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Biomedical subjects

W M Sage

Publications and source records attributed to W M Sage.

18 recordsLinked to original sources
PubMed1999

Disclosing physician financial incentives.

Federal and state regulatory initiatives as well as court decisions increasingly require managed care organizations to disclose physician financial incentives and have raised the issue of disclosure by physicians themselves. These mandates are based on ethical and legal principles arising from the patient-physician relationship and the relationship between health plan sponsors and enrollees. Disclosing incentives also serves important policy objectives: it can inform enrollees' choice of plan, reinforce enrollees' capacity to understand and exercise other rights under managed care, and discourage use of compensation methods that might compromise patients' access to treatment. However, significant conceptual and practical questions remain about implementing a disclosure mandate. Unresolved issues include the timing, content, and scope of disclosure, the relationship of disclosure to patients' substantive rights, and the impact of disclosure on trust between patients and physicians. These uncertainties exemplify the challenges facing policymakers, plans, and physicians as they determine how best to inform patients about managed care.

Conflict of Interest↗
PubMed1999

Regulating through information: disclosure laws and American health care.

Efforts to reform the American health care system through direct government action have failed repeatedly. Nonetheless, an alternative strategy has emerged from these experiences: requiring insurance organizations and health care providers to disclose information to the public. In this Article, Professor Sage assesses the justifications for this type of regulation and its prospects. In particular, he identifies and analyzes four distinct rationales for disclosure. He finds that the most commonly articulated goal of mandatory disclosure laws--improving the efficiency of private purchasing decisions by giving purchasers complete information about price and quality--is the most complicated operationally. The other justifications--which he respectively terms the agency, performance, and democratic rationales--hold greater promise, but make different, sometimes conflicting assumptions about the sources and uses of information. These insights have implications not only for health care, but also for other regulated practices and industries.

Decision Making↗
PubMed1996

'Health law 2000': the legal system and the changing health care market.

The failure of national health reform confirmed in many ways the conservative nature of the American legal system. Legislatures, regulatory agencies, and courts usually find themselves in a reactive posture, responding to groups and individuals aggrieved by changing circumstances. The rapid transformation of the U.S. health care system through managed care presents an extreme example of this phenomenon, involving billions of dollars, millions of lives, and thousands of existing laws. Over the next few years the legal system will face a host of difficult issues deriving from the integration of health care financing and delivery, and the consolidation of fragmented providers into large corporations and contractual networks. What emerges may be neither logical nor consistent but no doubt will reflect the intricate interplay of societal and individual interests in health care.

Contract Services↗
PubMed1994

Outcomes research.

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Health Care Costs↗
PubMed1988

Physician-generated cost containment in transurethral prostatectomy.

Cost containment need not be imposed on physicians by government, insurance companies and hospital administrators. Decreases in hospital cost can be achieved voluntarily by physicians without sacrificing quality of care, especially for common procedures with relatively homogeneous patient populations, such as transurethral prostatectomy. Variations in existing practice were identified and shared, and optimal scientific practice was discussed at 5 meetings of the division of urology during a 16-month period. Strict guidelines were not developed; surgeons were encouraged to apply cost-related knowledge individually. Resource use was measured before, during and after the intervention. A total of 356 transurethral prostatectomies was studied. There were significant decreases in preoperative and postoperative length of stay, specific ordering practices and total hospital charges. University faculty differed from community urologists and individual surgeons varied considerably. Suggestions for scientific cost management in prostatectomy are presented.

California↗
PubMed1987

Intensive care for the elderly: outcome of elective and nonelective admissions.

Survival, quality of life, and need for continuing medical care were evaluated for 134 elderly patients admitted to the intensive care units (ICU) at Stanford University Hospital and for a control group. Of the patient group, 57.5% were admitted to the ICU following elective surgery; 42.5% were emergency surgical and medical patients. Hospital mortality was 3.9% for elective and 22.8% for nonelective patients; 18-month mortality was 13.0% and 47.4%, respectively. Fifty-nine patients (60.8% of survivors) completed follow-up questionnaires. Subjective and objective quality of life was good. Quality of life was slightly worse for ICU survivors than for controls; elective and nonelective patients did not differ significantly. Although the cost of ICU hospitalization was high, additional medical care was not excessive. Nonelective patients required more continuing care than elective patients, and both groups required more than controls.

Activities of Daily Living↗
PubMed1986

Is intensive care worth it? An assessment of input and outcome for the critically ill.

The high cost of treatment in an ICU is clearly recognized; the ultimate benefit of that care in prolonging meaningful life is not as well quantified. We evaluated 337 mixed medical-surgical ICU patients for severity of illness and intensity of therapy and assessed their survival and quality of life 16 to 20 months after discharge. Mortality was 36.9% for emergency surgical and medical patients and 13.9% for elective surgical patients. A total of 140 patients responded to follow-up; 62.2% of patients not retired or homemakers were working full-time. Quality of life was good using both subjective and objective standards. There were few significant differences between elective surgical and other patients. Survival and life quality were related inversely to severity of illness and cost of treatment. Acute health on ICU admission predicted survival well; chronic health and age were better predictors of life quality.

Critical Care↗
PubMedDate not supplied

Fraud and abuse law.

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Disclosure↗
PubMedDate not supplied

Judge Posner's RFP: antitrust law and managed care.

The emergence of a competitive market in health care portends an increasingly important role for antitrust law. Managed care is even more difficult than fee-for-service practice to analyze in the quantitative, economic terms required by modern principles of antitrust law. This paper examines a recent court decision authored by a prominent judge and antitrust scholar: Blue Cross and Blue Shield United of Wisconsin v. Marshfield Clinic. The purpose of the paper is not to describe the law as it is or as it should be, but to illustrate the assumptions and gaps in understanding that can occur when courts are asked to evaluate this complex and rapidly changing industry without the benefit of sound empirical research.

Antitrust Laws↗
PubMedDate not supplied

Expanded managed care liability: what impact on employer coverage?

Policymakers are considering legislative changes that would increase managed care organizations' exposure to civil liability for withholding coverage or failing to deliver needed care. Using a combination of empirical information and theoretical analysis, we assess the likely responses of health plans and Employee Retirement Income Security Act (ERISA) plan sponsors to an expansion of liability, and we evaluate the policy impact of those moves. We conclude that the direct costs of liability are uncertain but that the prospect of litigation may have other important effects on coverage decision making, information exchange, risk contracting, and the extent of employers' involvement in health coverage.

Costs and Cost Analysis↗