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Biomedical subjects

U E Reinhardt

Publications and source records attributed to U E Reinhardt.

At least 19 recordsLinked to original sources
PubMed1999

Reforming American healthcare: an interim report.

At the beginning of this decade, health policy analysts and health management consultants went about the United States proclaiming that the sky was falling because something called "managed care" was about to revolutionize the financing and delivery of healthcare. In the process, it would rob US physicians not only of their long accustomed clinical freedom, but also of their long accustomed handsome incomes and job security. Understandably, in the face of many negative predictions, US physicians felt as if they were in dire straits. To be sure, the odd skirmish has been waged over healthcare costs and over clinical freedom. Viewed across the United States as a whole, however, managed care so far has been, in the words of a recent magazine article, "a mouse that roared." However, it is possible that a second revolution in the US healthcare system is yet to come, as Medicare and Medicaid turn over more and more of the functions of cost and quality control to private regulators. It is likely that the private regulators will consist of physician-driven integrated healthcare delivery systems, which take full capitation from Medicare and Medicaid and therefore assume full clinical control over healthcare, along with the financial risk inherent in capitation. For rheumatologists, this approach to healthcare represents both a danger and an opportunity.

Health Care Reform↗
PubMed1998

Quality in consumer-driven health systems.

In the global quest for improved 'quality' in health care, the purely clinical quality of health care should not be confused with the quality of the health care experience. Although the former is central to the latter, it is the latter that determines the overall quality of a health system. Americans have long had trouble with this crucial distinction. A survey of several distinct dimensions of the quality of the entire health care experience, for example, can help to explain why the technically sophisticated, expensive and often very luxurious American health system tends to earn relatively low scores in cross-national surveys in which respondents are asked to rate the overall quality of their health system. Many useful insights can undoubtedly be had from the system's myriad experiments with continuous improvements in the clinical quality of health care (just as Americans, however, could learn from similar experiments abroad). On the other hand, the bewildering and ethically dubious financial and managerial systems that Americans have put in place to foster continuous quality improvement in their health care may be self-defeating in the end. Policy analysts and policy makers in other countries may learn from the American experience to spare their citizens the agony.

Community Participation↗
PubMed1997

Economics.

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Delivery of Health Care↗
PubMed1997

Making economic evaluations respectable.

Policy-makers worldwide are on a quest to control national spending for health care and to enhance the value received for whatever is being spent on health care. One should think that the economic evaluation of clinical practice would play a major role in this quest. Alas, so far it has not, in spite of considerable progress in the development of suitable methodology for such evaluations. The central point of this paper is that the sheer conceptual and practical complexities of economic evaluations in this context are not the only and possibly not the major barrier to a more widespread use of this type of analysis. Just as important may be the suspicion among lay persons that such analyses are easily driven by the assumptions the analyst packages into the analysis which, in turn, opens economic evaluation to hidden bias toward favored results. It is proposed in this paper that this particular barrier to the use of economic evaluations in health policy could be overcome if these analyses were more routinely subjected to the rigorous and penetrating audits that are customary in financial accounting. Typically, research papers in economics are audited through peer review only as to the methodology employed. The suggestions here is that a proper, respectable audit ought to penetrate all the way to the data that were used to produce the findings in a study. The paper concludes with some suggestions on how to develop such an audit infrastructure.

Cost Control↗
PubMed1996

Economics.

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Health Care Costs↗
PubMed1996

Physician-sponsored networks. Will physicians take back medicine?

Until about the late 1980s, American physicians and their allies, hospitals and the health care manufacturing industries, dominated all facets of the health system--the clinical, the economic, and the political. The bulk of these providers' revenue flowed to them from a highly fragmented insurance system whose governing principle was to provide each insured patient free choice of doctor and hospital. Two distinct, concurrent shifts threaten to erode the medical profession's traditional dominance. The first is a rapid, general shift of control from the supply side of the health sector to its demand side. The second is a shift away from government control, over which organized medicine held much sway in the past, toward private regulators--the executives of the managed care industry. Is the trend towards greater dependence of practicing physicians on non-physician executives inevitable, or can physicians retain--and, in part, regain--their hitherto autonomous position in the health system?

Community Networks↗