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Biomedical subjects

J D Kleinke

Publications and source records attributed to J D Kleinke.

At least 19 recordsLinked to original sources
PubMed2005

Evidence-based medicine: health care's next holy war.

OBJECTIVE: To review evidence-based medicine (EBM), how it emerged, how it works, and what drug utilization patterns across the United States would look like if we applied EBM methods to this population. SUMMARY: There is a collective presumption about the overuse of pharmaceuticals, unchallenged by any substantive data, that has become part of American folklore: high drug use by people in this country actually represents overuse. This presumption is completely unfounded. On the contrary, a recent analysis carried out by the RAND Corporation indicated that fewer than 70% of people in the United States with chronic illness receive adequate medical treatment. CONCLUSIONS: The flow of almost all medical research strongly supports the conclusion that more medicine is better. EBM has ably pointed out that too many patients receive unneeded diagnostic and surgical procedures. It will also demonstrate that too few patients receive appropriate medical care.

Cost-Benefit Analysis↗
PubMedDate not supplied

Deconstructing the Columbia/HCA investigation.

Every issue raised by the current investigation into the business practices of Columbia/HCA serves as a signpost for the progress and problems inherent in market-driven health care reform. Actions against Columbia/HCA by regulators reveal deeply rooted resistance to the profit-motivated reforms embodied in the company's philosophy: the public's reluctance to accept necessary reductions in excess hospital capacity; the legal and cultural obstacles to the overdue alignment of physician and hospital economic interests; and the myriad reimbursement and accounting problems involved in the vertical integration of health care delivery. The investigation also underscores the antiquation of the reimbursement mechanisms and control systems in place for financing the delivery of care to Medicare beneficiaries.

Economic Competition↗
PubMedDate not supplied

Release 0.0: clinical information technology in the real world.

The industrialization of medical care delivery, compelled by fifteen years of reimbursement reform, has given rise to a commercial health information technology (HIT) industry. Well financed by Wall Street, the HIT industry offers a variety of ready-made solutions designed to transform a health care organization's raw data resources into useful clinical information. Many of the resulting clinical decision-support products are encumbered by numerous insurmountable intellectual and technical problems and, as a consequence, meet with cultural resistance from physicians. The long-awaited but costly implementation of electronic medical records (EMRs) will make these pioneering but flawed efforts obsolete, if EMR development successfully exploits recent technological breakthroughs and the ongoing consolidation of health care organizations.

Attitude of Health Personnel↗
PubMedDate not supplied

Just what the HMO ordered: the paradox of increasing drug costs.

Drug companies argue that newer, more expensive drugs offset other medical costs; health plans counter that they increase pharmacy costs more than they offer a "pharmacoeconomic" benefit. Neither side is universally right or wrong, and neither has the data to support its case. Increasing drug costs for selective therapeutic classes represent the fulfillment of managed care's original promise. Certain therapeutic classes of drugs offer pharmacoeconomic benefit, while others represent induced costs in excess of this benefit. Health maintenance organizations (HMOs) should determine one from the other and incorporate these findings into their plan designs; multitier drug coverage is the best method to achieve this.

Cost Control↗
PubMedDate not supplied

Vaporware.com: the failed promise of the health care Internet.

Contrary to the claims of its well-financed promoters, the Internet will not solve the administrative redundancies, economic inefficiencies, or quality problems that have plagued the U.S. health care system for decades. These phenomena are the result of economic, organizational, legal, regulatory, and cultural conflicts rooted in a health care system grown from hybrid public and private financing; cultural expectations of unlimited access to unlimited medical resources; and the use of third-party payers rewarded to constrain those expectations. The historic inadequacy of information technology to solve health care's biggest problems is a symptom of these structural realities, not their cause. With its revolution of information access for consumers, the Internet will exacerbate the cost and utilization problems of a health care system in which patients demand more, physicians are legally and economically motivated to supply more, and public and private purchasers are expected to pay the bills.

Delivery of Health Care↗
PubMedDate not supplied

The price of progress: prescription drugs in the health care market.

Pharmacy costs are rising in excess of general and medical cost inflation, leading to calls for price and utilization controls by public and private payers. Such controls would be ineffective and counterproductive because they would attempt to reverse two profound, historic phenomena at work in the U. S. health care system. The added costs associated with breakthrough medicines represent a major structural shift from the provision of traditional medical services to the consumption of medical products; they also represent the creation of economic, social, and public health utility that we value as a society. The balkanization of medical delivery, institutionalized under traditional reimbursement strategies and galvanized by federal law, does not adequately account for or efficiently accommodate this rotation and increased utility. Federal and state laws regulating health insurance and provider risk sharing need to be revamped to encourage rather than constrain the social progress embodied in expensive, breakthrough medical technologies.

Economics, Pharmaceutical↗
PubMedDate not supplied

Access versus excess: value-based cost sharing for prescription drugs.

The preponderance of published medical literature and clinical guidelines compels the expansion of pharmaceutical use among Americans, at the same time that private and public health plans seek to restrict such use. The emerging collision course between the march of medical science and the countermarch of medical policy arises from diverging views about the optimal use of drugs and growing philosophical conflict over the abundance and inequities that characterize the U.S. health care system. The consequent turmoil in the market's approach to managing drug benefits can be remedied through adoption of a value-based (rather than price-based) approach to pharmaceutical spending.

Biomedical Research↗