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Showing papers on "Health care published in 1972"


Journal Article
TL;DR: A linear health utility scale is described, complete with measurement instruments, that allows assignment of utility values to health states for any disease or treatment program and is the basis of a model that will rank programs by their effectiveness/cost ratios or select them into a subset achieving the maximum effectiveness under specific cost or other constraints.
Abstract: A linear health utility scale is described, complete with measurement instruments, that allows assignment of utility values to health states for any disease or treatment program. Given that the change produced by a health care program in the health states of a population is determinable, this utility scale permits assessment of the effectiveness of that program in terms of the change it produces in overall health utility. This is the basis of a model that will rank programs by their effectiveness/cost ratios or select them into a subset achieving the maximum effectiveness under specific cost or other constraints. Two algorithms are described, suitable respectively for priority ranking and for selection of programs giving maximum effectiveness under constraints, and the application of the model is discussed.

744 citations


Book
01 Jan 1972
TL;DR: The role of nutrition in the treatment of disease and metabolic disorders and the function of diet therapy are discussed in this article, where the principles of clinical nutrition and the role of dietetics and nutrition in health care are presented.
Abstract: Principles of clinical nutrition and the role of dietetics and nutrition in health care are presented in this text for health professionals. Basics in the science of nutrition are described: nutrient-biochemistry and metabolism; nutritional status and age group; and the geographic and social problems of nutrition. The therapeutic role of nutrition in treatment of disease and metabolic disorders, and the function of diet therapy are discussed. Nutritional care includes education, meal planning, and nursing and the identification and evaluation of the patient's nutritional needs. Information on foods and food choices for nutritional health is given. A detailed appendix includes reference materials, resource aids for nutrition information, tables of nutritive values of foods, food composition tables, and guidelines for nutritional status assessment

332 citations


Journal ArticleDOI
TL;DR: Most fundamental of the underlying themes of the new medical ethics is that health care must be a human right, no longer a privilege limited to those who can afford it.
Abstract: 9JL/tJT by ROBERT M. VEATCH ost of the ethical problems in the practice of medicine come up in cases where the medical condition or desired procecture itself presents no moral problem. Most day-today patient contacts are just not cases which are ethically exotic. For the woman who spends five hours in the clinic waiting room with two screaming children waiting to be seen for the flu, the flu is not a special moral problem; her wait is. When medical students practice drawing bloods from clinic patients in the cardiac care unit-when teaching material is treated as material-the moral problem is not really related to the patient's heart in the way it might be in a more exotic heart transplant, Many more blood samples are drawn, however, than hearts transplanted. It is only by moving beyond the specific issues to more basic underlying ethical themes that the real ethical problems in medicine can be dealt with. Most fundamental of the underlying themes of the new medical ethics is that health care must be a human right, no longer a privilege limited to those who can afford it. It has not always been that way, and, of course, is not anything near that in practice today. But the norm, the moral claim, is becoming increasingly recognized. Both of the twin revolutions have made their contribution to this change. Until this century health care could be treated as a luxury, no matter how offensive this might be now. The amount of real healing that went on was minimal anyway. But now, with the biological revolution, health care

257 citations


01 Jan 1972

187 citations


Journal ArticleDOI
TL;DR: The Federal Government and Juvenile Delinquency as mentioned in this paper has been identified as a major concern in the United States since World War 2 and has been a major cause of criminalization of children.
Abstract: PART 5: Juvenile Delinquency 1. Inertia and Innovation in the Care of Juvenile Delinquents A. Continuing Problems B. New Approaches 2.The Federal Government and Juvenile Delinquency A. Juvenile Delinquency as a National Concern B. Congressional Action 3. The Juvenile Court and Legal Issues A. Debate over the Court B. Legal Rights of Delinquents PART 6: Health Care for Children Old Problems and Youth 1. Development of Federal-State Programs in the New Deal and World War 2 A. Maternal and Child Health and Crippled Children's Services in the Social Security Act B. Child Health in World War 2 and the Postwar Era 2. Health Problems and Services for Children and Youth Since World War 2 A. Progress and Problems B. Expansion of Federal--State Maternal and Child Health and Crippled Children's Programs C. additional Programs and National Research Institutes 3. Mental Health and Retardation A. Mental Health B. Mental Retardation PART 7: Education 1. The Roosevelt Era A. Education in Depression and War B. Theories of Education 2. Education of Children of Minority Groups: New Trends and Old Problems A. Educational Experiences of Black Children B. Outlawing School Segregation C. The Education of Indian Children 3. Education Adjusts to the Cold War A. The Issue of Loyalty B. The National Interest in Educational Improvement C. New Programs for Government 4. Education and Reform A. Federal Initiatives in Support of Education B. Desegregation of the Schools C. Church and State D. Higher Education E. Education of Handicapped Children Chronology: Event Relating to the History of the Health, Education, and Welfare of Children and Youth, 1933-1973 1868 Selected Bibiliography 1915 Index 1958 1987

186 citations


Journal ArticleDOI
TL;DR: The analysis leads to the conclusion that the average American physician could profitably employ roughly twice the number of aides he currently employs and thus increase his hourly rate of output by about 25 per cent above its current level, and supports the thesis that American physicians tend to be wasteful in the use of their scarcest and most expensive resource.
Abstract: IN recent years, the American public has become greatly alarmed over an apparent shortage of physicians, a shortage which is expected to reach crisis proportions within the next decade. The predicted shortage stems, in part, from the nation's current efforts to make health care accessible to all income classes and from past neglect of medical-school facilities. However, there is also some evidence that the shortage is further aggravated by widespread inefficiency in the use of medical manpower. It is a matter which is increasingly attracting the attention of health-manpower specialists, but one on which opinions still differ widely. Somne students of the health-care sector have argued, as early as a decade ago, that it would be techniically imnpossible to add to the already hea\y patient load carried by American physicians.' In contrast, Rashi Fein's recent book The Doctor Shortage (1967) concludes with the assertion that physicians could increase their productivity still further, either by joining large-scale group practices or by delegating more of their workload to auxiliary personnel. Fein admits, however, that in the absence of more research, one "cannot be certain whether the gains from group-practice formation and from increased reliance on paramedical aides will be large or more modest." (p. 144) His argument therefore rests on essentially intuitive grounds. Fein's call for more research on the production of physicians' services is entirely justified. For, in spite of the crucial role played by physicians in the production and delivery of health services, there exists very little enmpirical information on the technical and economic determinants of the physician's productivity. This paper is an attempt to contribute to our understanding of this important parameter. Using a simnple model of physician behavior and a nationwide cross-section sample of physicians, the study seeks to identify the effects of auxiliary persoi)nel and of the mode of practice (solo or group) on the physician's rate of output. Our analysis leads to the conclusion that the average American physician could profitably employ roughly twice the number of aides he currently employs and thus increase his hourly rate of output by about 25 per cent above its current level. This figure takes on added meaning when it is recalled that a mere increase of 4 per cent in average physician productivity in the United States would add more to the aggregate supply of medical services than would the entire current graduating class froin American medical schools. Looked at in another way, our results suggest that, in choosing his combination of practice inputs, the average physician in our sample appears to have priced out his own time at a value much below that implicit in his medical fees. On either interpretation, the results therefore support the thesis that American physicians tend to be wasteful in the use of their scarcest and most expensive resource.

167 citations


Journal ArticleDOI
TL;DR: areas offering the greatest immediate potential for technologic applications include management information systems and "do-it-yourself" tests and devices for ambulatory medical care, hospital-discharge abstract systems, automation of commonly performed procedures in clinical laboratories, emergen...
Abstract: People's needs, not availability of technology, should determine policies and priorities for its application in health services. Technology can improve efficiency and assist in solution of problems, but cannot "drive the system" or cure all ills. Fragmentation of markets, lack of organized health-care systems, and absence of national policies and standards are serious deterrents to technologic innovation. To avoid costly failures, we should concentrate initially on applications that reinforce services of demonstrated efficacy and affect large numbers of patients and providers. Before widespread adoption, we must rigorously test and evaluate the cost effectiveness and acceptability of these applications. Areas offering the greatest immediate potential for technologic applications include management information systems and "do-it-yourself" tests and devices for ambulatory medical care, hospital-discharge abstract systems, automation of commonly performed procedures in clinical laboratories, emergen...

136 citations


Book
01 Jan 1972

129 citations


Journal ArticleDOI
TL;DR: The problem-solving performance of the experienced clinical neurologist is found to be a rigorous discipline that, although central to his delivery of health care, is not only ignored in his training but it is hampered by his training.
Abstract: The problem-solving performance of the experienced clinical neurologist, which superficially may look like a random art, is found to be a rigorous discipline that, although central to his delivery of health care, is not only ignored in his training but it is hampered by his training.

109 citations


Journal ArticleDOI
TL;DR: The numbers of health personnel, the proportion of the gross national product spent on health care, and the sheer quantity of services rendered have grown considerably faster than the economy as a whole.
Abstract: expectancy in 1965 for males than seventeen other countries, and poor emergency room and ambulatory care are among the diverse facts or allegations which have justified a wide variety of proposed reforms. And yet . the numbers of health personnel, the proportion of the gross national product spent on health care, and the sheer quantity of services rendered have grown considerably faster than the economy as a whole.1 If health care is in &dquo;crisis&dquo; now, then it was in crisis ten, twenty, and forty years ago as well. Several qualified observers have commented on the similarity between the 1932 analysis by the Committee on the Costs of

82 citations


Journal ArticleDOI
TL;DR: It was shown that individual judges consistently differed in the degree of harshness or permissiveness of their respective judgments, and that the number of independent judges required to reach a stable judgment of care quality exceeded the number logistically available to meet the probable future demands of third-party payors.
Abstract: A study of judgments of the quality of clinical care, made after retrospective analyses of hospital charts, in three clinical disciplines (obstetrics, surgery, pediatrics), revealed discrepancies, in intra-disciplinary judgments of the quality of clinical care, that cast doubt on the validity and the reliability of uncontrolled peer judgments of this quality. It was demonstrated that the degree of agreement between repeat judgments on the same cases by the same reviewers did not materially differ from the agreement seen in a different study involving serial judgments of the same kind made by different reviewers. It was shown: (1) that individual judges consistently differed, in the degree of harshness or permissiveness of their respective judgments; 2. that judges depended upon different aspects of clinical care to make final judgments of the quality of that care, and 3. that the number of independent (but professionally equally qualified) judges required to reach a stable judgment of care quality exceeded the number logistically available to meet the probable future demands of third-party payors. It was suggested that judgments of the quality of clinical care, derived from retrospective analyses of hospital charts, should be related to the compliance (or noncompliance) of the recorded care with pre-established sets of standards for that care.

Journal ArticleDOI
TL;DR: The profound changes which have occurred in the Cuban health services since 1958 are described and appraised and the process of decision—making and planning in Cuba today, with special emphasis on the health sector, is described.
Abstract: The profound changes which have occurred in the Cuban health services since 1958 are described and appraised in this article. The first part treats the main socioeconomic policies, particularly the urban and agrarian reforms, that have had an equalizing effect on the distribution of resources (including health resources) between regions and social classes. These socioeconomic developments have determined changes in mortality and morbidity patterns, particularly in the control of waterborne diseases, in the reduction of the level of malnutrition, and in the increasing prevalence of chronic conditions. The second part describes the main characteristics of the health services development in the last decade: centralization of inpatient facilities; decentralization of ambulatory ones; and the training of large numbers of physicians, paramedical personnel, and, especially, auxiliary personnel. The health services are structured according to a regional model that aims at the integration of preventive with curati...

Journal ArticleDOI
TL;DR: Whatever the future form of federal involvement, programs must be concerned with both the financing and the provision of health services on an adequate scale.
Abstract: Both Medicare and Medicaid so expanded in scope all previous programs that they constituted a new kind of federal commitment in the health care financing field. Both programs were expected to operate within the existing health care system; but with no provision for expanded supply of services, these programs helped contribute to a rapid rise in the cost of the various health care services. In terms of future developments, Medicare and Medicaid and any successor pro grams must show an increasing concern for improving the sys tem of providing health care. One possible direction of change is that involved with a health maintenance organization (HMO), the designation for a group paid to provide health services to an enrolled "population" on a prepaid per capita basis, such as has been tried in some states with Medicaid. Whatever the future form of federal involvement, programs must be concerned with both the financing and the provision of health services on an adequate scale.

Journal ArticleDOI
TL;DR: Today HEW is actively recruiting interdisciplinary health care teams for use throughout the country, where the application of behavioral science based knowledge about organization functioning has significantly improved their effectiveness.
Abstract: Many of these efforts involve the creation of interdisciplinary health care teams. Today HEW is actively recruiting such teams for use throughout the country. Hospitals are experimenting with different methods of team delivery of ambulatory care. Community health centers are developing team delivered comprehensive care to communities where the patient unit is a family. Administrators of such centers face many new and complex issues in organization management. These issues center around the organization of the health team, the structure of the total organization, educational policy and practices, staff motivation and community relations-to name a few. There exists a body of experience, mostly in nonmedical organizations, where the application of behavioral science based knowledge about organization functioning has significantly improved their effectiveness. Some of this knowledge and ex-

Journal ArticleDOI
TL;DR: Factors affecting the networks employed, their composition, the quality of ties that characterized the interaction within networks, and the effect that such networks had on decisions reached are examined.
Abstract: Middle-aged and elderly individuals using health care facilities from new resources provided information on the interpersonal network they employed in reaching such decisions. Specifically, we examined factors affecting the networks employed, their composition, the quality of ties that characterized the interaction within networks, and the effect that such networks had on decisions reached. The findings modify and extend earlier inquiries that focus on lay-referral systems and personal-influence networks as these relate to decision making.






Journal ArticleDOI
TL;DR: The authors indicate that this project is the first which coordinates compensatory infant education with com plete health care, with the prime educator being a public health nurse.
Abstract: The favorable results of the minimal stimulation program here described have important implications for all who provide health services for un derprivileged preschool children. The authors indicate that this project is the first which coordinates compensatory infant education with com plete health care, with the prime educator being a public health nurse.

Journal ArticleDOI
TL;DR: Major emphasis will be given to indicating the place of health care in this system and showing how related economic concepts can contribute to an understanding of problems of health Care in the United States.
Abstract: Health care affects and is affected by the economic system in so many ways as to preclude any attempt at complete enumeration or description The objective of this paper is more modest I shall assume that the reader is reasonably familiar with health care, its institutions, technology and personnel, but is less familiar with an “economic system” that is used by economists to describe and analyze economic behavior Therefore, major emphasis will be given to indicating the place of health care in this system and showing how related economic concepts can contribute to an understanding of problems of health care in the United States I shall also attempt to indicate some of the limitations of economics in dealing with such a complex area of human activity and concern

Journal ArticleDOI
TL;DR: Although American primary care physicians perform more complicated and varied tasks than British G.P.'s, such practices, for the most part, tend to be relatively restricted in dealing with many ordinary primary care problems.
Abstract: recent decades the proportion of physicians in primary medical care (including general practitioners, internists, and pediatricians) relative to all physicians has been declining,7 and consumers frequently complain about the difficulty of finding a primary physician, unwillingness of the doctor to make home calls, and impersonality in health care. It is fully apparent that modifications in the delivery of health services must deal with present difficulties if they are to be reasonably responsive to consumer needs and expectations.

Journal ArticleDOI
TL;DR: The study points up the fact that high motivation to work as a member of an interdisciplinary health team in a poverty setting is a necessary, but not a sufficient condition for such a collaborative endeavor.



01 Dec 1972
TL;DR: This study of chronic illness in the home originates in theoretical and practical questions posed by physicians, nurses, and biometricians.
Abstract: This study of chronic illness in the home originates in theoretical and practical questions posed by physicians, nurses, and biometricians. The study covers the following elements: The research plan, the patient sample, providing continued care, interviewing, classification of disease and mental status, effect of treatment program, classification of social factors, and interpretations. (7) Methods include statistical methods, evaluation schedule, and intake and outtake variables. (CK) A FILMED FROM BEST AVAILABLE COPY

Journal ArticleDOI
TL;DR: The development of neighborhood health centers in low-income communities throughout the United States in recent years has attracted widespread attention and response.
Abstract: The development of neighborhood health centers in low-income communities throughout the United States in recent years has attracted widespread attention and response. An increasing number of community groups and health institutions have begun to plan and initiate similar activities. Scholars and students of medical care programs have started to devote considerable attention to analyses of the progress and problems of the movement.'


Journal ArticleDOI
TL;DR: In this article, the authors address the issues related to health care in the United States and give primary emphasis to those variables whose influence is far ranging, and limit the discussion of any particular topic to its most important facets.
Abstract: This paper addresses some of the issues related to health care in the United States. In so doing, I give primary emphasis to questions involving access to health care. Even so, I limit the discussion of any particular topic to its most important facets. The principle of selection involves various criteria: insofar as possible, I discuss those issues that are important at a system level (particularly as they impinge on the allocation of resources), that involve economic arrangements influencing behavior and performance, and that can be illuminated by the economist's perspective. I attempt to give primary emphasis to those variables whose influence is far ranging. In so doing, of course, we cannot examine every network of interrelations. Although this simplifies the discussion, we pay a price for incompleteness. There is little choice, however. One of the difficulties with the health field stems from the fact that everything is interrelated: that intervention on one front has “side effects” on other fronts; that intervention designed to accomplish one purpose sometimes fails to do so because other factors that appear unrelated are not changed. To discuss everything is impossible. On the other hand, to say nothing because we cannot discuss everything is irresponsible. Finally, we will have to reach judgments even in spite of the relative weakness of the data available for analysis. We know far less, for example, about the availability of services (particularly if corrected for quality differentials) than we would like to. So, too, with the impact of differences in utilization on levels of health. The current refrain often seems to be, “But we have no output measures.” That, regrettably, is frequently the case. Nevertheless, just as we cannot be silent because of the complexity of intertwined relations, neither can we be silent because of insufficiency of data. We can use experience and judgment to arrive at (tentative) conclusions. Not knowing everything does not mean we know nothing.