The 'squeaky wheel' and health care policy

Article Abstract:

Competing interests and limited resources complicate the establishment of public policy for health care. A recent example is the decision by Blue Cross and Blue Shield to pay for an experimental treatment for advanced breast cancer. At a cost of $10 million, 1,200 women will undergo autologous bone marrow transplantation and chemotherapy. Even if the treatment is successful, questions remain. Will coverage for the treatment be covered by higher premiums, or will funds for other breast cancer treatments be reduced. The comparison that should be made is the cost-benefit ratio between breast cancer treatment of early disease and treatment for advanced disease. Screening can reduce mortality by 25 percent to 30 percent for women over 50 years of age, and perhaps for those between 40 and 50 years old. However, many insurers, including Blue Cross and Blue Shield, do not always cover the cost of mammography. Mammography costs approximately $50. The cost of treating one patient with advanced disease with autologous bone marrow transplantation is equal to the cost of 2,000 screening mammograms. The decisions on how to allocate limited medical care funds are not easy or uncomplicated, but answers are needed now. (Consumer Summary produced by Reliance Medical Information, Inc.)

Health aspects, Social policy, Health insurance, Cost (Economics), Costs (Economics), Medicine, Experimental, editorial

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Achieving a uniform federal primary care policy: opportunities presented by national health reform

Article Abstract:

Some of the proposals for national health care reform may force the federal government to allocate more funds to support primary care. In the past, government policies have consistently rewarded specialization. Title VII of the Public Health Service Act authorizes funding for primary care, but congressional appropriations declined during the 1980's. On the other hand, hospitals that train residents can apply for Medicare graduate medical education (GME) funding, and this encourages the training of specialists. The government has provided little money for research in primary care. The Medicare Resource-Based Relative Value Scale will favor primary care physicians because it will raise their fees while lowering specialists' fees. Reform proposals emphasize managed care plans, which will require primary care physicians to act as gatekeepers. The current administration has many incentives to increase its support for primary care.

Political aspects, Family medicine

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Who pays for published research?

Article Abstract:

Approximately one-fourth of the articles in the medical literature seems to be based on original medical research that is unfunded. Medical research is usually supported by funds from the government or private organizations, but the available funding has decreased since the 1980s. Of 196 articles published in 23 different medical journals in Oct 1991, 151 (77%) were based on research with total or partial funding and 45 (23%) were based on unfunded research. Of the funded studies, 79% were funded by the federal government, 10% by pharmaceutical companies, 10% by nonprofit foundations and 1% by university grants. The unfunded studies were based on different types of clinical research. Medical school faculty are expected to publish papers based on original research to advance their career. Funding from outside sources enables them to spend more time engaged in that research.

Economic aspects, Medical publishing

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