Health care and new technology.
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Biomedical subjects
Publications and source records attributed to G C Benjamin.
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We were well prepared to handle the worst case scenario with the Y2K computer bug. Fortunately, our concerns were unfounded. The threat of chemical and biological terrorism, however, is real, and it is a daily threat. Physicians play a major role in the identification of events as well as their mitigation. We all hope disasters will never occur. As with most emergencies, however, sound planning and training will reduce the risks to our patients.
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The authors report that individuals who are at highest risk of contracting HIV indicated the greatest concern about confidentiality and the greatest knowledge of local reporting laws. Although concern about confidentiality may not be cited as the most common reason to delay or defer testing, it is an important consideration for a minority of individuals--the very segment who are at highest risk of contracting HIV and are the most important targets of campaigns to encourage HIV testing. The particular concerns of this critical segment of the population at risk must be directly and carefully addressed and not lost in a general assessment of population-wide attitudes/concerns about HIV testing. Studies that examine individuals' concerns about HIV testing and privacy and do not stratify by level of HIV risk may obscure the important and heightened concerns of this most important subpopulation.
The presence of toxic stages of the dinoflagellate Pfiesteria piscicida and other morphologically related organisms was documented in three estuarine waterways on the lower Eastern Shore of Maryland in 1997. The Maryland Department of Health and Mental Hygiene, working closely with the local health departments, established a surveillance system to collect reports of human illnesses. Maryland's experience has formed the base on which national surveillance criteria for Estuary Associated Syndrome have been developed and regional surveillance protocols have been built. The cooperation of practicing physicians is essential to continued surveillance efforts to further delineate the extent and nature of human health effects following exposures to waters where toxic forms of these dinoflagellates are active. Physicians wishing to report persons who may have Estuary Associated Syndrome should contact their local health department. Persons wanting information or wishing to report finding lesioned fish or a fish kill in progress should call the Maryland Pfiesteria Hotline at 1- 888-584-3110.
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Introducing a new column on health policy issues of relevance to physician executives. What are the legislative options to provide children with health care coverage? Federal health initiatives for children have become the next frontier in health care reform. This column defines the problem in the U.S., describes voters' support for a federal initiative, and provides discussion of the options available to federal legislators.
The use of the federal budget process to change Medicare policy is of importance to physician executives because of its impact on the health care delivery system. In particular, changes in Medicare policy, driven by the need to shore up the solvency of a politically popular program, will create changes for other public and private purchasers of health care. Reforming Medicare through the budget process is not new. Physician fees have been frozen, reduced, and selectively increased as a result. In 1983, the hospital reimbursement methodology was changed to prospective payment through this process. The budget process will continue to be used to make policy changes because of the large amount that Medicare occupies of the federal budget. Given the profound impact changes in Medicare can have in other health care sectors, the lack of consensus for a long-term solution would mean those in the health care arena will have to be prepared for significant annual policy changes through the reconciliation process.
How can the tradition of patient-provider confidentiality be preserved and still meet the changing information needs of insurers, employers, public health agencies, policy analysts, and researchers? As countries grapple with the issue of a patient's right to medical record privacy, actions that the U.S. takes in this area will set precedents and have implications for nearly every health care electronic transaction. The Health Insurance Portability and Accountability Act requires the Secretary of Health and Human Services (HHS) to recommend standards for electronic financial and administrative transactions. The HHS focused on the confidentially of patient's health care information, guided by five principles in developing recommendations: (1) Boundaries; (2) Security; (3) Consumer Control; (4) Accountability; and (5) Public Responsibility.
More than 9,000 home health agencies provide services to Medicare beneficiaries. In 1996, 10 percent of Medicare beneficiaries received home health services at a total cost of +18 billion. Rapid growth has forced changes in the structure of the benefit payment system and has made home health an attractive area for fraudulent activities which are now being targeted. Collectively, this important benefit and relatively new industry will face changes in the way they do business and deliver services.
Inherent in any discussion on quality for a delivered service is understanding what outcomes you want to achieve and assuring that your consumer agrees. The Presidential Commission's Consumer Bill of Rights supports this principle. Its' goals include: strengthening consumer confidence by providing them with a system responsive to their needs and with a credible mechanism to address their concerns; reaffirming the importance of a strong relationship between patients and their health care providers; and, reaffirming the role consumers play in safeguarding their own health. Striking the balance between cost and quality requires all the stakeholders of the health care system to focus on the true issues that impact quality: outcomes, accountability, and consumer satisfaction, however defined.