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Full-Text Articles in Social and Behavioral Sciences
Physician Sovereignty: The Dangerous Persistence Of An Obsolete Idea, David M. Lawrence
Physician Sovereignty: The Dangerous Persistence Of An Obsolete Idea, David M. Lawrence
Center for Policy Research
The heart of the model is this: to quote Pogo, "We have met the enemy and it is us." We doctors are the problem, not because we are venal or self-serving or insulated from reality. Far from it. Most of us are hard-working, dedicated professionals. We are the problem, though, because of the way our profession developed in the 20th century. This model is no longer appropriate for what lies ahead. The notion of the sovereign physician comes from Paul Starr's 1982 work, "The Social Transformation of American Medicine: The Rise of a Sovereign Profession and the Making of a …
Do We Want To Measure The Quality Of Care For Vulnerable Older People? The Acove Approach., Neil S. Wenger
Do We Want To Measure The Quality Of Care For Vulnerable Older People? The Acove Approach., Neil S. Wenger
Center for Policy Research
There's limited information available about measuring the quality of medical care that is targeted to the needs of older patients. And there's very limited pressure on the system to provide high quality geriatric care. Why is that? Because the quality measures haven't been adequately developed and implemented, and it's more difficult to measure care for an older sample. Measuring care for ill older adults is complex, because they tend to have multiple medical conditions, and they demonstrate substantial variation in goals for care (Wenger and colleagues 2007). The Assessing Care of Vulnerable Elders (ACOVE) project began in 1998 as a …
Spending Health Care Dollars Wisely: Can Cost-Effectiveness Analysis Help?, Milton C. Weinstein
Spending Health Care Dollars Wisely: Can Cost-Effectiveness Analysis Help?, Milton C. Weinstein
Center for Policy Research
Are we getting the most health improvement possible for our money. In other words, are all the things that we do in medicine really worth it? That is where cost-effectiveness comes in. As a nation, we have been unwilling, at least publicly, to look explicitly at the value, in terms of improved health outcome, that we get for our health care dollars. With advances in medical technology putting unsustainable pressure on health care costs, our historical reluctance to measure value for health care may have to change. I start this brief by describing cost-effectiveness analysis as a method of determining …
Are The Benefits Of Medicine Worth What We Pay For It?, David M. Cutler
Are The Benefits Of Medicine Worth What We Pay For It?, David M. Cutler
Center for Policy Research
Is medical care worth it? Conventional wisdom says no, but my answer is emphatically yes. The benefits that we have received from medical advance are enormously greater than the costs. I suggest that public policy far outweighs the importance of cost containment relative to coverage expansion; we could in fact spend more and get a lot more for our health care dollars. In what follows, I talk about the costs and benefits of medical advance, focusing on two areas where I have done the most work: improvements in cardiovascular disease care and care for low birth weight infants. In each …
The Changing American Hospital In The Twenty-First Century, Ralph W. Muller
The Changing American Hospital In The Twenty-First Century, Ralph W. Muller
Center for Policy Research
One is always hesitant to speak about the future. A famous philosopher from New York, Yogi Berra, said "Making predictions is difficult, especially about the future," and I have some trepidation about doing so now. There is also the difficulty of understanding what really has happened in the past. I recall the Bolshevik general in 1917 who said "The future is clear, but the past is very murky." We anticipate the future with more clarity than is justified, even as we disagree on what is happening right now or what happened before. In that vein, I will describe the role …