The medical outcomes study: an application of methods for monitoring the results of medical care

Article Abstract:

The Medical Outcomes Study (MOS) was a 2-year investigation into the components of the current health delivery system and how these components affect the outcome of illness. The study had two main purposes: relate variations in patient outcomes to differences in the health care delivery system (including location, clinician specialty and training, use of system, aspects of the clinicians style and personality) and develop better instruments for recording and evaluating outcomes in routine medical practice. Over 500 physicians were randomly sampled from three major US cities. Longitudinal studies included 22,462 patients, and a group of 2,349 patients with major chronic illness and/or clinical depression. Reports of other treatments and hospitalizations of this group were monitored and the outcomes reported. Patients included in the longitudinal study were investigated at the beginning and end of the test period. The results of this study will be reported in a series of articles published mainly in this journal.

Health aspects, Research, Usage, Medical care, Longitudinal method, Chronically ill, Patient monitoring, Physiologic monitoring, Longitudinal studies

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How many physicians is enough?

Article Abstract:

In the January 26, 1990 issue of The Journal of the American Medical Association, Schwartz and Mendelson present an analysis of the supply of physicians in the United States and conclude that an oversupply will not occur in the foreseeable future. Their conclusion, however, is based on the notion that no oversupply is possible if demand is not being met. Although this may be true for many commodities, it is not necessarily true for medical services. In an ideal system, one might expect the satisfaction of increased demand for health services to result in increased health, but this is not necessarily the case. There may, in fact, be a point of optimal health care delivery beyond which costs will increase and public health will not improve. In order for valid conclusions to be drawn about the supply or possible oversupply of physicians, information on social benefits must be included in the analysis and planning. (Consumer Summary produced by Reliance Medical Information, Inc.)

Medicine, Practice, Medical practice, editorial

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Estimating physician workforce requirements: the devil is in the assumptions

Article Abstract:

A 1995 study estimated that the increase in physician supply would grow modestly until the year 2000 and then fall off. This contradicts other estimates that there will be a serious oversupply of physicians in years to come. Many of these estimates are based on assumptions that few agree with. However, some assumptions are commonly accepted. These include the general health of the US population, access to health care, the number of medical school admissions and graduate positions and the geographic inequities in medical care. It also seems clear that the huge debts incurred by medical students are determining what specialty they choose. Managed care programs will automatically limit the expansion in health care spending. It is unlikely that legislation is required to regulate physician supply, nor are market forces the best way to solve the problem. Actions undertaken by medical schools, hospitals, health care plans and professional societies may be more effective.

Editorial

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