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Biomedical subjects

P R Lee

Publications and source records attributed to P R Lee.

At least 19 recordsLinked to original sources
PubMed1992

Costs and coverage. Pressures toward health care reform.

Signs of discontent with the health care system are growing. Calls for health care reform are largely motivated by the continued increase in health care costs and the large number of people without adequate health insurance. For the past 20 years, health care spending has risen at rates higher than the gross national product. As many as 35 million people are without health insurance. As proposals for health care reform are developed, it is useful to understand the roots of the cost problem. Causes of spiraling health care costs include "market failure" in the health care market, expansion in technology, excessive administrative costs, unnecessary care and defensive medicine, increased patient complexity, excess capacity within the health care system, and low productivity. Attempts to control costs, by the federal government for the Medicare program and then by the private sector, have to date been mostly unsuccessful. New proposals for health care reform are proliferating, and important changes in the health care system are likely.

Delivery of Health Care↗
PubMed1991

How many physicians can we afford?

We project physician costs for the year 2,000 under several alternative scenarios, using different assumptions about the future supply of physicians and gross income (or expenditures) per physician. The supply of active, posttraining patient-care physicians is projected to increase from a ratio of 144 per 100,000 population in 1986 to 176 per 100,000 in 2,000. Depending on whether expenditures per physician increase at the rate of the consumer price index, the gross national product, or the historical 1982 through 1987 expenditure trends, there will be an additional cost (in constant 1986 dollars) of $21 billion, $30 billion, or $40 billion, respectively, compared with projected physician costs under a scenario of a constant physician-to-population ratio. The disproportionate growth of costs for practice overhead will pose a particular problem for efforts to restrain inflation of expenditures per physician.

Fee Schedules↗
PubMed1991

Drug promotion and labeling in developing countries: an update.

Recent studies of drug promotion and labeling in Third World countries since 1972 have observed important changes in the policies of multinational corporations. Earlier studies found that multinational and national drug companies often grossly exaggerated the indications for the drugs and minimized or ignored the hazards. In the latest study, initiated in 1987, considerable improvement in promotional practices of the multinational corporations has been found, but little or no improvement on the part of the national companies. As a result, physicians are still provided with grossly exaggerated claims and the hazards of prescription drugs are covered up or glossed over. A very serious problem--the marketing of fraudulent drug products--has been identified in a number of Third World countries. Drug products are shaped and colored to resemble the original multinational company product, but contain only a small percentage of the active ingredient stated on the label, or perhaps none at all. In Indonesia fraudulent drug products may represent 20-30% of all drug products in the market. Similar fraudulent products have been reported in Brazil, Thailand, Bangladesh and Malaysia.

Developing Countries↗
PubMed1990

Public policy issues affecting the health care delivery system of adolescents.

Policymakers are at an important crossroad in pursuing viable solutions to the dilemma of preventing and treating adolescent health problems. A variety of coordinated and comprehensive approaches will be needed to resolve these complex and often entrenched problems. In the absence of a national policy for children and youth, it is important that those concerned with these issues join efforts at the community, local, state, and national levels to move the policy agenda forward. As an interim step, it is necessary to work on building and evaluating model programs that will influence the development of new policy directions. Both efforts are needed to address the complex array of problems facing adolescents today. The future of adolescent health will be determined by a variety of factors, including public policy. Of particular importance in shaping public policy are four factors: (1) the American character, including ideas and attitudes that are the basis of politics and policy; (2) the pluralism that characterizes the process, including the relationship between government and the private sector and the dominant role of the private sector; (3) the federal system that distributes authority among various levels of government (federalism); and (4) incrementalism, which is the step-by-step process that characterizes the development of policies. Of particular importance in terms of adolescent health are the ideas and attitudes about adolescence and adolescents; the basic ideas that affect policies broadly; and the concepts of federalism, pluralism, and the role of the private sector in dealing with domestic social issues. Although the field of adolescent health continues to advance, many complex problems that have their origin in biological, behavioral, and sociocultural factors remain. Of particular importance are problems associated with lower socioeconomic status. The problems will not yield to the single-issue, categorical approach of the past but will require comprehensive strategies involving the health, education, income maintenance, job training, employment, and social service sectors. Public policies must support these integrated, coordinated approaches, and health providers concerned with adolescent health can and must play a vital role in this process.

Adolescent↗
PubMed1990

The drug swindlers.

In a number of important developing nations--among them Indonesia, India, and Brazil--clinical pharmacologists and other drug experts are revealing mounting concern over the marketing of fraudulent drug products. These are shaped, colored, flavored, marked, and packaged to mimic the real product. They may contain the actual antibiotic or other drug indicated on the label, but so "cut" that the product provides only a small fraction of the labeled amount, or they may contain only useless flour or starch. At best, they are worthless. At the worst, they can kill. In most instances, it is believed that these "drugs" are produced and marketed by local or domestic fly-by-night groups and not by multinational pharmaceutical firms. Blame for these practices is placed on inadequate or unenforced laws, only trivial punishments, bribery and corruption, and the fact that generally "nobody inspects the inspectors."

Brazil↗
PubMed1990

Physician payment reform--an idea whose time has come.

These discussions are selected from the weekly staff conferences in the Department of Medicine, University of California, San Francisco. Taken from transcriptions, they are prepared by Homer A. Boushey, MD, Professor of Medicine, and Nathan M. Bass, MD, PhD, Associate Professor of Medicine, under the direction of Lloyd H. Smith, Jr, MD, Professor of Medicine and Associate Dean in the School of Medicine. Requests for reprints should be sent to the Department of Medicine, University of California, San Francisco, School of Medicine, San Francisco, CA 94143.

Fees, Medical↗
PubMed1986

Drug promotion: the Third World revisited.

In 1973 and 1980 surveys, much of the promotion of prescription drugs in the Third World was found to be marked by gross exaggeration of clinical claims and glossing over of possible serious or fatal adverse reactions. In an expanded survey of the information distributed in 1984 to physicians in the United States, the United Kingdom, and 28 developing nations in Africa, Asia, and Latin America, striking changes were noted. Many of the pharmaceutical firms were found to be showing more restraint in limiting their claims in the Third World to those which can be supported by scientific evidence, and far more willingness to disclose serious hazards. The companies discarding a double standard in drug promotion have apparently not suffered any significant loss of profits. There is, however, evident need for further improvement by both multinational and domestic companies. The present study covered 1069 products representing 63 drug entities and fixed combinations, marketed by 303 companies.

Africa↗
PubMed1978

Nutrition policy--from neglect and uncertainty to debate and action.

Until recent years, nutrition has received little attention in U.S. agriculture, food, and health policies. This circumstance is changing. In the late sixties and early seventies, reports of hunger and malnutrition sparked public reaction and a shift in policy. The White House Conference on Food, Nutrition and Health in 1971 prompted the Senate select Committee on Nutrition and Human Needs to address itself to this problem, with the result that the Food Stamp, child nutrition, WIC, and Nutrition for the Elderly programs were initiated or expanded. Then, in the mid-seventies, the Select Committee turned its attention to broader issues of nutrition and health and declared that the goal of any food system is the maintenance and improvement of nutritional health of the population. This objective emerged as public policy in the Food and Agriculture Act of 1977. As the Select Committee continued its work, problems of overnutrition became more apparent. The culmination of its studies was the issuance early in 1977 of the "Dietary Goals for the United States," designed to improve the nutrition and reduce health problems of the population. To that same end, the Select Committee has also made recommendations regarding food labeling and nutrition education.

Aged↗