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Biomedical subjects

L D Brown

Publications and source records attributed to L D Brown.

At least 73 records · Page 4Linked to original sources
PubMed1986

Introduction to a decade of transition.

A brief review of the last decade or so of developments in health politics, policy and law suggests that health is no longer a field of mere "dynamics without change." Responding not only to economic strains but also to new conceptual challenges to the assumptions of the traditional medical model, in the 1970s and 1980s policy makers have launched various competitive and regulatory programs aimed mainly at containing costs. These interventions, however, have mainly sought savings through reductions in waste and inappropriate utilization; they have done little about deeper cost-increasing forces such as demographic trends, technology, and personnel patterns. Nor have these innovations on the cost side of the policy ledger been matched by action on the benefit side. Such changes await reconceptualization of the practical meaning of social justice and of the role of government in the health field.

Delivery of Health Care↗
PubMed1985

Technocratic corporatism and administrative reform in Medicare.

For two decades administrators of Medicare have tried to reconcile the competing goals adopted by the program's political creators--meeting obligations to the beneficiaries of a social insurance system, maintaining peace with and the participation of providers, and protecting the federal budget. Administrative efforts to balance these objectives have evolved in three phases. The search of the late 1960s for measures to placate providers and win consensus among them, gave way in the early and mid-1970s to new organizations and programs (Professional Standards Review Organizations, capital expenditure review, and others) that would impose controls on the program at the state and local levels, which in turn have yielded to more centralized and direct strategies, notably the prospective payment system adopted in 1983. The new federal activism may be initiating a period of "technocratic corporatism," in which administrators and providers will engage in increasingly structured negotiations over the details of reimbursement policies.

Aged↗
PubMed1984

Mirex-induced adaptive liver growth: a corticosterone-mediated response.

The adaptive liver growth response was investigated in intact and adrenalectomized rats. When adult male rats were given a single oral dose of mirex (100 mg/kg body weight) there was a 72% increase in relative liver weight (RLW) in 72 hr. Based on [3H]-thymidine [( 3H]TdR) incorporation into hepatic DNA, there was also a wave of DNA synthesis which peaked at 48 hr and decreased to essentially control values by 96 hr post mirex dose. In mirex-dosed adrenalectomised (Adx) animals, the RLW was increased by only 38% and there was sustained DNA synthesis. When mirex-dosed Adx rats were given corticosterone supplements, the RLW response was similar to the RLW response in intact mirex-dosed rats. However, the 48-hr DNA synthesis peak seen in intact mirex-dosed rats was eliminated. From these data it is suggested that mirex-induced adaptive liver growth has two components: a hypertrophic component which is mediated by corticosterone, and a hyperplastic component which is independent of corticosterone.

Adrenalectomy↗
PubMed1983

Tax and spend.

Explore the source record for details and available documents.

Financing, Government↗
PubMed1983

Competition and health care policy: experience and expectations.

Since 1970 federal policymakers have tried to strengthen competition and incentive-based market forces as alternatives to regulation in containing health costs. The effort to stimulate the growth of health maintenance organizations (HMOs) throughout the country has had limited results, and federal plans to promote competition by enacting changes in the health insurance market have so far come to little. Coalitions in some localities have shown growing interest in flexible HMO variants, however, and the intellectual force of the HMO critique of mainstream practices remains strong. Moreover, the federal government has shown new interest in prospective reimbursement of hospitals--a proposal that draws from both HMOs--competition--and hospital rate-setting programs--regulation--the element of prospectivity.

Economic Competition↗
PubMed1981

Competition and health cost containment: cautions and conjectures.

Market approaches based on reformed incentives and newly vigorous competition are increasingly proposed as reliable, preferable alternatives to public regulation in the quest for health care cost containment. Health maintenance organizations (HMOs) are often said to provide both theoretical and empirical support for market approaches and are expected to be important vehicles for the exercise of market forces in a "reformed" health care system. Yet experience in the 1970s with federal efforts to increase the number and enrollment of HMOs suggests that serious problems of organization, expectations, and political interest will arise even in a reformed marketplace.

Commerce↗
PubMed1978

The scope and limits of equality as a normative guide to federal health care policy.

In American political culture, as in much of Western political thought, the proposition that men are and ought to be treated as equal in the eyes of polity, law, and society is highly valued. Whether traditional arguments for equality can be properly extrapolated from the political and social spheres to a third sphere--the distribution of resources and services under public welfare state policies--is another question, rarely explored with care. In one of these policy areas, health care, the notion that each citizen is entitled by right to equal access to medical care has grown very popular. Federal programs that equalize access among groups by means of biomedical research, hospital construction and renovation, and financial aid for the elderly and poor have dominated federal health care policy since the end of the Second World War. Empirical consideration of the nature of medical care services, the structure of the health care system, and the consequences of programs to equalize access suggests, however, that public expectations and federal policy may have placed more weight on the principle of equality than it can properly bear. In recent years policy analysts have begun to insist that the equal access issue be viewed in the context of the national cost of medical services relative to that of other social goods, the cost effectiveness of medical services, and the degree to which health and illness result from behavior in an individual's power to pursue or avoid. Attracted by the new revisionist thinking, but unwilling to follow its arguments to their logical policy implications, federal policy makers have institutionalized their ambivalence. The mainstream equalizing programs continue to receive strong support, but they are now challenged by another set of federal programs based largely on revisionist premises. This seemingly inconsistent policy solution is probably the most rational approach to preserving the claims of equality of medical care services, while assigning the principle of equality an appropriately delimited scope.

Federal Government↗