{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,2]],"date-time":"2026-05-02T14:31:58Z","timestamp":1777732318425,"version":"3.51.4"},"reference-count":21,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2014,1,1]],"date-time":"2014-01-01T00:00:00Z","timestamp":1388534400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["INQUIRY"],"published-print":{"date-parts":[[2014,1,1]]},"abstract":"<jats:p>This article is about readiness of the U.S. health care system to deal with crises. Using the Ebola crisis as a reference, first it examines the response to the current challenge. However, that is the smaller objective of the article. Lately, we are also being challenged to deal with other kinds of epidemics like obesity, mental health diseases, and violence. These crises are not dramatic like the Ebola crisis. However, these are no less insidious than Ebola. If we are not ready for them, then these crises have the potential to undermine the long-term health and prosperity of our society. In this context, and therefore mainly, this article is about two major long-standing systemic problems in the U.S. health care system that the unfolding of the Ebola crisis has bared. One is about how the inherent problem in the design of American federalist system regarding state autonomy on health matters is creating a dysfunctional health care system. The other is about the inertia of the research industry in the health care system in clinging to an archaic outdated inefficient mind-set and methodology that fails to generate the right information required for an appropriate decision making in matters of health care delivery, including crises. These problems are not small, nor their solutions easy. However, no matter how uncomfortable and tedious, facing them is necessary and inevitable. The discussions and arguments in this article are to outline their nature broadly and to make a call to further a dialogue.<\/jats:p>","DOI":"10.1177\/0046958014564055","type":"journal-article","created":{"date-parts":[[2014,12,15]],"date-time":"2014-12-15T23:12:41Z","timestamp":1418685161000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Ebola Crisis in the United States"],"prefix":"10.1177","volume":"51","author":[{"given":"Avinash Raghunath","family":"Patwardhan","sequence":"first","affiliation":[{"name":"George Mason University, Fairfax, VA, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2014,12,14]]},"reference":[{"key":"bibr1-0046958014564055","doi-asserted-by":"publisher","DOI":"10.1038\/ijo.2008.102"},{"key":"bibr2-0046958014564055","unstructured":"Angell M. The epidemic of mental illness: why? The New York Review of Books. June 23, 2011. http:\/\/www.nybooks.com\/articles\/archives\/2011\/jun\/23\/epidemic-mental-illness-why\/. Accessed November 21, 2014."},{"key":"bibr3-0046958014564055","unstructured":"Fudin S. America\u2019s gun violence epidemic [Infographic]. MPH@GW Blog. March 18, 2014. http:\/\/publichealthonline.gwu.edu\/americas-gun-violence-epidemic-infographic\/. Accessed November 21, 2014."},{"key":"bibr4-0046958014564055","unstructured":"List of all commitments\/contributions and pledges as of 21 November 2014. Financial Tracking Service. http:\/\/fts.unocha.org\/reports\/daily\/ocha_R10_E16506_asof___1412050300.pdf Accessed November 21, 2014."},{"key":"bibr5-0046958014564055","unstructured":"Letter from the President\u2014emergency appropriations request for Ebola for fiscal year 2015. The White House. http:\/\/www.white-house.gov\/the-press-office\/2014\/11\/05\/letter-president-emerge-ncy-appropriations-request-ebola-fiscal-year-2015. Published November 5, 2014. Accessed November 21, 2014."},{"key":"bibr6-0046958014564055","unstructured":"Fox M, Naggiar S. Dozens of volunteers have come back safe from Ebola hot zone. EBOLA VIRUS OUTBREAK STORYLINE. NBC NEWS. October 29, 2014. http:\/\/www.nbc-news.com\/storyline\/ebola-virus-outbreak\/dozens-volunteers-have-come-back-safe-ebola-hot-zone-n237001. Accessed Nov-ember 21, 2014"},{"key":"bibr7-0046958014564055","unstructured":"USAID PREDICT. http:\/\/www.vetmed.ucdavis.edu\/ohi\/predict\/index.cfm. Accessed November 21, 2014."},{"key":"bibr8-0046958014564055","unstructured":"Patane M. NewLink moving ahead with Ebola vaccine trials. October 21, 2014. http:\/\/www.desmoinesregister.com\/story\/money\/business\/2014\/10\/20\/newlink-genetics-canada-ebola-vac-cine-world-health-organization\/17609697\/. Accessed November 21, 2014."},{"key":"bibr9-0046958014564055","unstructured":"ZMappTM information sheet. Mapp Biopharmaceutical, Inc.http:\/\/www.mappbio.com\/zmapinfo.pdf. Published August 12, 2014. Accessed November 21, 2014."},{"key":"bibr10-0046958014564055","unstructured":"CDC Emergency Operations Center (EOC). http:\/\/www.cdc.gov\/phpr\/eoc.htm. Published January 10, 2014. Updated January 10, 2014. Accessed November 21, 2014."},{"key":"bibr11-0046958014564055","unstructured":"APIC Ebola Readiness Poll results of an online poll of infection preventionists 2014. The Association for Professionals in Infection Control and Epidemiology (APIC). http:\/\/apic.org\/Resource_\/TinyMceFileManager\/Topic-specific\/Ebola_Readi-ness_Poll_Results_FINAL.pdf. Published October 24, 2014, Updated November 20, 2014. Accessed November 21, 2014."},{"key":"bibr12-0046958014564055","unstructured":"Johnson R, Gamio L. How likely is it that you will die from Ebola? The Washington Post. November 17, 2014. http:\/\/www.washingtonpost.com\/wp-srv\/special\/world\/how-deadly-is-ebola\/. Accessed November 21, 2014."},{"key":"bibr13-0046958014564055","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMp1413425"},{"key":"bibr14-0046958014564055","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMp1413816"},{"key":"bibr15-0046958014564055","doi-asserted-by":"publisher","DOI":"10.1056\/NEJ-Me1413139"},{"key":"bibr16-0046958014564055","unstructured":"Christian S, Catherine Dower C. Scope of practice laws in health care: rethinking the role of nurse practitioners. California Healthcare Foundation. http:\/\/www.chcf.org\/publications\/2008\/01\/scope-of-practice-laws-in-health-care-rethinking-the-role-of-nurse-practitioners#ixzz3JiwGI17J. Published January 2008. Accessed November 21, 2014."},{"key":"bibr17-0046958014564055","doi-asserted-by":"publisher","DOI":"10.1037\/0033-2909.86.3.638"},{"key":"bibr18-0046958014564055","doi-asserted-by":"publisher","DOI":"10.1016\/j.jclinepi.2011.06.022"},{"key":"bibr19-0046958014564055","unstructured":"Feynman RP. Appendix F\u2014personal observations on reliability of shuttle (Report of the Presidential Commission on the Space Shuttle Challenger Accident). June 6, 1986. https:\/\/www.e-education.psu.edu\/files\/meteo361\/file\/nasa_report.pdf Accessed November 21, 2014."},{"key":"bibr20-0046958014564055","unstructured":"Pandemic flu history. FLU.GOV, U.S. Department of Health & Human Services. http:\/\/www.flu.gov\/pandemic\/history\/index.html. 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