Quality and cost: choices and responsibilities

Article Abstract:

The changing roles of occupational physicians in health care planning is the topic of the December 1990 issue of the Journal of Occupational Medicine. The problems presented by two frequently conflicting goals - providing quality health care and limiting medical costs - are discussed. In a health care system in which cost was not a consideration, physicians would always provide the most effective care. Even in such a case, though, the question of who would decide on what constituted the most effective care would arise. Patient's perceptions concerning the effects of treatments can also determine the kind of care delivered, as illustrated by the common preference of lung cancer patients for radiation (which has a low immediate probability of death, but a poor likelihood of survival beyond two years) over surgery (higher chance of immediate death, better long-term prognosis). When cost becomes important, the context of such decisions changes, leading to more intense discussion of the issues. All improvements that can be made in care need not be instituted, since many costly ones would only produce very small improvements in health. For instance, performing six tests on the same individual to diagnose colon cancer costs a total of $47,000,000, while doing one test costs $1,175. While each additional test adds security regarding the diagnostic conclusion, it cannot make sense to subject each patient to multiple tests when such enormous costs are involved. Studies are cited that illustrate the difficulty of making simple comparisons of costs and effects. Practitioners must not automatically oppose any attempt to regulate their autonomy, as they have been known to do in the past. Rather, they must work against policies that compromise effectiveness, and support policies that promote efficiency. The health care professions need to invent a ''science of parsimonious care'', and need to teach patients how to use their alternatives most appropriately. It is ethically defensible for physicians to ration care according to social priorities, rather than to the needs of the individual, only if patients have alternatives when they enroll in a health care plan. Cooperative opposition to such rationing is a strategy open to health care professionals, who must preserve their commitment to each patient's welfare. (Consumer Summary produced by Reliance Medical Information, Inc.)

Evaluation, Medical care, Medical care, Cost of, Health care costs, Cost (Economics), Costs (Economics)

---

Ensuring value by supporting consumer decision making

Article Abstract:

Consumer involvement in medical decision making has increased in recent years, spurred in part by the discovery that treatment outcome improves when patients have a say in their care. Consumers, in general, want more control. Moreover, the utilization of services is strongly influenced by consumer demand; one study found that a large number of participants agreed with the statement ''the better a doctor is, the more tests he will order....'' Consumer demand, litigation, and financial incentives for health care providers combine to raise care costs. Does the education of healthy people affect the medical decision-making process? The answer appears to be affirmative: studies have shown reductions in the rate of emergency room use, total medical visits, and visits for minor illnesses after education programs were instituted. One limitation to patient participation in medical decision making is the impossibility of patients and doctors really speaking the same language, where medical matters are concerned. One company, Options & Choices, Inc., is evaluating the effects on informed choice of consultation with professional health educators who provide nondirective, neutral information. The group has tested its service at several companies. Selected theories regarding the ways health care is used are explained briefly. For instance, the Pareto principle holds that resources are not consumed evenly by all segments of the population, and that a small proportion of people use a large proportion of services. ''Medical vacationers'' (people who use up all their sick leave) are subsidized by staff members who remain on the job. Sometimes the use of certain kinds of benefits (mental health, maternity) is closely associated with the use of other kinds (workers' compensation), creating the possibility of early intervention for such high-need employees. Other benefits of supplying consumers with the tools necessary to further their mental and emotional understanding of health care choices are mentioned as well. (Consumer Summary produced by Reliance Medical Information, Inc.)

Health aspects, Consumer behavior, Patients, Health services administration

---

The physician as a manager

Article Abstract:

The occupational physician is a key company resource in the management of health related issues in the workplace. Management techniques in the planning, resourcing, implementation, evaluation, and stewardship of programs are an important part of a physicians duties. To insure the success of occupational health programs a physician must be willing to accept these responsibilities.

Offices & clinics of medical doctors, Medicine, Industrial, Industrial medicine

Similar abstracts:

• Abstracts: Collaborative ventures in outcomes management: roles and responsibilities in a service line model. Outcomes management: from theory to practice
• Abstracts: Possible progress and unresolved conflicts resulting from guidelines on good epidemiologic practices. Skin and eye diseases among arc welders and those exposed to welding operations
• Abstracts: Patterns of mortality in pulp and paper workers. Feasibility of identifying high-risk occupations through tumor registries
• Abstracts: Congress eyes curbs on tax-exempt bonds. Boon or bane, business coalitions have entered the health care scene

This website is not affiliated with document authors or copyright owners. This page is provided for informational purposes only. Unintentional errors are possible.