Transfusion‐associated septic events have been reduced by the introduction of improved donor screening and skin disinfection methods, as well as implementation of first aliquot diversion and bacterial testing. Recent reports of septic reactions indicate that bacterial contamination of blood components continues to be the predominant transfusion‐associated infectious risk in Europe and North America . From 2011 to 2015, the US Food and Drug Administration (FDA) reported 14 fatalities caused by blood components contaminated with bacteria . In Canada, the Transfusion Transmitted Injuries Surveillance System Programme Report for 2006–12 described 33 transfusion reactions involving bacterially contaminated blood components . Only one probable transfusion reaction involving a platelet unit contaminated with Staphylococcus aureus has been reported in the UK since universal screening of platelet concentrates using an automated culture method was implemented in 2011. However, in this period there have been three near misses where bacterial contamination with S. aureus was detected. Transfusion of those units was prevented because the presence of aggregates was noted during visual inspection of the platelet concentrates . Results of platelet screening with automated culture methods have been summarised in a recent review by Benjamin and McDonald and an ISBT Forum on bacterial contamination in platelets . The data were collected from 16 published reports and 18 contributions (from 16 countries), respectively. These studies revealed an incidence of confirmed positive cultures ranging from 0.01% to 0.1%. Septic reactions representing false‐negative culture results were reported at rates of approximately 0.007%.

The World Health Organization has estimated that by the year 2050, the world’s population over 60 years will double from about 11% in 2015 to 22% . This means that there will be approximately two billion people aged 60 or older living on the planet. Of these, approximately 20% or 400 million will be 80 years or older. In the year 2015, Japan was the only country in the world with 30% or more of the population in the 60 years or older group. The WHO is projecting that by the year 2050, more than 25 countries, including most countries in Europe, will have a population distribution very similar to that of Japan. For example, the percentage of Italians older than 60 years will increase from approximately 20% in 2010 to approximately 33% in the year 2050. This increase in the number of people in older age groups is associated with an increase in life expectancy. For example, in Japan, life expectancy at age 60 is 86 years and in at least 13 other countries life expectancy at age 60 is now 85 years (Table 1.1). Further, the number of centenarians is also increasing, and in several regions of the world, including Sardinia, Italy and Icaria, Greece, there are a disproportionately large number of people in this age group.

Dr. Lane is a new graduate and has entered into the field of hospital medicine. During her limited time as a hospitalist, it has become clear to Dr. Lane that she has a gap in her working knowledge of the healthcare system as a whole. During residency, she focused most of her attention on patient care and less on understanding the system in which she works. She is also starting to realize the impact the current healthcare system has not only on her patients but on herself as a healthcare provider. Understanding the basics of healthcare and the healthcare systems in which you work is an important aspect of being a successful hospitalist. This chapter will aim to provide a brief overview of the U.S. healthcare system and introduce you to the different aspects of the Affordable Care Act.