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Biomedical subjects

M Krasner

Publications and source records attributed to M Krasner.

10 recordsLinked to original sources
PubMed1977

Cost factors in urban telemedicine.

This paper reports on the cost effectiveness of a pediatric primary care system utilizing nurse practitioners (NPs) linked to a physician consultant through bidirectional interactive cable television. In addition, it discusses ways in which multiple uses enhance the economic feasibility of a telemedicine consultation link in a given geographic area. The overall consultation rate during periods of remote physician coverage was 21 per cent, compared with 24 per cent during on-site coverage. The telephone became a partial substitute for the TV for some uses but could not replace it in diagnostic decisions. As telemedicine is obviously underutilized in a one-satellite system, we compare a five-satellite network with other ways of delivering service. The resulting estimated cost of $18.50 an hour, or 2/3 of the cost of a physician providing direct care, includes a TV component of $5.30 an hour of use in a 1,750-hour year. The critical factor is that the NP can be a physician substitute if there is TV backup. The TV appears to prevent unnecessary referrals compared to a physician on site. Whether TV increases the length of the consult compared to the phone for conditions of equal severity is not entirely clear. If TV is compared to transporting a patient to a central place, the implicit value of transport time and disutility required to justify using TV is $7.55 per consult in a five-clinic network. Geographic and other barriers to physician availability enhance the potential for application fo telemedicine.

Child↗
PubMed1977

New health practitioners and dermatology manpower planning.

To assess the need for dermatologists in the United States, the potential role of new health practitioners in this specialty is considered. Available data on physician extenders in general and informed opinion on dermatologist extenders in particular suggest that specially trained, nonphysician personnel could substantially augment the supply of dermatological services. At present, however, widespread adoption of new staffing patterns appears unlikely. A long-run trend toward greater use of all categories of ancillary personnel in this specialty is expected, and the profession is urged to play an early and active role in this trend's development.

Allied Health Personnel↗
PubMed1977

National dermatology manpower requirements: the experience of prepaid group practices.

Ten prepaid group health plans across the country were surveyed as part of an effort to estimate the need for dermatologists in the United States. Although generalizing the experiences of prepaid group practices to the general population is at best an imprecise approach, the dramatic shortage suggested by the data cannot be completely ascribed to the method used. Whereas the average ratio in the surveyed plans was 2.8 dermatologists per 100,00 subscribers, there are only about 1.9 dermatologists providing patient care per 100,000 persons in the general population. The difference between prepaid plan subscribers and the general population in annual visits to dermatologists is even more dramatic: 193 per 1,000 subscribers compared to 84 per 1,000 population.

Dermatology↗
PubMed1977

Dermatologists for the nation. Projections of supply and demand.

Because inappropriate supply of physician specialists involves unnecessary human suffering or waste of human resources and because free market forces are ineffective in the medical sector, deliberate planning of supply is necessary. A model projecting the future supply of dermatologists was formulated on the basis of current residency capacity, which produces 250 dermatologists annually, and current experience regarding life expectancy and retirement. The model implies that an equilibrium supply of 8,800 dermatologists, or three per 100,000 population, will be realized early in the 21st century. A number of methods were used to estimate the demand for care, and, under conditions of general access, three dermatologists per 100,000 appear to be appropriate. Thus, maintaining current training capacity seems to be prudent, but because of many unknown and unpredictable factors, periodic reassessment is necessary.

Adolescent↗
PubMed1975

An index of insurance adequacy for fertility-related health care.

Health insurance plans are evaluated here in terms of ability to guarantee financial access to a set of basic fertility-related health services. Extent of coverage is determined by whether a service is a contract benefit, its market cost, and how often it is used in a given population in one year. Comprehensive coverage removes a deterrent to utilization of preventive care such as well-baby visits, prenatal care, and family planning. In a total population of women of child-bearing age, each is likely to need some fertility-related care in a given year. The method of calculating adequacy involves using best available estimates of deliveries, abortions, etc. per 1,000 women, and, within each category, of components such as cesarean section. Local or national cost data can be used to derive an average cost per service and an aggregate for a group. The method of comparing this with plan benefits depends on the way benefits are expressed. Jacksonville, Fla. medical market data were used in a trial of the method on a plan for Federal employees, which shows 70 per cent coverage of estimated expense.

Abortion, Induced↗