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PubMedDate not supplied

Patient safety and the need for professional and educational change.

Questionable quality of health care delivered in the United States has become a front-line issue, taking a strong place alongside more traditional concerns such as increasing costs and access to care. Given that nurses comprise the largest component of the health care workforce, safety and error reduction in health care are central concerns for the profession.

Clinical Competence↗
PubMed2003

The burden of genetic disease on inpatient care in a children's hospital.

The important role of genetics in pediatric illness has been increasingly recognized, but the true impact has not been well delineated. An important study of pediatric inpatient admissions to a children's hospital in 1978 found a genetic basis for disease in just less than half of admitted patients. We sought to update this study in light of current hospitalization practices and new knowledge about genetics. We systematically reviewed the records of 5,747 consecutive admissions (4,224 individuals), representing 98% of patients admitted in 1996 to Rainbow Babies and Children's Hospital (Cleveland, OH). Each patient was assigned to one of five groups on the basis of the presence or absence of an underlying chronic medical condition and whether that condition had a genetic basis or susceptibility. An underlying disorder with a significant genetic component was found in 71% of admitted children. The vast majority (96%) of underlying chronic disorders in children in this study were either clearly genetic or had a genetic susceptibility. Total charges for 1996 were >$62 million, of which $50 million (81%) was accounted for by disorders with a genetic determinant. The 34% of admissions with clearly genetic underlying disorders accounted for 50% (>$31 million) of the total hospital charges. The mean length of stay was 40% longer for individuals with an underlying disease with a genetic basis than for those with no underlying disease. Charges and length of stay were similar for children with underlying chronic disorders, regardless of the cause. This study begins to quantify the enormous impact of genetic disease on inpatient pediatrics and the health care system. Additional study and frank public discourse are needed to understand the implications on the future health care workforce and on the utilization of health care resources.

Child↗
PubMedDate not supplied

Quality health care in an era of limited resources. Challenges and opportunities.

Quality health care is a complex phenomenon. The factors contributing to quality in health care are as varied as the strategies needed to achieve this elusive goal. This article examines the impact of medical errors, health finance (insurance), moral hazard, and provider shortages on the quality of health care today in the United States. Emphasis is given to the need to restore public trust and to create a health care system that maximizes scarce physical, fiscal, and human resources.

Delivery of Health Care↗
PubMed1998

On the commodification of medicine.

The author reviews key themes of medicine and medical education in the 20th century, such as the revolution in therapies and the consequent and continuing changes in the economics of health care; workforce issues, including the controversy over the optimum number of residency slots; and the impact of managed care on teaching hospitals and medical schools. This impact is part of "the commodification of health care," in which health care is beginning to be bought and sold in a market, where prices determine outcomes, and where the not-for-profit, service orientation of health care providers is threatened. He discusses in detail the pressures this new health care environment places on medical schools and teaching hospitals, and recounts the first Senate Finance Committee hearing in April 1994 on the subject of academic health centers under health care reform. Soon after, the Committee approved legislation to create the Graduate Medical Education and Academic Health Center Trust Fund, to be financed by a 1.5% tax on private health care premiums in addition to Medicare Graduate Medical Education payments. The provision was later dropped from a similar bill that came before the full Senate, but has since been introduced as the Medical Education Trust Fund Act of 1997. The author concludes by cautioning that matters will grow more difficult in the near future, since the threats to academic medicine's institutions have not yet become part of the national political agenda.

Academic Medical Centers↗
PubMed1975

Medical ideologies in conflict.

During the 1960s, the growing dissent within the medical profession heightened the ideological differences among physicians. This paper focuses on the ideological differences among three groups within medicine: traditionalists, liberals, and radicals. A content analysis of selected medical editorials and articles during 1972 was used to identify differences in ideological content for the following areas: professional unity; authority; self-regulations; self-education; the role of health professionals; manpower; medical education; research; health care; financing health care; and governmental relations.

American Medical Association↗
PubMed1980

Optimism on attaining health care equity.

In spite of persistent problems, progress of the last 40 years gives grounds for optimism about trends toward equity in health care. In the United States, substantial improvements have been achieved in the coverage of insurance providing economic access to medical care, in the extent of group medical practice, in health manpower resources, in the supply and distribution of hospital beds, in the scope of preventive public health services, in medical care of the poor, in the surveillance of medical care quality, in the availability of sound patterns of health care delivery, in comprehensive planning of health resources and services, and in the health status of the population. All these gains have made against the bitter opposition of conservative interests. With continued and determined efforts, one may be optimistic about achieving further progress toward health care equity.

Delivery of Health Care↗