Search PubMed⌕ Search

Biomedical subjects

C Muller

Publications and source records attributed to C Muller.

At least 217 records · Page 12Linked to original sources
PubMed1978

[Socio-psychological concepts of status, role and norm, and systemic mechanisms in the psychotic family].

Socio-psychological contributions can improve the systemic approach to family therapy. For instance, the notions of "role", "status" and "norm" discussed in this paper, can be applied to the concept of "identified patient". This appears to be the only pathological designation, as role assignment per se is not necessarily abnormal. It is suggested that pathogenic mechanisms playing a part in psychotic families, can also be used therapeutically. Family therapy tends to confirms the principle that small group norms are more readily modified than those of single individuals.

Communication↗
PubMed1977

Cost factors in urban telemedicine.

This paper reports on the cost effectiveness of a pediatric primary care system utilizing nurse practitioners (NPs) linked to a physician consultant through bidirectional interactive cable television. In addition, it discusses ways in which multiple uses enhance the economic feasibility of a telemedicine consultation link in a given geographic area. The overall consultation rate during periods of remote physician coverage was 21 per cent, compared with 24 per cent during on-site coverage. The telephone became a partial substitute for the TV for some uses but could not replace it in diagnostic decisions. As telemedicine is obviously underutilized in a one-satellite system, we compare a five-satellite network with other ways of delivering service. The resulting estimated cost of $18.50 an hour, or 2/3 of the cost of a physician providing direct care, includes a TV component of $5.30 an hour of use in a 1,750-hour year. The critical factor is that the NP can be a physician substitute if there is TV backup. The TV appears to prevent unnecessary referrals compared to a physician on site. Whether TV increases the length of the consult compared to the phone for conditions of equal severity is not entirely clear. If TV is compared to transporting a patient to a central place, the implicit value of transport time and disutility required to justify using TV is $7.55 per consult in a five-clinic network. Geographic and other barriers to physician availability enhance the potential for application fo telemedicine.

Child↗
PubMed1977

Does the sex of the psychiatrist influence attitudes toward the patient's family?

The authors sought to verify the hypothesis that the physician's sex would influence the evaluation of the parents of this patients. Based on a study of the case histories of 100 male and 100 female patients who were examined with equal frequency by male and female physicians, the authors conclude that no significant differences are demonstrated by this investigation.

Attitude of Health Personnel↗
PubMed1976

Reproductive efficiency as a social indicator.

An index of reproductive effiency (RE) is proposed as a social indicator that will meet the need to consider various forms of pregnancy wastage, to compare their relative costs, and to guide reproductive health policy accordingly. This article discusses conceptual and measurement aspects of RE. Conversion of wanted to unwanted pregnancies and the reverse, interpretation of abortion in relation to other pregnancy outcomes, defining the end point for the reproductive process and criteria for the events to be included as significant outcomes are conceptual issues. Measurement problems include: whether aggregation is justified, prospective and retrospective tracking of outcomes, record limitations, duplication of adversities in a single pregnancy, and selection of optimal rate for comparison. A measurement of RE for the entire United States based on the National Natality Survey of 1964-1966 is presented, showing 74.5 percent of pregnancies resulting in healthy liveborn infants. For those years, data on abortions could not be included. Within the group of reported pregnancy losses, the importance of congenital abnormalities and low-birth-weight babies is enhanced by application of economic weights based on associated medical care costs. Changing opportunities for birth timing, prenatal and infant care, and control of family size are social means of reducing adverse outcomes associated with teenage pregnancy and high-parity births, often found together with poverty. Successive increments in RE may be progressively more expensive to achieve, and cost effectiveness comparison will be necessary.

Abortion, Legal↗
PubMed1975

An index of insurance adequacy for fertility-related health care.

Health insurance plans are evaluated here in terms of ability to guarantee financial access to a set of basic fertility-related health services. Extent of coverage is determined by whether a service is a contract benefit, its market cost, and how often it is used in a given population in one year. Comprehensive coverage removes a deterrent to utilization of preventive care such as well-baby visits, prenatal care, and family planning. In a total population of women of child-bearing age, each is likely to need some fertility-related care in a given year. The method of calculating adequacy involves using best available estimates of deliveries, abortions, etc. per 1,000 women, and, within each category, of components such as cesarean section. Local or national cost data can be used to derive an average cost per service and an aggregate for a group. The method of comparing this with plan benefits depends on the way benefits are expressed. Jacksonville, Fla. medical market data were used in a trial of the method on a plan for Federal employees, which shows 70 per cent coverage of estimated expense.

Abortion, Induced↗
PubMed1975

The long-term care marketplace: an analysis of deficiencies and potential reform by means of incentive reimbursement.

This study analyzes the institutional, economic, and regulatory deficiencies of the long-term care sector of the health industry and develops an incentive reimbursement model as a means for correcting or ameliorating some of the stated deficiencies. The reimbursement model presents a schema which attempts to match patients to facilities, needs to services, and services to cost. A capital expansion coupon program is proposed, both as a suitable vehicle for channeling incentive rewards accruing to nonprofit institutions, and as a mechanism for subsidizing the approved expansion and/or renovation plans of "efficient" providers of care.

Community Participation↗
PubMed1975

Capital expenditures and the availability of funds.

Data on capital expenditures and the availability of funds assembled from the annual financial and service records of 42 short-term voluntary hospitals in New York City over two decades were used to analyze the behavior of annual capital expenditures on building and equipment assets. Desired expenditures on capital as a factor of production are viewed as being the result of changes in anticipated output and of the substitution of capital for labor. Actual capital expenditures in each year also reflect the availability of flows of nonoperating revenues and the completion of capital programs initiated in previous years. Nonoperating revenues include philanthropy and earnings on financial assets as principal sources. A monetary revenue series, adjusted for changes in hospital charges, was used to measure output and thus to seperate the effects of demand for hospital services and supply of funds on investment behavior. The data were approached as annual aggregates for 42 hospitals over the years 1946-1966 and as annual hospital averages for teaching and nonteaching hospitals over the same period. In both approaches four causal factors-output, substitution, the flow of nonoperating revenues, and a distributed lag-explained about 95 per cent of the sample variance of capital expenditures. Allowing for available funds reduced the average time required for 95 per cent completion of a capital adjustment from 7 to 3 years. Responsiveness of hospitals to these economic variables suggests that socially desired investment can be attained by (a) "monetizing" needs of groups now underserved; (b) improving availability of funds if used for acceptable public purposes; and (c) including consumers in determining institutional and regional priorities.

Charities↗
PubMed1975

Medical education for women: how good an investment?

Reluctance to train women for medical careers has been justified by the failure of women to use their education. Using data from studies of physician practice patterns and of educational costs, this article presents a preliminary estimate of the "loss" of investment involved in educating women for medicine. Women physicians are estimated to practice an average of two-fifths fewer hours over their lifetimes than do men, with a consequent loss of educational investment of about $55,000. Suggestions are made for reducing this loss. The finding of some loss of investment should not be used as an argument for discriminatory treatment of women seeking a medical education, as the rights of women as individuals must be recognized.

Costs and Cost Analysis↗