PubMed · 6145846
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A D Chant. 1984-06-23. Practising doctors should not manage.. https://doi.org/10.1016/s0140-6736(84)91887-7
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Health care expenditures account for over 14% of the gross domestic product in the United States. Managed care has evolved to control these costs. Because diabetes accounts for nearly 15% of health care expenditures, the strategies used by managed care organizations are expected to have a particular effect on diabetes. Managed care organizations have two primary goals: to control costs and to provide care of sufficient quality to attract and satisfy enrollees. Managed care organizations have designed strategies to meet these goals. Four primary managed care strategies and their effects on diabetes care are discussed: 1) payment incentives rewarding desired provider practice patterns; 2) designation of providers who possess desirable practice behaviors; 3) coverage policies that control the services paid for; and 4) traditional insurance strategies that determine who is eligible for insurance and what premiums are to be paid. The few direct studies of the effects of each strategy on the care of diabetic persons are discussed. The conclusion is that although managed care organizations have the potential to provide excellent care for diabetic persons, little evidence exists that they have improved either the quality or the cost-effectiveness of diabetes care. Recommendations to guide the development of cost-effective care for diabetic persons are presented.
OBJECTIVE: To estimate the cost per woman delivered of pregnancies from an in vitro fertilization (IVF) program, and to assess what factors contribute to the cost. METHODS: The cost during 2 years' experience of a single IVF program was analyzed retrospectively. Cost analysis included cost of the IVF procedure itself as well as costs incurred because of maternal and neonatal complications. RESULTS: The major contributor to the total cost of IVF was high-order multiple pregnancies. The cost per woman delivered of singleton or twin pregnancies was approximately $39,000, whereas the cost per woman delivered of triplet and quadruplet pregnancies was approximately $340,000. CONCLUSION: In vitro fertilization can be cost-effective if steps are taken to minimize high-order multiple (triplet or more) pregnancies.
The key to reducing morbidity and mortality from skin cancer is early detection. Prevention through education is, of course, ultimately the best outcome of collective human efforts. Many questions are still unresolved, but skin cancer screening by general internists, family practitioners, dermatologists, and other health professionals could prove cost-effective and reliable. As more knowledge becomes available, clinicians will have the resources to improve skills in prevention and early detection.