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PubMed1976

Obstetrics in family practice: a personal and political perspective.

A heated debate is currently taking place concerning the style, methods and location of future obstetrical and neonatal care. On the one hand, there is a trend toward increasing technology of obstetrical and neonatal care with some professional groups favoring regionalization of these services to large regional centers. On the other hand, there are counterforces to such regionalization including community hospitals, many practicing obstetricians, nurse midwives, the women's liberation movement, the "alternative lifestyle movement," the Leboyer concept of delivery, the family-centered maternity care movement, and the family practice movement. This paper explores these issues and presents important reasons for family-oriented obstetric and neonatal care involving the family physician in community settings readily accessible to patients. The inclusion of obstetrical care as an integral part of family practice is important to the growth and development of the specialty.

Delivery, Obstetric↗
PubMed1992

[Options for continued development of medical care].

The German health care system is currently faced with challenges that stem from the changing demographic structure of the population as well as from the increasing implementation of costly technological advances in diagnosis and treatment in the presence of inadequate preventive and rehabilitative structures. Ever-rising expectations and demands on the part of German citizens and the increasing number of doctors are threatening to overburden the increasingly limited financial resources of the health care system. The pressure for allocatory measures has led to intense competition amongst the various specialties and sectors of the health care system. In this paper the author describes the current developments with regard to the evolution of the health care system in the near future. He predicts an increasing demand for long-term care facilities especially for the elderly, for more easily accessible rehabilitative services as well as a continuing increasing demand for high-tech services. The pressure of these qualitative as well as quantitative demands in the face of intersectoral competition and limited financial resources will necessarily lead to a restructuring of the professional as well as non-professional system with new forms of organization for in-patient as well as out-patient services that will address these issues.

Cost Control↗
PubMed1992

Laser technology planning.

Lasers continue to be a highly useful and important surgical tool, and, in today's competitive healthcare environment, they are also an effective marketing tool. The public perceives lasers to be "high-tech" instruments, associating them with excellence of care. And the availability of state-of-the-art equipment such as lasers is often critical to medical staff recruitment. However, lasers are not universal surgical tools, as some proponents suggest. They are costly, and other less expensive technologies are acceptable and sometimes more desirable for certain procedures. Also, marketing reasons alone cannot justify laser acquisition. Faced with new, more restrictive federal regulations for Medicare reimbursement of capital expenses, hospitals need effective technology planning more than ever, particularly when planning for such "high-ticket" items as lasers. They can no longer afford to acquire lasers based on the perceptions of the public or the demands of one or even a few physicians; poor planning in the past has caused many new lasers to collect dust from low utilization. (ECRI's 1991 user survey on general-purpose surgical lasers found that, on average, hospitals use lasers in less than 5% of their total surgical procedures.) Hospitals need to approach the acquisition of laser technology cautiously to ensure that the appropriate equipment is obtained, that it will be well utilized for procedures in which it offers a demonstrable improvement over alternative technologies, and that it will also conform to the overall strategic plan of the institution. The purpose of this article is to provide guidance on the technology acquisition process, whether a hospital is acquiring its first laser or has a well-established laser program.(ABSTRACT TRUNCATED AT 250 WORDS)

Capital Expenditures↗
PubMed1992

[Ethical problems from the caregivers' viewpoint].

In a first part the different perspective of physician and nurse is outlined. Then the ethical principles of the health professionals are outlined. The variant views--descriptive and normative--are described. In a second part the dilemmas emerging in daily practice of health care workers are demonstrated. Questions regarding the importance of well-being and illness are raised. Does CAN mean also that one SHOULD, i.e. for transplantation of organs? What are the guiding criteria for this advanced medicine. Since ethical decisions always touch at least two human beings they touch us over and over--profoundly.

Ethics, Medical↗