Biomedical subjects
Publications and source records attributed to T P Weil.
In an attempt to find some remedies within what is already a highly competitive and politically charged environment, this article's purpose is to specify some major steps that the management of integrated delivery systems might heed in the next decade to curtail their expenditures and better position themselves for the future.
During the past decade, 'merger mania' has been a striking trend in the US health field as a strategy to improve the integration of services, to reduce expenses, and to increase the ability of providers to manage risk-based payment. However, during the past quarter of a century limited operational and fiscal evidence has been published in both the health and general management literature that strongly supports the efficacy of horizontal mergers. This article further argues that a likely scenario over the next decade, in spite of disappointments among these mergers in effecting significant cost reductions, is for the US health networks to continue acquiring additional providers and insurers. After these alliances gain significant market penetration, they are expected to behave as oligopolists. For these mergers to eventually achieve their earlier projected savings, the health field's leadership will be forced to implement cost-cutting measures such as: more vigorously coordinating the network's key clinical services to reduce competition for revenues among the partners within an alliance, closing superfluous hospitals and centralizing expensive tertiary services, encouraging surplus physicians to relocate to under-served areas, and providing direction to carefully integrate the best elements of what the competitive and regulatory strategies are able to offer to improve access, social equity, quality of care, and to reduce total health expenditures.
Vertical integration is a concept used by health systems when attempting to achieve economies of scale, greater coordination of services, and improved market penetration. This article focuses on the actual outcomes of utilizing vertical integration in the health field and then compares these findings with those reported in other industries. This analysis concludes that this organizational model does not work particularly well in the health industry, as illustrated by health alliances' poor fiscal performance when they acquire physician practices or when they start their own HMO plans.
Sporadic reports in the media focus on the difficulty of America's social welfare leadership to protect children at risk and to allocate scarce resources. These criticisms suggest the need for valid conclusions in both socio-psychological and economic terms for evaluating the efficacy of three key strategies used for children at risk: reunification, foster and kinship care, and adoption. This article calls for creating a comprehensive data base that supplies the most critical variables leading to reasonable successes and the average cost per case when comparing children reunified with a biological parent to those who are placed into out-of-home settings and to those who are adopted. This analysis to include public and private expenditures for services provided by human services--welfare, special education, judicial, correctional, mental health, medical, and other related organizations.
Whether market-driven or government-driven approaches should be used to curtail future health care expenditures has become the debate of the decade on Capitol Hill and in state legislatures. After examining both the competitive and the regulatory models to constrain health care costs, it is argued that to achieve an effective and efficient health care system, a properly structured market-driven approach should be blended with a minimal number of safety and soundness regulations. To successfully implement such a half-competitive, half-regulatory system in the United States, it will be necessary, for example, to empower thirdparty payers and providers to negotiate prices without direct government involvement; to modify enormous regional differences in use rates and health care costs for various treatments with more rigid treatment protocols that are promulgated by the managed care plans; to minimize administrative-type expenditures that have no visible, beneficial effect in improving quality patient care; and to curtail the supply of underutilized health care resources as another means to constrain health care expenditures. These strategies would have significant political, social, economic, and patient care implications for the United States but might result in our health care cost dilemma appearing to the public as finally being "under control."
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Whether the health field in the United States should have more competition or more government regulation is now at the center of the public policy debate. After examining the market-driven and regulatory models to constrain cost and improve access to care, this article argues against supporting either extreme and instead favors a blended approach where the emphasis is on practicality rather than ideological exactness. Such a mixed strategy is predicted to eventually gain acceptance, legitimacy, and momentum, since such a hybrid design is more consistent with America's cultural and political values.
Whether the health field in the United States should be dominated by more competition or by more government regulation is now at the center of the public policy debate. After examining the market-driven and regulatory models to constrain cost, improve quality, and enhance access to care, the article argues that our current centrist political philosophy can be expected to continue on Capitol Hill and among the state legislatures. As a result, this will force health information managers to labor within a blended approach that is partially market driven and partially governed by regulations. How such a hybrid system will affect the future role of health information professionals, integrated information systems, and other related topics is also discussed.
Merger mania has been a striking trend in the health and managed care fields during the last decade, promising to improve integration of services, decrease excess capacity, enhance price competition, and increase the ability of providers and insurers to handle risk-based payment. In view of these promises, our first argument in this paper is that undoubtedly strong, well-financed managed care plans and health networks will continue to utilize the merger concept to acquire additional insurers and providers, eventually gaining more control over the organization and the financing of a region's health care delivery system. Our second thesis is that the quasicompetitive, quasiregulatory authority inherent in the Telecommunications Act of 1996, somewhat similar in concept to the American Hospital Association's earlier Ameriplan (1970), might serve as an appropriate model for Congress to use in designing future managed care, health field, and federal/state governmental interrelationships.
As health networks battle for additional market share and encourage additional Medicaid HMO subscribers to use their physicians and hospitals, more health executives are analyzing proposals of how to attract qualified doctors to practice in poor rural or inner-city communities. Supplying more physicians to those areas by increasing the number of medical schools, expanding the National Health Service Corps (NHSC) program, and allowing more international medical graduates (IMGs) to pursue residency training in the United States have been relatively unsuccessful strategies to improve America's geographic maldistribution of medical manpower. This article focuses on several approaches that health networks might use to increase market penetration and at the same time deliver enhanced health services to the underserved. Health networks may provide eminent leadership in the overall design and governance of soundly conceived Medicaid HMOs; strengthen existing or develop additional community health/primary care centers; interface more effectively with local schools to foster Medicaid HMOs for children of low-income families; and reimburse at "premium rates" primary care physicians who practice in underserved communities. The reluctance of physicians to practice in these areas and of middle-income and upper-income taxpayers, and therefore elected officials, to support increased spending or redirection of funds continue to be major barriers for health alliances to demonstrate willingness to invest additional resources in poor inner-city and rural environments.
Sporadic reports in the media focus on the inability of America's social welfare leadership to protect children at risk and to allocate judiciously scarce resources. These criticisms suggest the importance of arriving at valid conclusions in both socio-psychological and economic terms so that human service specialists can evaluate the efficacy of three key strategies used for children at risk: reunification, foster care; and adoption. Rather than continuing to modify public policy without much empirical evidence, this article calls for creating a comprehensive data base that supplies the most critical treatment variables leading to reasonable successes and to the average cost per case when comparing children reunified with a biological parent to those who are placed into out-of-home settings and to those who are adopted. This proposed analysis should include public and private expenditures for the services provided by human services-welfare, special education, judicial, correctional, mental health, medical, and other related organizations.
An almost unending debate over the future shape of America's health care system increasingly focuses on the continuum between managed competition and government regulations, and the question: What is right for the United States? The Maryland all-payer, rate setting system for its 50 hospitals, where over a third of the state's population is enrolled in managed care plans, is used as an example of relatively successful blending of competitive and regulatory strategies. This article concludes with the theme that given America's penchant for compromise, competitive and regulatory approaches can coexist in a pluralistic health system that constrains the use of services and costs, and enhances access and the quality of patient care.
The Germany multipayer universal health insurance plan in 1992 consumed 8.7% of its nation's total expenditures. Nevertheless, its macromanaged approach has allowed until recently for pluralism, decentralization, and self-regulation among providers and sickness funds (not-for-profit, third party payers). With 34.8% more physicians per 1,000 persons, German doctors provided twice as many patient contacts per capita than in the United States. Due to economic constraints and increases in payroll taxes, the Federal Republic of Germany's parliament, with its 1993 health reform plan, virtually froze all payments to providers for a 3-year period. Among other contentious provisions were the following: (1) limiting the entry of new physicians into municipalities that are considered by government health manpower planning experts to be oversupplied in that specialty; (2) requiring community-based physicians to participate in controlling pharmaceutical costs; and (3) eliminating some of the German traditional barriers between their in- and out-of-hospital physicians. This article focuses on how the Germans now micromanage their physician and other ambulatory care services within a macromanaged system that, in terms of patient access, benefits, quality, and cost, should be the envy of the Americans.
The cutbacks in Medicare and Medicaid reimbursement, and the Republican takeover of Capitol Hill and the state legislatures as a result of recent elections, suggest that the payer-driven forces of managed care, capitated payment, and the regional networks (alliances) will serve as centerpieces to improve the organization, financing, and delivery of America's health services. These "voluntary" alliances that are now being forged as an amalgam of health providers and insurance underwriters, often foreshadow the powerful, geographically linked regional health networks that are evolving into oligopolies throughout the United States. As the Department of Justice and the Federal Trade Commission are unable to appropriately analyze the efficacy of most prospective mergers, the American health field increasingly can expect monopolistic environments. In this process, the public eventually may demand the formation of state health services commissions. Within this framework, the German decentralized, multipayer, multitier approach, which historically is self-governing and allows for negotiating reimbursement rates between insurers and providers, offers a preferred option to the traditional American public utility model.
Can Americans expect the same gridlock and pork between now and the 21st Century? What are the possible directions that the United States can move in regarding health care reform and the long-term financing of health entitlement programs? Here, the author offers a snapshot of current politics and some predictions for the next four years. And explores the question: Are Americans willing to make the necessary sacrifices for future generations to profit by the significant changes needed by entitlement and health reform, or will it be business as usual? America's centrist perspective was recently reinforced by the 1996 election, suggesting that no major innovations in entitlement or in the health system should be anticipated in the next four years.
Since current public officials lack the courage and political will to significantly raise payroll taxes or constrain Social Security, Medicare, and Medicaid benefits, it can be expected that long-term deficit spending will continue, effecting a predictable series of events that have strong, negative ramifications for the American health care system. The author suggests modifications to how our nation's health system should be organized and financed in order to avert these dire predictions.
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Explore the source record for details and available documents.