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Biomedical subjects

B C Vladeck

Publications and source records attributed to B C Vladeck.

At least 91 records · Page 5Linked to original sources
PubMed1981

Equity, access, and the costs of health services.

Access to health care services for the poor and elderly have improved dramatically over the last 15 years, largely as a result of Medicare, Medicaid, and other Federal initiatives. The poor now consume roughly the same volume of health services as the nonpoor. Yet there are still substantial access barriers for many of the chronically ill, minorities, and residents of inner cities and rural areas. Of broader concern, the improvements in access are now threatened by the response to rising health care costs. Those cost increases are themselves partly--but only partly--attributable to Medicare and Medicaid themselves. True cost containment, as opposed to program cost containment, can restrain cost increases without damaging access, but is politically more difficult to accomplish than measures to reduce access.

Aged↗
PubMed1979

The design of failure: health policy and the structure of federalism.

This paper explores the impact of the federal structure of American government on health policy through the examination of three case studies of unsatisfactory policy: Medicaid cutbacks; provider licensure; and health planning under P.L. 93-641. Problems arise in three areas because of a disjunction between administrative or regulatory responsibilities and financial accountability. How the division of responsibilities among different levels of government might be managed better is examined briefly, in the context of possible state roles under a system of national health insurance.

Government Agencies↗
PubMed1977

Interest-group representation and the HSAs: health planning and political theory.

Examination of the provisions of the National Health Planning and Resources Development Act, P.L. 93-641, concerning the composition of Health Systems Agencies, which are to be the primary building-blocks of local health planning, suggests that expectations of substantial change may be unrealistic. Specifically, in its provision for representation on the HSAs, Congress appears to have been accepting an implicit theory of pluralist interest-group representation that has long been prevalent in other sectors of public life in the United States, and long subject to significant criticism. Such forms of representation tend to lead to bargaining, log-rolling, and collusive competition among narrowly-defined special interests, with the interests of the broader general public less well-served. The application of this theory to health planning in P.L. 93-641 is examined, and predictions drawn about the implications of this analysis for health planning and health policy in the United States in general.

Community Participation↗
PubMed1975

Sequential changes in cerebral blood flow and distribution of flow within the brain during hemorrhagic shock.

Sequential changes in cerebral blood flow as well as in regional blood flow to the brain (brain stem, cerebellum, hypothalamus, white matter and grey matter) were measured in unanesthetized dogs subjected to gradual prolonged hemorrhage according to a protocol which stimulates the most commonly encountered type of clinical hemorrhagic shock. Microspheres labeled with five different radioactive isotopes were injected into a left atrial catheter at five different times: control, early hypotension (immediately after hemorrhage), late hypotension (just before reinfusion of the shed blood), as well as one and eight hours after reinfusion of the shed blood. Immediately after hemorrhage, the total cerebral blood flow decreased slightly, but increased when calculated as a percent of the cardiac output. In the late hypotensive, hypovolemic stage, there was decreased flow calculated both as percentages of cardiac output and absolute flow as compared with the initial response to hemorrhage. Immediately after reinfusion of the shed blood, there were further reductions of flow. Eight hours subsequently, flow rose to values slightly above control. The patterns of each region was almost identical to that of the total cerebral flow. Since each of the major regions of the brain are approximately equally affected, changes in the level of consciousness and other cerebral functions occurring with hypovolemic shock may reflect circulation of the white matter as well as that of the whole brain.

Animals↗