The changing economic context of medical decision-making.
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An awareness of potential conflict between medical schools and private practice prompted an attitudinal assessment of faculty practice plans (FPPs). A representative sample of eight medical school FPPs in seven different communities was selected for study. For each FPP, a sample of health care leaders, stratified at different levels of administrative responsibility, was selected from academic medical centers and from community settings. Topics for FPP assessment were chosen for their relevance to physician and lay administrators involved with academic and community practice. Questions were answered on a yes-no basis and were graded by intensity of response. Although only two of the questions revealed statistical disparity on a simple yes-no basis, the intensity of response differed significantly in eight of the 14 questions asked. This study gives consideration to the strategic implications of FPPs for universities, medical schools, and organized medicine.
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This review summarizes the capabilities and contributions of quantitative sector models for understanding trends in hospital expenses and the effects thereon of various public policies. After some brief historical notes on the use of analogous models in other policy areas, the general classes of national, partial, and narrow health sector models are introduced with special attention to method of validation and behavioral structure. Fourteen published models, described and critically reviewed with regard to these criteria, are assessed for their individual application to important policy and behavioral issues. Suggestions are offered for improvements and new initiatives in the use of sector models both in forecasting and in the study of procompetitive policies and reimbursement rule changes.
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