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Biomedical subjects

B C Vladeck

Publications and source records attributed to B C Vladeck.

At least 73 records · Page 4Linked to original sources
PubMed1988

Medical gridlock.

Explore the source record for details and available documents.

Acquired Immunodeficiency Syndrome↗
PubMed1988

Quality assurance through external controls.

Concern since the early part of this century for the quality of health care services has led to external controls in the United States that are more extensive, more intrusive, and more complex than they are elsewhere in the world. I suggest that this is the result of the decentralized nature of our health care system and the dominance of the American legal system and its adversarial orientation. This in turn has led to external control processes that focus on quantifiable, but often secondary or tangential, aspects of service that measure what is minimally acceptable rather than what is optimal. Perhaps it would be more fruitful for external control to intervene at a higher level by creating expectations for the process of quality assurance--that is, to create a system of external controls over internal controls. This, in turn, may lead to a quality assurance system focused on the more central, if more subjective, dimensions of health care.

Humans↗
PubMed1985

Reforming Medicare provider payment.

The basic thesis of this paper is that, in the short to medium term (that is to say, the politically relevant term), fee-for-service payment will be the dominant form of Medicare transaction--and that is not such a bad thing. Capitated arrangements will grow, and should be encouraged, especially for long-term-care services, but for reasons to be discussed, it would be a mistake to put too many policy eggs into that basket. As the nascent Prospective Payment System (PPS) for hospital care reveals, fee-for-service payment can take almost an infinite variety of forms, and the connection between the choice of form and the cost impact is highly variable and somewhat uncertain. PPS needs considerable improvement; so, unquestionably, does the current nonsystem of physician payment. An analysis of potential improvements in both arenas will constitute the bulk of this discussion. That emphasis reflects not only the personal predilections of the author, but also the contention that those are the most sensible things to talk about.

Aged↗
PubMed1985

The dilemma between competition and community service.

In this updated speech originally presented before the California Hospital Association, the author suggests that hospitals exist under an evolving social contract, originally between a hospital and its community but more recently between hospitals and the federal government, to ensure that health care services are provided to those who need them, regardless of ability to pay. Although the current competitive climate may not favor patients who cannot pay, he points out that the pendulum is likely to swing back to support the original terms of the social contract between providers and patients. He concludes that the most competitive stance that hospitals can now adopt is to provide services to those who need them. Full hospitals, he notes, rarely close.

Bed Occupancy↗
PubMed1984

Medicare hospital payment by diagnosis-related groups.

On 1 October 1983, the Medicare system began a phased transition to a new payment method for hospitals based on uniform payments by diagnosis-related group (DRG). This article reviews the rationale for DRG-based reimbursement, describes the new Medicare system, and discusses its implications for hospitals, physicians, and hospital-physician relations. Although it is too early to evaluate its impact, this payment system will probably encourage more operational interaction between hospital administrators and organized medical staffs, and accelerate trends towards salaried service chiefs in community hospitals and greater external scrutiny of physicians' activities.

Diagnosis-Related Groups↗
PubMed1984

Comment on "Hospital reimbursement under Medicare".

The federal plan to establish uniform national rates under DRGs is a triumph of conceptual neatness over sound policy; it will produce no net savings to the Medicare trust fund. Proposals to contain hospital costs have yet to deal with uncompensated care, quality assurance, and the explicit integration of long-term care.

Cost Control↗
PubMed1983

The aging of the population and health services.

The demographic revolution--engendered in large part by modern medicine--which has led to the extraordinary and continuing increase in the number and proportion of elderly persons in the population has profound implications for health services. The elderly are disproportionately heavy utilizers of health care, primarily because of the prevalence of chronic disease. In the United States most health care for the elderly is financed through public funds, and costs have been increasing at an alarming rate. There is wide consensus that, for all the excellence of performance of the medical care system in treating acute episodes, care of chronic disease is frequently unsatisfactory in both quality and cost. Given the demographic imperatives, reform of mechanisms for chronic care is thus essential.

Aged↗