Showing papers in "Journal of Health Politics Policy and Law in 1980"
TL;DR: Though knowledge about physician's assistants and nurse practitioners is far from conclusive, these new health practitioners appear to perform a large percentage of primary care services at a high level of quality and productivity.
Abstract: Although knowledge about physicians assistants and nurse practitioners is far from conclusive review of the literature indicates that these new health practitioners (NHPs) appear to perform a large percentage of primary care services at a high level of productivity in the U.S. Moreover the gap between the physician/NHP substitution ratio and the NHP/physician cost ratio seems wide enough to assure cost savings when NHPs are used well. (Authors modified)
49Â citations
TL;DR: There is a need for subsidization of a more comprehensive set of long-term care services, a review of reimbursement policies, and improved methods of allocating existing nursing home beds among persons desiring care.
Abstract: Nursing homes represent the fastest growing component of health care expenditures, over half of which come from public funds. This paper reviews research on nursing home utilization with regard to several policy issues concerning the subsidization of long-term care by Medicaid. As a background, the paper defines and contrasts three concepts; need, demand, and utilization. It then indicates how Medicaid policies regarding reimbursement of homes and eligibility for support can result in a chronic shortage of beds and describes the estimated effects on utilization of eight variables: Medicaid generosity, age structure, family resources, racial composition, residence, financial capability of the elderly, price of nursing home care and alternative sources of care. The paper concludes that there is a need for: subsidization of a more comprehensive set of long-term care services, a review of reimbursement policies, and improved methods of allocating existing nursing home beds among persons desiring care.
34Â citations
28Â citations
TL;DR: Analysis of the efforts of health care consumers to organize independently of, but with reference to, the Health Systems Agency in east central Illinois concludes that health care planning cannot be considered apart from a context of politics, and that community organization is important for consumers wishing to exercise power.
Abstract: This article analyzes the efforts of health care consumers to organize independently of, but with reference to, the Health Systems Agency in east central Illinois. Beginning with a tactical investigation which disclosed a lack of effective public participation, consumers formed an organization which conducted a series of community forums to provide information and generate publicity about local health care issues, sponsored training workshops for consumer leaders and HSA board members, worked to delay the final designation of the agency, and organized to take control of the local HSA board. They recruited a large number of new HSA members, enlisted provider and consumer candidates to run for the board, conducted a vigorous election campaign, and finally claimed a majority of seats. Among the conclusions drawn are that health care planning cannot be considered apart from a context of politics, and that community organization is important for consumers wishing to exercise power.
23Â citations
TL;DR: This article delineates several of the more important policy issues raised by the holistic movement, a phenomenon that represents a challenge to the present organization of health care institutions as well as to scientific medicine.
Abstract: A forthright rebellion against the philosophical and clinical orientations of scientific medicine has occurred in the United States during the 1970s. This rebellion includes a growing number of people engaged in self-care practices in attempts to alter their health status through "lifestyle" adjustments, as well as a diverse amalgamation of practitioners (both medical and otherwise), who offer a wide range of therapies outside the mainstream of modern medical practice. Holistic health care has lately become the rubric under which these therapies are grouped. Scientific medicine is the term commonly used to refer to procedures officially sanctioned by the organized medical profession. In the late 19th century, scientific medicine emerged as an advance beyond allopathic medicine after germ theory provided an explanation and, later treatment for infectious diseases. Financial support by private philantropic foundations came in the wake of the Flexner Report on medical education, which provoked a reorganization of medical education in the United States. The subsequent hegemony of scientific medicine thus became assured. To date, few policy analysts have attempted to assess holism and its health policy implications. This article delineates several of the more important policy issues raised by the holistic movement, a phenomenon that represents a challenge to the present organization of health care institutions as well as to scientific medicine.
19Â citations
TL;DR: Historical investigation of registered nurses' efforts in the United States and a case study of the 1976 Seattle Nurses' strike indicate major obstacles to the professionalizing project.
Abstract: Registered nurses have been attempting to achieve professional status for nearly a century. Historical investigation of their efforts in the United States and a case study of the 1976 Seattle Nurses' strike indicate major obstacles to the professionalizing project. The most important of these are the inability of the nurses to control the labor supply, and their failure to define or monopolize a distinct set of tasks. One result is functional redundancy: there is no job nurses perform that is not also performed by some other occupation.
19Â citations
TL;DR: The opportunity to affect significantly the consumption of cigarettes in the United States through government action appears quite limited.
Abstract: The opportunity to affect significantly the consumption of cigarettes in the United States through government action appears quite limited. Fifty million Americans smoke cigarettes. The United States is a leading producer of tobacco leaf and utilizes a price support system which is designed to protect tobacco growers. The industry is profitable and politicaly well connected. Several states are important producers of tobacco while others benefit from the excise tax imposed on cigarettes. The opposition to smoking is relatively weak and divided. Nevertheless, the tobacco industry worries about the future market for cigarettes.
17Â citations
TL;DR: This paper addresses a subject that is often overlooked in the literature on licensing: the inherent conflict-of-interest in professional licensing boards, where the predominant voice on the boards is that of the regulated profession and, more directly, of practitioners who have a vested interested interest in their own policy making.
Abstract: Licensing of the health professions is an issue of public policy which has been under fire for years. Economists argue that licensing stifles competition and increases health care costs. Manpower specialists contend that statutory scopes of practice create arbitrary barriers to both geographic and career mobility, and contribute to the reduced utilization of newer, emergent categories of health personnel. This paper addresses a subject that is often overlooked in the literature on licensing: the inherent conflict-of-interest in professional licensing boards, where the predominant voice on the boards is that of the regulated profession and, more directly, of practitioners who have a vested interested interest in their own policy making. A number of seminal court decisions are examined that address this issue and a new model for licensing boards is proposed. While this model would do away with the present structure of the boards, it would not sacrifice the critical role of technical information that only the licensed professions can provide.
13Â citations
12Â citations
TL;DR: This paper analyzes using classical approaches of deontology and teleology the necessity for cost-benefit analysis in evaluating Occupational and Safety Health Administration standards, thus raising difficult ethical questions.
Abstract: Recent court decisions have stressed the necessity for cost-benefit analysis in evaluating Occupational and Safety Health Administration (OSHA) standards, thus raising difficult ethical questions which this paper analyzes using classical approaches of deontology and teleology. Since both modes of analysis have deficiencies, the need for a synthesis using economic and noneconomic measures is suggested.
10Â citations
TL;DR: Recent developments in federal antitrust law regarding the health professions and the delivery of medical care are surveyed in terms of their implications for mounting antitrust attacks against the domination of nonphysician health care providers by physicians and other sectors of the health care industry.
Abstract: This article surveys recent developments in federal antitrust law regarding the health professions and the delivery of medical care. In the last four years there has been a steady erosion of the affirmative defenses traditionally available to health care providers, both institutional and individual. The article surveys these developments in terms of their implications for mounting antitrust attacks against the domination of nonphysician health care providers by physicians and other sectors of the health care industry. Three specific practices are discussed in light of their susceptibility to antitrust remedy: the denial of admitting privileges, third-party reimbursement, and physician backup to nonphysician practitioners. The article concludes with some caveats and admonitions to judges presiding over any cases which arise in this area.
TL;DR: The reasons for this contrast between Cuba and other Latin American countries are concluded to be largely political, suggesting that the severe health deficiencies of most developing countries are not inevitable consequences of poverty.
Abstract: In comparison to other Latin American countries at a similar or more advanced stage of economic development, Cuba has a relatively high ranking on major health status indicators. This paper examines the reasons for this contrast and concludes that they are largely political. This suggests that the severe health deficiencies of most developing countries are not inevitable consequences of poverty.
TL;DR: Both sides of the issue of institutionalization vs. home care of the aged in need of medical care are investigated by drawing on published conference proceedings and empirical studies reported in the literature.
Abstract: The question of institutionalization vs. home care of the aged in need of medical care has been debated extensively. The arguments for deinstitutionalization have stressed the issue of cost. Home care is felt to be more cost efficient than institutional care. In this paper, both sides of the issue are investigated in detail by drawing on published conference proceedings and empirical studies reported in the literature.
TL;DR: Five factors are hypothesized to be important in determining the extent of HMO impact on a community: employer attitudes, hospital capacity, physician supply, planning and regulatory decisions, and comprehensiveness of health benefit coverage.
Abstract: This paper reviews the evidence concerning the impact of HMO growth on traditional providers. Primary emphasis is placed on the results of three case studies conducted by the author. Based on the case studies, five factors are hypothesized to be important in determining the extent of HMO impact on a community: employer attitudes, hospital capacity, physician supply, planning and regulatory decisions, and comprehensiveness of health benefit coverage. Since research on this general topic is in its infancy, several important questions deserving future research effort also are identified.
TL;DR: The paper addresses some of the ethical and legal issues involving the rights of psychiatric patients to refuse treatment, focused on two recently decided cases--Rogers v. Okins, and Rennie v. Klein.
Abstract: The paper addresses some of the ethical and legal issues involving the rights of psychiatric patients to refuse treatment. Particular attention is focused on two recently decided cases--Rogers v. Okins, and Rennie v. Klein--that deal with the rights of involuntarily committed patients to refuse psychotropic medications. Both cases approach this issue in different ways, but inevitably point to some very complicated philosophical concepts such as the meaning of self-determination, autonomy and identity of personhood, especially as these concepts are applied to mentally ill patients.
TL;DR: This article on hospital planning programs in France and North-Rhine Westfalia assembles information on the formal building blocks of inter-organizational relations in the formulation and implementation process to draw inferences that are relevant to policy and research.
Abstract: This article on hospital planning programs in France and North-Rhine Westfalia (a state in the Federal Republic of Germany), assembles information on the formal building blocks of inter-organizational relations in the formulation and implementation process. Because these planning programs are embedded in past social policy developments and institution-building, it is necessary to first compare the two countries' compulsory health insurance schemes. This is followed by a general profile of each health care system. A third section examines the formulation and implementation of the countries' hospital planning programs and participation patterns. Based on this comparison, inferences are drawn that are relevant to policy and research. The analysis yields three major conclusions. First, despite abundant legal and administrative controls at the disposal of central health bureaucracies, the capability of the national leadership to influence the hospital system through innovative planning is limited by jurisdictional, institutional, functional and territorial fragmentation, and differentiation of control and public responsibility in health. However, the diverse goal orientations of participants may provide the necessary tension to allow for some change in otherwise highly structured political and administrative systems. Second, despite differences in historical, political and administrative developments, the decision making systems for health care policies in France and the Federal Republic, with the exception of health insurance, are strikingly similar to the fragmented decision making system in the United States. Third, the effect of government-mandated participation is empirically uncertain. Opening up the circle of participants seems to have reinforced alliances between public bureaucracies and corporate vested interests. Hospital planning continues to be carried out for rather than with the consumer and citizen. Hospital planning which is a mixture of goal and process-oriented planning does not change the basic orientation of health care systems, which are disease-oriented, and hospital-centered.
TL;DR: The reality of the VA regionalization is examined on a national basis and illustrated by an in-depth study of five hospitals in one district, indicates that there has been little use of resource allocation methodology and that few planning resources have been allocated to this effort.
Abstract: Criticisms of the Veterans Administration health care system have centered in part on the ability of the system to reallocate resources in response to the changing needs of veterans. VA hospitals use traditional budgeting and planning processes; new programs and projected increases in workload are added to the previous year's budget to yield the budget for the succeeding year. Since these activities occur on an individual institution bases, there is little effort to plan cooperatively between hospitals or to reassess the fundamental allocation of resources based on veteran needs. Over the past two years, the VA has devised a program of regionalized budgeting and planming. The publicity surrounding VA regionalization reflects the idealized potential of shared resources and joint planning within each of the newly created VA medical districts. The reality of the program, however, when examined on a national basis and illustrated by an in-depth study of five hospitals in one district, indicates that there has been little use of resource allocation methodology and that few planning resources have been allocated to this effort. As a result, the district program is a collation of individual hospital budgets, and plans to yield the district budget and plans. Regionalization is unlikely to succeed in any meaningful manner within the VA unless further changes occur in district resource allocation methods.
TL;DR: Several issues which might arise in the context of national health insurance legislation are considered, including reimbursement rates and methods, certification and licensure, training subsidies, deployment incentives, and compatibility with an increased supply of physicians.
Abstract: This article considers a number of issues which might arise in formulating policy for new health occupations. Its particular focus is on nurse practitioners and physicians' assistants and their treatment under potential national health insurance arrangements. The development and expansion of these occupations are described, as is the evidence on their performance with respect to the quality of medical care provided, the impact on the cost of such care, and changes in access to care. We then discuss several issues which might arise in the context of national health insurance legislation, including reimbursement rates and methods, certification and licensure, training subsidies, deployment incentives, and compatibility with an increased supply of physicians.
TL;DR: It is argued that in order for cost-containment to be effective in the United States, planning agencies need to have control over resource allocation.
Abstract: This paper reviews case studies of eighteen countries to identify similarities and differences in health planning problems and institutional arrangements for resolving them. On the basis of this review, it is argued that in order for cost-containment to be effective in the United States, planning agencies need to have control over resource allocation.
TL;DR: Survey data from a rural west Texas population were used to evaluate the relative importance of characteristics of the population and the organization of the health care delivery system in determining whether individuals are affiliated with an urban or rural source of care.
Abstract: The published literature suggests that 2 factors affect where people seek medical care: the characteristics of the population and the organization of the health care delivery system. In this study survey data from a rural west Texas population were used to evaluate the relative importance of these factors in determining whether individuals are affiliated with an urban or rural source of care. Population characteristics appear to be the more important determinants; in fact where people seek care may not be substantially altered by restructuring the organizational and geographical components of the health care delivery system. (Authors)
TL;DR: Analyzing the Canadian case in this broad perspective reveals that the influence of ideological and institutional forces, and principal actors is more important than most commentators believe, and that the dynamism in health policy formulation has resulted in a great deal of internal conflict as well as politicization and provincialization.
Abstract: Because health policy is the result of a tremendous variety of shifting forces, it is necessary to be eclectic in the approach used to study it. Analyzing the Canadian case in this broad perspective reveals that the influence of ideological and institutional forces, and principal actors is more important than most commentators believe, and that the dynamism in health policy formulation has resulted in a great deal of internal conflict as well as politicization and provincialization.
TL;DR: An analysis of factors which influence the probability of a professional liability claim occurring for physicians in each of the four Census Regions suggests variations across Census Regions in population characteristics, availability of medical resources and supply of legal services are determinants of the occurrence of claims.
Abstract: The problem of professional liability claims and impact on the medical care market has become increasingly important in recent years. Professional liability insurance premiums, and the practice of defensive medicine by physicians in response to potential professional liability claims, have been cited as partly responsible for the increasing costs of medical care. This study is an analysis of factors which influence the probability of a professional liability claim occurring for physicians in each of the four Census Regions. The data analyzed are from the Eleventh Periodic Survey of Physicians conducted by the American Medical Association in 1977, in which respondents indicated whether they had a professional liability claim filed against them. A logit analysis suggests that variations across Census Regions in population characteristics, availability of medical resources and supply of legal services are determinants of the occurrence of claims.
TL;DR: This paper argues that before further major initiatives are undertaken, the establishment of a better information base and an improved understanding of the interrelationships of the numerous mental health policies are necessary.
Abstract: A confusing array of options to reform mental health care is now under consideration by policymakers. To clarify the implications of these options, five categories of actions are distinguished. These reforms are: federal program change, litigation, state commitment statute reform, alterations in private market variables and efforts to change attitudes. The overlaps among them are discussed as is the importance of knowing more about the relative effectiveness of each action. Wide-ranging reforms have been underway on an ad hoc basis for sometime. This paper argues that before further major initiatives are undertaken, the establishment of a better information base and an improved understanding of the interrelationships of the numerous mental health policies are necessary.
TL;DR: The personal experiences of the author are investigated in investigating the circumstances which led the state of Tennessee to deviate from this norm with its Primary Care Act of 1973.
Abstract: Departments of public health have played a relatively limited direct role in providing primary care to medically underserved areas, a function which has long been the province of the private medical practitioner. This article reports on the personal experiences of the author in investigating the circumstances which led the state of Tennessee to deviate from this norm with its Primary Care Act of 1973. The limited scope of the measure and the timing of its introduction, together with careful attention to the dynamics of health care politics, were critical to the passage of the Act. Even though considerable time has elapsed since this article was written, and increased interest in primary care is evident in other areas and at various levels of government, the obstacles and issues involved in providing care to underserved areas remain topics of debate in Tennessee and elsewhere.
TL;DR: The paper reports the findings of a study of the neighborhood health center (NHC) program which was initiated by the Office of Economic Opportunity (OEO) in 1965 and argues that the conflicts which evolved within the system were the natural outcome of the divergence in the goals of the different actors.
Abstract: The paper reports the findings of a study of the neighborhood health center (NHC) program which was initiated by the Office of Economic Opportunity (OEO) in 1965. The study focuses on the structure of the NHC system (funding agency, operating agency, and community board), analyzes the goals of the different sets of actors, and argues that the conflicts which evolved within the system were the natural outcome of the divergence in the goals of the different actors. Based on a series of 88 in-depth interviews with key health officials in OEO as well as project officers in NHCs throughout the country, the study suggests a framework for a more comprehensive analysis of the outcome of the NHC program and notes the implications of these findings for some current health legislation.
TL;DR: Some of the chronic problems, such as funding, image, constituency and acceptance, that this institution has faced are discussed and suggestions are made about how to address specific areas of concern.
Abstract: This paper reviews identifying characteristics of the urban public hospital and discusses some of the chronic problems, such as funding, image, constituency and acceptance, that this institution has faced. Alternative courses of action for dealing with these problems are considered. No single solution is recommended for every community, but suggestions are made about how to address specific areas of concern.