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Biomedical subjects

D M Fox

Publications and source records attributed to D M Fox.

At least 19 recordsLinked to original sources
PubMed1991

Photographing medicine.

This article addresses the issue of conventions in medical photography since it was developed 150 years ago. It points out, that precisely those photographs that seem to break with conventions, might become very useful to the historian of medicine. Especially photographs of medical interventions intended for a larger, non-professional audience often do not portray those medical activities, that take up most time and energy in modern medicine, i.e. the management of chronic diseases. Photographs can help to document the tension between health policy and everyday medical practice.

History, 19th Century↗
PubMed1991

Tax administration as health policy: hospitals, the Internal Revenue Service, and the courts.

Since 1969 federal tax policy has permitted nonprofit hospitals to turn away indigent patients or to transfer them to public hospitals. The Internal Revenue Service made health policy, but its officials remain convinced that they were not making policy at all. Convinced that it was reasoning from legal principles, the Revenue Service accepted the hospital industry's view of the history and purpose of hospitals. The federal courts further obscured the problem. Moreover, the Revenue Service took no interest in the effects of its ruling on the services provided by tax-exempt hospitals until 1989. We describe these events and seek to explain them by linking the recent history of health policy to the assumptions that govern the making of tax policy. We conclude that the making of health policy by tax officials who are not accountable for it and who believe that they are not making policy at all is not in the public interest.

American Hospital Association↗
PubMed1991

Sharing governmental authority: Blue Cross and hospital planning in New York City.

Hospital planning in New York has been since the 1930s an intensely political process with high stakes. The leaders of Blue Cross and their allies used the hospital planning process in the city and the state as a means to extend and protect corporate authority in what they took to be the public interest. When Blue Cross was established in the 1930s, its leaders used the mechanisms of formal planning as part of their solution to pressing problems in the organization and distribution of hospital services. In the decade after World War II, Blue Cross had an immense impact on hospital planning in New York as a result of its growth and its underwriting policies. Conflicts between Blue Cross and state regulators beginning in the 1950s led to a new formulation of the politics of planning. Blue Cross became a partner with the state in regulating hospitals. The state and Blue Cross behaved as co-regulators until the 1980s. The interpretation in this paper revises the earlier accounts of health politics in New York by Law (1976) and Alford (1975).

Blue Cross Blue Shield Insurance Plans↗
PubMed1991

The Milbank Quarterly and health services research, 1977-1990.

This article explores the relationship between the Quarterly and the contemporary history of health services research. Between 1977 and 1990 most of the articles in the Quarterly addressed the dominant concerns of the growing constituency that identified with the newly named field of health services research. However, the Quarterly also reflected its editor's interest in an older tradition of health care reform and public health in the United States and abroad. An analysis of the articles published in the Quarterly in three periods (1977-1981, 1981-1986, 1986-1990) reveals themes that received consistent attention, others that received increasing attention, and still others that were accorded diminished attention. This analysis highlights the value of the Quarterly as a source of insight about the individuals who have written for, edited, guided, and read it.

Forecasting↗
PubMed1990

Chronic disease and disadvantage: the new politics of HIV infection.

HIV infection is now perceived as the end stage of a chronic disease that is spreading most rapidly among blacks and Hispanics. The politics of the HIV epidemic in the 1980s were dominated by four interacting factors: fear and fascination; who had the disease and to whom it seemed to be spreading; the endemic problems of United States social policy; and the impact on policy of advances in scientific knowledge. This paper analyzes the political history of each of these factors and describes the dominant policies of the federal government and the states regarding HIV in the areas of surveillance, prevention, research, and financing. Four uncertainties will have a profound influence on the future politics of the HIV epidemic: how the states and the federal government will address the general problems of paying for the care of people with chronic diseases and providing access to care for the uninsured and the underinsured; the number and distribution of the sexual behaviors that transmit infection with HIV and the effectiveness of policies to persuade people to modify these behaviors; precisely who uses addictive drugs and the effectiveness of measures to change their behavior; and the natural history of the virus.

Chronic Disease↗
PubMed1990

Health policy and the politics of research in the United States.

During the past decade research has been more important to the health policy-making process in the United States than at any time in the past. This article describes and assesses three competing normative models for research on health affairs: economizing, social conflict, and collective welfare. The three models provide a context for the history of research bearing on health policy in the past half century, with particular pertinence to the years since 1980. The article concludes with a discussion of some of the consequences of the new legitimacy of research.

Conflict, Psychological↗
PubMed1990

Financing health care for persons with HIV infection: guidelines for state action.

Financing health care for persons with HIV infection is an increasing burden on states and their taxpayers. The major problems of state policy in the 1990s are how to organize and finance both early detection of infection and preventive drug treatment for persons without symptoms and how to provide a full range of health and social services for infected persons whose life expectancy is unknown. This article first describes the shift in the perceptions of HIV infection from a plague to a chronic disease and the implications of this shift for state government. Then it places the history of financing for health care in the context of general health care financing policy during the past decade. Next it describes the history of state action to finance care for HIV infection, especially the use of of Medicaid Waivers, problems of state financing for expensive prescription drugs, and state initiatives, especially in California, Michigan, New Jersey and New York. Finally, the article presents seven policy questions that states should consider in deciding what, if any, legislation or regulations to enact in order to organize treatment and pay some or all of the costs of care for persons with HIV infection.

Acquired Immunodeficiency Syndrome↗
PubMed1989

Health policy and ERISA: interest groups and semipreemption.

This paper is a history of the health policy results of the Employee Retirement and Income Security Act of 1974, particularly section 514, which preempts state laws "which relate to any employee benefit plan" but permits states to continue to regulate the business of insurance. This history exemplifies how health policy is often made outside conventional arenas. On the basis of published primary sources and interviews with a number of key participants, the paper describes how interest groups which rarely act together coalesced to create and sustain semipreemption and its effects on state and federal health policy. The paper concludes with an assessment of recent state legislative efforts to address the problems created by ERISA semipreemption. The ironical results of semipreemption occurred because of the absence of a coalition of interest groups that was sufficiently strong to resolve the fundamental questions raised by our commitment to linking health insurance to employment.

Health Benefit Plans, Employee↗
PubMed1989

Policy and epidemiology: financing health services for the chronically ill and disabled, 1930-1990.

The six-decade rise in chronic disease and disability, along with interested parties and their beliefs about duly organized health care, shaped financing policy for American health services. If by the late 1930s some scientists and health experts convinced other colleagues to recognize the prominence of chronic illness, physicians and hospital leaders took ten more years to view the management of those illnesses as a major priority, largely owing to prevailing payment schemes. Chronic disease, since the introduction of Medicare and Medicaid, has become the key focus of insurer and public health care financing. Added incentives for disease prevention and treatment in less costly settings, and recalculation of doctors' fees, may lead to meeting the growing chronic care demands without sharp cost increases.

Blue Cross Blue Shield Insurance Plans↗
PubMed1989

The history of responses to epidemic disease in the United States since the 18th century.

History offers some guidance for understanding social and policy responses to the AIDS epidemic. Pertinent themes in the history of responses to epidemic disease in the United States in the past two hundred years include an initial underestimation of the severity of the epidemic; the prevalence of fear and anxiety; flight, denial, and scape-goating as a result of fear; efforts to quarantine and isolate carriers and the sick; the assertion of rational policies by coalitions of business, government, and medical leaders; the recruitment of a special cadre of physicians to treat the sick; the similarity of responses to both epidemic and endemic infectious diseases; and the high cost of epidemics, which is shared by government, philanthropy, and private individuals. However, until more is known about the natural history of AIDS, generalizations about past epidemics must be cautiously applied to our present circumstances.

Acquired Immunodeficiency Syndrome↗