Search PubMed⌕ Search

Biomedical subjects

D Blumenthal

Publications and source records attributed to D Blumenthal.

123 records · Page 7Linked to original sources
PubMedDate not supplied

Trends in adult visits to primary care physicians in the United States.

BACKGROUND: Although numerous changes are apparent in the US health care system, little is known about how these changes have altered the work of primary care physicians. METHODS: We analyzed a nationally representative sample of 136,233 adult office visits to general internists, general practitioners, and family physicians contained in the 1978 through 1981, 1985, and 1989 through 1994 National Ambulatory Medical Care Surveys. Annual sample sizes varied between 5662 and 19,977 visits. Measures included the characteristics of patients presenting to primary care physicians, physician activities during these visits, and the disposition of the visits to primary care physicians. RESULTS: Visits to primary care physicians have diminished as a proportion of all adult visits from 52% in 1978 to 41% in 1994. Dramatic trends in adult primary care included the growing racial or ethnic diversity of patients, the doubling (since 1985) of health maintenance organization coverage, increased provision of prevention services, changes in the most common medications, and an 18% increase in the duration of adult visits to primary care physicians. CONCLUSIONS: Trends in primary care practice reflect changes in society and in the US health care system, including demographic changes, an emphasis on prevention, and the growth of managed care. The increasing role of managed care, with its emphasis on increased productivity, appears at odds with primary care physicians' increasing responsibility for prevention and the associated increase in the duration of primary care visits.

Age Distribution↗
PubMedDate not supplied

Market forces and unsponsored research in academic health centers.

CONTEXT: Increased competitive pressures on academic health centers may result in reduced discretionary funds from patient care revenues to support the performance of unsponsored research, including institutionally funded and faculty-supported activities. OBJECTIVE: To measure the amount and distribution of unsponsored research activities and their outcomes. DESIGN AND SETTING: Survey conducted in academic year 1996-1997 of 2336 research faculty in 117 medical schools. Responses were weighted to provide national estimates. MAIN OUTCOME MEASURES: Institutionally funded research as a proportion of total direct costs of research was compared across stages of market competition. Logistic regression was used to assess the relationship of performing unsponsored research to faculty characteristics and market stage. RESULTS: Overall, 43% of faculty received institutional funding for research. Young faculty were more likely than others to receive institutional support (adjusted odds ratio [OR], 1.4; 95% confidence interval [CI], 1.1-1.9; P = .004). The amount of institutional support as a proportion of total funding was more than twice as high in less competitive markets (6.1%) compared with the most competitive markets (2.5%; P = .05). Most faculty (55%) performed faculty-supported research. Clinical researchers (OR, 1.6; 95% CI, 1.1-2.3), principal investigators (OR, 4.3; 95% CI, 2.8-7.0), faculty with high levels of research effort (OR, 6.2; 95% CI, 4.0-9.5) or institutional funding (OR, 1.9; 95% CI, 1.4-2.6), and faculty in the most competitive markets (OR, 1.9; 95% CI, 1.4-2.5) were more likely than others to conduct faculty-supported research. When undertaken by clinical researchers, these activities were supported by clinical income, extra hours worked, and discretionary funds, and often led to publications (76%) or grant awards (51%). CONCLUSIONS: Many academic health center faculty receive institutional support to conduct their research or fund the research themselves. Market pressures may be affecting the level of institutional funding available to faculty.

Academic Medical Centers↗
PubMedDate not supplied

Federal funding for AIDS research: decision process and results in fiscal year 1986.

With the history of the U.S. federal budget for fiscal year 1986 as a vehicle, the usual processes in the executive branch and the Congress that establish health research priorities and the unusual developments that have shaped priorities for AIDS are described. In the 3 years between the initial formulation of the AIDS budget and its execution, there were numerous revisions and evidence of poor communication between scientists and policy makers. On the basis of this analysis, two recommendations are made: the director of the National Institutes of Health and the heads of other U.S. Public Health Service agencies should have discretionary funds to use for AIDS activities; and better channels of communication between the Congress, the Public Health Service, and outside biomedical researchers should be established for consultation on priorities for AIDS research.

Acquired Immunodeficiency Syndrome↗
PubMedDate not supplied

A tale of two systems: the changing academic health center.

Major changes in academic health centers (AHCs) may not be confined to the United States. Both Partners HealthCare System in Boston and University College London School of Medicine/University College Hospital Trust in London have recently undergone mergers, downsizing, and cost cutting on unprecedented scales. A comparison of the recent histories of these eminent AHCs reveals striking similarities in the clinical and academic pressures bearing down upon them and in their responses. It also reveals important differences in their situations and actions, traceable in large part to the contrasting roles of governments and markets in the health care economies of these two countries.

Academic Medical Centers↗
PubMedDate not supplied

Physician income targets: new evidence on an old controversy.

This study uses a unique set of data to identify the factors that affect physician income targets among a nationally representative sample of young (under age 40) physicians in 1987. The study reveals that income targets respond directly to actual income, but that this relationship is rather inelastic. Among self-employed physicians, for example, a 10% decline in actual income would reduce the target by only 3%. Thus, our study provides the first direct evidence to quantify how a decline in income will increase the divergence between actual and target income. Moreover, in quantifying this divergence, our results provide an upper bound on the dollar value of any demand inducement that may ensue. The results suggest that targets are set, at least in part, to compensate physicians for pecuniary and nonpecuniary costs associated with medical practice. Discrimination, dissatisfaction, financial risks, and training costs all appear to raise income targets. Physicians may desire higher incomes to compensate them for discrimination or other difficulties they have encountered in practicing medicine.

Adult↗