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Biomedical subjects

Mark Schlesinger

Publications and source records attributed to Mark Schlesinger.

At least 37 records · Page 2Linked to original sources
PubMed2004

Translating research into practice: speeding the adoption of innovative health care programs.

For this study, the authors conducted case studies of four varied clinical programs to learn key factors influencing the diffusion and adoption of evidence-based innovations in health care. They found that the success and speed of the adoption/diffusion process depend on: the roles of senior management and clinical leadership; the generation of credible supportive data; an infrastructure dedicated to translating the innovation from research into practice; the extent to which changes in organizational culture are required; and the amount of coordination needed across departments or disciplines. The translation process also depends on the characteristics and resources of the adopting organization, and on the degree to which people believe that the innovation responds to immediate and significant pressures in their environment.

Decision Making, Organizational↗
PubMed2003

Measuring community benefits provided by nonprofit and for-profit HMOs.

Despite the dramatic shift from nonprofit to for-profit ownership in the managed care industry, little is known about the implications for health plans' relations with the communities in which they operate. This paper provides the first comprehensive comparison of the community benefit activities of nonprofit and for-profit health maintenance organizations (HMOs). We develop a conceptual framework for identifying these activities and provide evidence from a nationally representative survey of plans fielded in 1999. We find that nonprofit plans exceed their for-profit counterparts on some, but not all, aspects of community benefit activity. The most consistent ownership-related differences involve redistributive programs (subsidized services and general philanthropy), commitments to medical research, and services that benefit the entire local population, beyond the plan's enrollees. Other forms of community benefits show mixed or modest differences between nonprofit and for-profit plans. Unexpectedly, for-profit plans actually appear more active in helping consumers deal with information asymmetries. The paper concludes with a discussion of implications for policy and future research.

Community Health Planning↗
PubMed2002

Clinicians as advocates: an exploratory study of responses to managed care by mental health professionals.

Utilization review and other managed care techniques require that health care professionals assume new responsibilities as patient advocates. This article explores the extent to which characteristics of providers or their experiences with managed care practices predict the nature and extent of advocacy behavior. Interviews of 142 mental health providers revealed that experiences of harmful utilization review and norms of professionalism significantly predicted advocacy behavior. However, providers who were concerned about disaffiliation were less likely to challenge the plan directly but more likely to alter their presentation of the case to reviewers. Providers who believe that managed care plans retaliate against advocacy behavior appear to substitute covert advocacy for direct advocacy. These results are preliminary but suggest that providers condition their advocacy behavior in response to their experiences with and perceptions of managed care plans.

Behavioral Medicine↗
PubMed2002

Not afraid to blame: the neglected role of blame attribution in medical consumerism and some implications for health policy.

A crucial aspect of medical consumerism has been overlooked in past research and policymaking: how consumers decide whom to "blame" for bad outcomes. This study explores how, in a system increasingly dominated by managed care, these attributions affect consumers' attitudes and behavior. Using data from the experiences of people with serious mental illness, hypotheses are tested regarding the origins and consequences of blaming for medical consumerism. Blame was allocated to health plans in a manner similar, but not identical, to the way in which blame was allocated to health care professionals. Both allocations are shaped by enrollment in managed care, with blame allocation affecting consumers' subsequent willingness to talk about adverse events. Policy implications include the need for more finely tuned grievance procedures and better consumer education about managed care practices.

Attitude to Health↗
PubMed2002

Voices unheard: barriers to expressing dissatisfaction to health plans.

Consumers dissatisfied with their health plan can either "exit" (switch service providers) or "voice" (complain to the current provider). Policymakers' efforts to help consumers voice their dissatisfaction to health plans or external mediators have been disappointing, in part because little is known about the determinants of voice. This article represents the first comprehensive assessment of voicing in response to problematic experiences with health plans. A national consumer survey from 1999 is used to test hypotheses about characteristics of problems, patients, and settings that might inhibit voice and assess state regulations intended to enhance voice. Although problems associated with plans led to more voice than exit, voice is circumscribed by several factors: certain groups, such as racial minorities, do not express their grievances as often; episodes with severe health consequences for patients are not reported as regularly. The findings suggest that even though regulatory initiatives have not increased the frequency of voice, they have made grievances more effective, at least in jurisdictions where citizens know about the laws.

Adult↗
PubMed2002

A loss of faith: the sources of reduced political legitimacy for the American medical profession.

The political legitimacy and policymaking influence of the medical profession have greatly declined in American society over the past 30 years. Despite speculation about the causes, there has been little empirical research assessing the different explanations. To address this gap, data collected in 1995 are used to compare attitudes of the American public and policy elites toward medical authority. Statistical analyses reveal that (1) elites are more hostile to professional authority than is the public; (2) the sources of declining legitimacy are different for the public than they are for policy elites; and (3) the perceptions that most threaten the legitimacy of the medical profession pertain to doubts about professional competence, physicians' perceived lack of altruism, and limited confidence in the profession's political influence. This article concludes with some speculations about the future of professional authority in American medicine.

Attitude to Health↗
PubMed2002

Policy feedback and public opinion: the role of employer responsibility in social policy.

This study extends the literature on policy feedback and explores the extent to which public attitudes reflect learning from past government initiatives. We analyze the ways in which feedback mechanisms affecting public attitudes may differ from those earlier identified in the literature. We apply this general analytic framework to help explain variation in public attitudes toward private employer involvement in health care, explore possible causal pathways, and offer some preliminary empirical tests of these hypotheses. There are different levels of public support for the notion of employer obligation involving medical care, long-term care, and the treatment of substance abuse. Our evidence suggests that lessons about the performance of institutions in each of these policy domains represent the most important effect of existing policy on public attitudes. Furthermore, these differences correspond to what one would expect based on our model of policy feedback and cannot be explained by other plausible sources of policy legitimacy.

Attitude to Health↗
PubMed2002

On values and democratic policy making: the deceptively fragile consensus around market-oriented medical care.

Market-oriented strategies, embodied in managed competition, have become the primary focus of contemporary U.S. health policy. This dominance reflects the emergence of a bipartisan coalition of support among political elites. This study traces the historical evolution of elite support for the market and suggests that the consensus favoring managed competition is deceptively fragile, with support riven by cleavages in the values used to judge fairness in the allocation of medical care. A unique data set of matched questions asked of both policy elites and the general public is used to document these differences in ethical norms. The implications of these cleavages help to explain three puzzling aspects of contemporary U.S. health policy: (1) the persisting inability to translate the principles of managed competition into politically feasible reforms, (2) the repeated failures to implement demonstration projects intended to test competitive pricing within the Medicare program, and (3) the inability of state regulations to assuage the public's concerns about managed care. Some prescriptions for a more revealing and effective treatment of market reforms in health policy conclude this study.

Consensus↗
PubMed1993

Is health care different? Popular support of federal health and social policies.

Over the past several years there has been a striking increase in policy-makers' attention to health care reform. This paper explores whether there has been a corresponding shift in popular attitudes and identifies factors that may have changed these attitudes. The first part of the analysis relies on survey data collected between 1975 and 1989 to estimate a set of regression models, relating support for federal involvement in health care, antipoverty programs, and general domestic policies to a set of sociodemographic characteristics.... The second part of this study explores motivations that might account for these patterns. We identify a half dozen ways in which health care may be viewed as "different," that is, more or less appropriate for federal action. Analysis of survey data from 1987 suggests that there are relatively small differences in the attitudes and perceptions that motivate support for federal health initiatives, relative to federal domestic policies in general. However, there are more striking differences between health programs and more overtly redistributive policies.... We suggest that the growing support for federal intervention in health care, relative to other social policies, is in part an inadvertent by-product of ideological positions popularized during the Reagan and Bush administrations. We draw from these results some predictions about the course of the ongoing debate over federal health policies.

Altruism↗
PubMedDate not supplied

A broader vision for managed care, Part 3: The scope and determinants of community benefits.

Managed care plans have been encouraged to address the health of the communities in which they are located. This paper presents the first nationally representative portrait of health maintenance organizations' (HMOs') community benefit activities, based on survey data from 1999. We found that HMOs were engaged in a wider variety of community involvements than were identified in past legal decisions and legislation defining "community benefits" for health plans. The scope of community activities was broader for HMOs that enroll Medicaid recipients, are influenced by local business leaders, operate under nonprofit ownership, and are located in states with community benefit reporting laws.

Community-Institutional Relations↗
PubMedDate not supplied

Public expectations of nonprofit and for-profit ownership in American medicine: clarifications and implications.

Policymakers, advocates, and scholars frequently make claims about how the American public sees ownership affecting the delivery of medical care. In this paper we provide a comprehensive assessment of how Americans think about nonprofit and for-profit ownership. We summarize findings from surveys fielded between 1985 and 2000 and supplement them with findings from a new survey. Most Americans believe that ownership matters for multiple aspects of medical care; they expect nonprofit hospitals and health plans to be more trustworthy, fair, and humane but lower in quality. People who are better informed about ownership have more positive expectations about nonprofits' performance.

Delivery of Health Care↗