Preserving the physician-patient relationship in the era of managed care

Article Abstract:

The basic elements of an ideal physician-patient relationship may be jeopardized by the expansion of managed care. An optimal physician-patient relationship is based on patients' choice of providers, communication, competence, compassion, care continuity and a lack of conflict of interest. In 1995, neither the insured nor the uninsured have an ideal relationship with their physicians. The continued growth of managed care with the accompanying cost controls and price competition may cause some managed care companies to fold. Such closures will jeopardizes patient choice and care continuity. Employers' restrictions and managed care companies' physician selection decisions may further narrow choice. The lack of health care quality measures and managed care's stress on primary care may negatively influence competence. The emphasis on efficiency may reduce communication time. Rewarding physicians for limiting use of some medical services may create conflicts of interest.

Social aspects, Management, Physician and patient, Physician-patient relations, Medical care, Cost of, Health care costs, Managed care plans (Medical care)

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Cost savings at the end of life: what do the data show?

Article Abstract:

The use of hospices and advance directives during the last few months of life could save a significant amount of money but it is unclear whether most Americans could eliminate their desire for aggressive end-of-life treatments. A review of studies which evaluated the cost savings from hospices found the estimates ranged from no savings to a 68% reduction in costs. Overall it seems likely that hospices could reduce costs by 10% in the final year of life, which would save about $10 billion per year.

Advance directives (Medicine), Hospice care

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Influence of Age on Medicare Expenditures and Medical Care in the Last Year of Life

Article Abstract:

Patients 85 and older receive fewer health care services and less aggressive treatment in the last year of life compared to younger patients. This is true regardless of sex, race, medical condition, cause of death, and geographical area. This explains why Medicare expenditures in the last year of life are lower in those 85 and older.

Finance, Medical care, Demographic aspects, Medicare

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