caring for patients with hemophilia began to explore new ways to manage this chronic disease.1 Comprehensive centers were built on a multidisciplinary approach and linked to community services.1 As patients and families became better educated, they learned self-administration of blood products outside the hospital.1 Many hospitalized patients would then be transferred to an ambulatory setting for medical care. However, since reimbursement was mainly limited to in-hospital care, these programs could not . . .