Showing papers on "Health care published in 1976"

Measuring the quality of medical care. A clinical method.

Abstract: We outline the implementation of a new method of measuring the quality of medical care that counts cases of unnecessary disease and disability and unnecessary untimely deaths. First of all, conditions are listed in which the occurrence of a single case of disease or disability or a single untimely death would justify asking, "Why did it happen?" Secondly, we have selected conditions in which critical increases in rates of disease, disability, or untimely death could serve as indexes of the quality of care. Finally, broad categories of illness are noted in which redefinition and intensive study might reveal characteristics that could serve as indexes of health. We describe how these inth of the general population and the effects of economic, political, and other environmental factors upon it, and to evaluate the quality of medical care provided both within and without the hospital to maintain health and to prevent and treat disease.

The sickness impact profile: validation of a health status measure.

Abstract: The Sickness Impact Profile (SIP), a measure of health status, is being developed as an outcome measure of health care. A preliminary study of the validity of the SIP was conducted on a sample of 278 subjects who were grouped into four subsamples differing in land and severity of sickness. Selfasses

WHO SHALL LIVE? Health, Economics and Social Choice

Abstract: In this classic book, Professor Victor Fuchs draws on his deep understanding of the strengths and limitations of economics and his intimate knowledge of health care institutions to help readers understand the problems every nation faces in trying to allocate health resources efficiently and equitably. Six complementary papers dealing with national health insurance, poverty and health, and other policy issues, including his 1996 presidential address to the American Economic Association, accompany the original 1974 text. Health professionals, policy makers, social scientists, students and concerned citizens will all benefit from this highly readable, authoritative, and nuanced discussion of the difficult choices that lie ahead.

A data bank for patient care, curriculum, and research in family practice: 526,196 patient problems.

Abstract: The health care problems that 88,000 patients presented to 118 family physicians over two years were evaluated. As a result, 526,196 health care problems were noted. Ninety percent of all problems were contained within 169 descriptive problems using the RCGP coding system for primary care. Knowledge of the profile of patient problems as they present to the family physician will alow for the development of a logical curriculum for the family practice resident and of patient care systems in family medicine. An appropriate methodology for the development of curriculum is discussed.

Health Status Index Models: A Unified Mathematical View

Abstract: A general mathematical formulation of the health status index model is developed. Equations are given for three types of population health indexes and for the determination of the amount of health improvement created by a health care program. Fourteen of the major health status index models from the literature are analyzed, and it is shown that each can be viewed as a special case of the general formulation. It is hoped that the paper will help to unify the health status index concept, will serve to standardize terminology and notation, and will facilitate comparisons of the various models.

The alcoholic physician: a survey.

Abstract: The authors conducted interviews with 98 recovered alcoholic physicians, all of whom had been entirely abstinent for a minimum of one calendar year. Psychiatry was the only specialty clearly overrepresented. A disproportionate number of subjects reported high standing in their medical school classes. Nearly half of the sample had experienced difficulty with drugs other than alcohol. While legal sanctions and admission to health care and correctional institutions were common among this group, relatively little formal response of a disciplinary nature from colleagues or medical organizations was reported.

The erosion of professional authority: a cross-cultural inquiry in the case of the physician.

Abstract: The extent to which the erosion of professional authority observed in the United States is also occurring in the United Kingdom and the U.S.S.R. is examined in the case of the primary care physician. Informal interviews with health practitioners in these diverse societies revealed that the model of the professions which bases physicians' autonomy and authority on the occupational characteristic of a monopoly of specialized knowledge is subject to some revision. Education of the patient emerged as a critical factor in eroding physician authority in both countries, while patient age affected authority relations differentially in the two societies. Despite variations in the level of bureaucratization of health care, the role of the physician, as gatekeeper to non-medical benefits, served to counteract the erosion trend in both. The legacy of deference to the upper classes in Great Britain and in the U.S.S.R., an ideology of health as a citizen's obligation plus the "mothering' ambience of a largely female personnel are varying societal characteristics which also affect physician authority.

Delivery of Health Care for Children: Report of an Experiment

Abstract: This paper summarizes an experiment evaluating the effectiveness of primary pediatric care delivered to a sample of low-income inner-city families. Primary pediatric care in this study was similar to pediatric group practice. The study findings indicated that the effects of primary care compared with the episodic care received by the control families were appreciable. This included the decreasing of hospitalizations, operations, illness visits, and appointment breaking; increasing of health supervision visits, preventive services, and patient satisfactions; and accomplishing these changes at a lower cost. Patient morbidity was not altered. Medicaid made no difference in the care patterns of the experimental families and apparently benefited only those control families who were white. The controlled clinical trial offers the best opportunity to compare different models of primary care and the data obtained can be used for planning health services for children.

An epidemiological model for health policy analysis

Abstract: Health programs needing health and other related data have failed in their solutions because they have lacked a rational framework for analysis. A cursory analysis of present disease patterns reveals chronic conditions for which the present system of organized health care has no immediate cures. On the other hand, infectious diseases of decades past have been all but eliminated by vaccines and antibiotics. Before we are able either to prevent or to arrest current disease processes, we must dissect the health field into more manageable elements that reflect a creative area for epidemiological models. An epidemiological model that supports health policy analysis and decisiveness must be broad, comprehensive, and must include all matters affecting health. Consequently, four primary divisions have been identified: (1) System of Health Care Organization; (2) Life Style (self-created risks); (3) Environment; and (4) Human Biology. An application of the epidemiological model involves four steps: (1) the selection of diseases that are of high risk and that contribute substantially to the overall morbidity and mortality; (2) to proportionately allocate the contributing factors of the disease to the four elements of the epidemiological model; (3) to proportionately allocate total health expenditures to the four elements of the epidemiological model; and (4) to determine the difference in proportions between (2) and (3) above. Five tables illustrate how the epidemiological model is applied, showing the diseases selected for analysis; the contributing factors of each disease to the four components of the epidemiological model; the distribution of Federal outlays for medical and health-related activities by category; the distribution of Federal outlays of health expenditures by category; and a comparison of Federal health expenditures to the allocation of mortality in accordance with the epidemiological model. The conclusion to be drawn from this study is that, based on current procedures for reducing mortality and morbidity, little or no change in our present disease patterns will be accomplished unless we dramatically shift our health policy.

Some Economics of Hospital Waiting Lists in the NHS

Abstract: The article concerns waiting for inpatient admission in the NHS and focuses on three aspects of this persistent problem. These are the merits or otherwise of rationing health care through waiting as opposed to pricing, the interpretation of waiting lists as a proxy for excess demand in the ‘market’ for inpatient care, including a critical examination of the logic and empirical evidence underlying the view that inpatients pay a time price for their admission, and the question of an admissions index to replace the largely inconsistent admission criteria currently employed in the hospital service. In particular the construction of an index incorporating the values of fairness and efficiency is discussed and the following characteristics suggested for inclusion: time already spent on the waiting list; urgency based on expected rate of deterioration of the patient's condition; urgency based on the patient's health status; urgency based on the ‘social productivity’ of the patient and the number of economic dependants; and urgency based on other social factors.The conclusions are that emphasis should be placed on waiting times rather than lists, that systematic admissions criteria should be developed and that the latter should incorporate social judgements which to date have been ignored or dominated by clinical judgements.

Psychiatric priorities in developing countries.

Abstract: Many psychiatrists assert that an expansion of mental health services in the developing countries is overdue. This will only take place if: (i) the tasks of mental health care are undertaken by a wide range of non-specialist health workers, including those responsible for primary health care; and (ii) services are directed initially at a very limited range of priority conditions. The method of priority selection is discussed, and the process required for translation of priority decisions into health action is exemplified by two illustrations.

Bibliography of Operations Research in Health-Care Systems

Abstract: This paper presents a bibliography of the articles that were published before March 1976 and that describe applications of operations research techniques to health-care delivery systems.

Why organization development hasn't worked (so far) in medical centers.

Abstract: An exasperated corporation executive recently summed up what was, to him, the paramount problem of any business: It's full of people. Organization Development, born in industry, has done much good in that setting, but it often multiples the problems of a health care system rather than solving them. Here are some of the reasons--many of them people.

Equality and rights in medical care.

Abstract: In this article I present arguments intended to support the following conclusions: 1. To say there is a right to health care does not imply a right to equal access, a right that whatever is available to any shall be available to all. 2. The slogan of equal access to the best health care available is just that, a dangerous slogan which could be translated into reality only if we submitted either to intolerable government controls of medical practice or to a thoroughly unreasonable burden of expense. 3. There is sense to the notion of a right to a decent standard of care for all, dynamically defined, but still not dogmatically equated with the best available.

Health, Family Structure, and Labor Supply

Abstract: I consider the health, family structure, and labor supply inter-relationships at both a theoretical and empirical level. The paper is organized in the following way. SectionI introduces the material. In Section II, a theoretical model of family time allocation among market, home, and health activities is developed. The concept of a family health maintenance function is formalized to generate qualitative predictions of the effect of wages, health status, health care efficiency, and property income on the labor supply of husband and wife. In Section III, data from the older male portion of the National Longitudinal Surveys are used to estimate labor supply functions for married and single men with special attention to differences in poor health responses. A simultaneous model of male labor supply and other family income (chiefly transfer income and the earnings of the wife) is then estimated to determine whether variations in the work hours of males, largely due to health differences, induce any substantial changes in income producing activities by other family members. Finally, in Section IV the detailed time budget data on both males and females from the Productive Americans Survey are used to estimate more precisely the effect of health on total family time allocations. These data provide estimates of the impact of poor health on home production time as well as market time for both husband and wife.

Medicaid records as a valid data source: the Tennessee experience.

Abstract: Health care researchers rarely employ Medicaid claim files as a data base, in part because they are designed to serve fiscal and administrative ends. Indeed, some investigators have emphasized the deficiencies in such records. In contrast, we have found Tennessee Medicaid data to be suitable for research. A statewide automated data processing system reduces the occurrence of many of the errors noted by others. Further, analysis of the July 1974 month of payment file illustrates the accuracy and internal consistency of Tennessee Medicaid data. Specimen legend drug results for ambulatory patients suggest investigations of physician prescribing patterns. Evaluation of the Medicaid claims processing system suggests other applications in health care administration and research. In a time when available resources are dwindling, the incisive use of Medicaid claims files offers an attractive alternative to expensive new systems of data collection and analysis.

Analytical Approach to Marketing Decisions in Health-Care Organizations

Abstract: We discuss the potential applicability of a new choice model and scaling procedure to the marketing decisions of health-care organizations. After a brief exposition of this analytical procedure the paper focuses on an illustrative application to the hospital selection decision under two scenarios-surgery with a rapid recovery period and serious surgery that requires a long hospitalization period. The paper concludes with some suggestions for future use of conjoint measurement and related techniques in marketing studies of health care organizations.

Integrating mental health services into primary medical care.

Abstract: Primary care clinicians occupy a strategic position in relation to the emotional problems of their patients. Integrating mental health and primary medical services promotes available, coordinated, accessible, and less stigmatizing treatment by recognizing an indivisibility of the total person in ill

Age differences in health care spending, fiscal year 1975.

Abstract: This report of health care spending in fiscal year 1975 reveals that of the $103.2 billion spent by the Nation for personal health care, 15 percent was spent for those under age 19, 56 percent for persons aged 19-64, and 29 percent for those aged 65 or older. The average health care bill for the oldest group was $1,360; it was $472 for the intermediate age group and $212 for the young. Third-party payments met 71 percent of the aged group's health care expense and 66 percent of the health expenditures of persons under age 65. Public funds paid for one-fourth of the health expenses of the young, nearly one-third of the health bills of those aged 19-64, and two-thirds of those of the aged. Medicare alone paid 72 percent of the hospital expense for the aged and 54 percent of their doctor bills. The average direct payment by the consumer amounted to $390 for those aged 65 and older and $128 for persons under age 65.

Criteria for evaluation of ambulatory child health care by chart audit: development and testing of a methodology

Abstract: In May 1970, the Executive Board of the American Academy of Pediatrics (AAP) directed its Committee on Standards to study methods by which the quality of ambulatory health care for children and youth might be evaluated. Recognizing that medical care for children is provided by physicians with varying backgrounds, training, and experience, the focus of the study was to be solely on the quality of care provided. The position of the AAP is that children from all sections of the country should receive the same basic quality of care. The Joint Committee on Quality Assurance (JCQA) was formed in January 1971. Each major organization whose members provide at least some primary care for children was invited to participate: the AAP; the American Academy of Family Physicians; the American Medical Association; the American Public Health Association; the American Osteopathic Association; the Department of Health, Education, and Welfare; the American Society of Internal Medicine; the Ambulatory Pediatric Association; the Student American Medical Association; and the National Medical Association. The membership included physicians from urban and rural areas throughout the United States and both individual and group private practice as well as from academic institutions. A major goal of the study was to provide physicians and medical groups with empirically based criteria and a tested methodology for establishing peer review guidelines. The purpose of these guidelines was to assess by chart audit the quality of ambulatory health care provided regardless of the provider, the geographic area, the setting, or the delivery system. One of the Committee9s first tasks was to agree on an operational definition of quality of care.