Money Talks, Patients Walk?

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/71560/1/j.1525-1497.2001.10118.x.pd

Beyond Costs and Benefits: Understanding How Patients Make Health Care Decisions

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/139978/1/onco0005.pd

Morality and the limits of societal values in health care allocation

In this paper, we consider whether there is a clear moral justification for the proposal that societal value preferences (SVPs) should be included in Cost Effectiveness Analyses (CEA) of health care resource allocations. We argue, first, that proponents of the use of SVPs need to be clear about the relationship between these values and moral principles. In particular, once moral principles are accepted as ruling out some SVPs (such as those that are irrational or revealing prejudice), an account is required of why we need to appeal to SVPs rather than moral principles to determine a just division of health care resources. Secondly, we consider whether an independent moral justification might underwrite the use of SVPs. In various places in the literature the notions of representation, presumed consent and democratic decision making appear to be invoked as candidates for fulfilling this justificatory role. We discuss some problems with each of these justifications in the hope of eliciting a more comprehensive proposal from the proponents of SVPs. We conclude that, although a number of interesting proposals have been made, no compelling justification for including SVPs in CEA has yet been systematically articulated. Copyright © 2002 John Wiley & Sons, Ltd.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/35159/1/665_ftp.pd

Solid-Organ Transplantation in HIV-Infected Patients

Before the introduction of highly active antiretroviral therapy in the mid-1990s, transplantation centers were understandably reluctant to provide scarce solid organs for patients infected with the human immunodeficiency virus (HIV). However, because treated patients can now expect to live substantially longer than before, many will have end-stage organ disease long before they have life-threatening conditions related to HIV infection. It is therefore time for the transplantation community to readdress the safety, efficacy, and propriety of transplanting scarce organs in HIV-positive patients who need them. In this article, we provide ethical arguments for viewing transplantation in patients with HIV infection as analogous to transplantation in patients with other chronic illnesses. Accordingly, transplantation in HIV-positive patients should be initiated at major centers and should not be considered experimental. In addition, reimbursement for such procedures should be similar to that for transplantation in other patients, unless evidence accumulates that HIV-infected transplant recipients fare poorly

How Physicians React to Cost-Effectiveness Information

Since 1998, the growth of health care spending has accelerated to levels not seen since the 1980s. This growth has renewed pressures on physicians to practice “cost-effective” care, since physicians’ decisions account for the vast majority of all health care spending. But little is known about what physicians think about cost containment, and how they incorporate cost-effectiveness information into their practice patterns. This Issue Brief summarizes three related studies that describe primary care physicians’ attitudes toward considering costs in their clinical decisions, and the effects of providing cost-effectiveness information on physicians’ recommendations

Changing Times, Changing Opinions: History Informing the Family Presence Debate

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/75754/1/j.aem.2005.05.027.pd

The world of Grace Paley's short stories: traditional women in a changing America

Call number: LD2668 .R4 ENGL 1988 U24Master of ArtsEnglis

Power spectrum analysis of heart rate fluctuations : the renin-angiotensin system's role as short term cardiovascular control system

Thesis (B.S.)--Massachusetts Institute of Technology, Dept. of Chemical Engineering, 1981.MIT copy bound with: Solute concentration effects on the rejection of rigid macromolecules from microporous membranes / by Debasish Tripathy [1981]Includes bibliographical references (leaf 32).byt Frank Andrew Ubel, III.B.S

A Matter of Perspective: Choosing for Others Differs from Choosing for Yourself in Making Treatment Decisions

Many people display omission bias in medical decision making, accepting the risk of passive nonintervention rather than actively choosing interventions (such as vaccinations) that result in lower levels of risk. OBJECTIVE : Testing whether people's preferences for active interventions would increase when deciding for others versus for themselves. RESEARCH DESIGN : Survey participants imagined themselves in 1 of 4 roles: patient, physician treating a single patient, medical director creating treatment guidelines, or parent deciding for a child. All read 2 short scenarios about vaccinations for a deadly flu and treatments for a slow-growing cancer. PARTICIPANTS : Two thousand three hundred and ninety-nine people drawn from a demographically stratified internet sample. MEASURES : Chosen or recommended treatments. We also measured participants' emotional response to our task. RESULTS : Preferences for risk-reducing active treatments were significantly stronger for participants imagining themselves as medical professionals than for those imagining themselves as patients (vaccination: 73% [physician] & 63% [medical director] vs 48% [patient], P s<.001; chemotherapy: 68% & 68% vs 60%, P s<.012). Similar results were observed for the parental role (vaccination: 57% vs 48%, P =.003; chemotherapy: 72% vs 60%, P <.001). Reported emotional reactions were stronger in the responsible medical professional and parental roles yet were also independently associated with treatment choice, with higher scores associated with reduced omission tendencies (OR=1.15 for both regressions, P s<.01). CONCLUSIONS : Treatment preferences may be substantially influenced by a decision-making role. As certain roles appear to reinforce “big picture” thinking about difficult risk tradeoffs, physicians and patients should consider re-framing treatment decisions to gain new, and hopefully beneficial, perspectives.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/72417/1/j.1525-1497.2006.00410.x.pd