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Biomedical subjects

David Barton Smith

Publications and source records attributed to David Barton Smith.

6 recordsLinked to original sources
PubMed2006

Racial disparities in care: the concealed legacy of a divided system.

BACKGROUND AND OBJECTIVES: New national initiatives to end racial disparities in health could benefit from the experience with Title VI enforcement in the Medicare Program. GOALS: The goals of this study were to describe events in a test case to extend Medicare Title VI conditions for hospitals to the practice patterns of its medical staff and how the outcome shaped disparities. METHOD: This article distills interviews, archives, and secondary data sources. STUDY DESIGN: This study is an historical narrative. RESULTS: The test case was a costly failure. Although the Title VI effort eliminated segregation on hospital floors and equalized overall use, physician practice patterns were left unexamined, contributing to the persistence of disparities in treatment. CONCLUSIONS: If current efforts are to be successful, they will need to 1) address the structural issues that shape disparities, 2) pay particular attention to reengineering care in ways that overcome historic patterns, and 3) ensure a greater degree of accountability.

Alabama↗
PubMed2005

The politics of racial disparities: desegregating the hospitals in Jackson, Mississippi.

As health care policymakers and providers focus on eliminating the persistent racial disparities in treatment, it is useful to explore how resistance to hospital desegregation was overcome. Jackson, Mississippi, provides an instructive case study of how largely concealed deliberations achieved the necessary concessions in a still rigidly segregated community. The Veterans Administration hospital, the medical school hospital, and the private nonprofit facilities were successively desegregated, owing mainly to the threatened loss of federal dollars. Many of the changes, however, were cosmetic. In contrast to the powerful financial incentives offered to hospitals to desegregate and ensure equal access in the early years of the Medicare program, current trends in federal reimbursement encourage segregation and disparities in treatment.

Hospitals↗
PubMed2005

Going backward into the future.

Racial and ethnic disparities in medical treatment persist 40 years after passage of Medicare and Medicaid legislation. Concerns about rising healthcare costs have overshadowed efforts to eliminate inequality in treatment. Eliminating disparities in treatment requires linking goals with financial incentives.

Delivery of Health Care↗
PubMedDate not supplied

Racial and ethnic health disparities and the unfinished civil rights agenda.

Civil rights-era efforts to end disparities in health care in federally financed health programs faced three successively more difficult challenges: (1) ending Jim Crow practices, (2) eliminating more subtle forms of segregation, and (3) assuring nondiscriminatory treatment in integrated settings. Federal efforts peaked with the implementation of the Medicare program. Visible symbols of Jim Crow disappeared, and most crude disparities in access were eliminated. The unfinished parts of the civil rights-era agenda, the persistence of more subtle forms of segregation, and the failure to assure nondiscriminatory treatment pose major challenges to current efforts to eliminate health care disparities.

Civil Rights↗
PubMedDate not supplied

The perils of healthcare workforce forecasting: a case study of the Philadelphia metropolitan area.

In 1996, a widely circulated and influential forecast for the Philadelphia Metropolitan Area stated that a decline in hospital and healthcare employment in the region would occur over the next five years. It also suggested that this decline would exacerbate the problem of an oversupply of nurses seeking hospital employment. The forecast reflected a regional leadership and expert consensus on the impact of the managed care transformation on workforce needs and was supported by short-term statistical trends in regional utilization and employment. Confounding these predictions was the fact that hospital and healthcare employment actually grew. By the end of 2001, hospitals in the region were experiencing problems in recruiting sufficient numbers of nurses, pharmacists, and technicians. The forecast failed to anticipate the impact of a strong regional economy on supply and underestimated the resilience of underlying forces that have driven the long-term growth in healthcare workforce demand. More effective ongoing monitoring can help moderate the fluctuation of workforce shortages and surpluses.

Adult↗