Ethics, Physician Incentives and Managed Care

The authors review the principle features of the managed care system in an effort to understand the ethical assumptions inherent in managed care. The interrelationships among physician incentives, responsibilities of patients and the physician-patient relationship are examined in light of the ethical concerns identified in the managed care system. The managed care system creates ethical tensions for those who influence the allocation of scare resources. Managed care’s administrative controls have increasingly changed the doctor-patient relationship to the business person-consumer relationship. Managed care goals of quality and access demand that physicians be both patient advocate and organizational advocate, even though these roles seem to conflict. A reemphasis of managed care’s moral mission is essential for enabling physicians, patients, payers and policymakers to fulfill their new role and to preserve the fidelity of the doctor-patient relationship

Racial and Ethnic Differences in Cardiovascular Disease Risk Factors in U.S. Older Women: Findings from Behavioral Risk Factor Surveillance Survey, 2003 & 2004

The purpose of this study was to examine racial and ethnic variations in the modifiable CVD risk factors in older women (65 years and older). The study data was drawn from the merged 2003 and 2004 national Behavioral Risk Factor Surveillance Survey (BRFSS). Multinomial regression analyses for indicator outcome and multiple logistic regression analyses for binary outcomes were performed to determine the relationship between each of the six dependent variable and the independent variables. Compared to older white women, older black women had significantly higher odds of hypertension, diabetes and obesity. No significant association was found between Hispanics and hypertension. However Hispanics were found to be more likely to have diabetes and no leisure-time physical activity compared to whites. Hispanics were also found to have lower odds of smoking compared to whites. American Indian and Alaskan Native (AIAN) s were found to have significantly higher odds of diabetes and obesity compared to whites. No significant association between AIANs and smoking was found. Overall, there are striking racial and ethnic differences in the CVD risk factors among older U.S women after controlling for socio-economic status. It is evident from these findings that in designing interventions to reduce cardiovascular risks for elderly women, clearly “one size does not fit all.” These findings highlight the need for development and implementation of appropriate public health programs aimed at these various target communities

Physician Incentives: Managed Care and Ethics

The authors review the principle features of the managed care system in an effort to understand the ethical assumptions inherent in managed care. The interrelationships among physician incentives, responsibilities of patients and the physician-patient relationship are examined in light of the ethical concerns identified in the managed care system. The managed care system creates ethical tensions for those who influence the allocation of scare resources. Managed care\u27s administrative controls have increasingly changed the doctor-patient relationship to the businessperson-consumer relationship. Managed care goals of quality and access demand that physicians be both patient advocate and organizational advocate, even though these roles seem to conflict. A reemphasis of managed care\u27s moral mission is essential for enabling physicians, patients, payers and policymakers to fulfill their new role and to preserve the fidelity of the doctor-patient relationship

Organizational Culture in a Terminally Ill Hospital

This study analyzed an organizational culture in a community hospital in Texas to measure organizational culture change and its impact on Patient Satisfaction (PS). The study employed primary and secondary data, combining quantitative and qualitative methods for a case study. Participant observation was used and archival data were collected to provide a better understanding of the organizational culture and the context in which change was taking place. This study also applied a “Shared Vision” of the organization as the central process in bringing forth the knowledge shared by members of the community hospital who were both subjects and research participants. The results from the study suggest an increase in PS due to the shared vision of one subculture within the hospital. There were powerful subcultures in this organization based on occupation and specialization, and their interests and functional orientations were not conducive to a systems approach. Hospital management was conducted in “silos” and there was lack of feedback between organizational levels of the hospital, especially in financial management, with organizational dysfunctionality in reacting and adapting to the health care market

Pulmonary impairment after tuberculosis and its contribution to TB burden

<p>Abstract</p> <p>Background</p> <p>The health impacts of pulmonary impairment after tuberculosis (TB) treatment have not been included in assessments of TB burden. Therefore, previous global and national TB burden estimates do not reflect the full consequences of surviving TB. We assessed the burden of TB including pulmonary impairment after tuberculosis in Tarrant County, Texas using Disability-adjusted Life Years (DALYs).</p> <p>Methods</p> <p>TB burden was calculated for all culture-confirmed TB patients treated at Tarrant County Public Health between January 2005 and December 2006 using identical methods and life tables as the Global Burden of Disease Study. Years of life-lost were calculated as the difference between life expectancy using standardized life tables and age-at-death from TB. Years lived-with-disability were calculated from age and gender-specific TB disease incidence using published disability weights. Non-fatal health impacts of TB were divided into years lived-with-disability-acute and years lived-with-disability-chronic. Years lived-with-disability-acute was defined as TB burden resulting from illness prior to completion of treatment including the burden from treatment-related side effects. Years lived-with-disability-chronic was defined as TB burden from disability resulting from pulmonary impairment after tuberculosis.</p> <p>Results</p> <p>There were 224 TB cases in the time period, of these 177 were culture confirmed. These 177 subjects lost a total of 1189 DALYs. Of these 1189 DALYs 23% were from years of life-lost, 2% were from years lived-with-disability-acute and 75% were from years lived-with-disability-chronic.</p> <p>Conclusions</p> <p>Our findings demonstrate that the disease burden from TB is greater than previously estimated. Pulmonary impairment after tuberculosis was responsible for the majority of the burden. These data demonstrate that successful TB control efforts may reduce the health burden more than previously recognized.</p

Differences in risk factors for children with special health care needs (CSHCN) receiving needed specialty care by socioeconomic status

<p>Abstract</p> <p>Background</p> <p>The purpose of this study is to identify factors affecting CSHCN's receiving needed specialty care among different socioeconomic levels. Previous literature has shown that Socioeconomic Status (SES) is a significant factor in CHSHCN receiving access to healthcare. Other literature has shown that factors of insurance, family size, race/ethnicity and sex also have effects on these children's receipt of care. However, this literature does not address whether other factors such as maternal education, geographic location, age, insurance type, severity of condition, or race/ethnicity have different effects on receiving needed specialty care for children in each SES level.</p> <p>Methods</p> <p>Data were obtained from the National Survey of Children with Special Health Care Needs, 2000–2002. The study analyzed the survey which studies whether CHSCN who needed specialty care received it. The analysis included demographic characteristics, geographical location of household, severity of condition, and social factors. Multiple logistic regression models were constructed for SES levels defined by federal poverty level: < 199%; 200–299%; ≥ 300%.</p> <p>Results</p> <p>For the poorest children (,199% FPL) being uninsured had a strong negative effect on receiving all needed specialty care. Being Hispanic was a protective factor. Having more than one adult in the household had a positive impact on receipt of needed specialty care but a larger number of children in the family had a negative impact. For the middle income group of children (200–299% of FPL severity of condition had a strong negative association with receipt of needed specialty care.</p> <p>Children in highest income group (> 300% FPL) were positively impacted by living in the Midwest and were negatively impacted by the mother having only some college compared to a four-year degree.</p> <p>Conclusion</p> <p>Factors affecting CSHCN receiving all needed specialty care differed among socioeconomic groups. These differences should be addressed in policy and practice. Future research should explore the CSHCN population by income groups to better serve this population</p

Physician Supply: An Economic and Policy Perspective

The number of graduates of United States allopathic medical schools has been relatively constant for two decades while national health care utilization and expenditures have risen rapidly. Growing demand for medical residents has largely been met with international medical graduates (IMGs). Physician groups have been concerned about the specter of a surplus of doctors driven by managed care pressures. Deans of allopathic medical schools have been reluctant to increase the supply of United States medical graduates; this is partly due to the lack of economic incentives to admit more students. Consistent with criticism made by Princeton economist Uwe Reinhardt and physician Fitzhugh Mullan, it is argued here that increased numbers of physicians can lead to improved access for lower income groups and rural areas

Physician Supply: An Economic and Policy Perspective

The number of graduates of United States allopathic medical schools has been relatively constant for two decades while national health care utilization and expenditures have risen rapidly. Growing demand for medical residents has largely been met with international medical graduates (IMGs). Physician groups have been concerned about the specter of a surplus of doctors driven by managed care pressures. Deans of allopathic medical schools have been reluctant to increase the supply of United States medical graduates; this is partly due to the lack of economic incentives to admit more students. Consistent with criticism made by Princeton economist Uwe Reinhardt and physician Fitzhugh Mullan, it is argued here that increased numbers of physicians can lead to improved access for lower income groups and rural areas

A growing market. As obesity rates rise, so do the opportunities for marketers of specialized services

Almost two out of three American adults are currently classified as overweight or obese, and the skyrocketing economic cost of obesity in the United States includes direct medical costs (estimated at 5%-7% of national health expenditures), lost productivity of workers, and other often intangible but real costs. And the phenomenon of obesity is spreading at an alarming rate, not just in industrialized countries but also in developing countries, where it exists alongside malnutrition. While the advent of such widespread obesity is well-known, what is less well-known is the impact that this epidemic is having on suppliers of medical services. This article helps provide some insight into the impact of obesity on medical care with a case study of the market for bariatric hospital beds and related services