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Biomedical subjects

S J Tanenbaum

Publications and source records attributed to S J Tanenbaum.

9 recordsLinked to original sources
PubMed1996

"Medical effectiveness" in Canadian and U.S. health policy: the comparative politics of inferential ambiguity.

OBJECTIVE: To compare Canadian and U.S. policymaking to determine how different health care systems may use health services research differently in responding to the common problem of ineffective medical care. DATA SOURCES/STUDY DESIGN/DATA COLLECTION: Not applicable. PRINCIPAL FINDINGS: The United States and Canada are making surprisingly divergent responses to the problem of medical ineffectiveness: reinforcement of the solidarity principle and deprivatization in Canada, and reinforcement of market competition and privatization in the United States. In doing so, Canadian policymakers overstate the societal applicability and U.S. policymakers the individual applicability of outcomes research findings. CONCLUSIONS: Probabilistic findings of medical effectiveness are fundamentally ambiguous as they relate to action. They therefore invite divergent policy responses from different policy regimes. Health services researchers must not imagine that research findings are sufficient to determine the course of health policy.

Attitude of Health Personnel↗
PubMed1995

Think before you prep: defining the terms of change in American healthcare.

United States physicians are grappling with a fundamental reorganization of the healthcare system. Although many remain skeptical of governmental efforts at reform, they seem to take as given an industrial efficiency model of change, including large and integrated managed care arrangements and performance measurement based on outcomes such as quality. This uncharacteristic acquiescence seems to derive in part from a confounding of concepts. This article makes three distinctions: among knowledge about practice, knowledge about quality, and outcomes research; between outcomes research and the outcomes movement; and between the outcomes movement and other options for healthcare reform. The suggestion that statistical measurement of specific variables ought not to have a priori precedence over other ways of thinking--and doing something--about healthcare is made.

Efficiency, Organizational↗
PubMed1995

Medicaid eligibility policy in the 1980s: medical utilitarianism and the "deserving" poor.

Between 1981 and the early 1990s, the Medicaid program grew substantially, in part because, for the first time in the program's history, eligibility for medical assistance was severed from eligibility for income-maintenance payments. Program participation had always been reserved for the "deserving poor," and these were originally defined as persons excluded from market relationships through no fault of their own. The Medicaid expansion of the 1980s, however, created a new constituency of poor, and not-so-poor, persons whose actual or predictable medical problems promised a calculable return on program funds.

Aged↗
PubMed1994

Knowing and acting in medical practice: the epistemological politics of outcomes research.

Recent health care policymaking favors outcomes research as a response to the putative ineffectiveness, as well as the undeniable expense, of American medicine. This small-scale ethnographic study conducted in a department of internal medicine evaluates claims that probabilistic knowledge will improve clinical practice. It finds that physicians are primarily determinists and that although they reason probabilistically in some instances, they rely on personal experience over research data at these times; that doctors view outcomes research as useful but not definitive and in no way immune to the social influences on medical knowledge generally; and that their mix of determinism and probabilism is well suited to the nature of medical work. The recent ascendancy of outcomes research is as much political as scientific, empowering the research community relative to practicing physicians, lending medical legitimacy to payer-promulgated practice guidelines, and creating additional clinical work around a false standard of medical certainty.

Attitude of Health Personnel↗
PubMed1993

Selling cost containment.

Health care expenditures in the United States have continued to grow despite efforts to control them. This Article discusses the need for health care reform, outlines the model that reform should follow, and considers why the United States has not progressed toward a workable solution. It introduces a single-payer approach to cost containment and explains how such an approach could be "sold" in the United States. Finally, the Article examines various ways to mobilize support for such health care reform.

Attitude of Health Personnel↗