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Biomedical subjects

L L Curtin

Publications and source records attributed to L L Curtin.

At least 19 recordsLinked to original sources
PubMed2000

2000 and beyond: a perspective.

There once was a beautiful city in which the people were prosperous and, for the most part, happy. However, there was a very high road that perched precariously along the rim of a deep canyon. A number of people slipped and fell over the edge and were killed. Others were injured in the fall, some very seriously. The medical establishment of this fine city developed a superb emergency response team, built and staffed several trauma centers, and designed efficient rehabilitation facilities. As the population of the city grew, proportionately more people fell off the cliff. The medical establishment gained more experience and devised ways to save people who previously would have died. However, certain people thought of another possibility: Why not erect a fence at the top of the cliff? When they voiced the idea, many were quite disturbed. The ambulance drivers weren't keen on the idea, neither were the ambulance manufacturers, nor were those who made their living in the hospital industry. The medical authorities explained that the problem was far more complex than people realized, that building a fence was far from practical, and that health was far too important to be left in the hands of people who were not experts. "Leave it to us," they said, "for soon we will genetically engineer people who do not bruise or become injured by such falls." So, no fences were built and, as time passed, this city found itself spending more money on medical care than anyone in the history of the world. As the price of treating people kept rising, many people could not afford medical care....

Humans↗
PubMed1999

The impact of market-based 'reform' on cultural values in health care.

The many issues managed care poses for providers and health networks are crystallized in the moral problems occasioned by its shifting of the financial risks of care from insurer to provider. The issues occasioned by market-based reform include: the problems presented by clashes between public expectations and payer restrictions; the corporatization of health service delivery and the cultural shift from humanitarian endeavor to business enterprise the depersonalization of treatment as time and money constraints stretch resources, and the culture rewards efficient "business-like" behavior the underfunding of care for the poor and uninsured, even as these populations grow the restructuring of care and reengineering of healthcare roles as the emphasis shifts from quality of care to conservation of resources rapid mergers of both health plans and institutional providers with all the inherent turmoil as rules change, services are eliminated, and support services are minimized to save money the unhealthy competition inherent in market-based reform that posits profit taking and market share as the measures of successful performance the undermining of the professional ethic of advocacy the use of incentives that pander to greed and self-interest. The costs of sophisticated technologies and the ongoing care of increasingly fragile patients have pulled many other elements into what previously were considered "privileged" professional interactions. The fact that very few citizens indeed could pay out-of-pocket for the treatment and ongoing care they might need led to social involvement (few people remember that both widespread health insurance and public programs are relatively recent phenomena--only about 30 years old). However, whether in tax dollars or insurance premiums, other people's money is being spent on the patient's care. Clearly, those "other people" never intended to give either the patient or the professional open-ended access to their collective pocketbooks. Just what form their involvement ought to take is being tested as "managed care" attempts to control the costs. What limits are acceptable to providers?: lower profit margins? quality controls? acceptable risk levels? To patients?: restricted choice? restricted mobility? restricted access to high tech? And to the general public?: decreased access to high tech? higher taxes? underserved populations? Abandonment of the sick or poor? Which "techniques" are acceptable, and which are not?: risk-sharing with providers? financial incentives for decision makers? rationing access? imposing behavioral parameters? The issues posed by market-based managed care cannot be adequately addressed merely in terms of social resources, nor will answers be found in subordinating human rights to practical materialism. Negotiating ethical guidelines for the "safe" handling of such problems to the good of individuals and of society requires a revitalization of the "old" values: the old commitment to master craftsmanship and altruism, the old emphasis on patient advocacy and human rights. However, these old values must be applied with the "new" knowledge of lifestyle choices (and thus personal responsibility), likely outcomes (and thus reasonable options), and the limits of success (and thus fair redeployment of health resources).

Attitude to Health↗