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Biomedical subjects

D W Light

Publications and source records attributed to D W Light.

At least 37 records · Page 2Linked to original sources
PubMed1997

The rhetorics and realities of community health care: the limits of countervailing powers to meet the health care needs of the twenty-first century.

As the paradox of medical success leaves behind more chronicity, policy makers around the world increasingly focus on community-based programs both to address chronic health problems and to prevent major disorders. This essay presents my comparative sociological framework of ideal-type models for understanding the countervailing powers that underlie and shape different kinds of heath care systems and their limitations in addressing the health care needs of the twenty-first century. In this context, I then analyze the revival of community health care rhetoric in the United States and compare it to the realities in which it operates. The realities of institutional power, fragmentation in funding, illness as a private condition and health care as a private good, the lack of societal commitment, competition, and the waning of community cohesion all suggest that communal democracy will be difficult to achieve. Current successes require further investigation. Examples from abroad suggest, ironically, that community health care develops best if the state and health professionals make a deep commitment to it, against their own immediate interests but for their enlightened self-interest.

Community Health Services↗
PubMed1995

Professional dynamics and the changing nature of medical work.

The organization and delivery of health care in the United States is undergoing significant social, organizational, economic, political, and cultural changes with important implications for the future of medicine as a profession. This essay will draw upon some of these changes and briefly review major sociological writings on the nature of medicine's professional status to examine the nature of professional dynamics in a changing environment. To this end, we focus on the nature of medical work and how this work impacts on and is impacted by medicine's own internal differentiation and the presence of contested domains at medicine's periphery. We trace this dynamic through a number of issues including the multidimensional nature of medical work, the role of elites in that work, and how changes in the terms and conditions of work can exert changes at medicine's technical core. We close with some thoughts on the relationship of public policy to medicine's professional status, the role health policy might take in shaping a new professional status, the role health policy might take in shaping a new professional ethnic for medicine, and the role sociologists might play in this process.

Delivery of Health Care↗
PubMed1994

Barriers to out-of-hospital care for AIDS patients.

Inappropriate delays in hospital discharge for AIDS patients add to the expense of health care, as well as to the stress felt by the patient. It has been postulated that delays are due to a lack of suitable out-of-hospital services and weak patient support networks. The charts of AIDS patients discharged from hospitals in northern New Jersey and southern New Jersey/Philadelphia, PA between 3/88 and 1/90 (n = 601 discharges for 454 patients) were examined to determine the discharge services or goods which were ordered and/or received, the extent of actual delay, and the causes of these delays. While regional variations were evident, differences in the profession of the discharge planner were associated with having care ordered and received and delays in discharge; as were availability of a support system, presence of a case manager, and race. A nurse or a social worker (as compared to a doctor as discharge planner) were more likely to effectively order and arrange out-of-hospital care, and were thus more likely to experience delays in hospital discharge. Failures of physicians to make timely requests for care were also associated with delays. Recommendations for future research were made.

Acquired Immunodeficiency Syndrome↗
PubMed1992

The practice and ethics of risk-rated health insurance.

Health insurance in the United States is driven by competitive risk rating and is promoted as the best way to give policyholders optimal value for their money and to be fair to those with lower risks. In practice, however, competitive risk rating costs more than noncompetitive, universal systems of health insurance, and it erodes the basic function of insurance to spread infrequent large losses over a wide base. This article describes not only how risk rating covers least those with the greatest medical bills, but also how it has spawned a labyrinth of complex manipulations by insurance companies to charge more or pay less than actuarially fair risk rating would justify. The final section shows that even if risk rating were done fairly, it contradicts moral fairness. Many of the leading proposals for national health insurance do not address these practical and ethical issues. The medical profession and policymakers need to discuss them and take a stand on them.

Actuarial Analysis↗
PubMed1992

Equity and efficiency in health care.

Adam Smith's belief that markets will make society more equitable and efficient is examined in the case of reforms to make health care more competitive. Eight ways in which health care does not often satisfy the requirements for competitive markets, and nine ways in which providers can manipulate markets are identified. The concept of 'embedded inefficiencies' is introduced to explain why competition may not increase efficiency.

Contract Services↗
PubMed1992

The radical experiment: transforming Britain's national health system to interlocking markets.

The reforms of Britain's National Health Service (NHS) are the most sweeping attempt in the world to transform a social system of administered services into a system of buyers and sellers. At issue are basic questions about the nature of human behavior and the nature of inefficiency. This article outlines the NHS and its problems, shows how narrow and misleading the market-based diagnosis was of those problems, explains the reforms, and assesses their likely impact.

Humans↗