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Biomedical subjects

D W Light

Publications and source records attributed to D W Light.

At least 19 recordsLinked to original sources
PubMed1999

Good managed care needs universal health insurance.

Although the increase of corporate managed care has helped to reduce excesses and costs, continued gains in cost-effectiveness depend on good clinically managed care. Benefits of clinically managed care depend on stable contracts and universal coverage. Instead, employers are decreasing coverage and creating a market of "lemons" in which low-cost plans are rewarded for cost-cutting tactics. These tactics have spawned movements that demand rights for patients and providers. Choosing to shore up those rights, however, will increase the number of uninsured persons. This tragic choice, which no other industrialized nation has permitted, will not be resolved until some form of universal health insurance is implemented.

Cost Control↗
PubMed1998

Keeping competition fair for health insurance: how the Irish beat back risk-rated policies.

OBJECTIVES: This paper describes how Ireland created a level playing field for competition in health insurance, the strategies of a major insurer to introduce risk-rated policies that would segment the market, the successful campaign to block these policies, and the policy implications of the European Union requirement of competition in health insurance. METHODS: Policy documents, interviews, and press reports were analyzed. RESULTS: The minister of health forced the commercial insurer to withdraw its policies and replace them with community-rated policies. CONCLUSIONS: Because it is easier and more profitable for insurers to engage in risk selection than to become more efficient, beneficial competition in health insurance markets is extremely difficult to create. Carefully drawn rules and monitoring are required to overcome inherent causes of market failure. The current enthusiasm for saving money through competitive schemes in health insurance seems likely to produce higher costs and greater inequality.

Adolescent↗
PubMed1998

Managed care in a new key: Britain's strategies for the 1990s.

The new Labour government in Britain has issued three variations of a White Paper that outline significant changes in how the world's largest managed care health system will be run. All three emphasize systemwide criteria for quality, effectiveness, and health gain, which in turn imply redressing past inequalities in funding and service. One, the Scottish Paper, eliminates Thatcher's internal market and returns to a simple organizational structure centering on the health boards. The other two propose combining primary care practices into purchasing groups, a daunting task that will spawn many new problems and expenses as it recreates the internal market.

Budgets↗
PubMed1997

From managed competition to managed cooperation: theory and lessons from the British experience.

The United Kingdom led the world in transforming the largest single health care system from a publicly administered service to a set of interlocking contracts. Policy lessons that can be adapted by employers, nations, and other large payers are identified. These lessons are drawn from the improvements that the British made over the design of managed competition, the mistakes and problems they experienced, the underlying trends toward privatization and class discrimination, and the limitations to competition that have led the British toward managed cooperation in collaborative purchasing for the health needs of communities. Yet market reform and the rhetoric of efficiency have justified the shrinking of health services, the shift of costs to household budgets, and the use of public moneys to support private services and investors at greater expense by moving properties and services off the public ledger. In these ways, managed competition can Americanize health care and pose fundamental questions about what policy goals are really being pursued.

Cooperative Behavior↗
PubMed1997

Managed care.

Explore the source record for details and available documents.

Health Care Reform↗
PubMed1997

The rhetorics and realities of community health care: the limits of countervailing powers to meet the health care needs of the twenty-first century.

As the paradox of medical success leaves behind more chronicity, policy makers around the world increasingly focus on community-based programs both to address chronic health problems and to prevent major disorders. This essay presents my comparative sociological framework of ideal-type models for understanding the countervailing powers that underlie and shape different kinds of heath care systems and their limitations in addressing the health care needs of the twenty-first century. In this context, I then analyze the revival of community health care rhetoric in the United States and compare it to the realities in which it operates. The realities of institutional power, fragmentation in funding, illness as a private condition and health care as a private good, the lack of societal commitment, competition, and the waning of community cohesion all suggest that communal democracy will be difficult to achieve. Current successes require further investigation. Examples from abroad suggest, ironically, that community health care develops best if the state and health professionals make a deep commitment to it, against their own immediate interests but for their enlightened self-interest.

Community Health Services↗
PubMed1995

Professional dynamics and the changing nature of medical work.

The organization and delivery of health care in the United States is undergoing significant social, organizational, economic, political, and cultural changes with important implications for the future of medicine as a profession. This essay will draw upon some of these changes and briefly review major sociological writings on the nature of medicine's professional status to examine the nature of professional dynamics in a changing environment. To this end, we focus on the nature of medical work and how this work impacts on and is impacted by medicine's own internal differentiation and the presence of contested domains at medicine's periphery. We trace this dynamic through a number of issues including the multidimensional nature of medical work, the role of elites in that work, and how changes in the terms and conditions of work can exert changes at medicine's technical core. We close with some thoughts on the relationship of public policy to medicine's professional status, the role health policy might take in shaping a new professional status, the role health policy might take in shaping a new professional ethnic for medicine, and the role sociologists might play in this process.

Delivery of Health Care↗
PubMed1994

Barriers to out-of-hospital care for AIDS patients.

Inappropriate delays in hospital discharge for AIDS patients add to the expense of health care, as well as to the stress felt by the patient. It has been postulated that delays are due to a lack of suitable out-of-hospital services and weak patient support networks. The charts of AIDS patients discharged from hospitals in northern New Jersey and southern New Jersey/Philadelphia, PA between 3/88 and 1/90 (n = 601 discharges for 454 patients) were examined to determine the discharge services or goods which were ordered and/or received, the extent of actual delay, and the causes of these delays. While regional variations were evident, differences in the profession of the discharge planner were associated with having care ordered and received and delays in discharge; as were availability of a support system, presence of a case manager, and race. A nurse or a social worker (as compared to a doctor as discharge planner) were more likely to effectively order and arrange out-of-hospital care, and were thus more likely to experience delays in hospital discharge. Failures of physicians to make timely requests for care were also associated with delays. Recommendations for future research were made.

Acquired Immunodeficiency Syndrome↗
PubMed1992

The practice and ethics of risk-rated health insurance.

Health insurance in the United States is driven by competitive risk rating and is promoted as the best way to give policyholders optimal value for their money and to be fair to those with lower risks. In practice, however, competitive risk rating costs more than noncompetitive, universal systems of health insurance, and it erodes the basic function of insurance to spread infrequent large losses over a wide base. This article describes not only how risk rating covers least those with the greatest medical bills, but also how it has spawned a labyrinth of complex manipulations by insurance companies to charge more or pay less than actuarially fair risk rating would justify. The final section shows that even if risk rating were done fairly, it contradicts moral fairness. Many of the leading proposals for national health insurance do not address these practical and ethical issues. The medical profession and policymakers need to discuss them and take a stand on them.

Actuarial Analysis↗
PubMed1992

Equity and efficiency in health care.

Adam Smith's belief that markets will make society more equitable and efficient is examined in the case of reforms to make health care more competitive. Eight ways in which health care does not often satisfy the requirements for competitive markets, and nine ways in which providers can manipulate markets are identified. The concept of 'embedded inefficiencies' is introduced to explain why competition may not increase efficiency.

Contract Services↗