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At least 19 recordsLinked to original sources
PubMed1987

Economic competition in health care: a moral assessment.

Economic competition threatens equity in the delivery of health care. This essay examines four of the various ways in which it does that: the reduction of charity care, increased patient cost-sharing, "cream-skimming" of healthy subscribers, and lack of information to patients about rationed care that is not prescribed. In all four cases, society must guard against distinct inequities and injustices, but also in all four, either the particular problem is not inherent in competition or, though inherent, it is not irremediable. Competition therefore cannot be finally morally accepted or rejected as an economic structure for delivering health care without knowing what among a wide range of supplementary things our society is actually going to do with it.

Cost Allocation↗
PubMed1992

Will Medicare beneficiaries switch physicians? A test of economic competition.

We assess the potential of increased economic competition by examining whether Medicare beneficiaries are willing to switch to physicians who agree to accept all services on assignment. Data come from a survey of Medicare beneficiaries conducted in November 1988. Our principal finding is that beneficiaries are not sensitive to price when making decisions about whether or not to switch physicians. Less than one-half of 1 percent of the sample had switched physicians for economic reasons in the year prior to the survey. Furthermore, willingness to switch was not correlated with ability to pay. We conclude that policies aimed at altering consumer demand may not be the most effective way to control Medicare costs.

Aged↗
PubMed1978

Rx for health care economics: competition, not rigid NHI.

While competition may serve consumers well in the production of many goods and services, it does not function equally well in all of the nation's economic sectors. And the health services sector does not fit the competitive model at all well. The market for medical care services might be restructured, however, so competition might yield more of the benefits it yields in other markets.

Capitation Fee↗
PubMed1975

Ethanol fermentation and potential.

Ethyl alcohol is one of the United States and world's major chemicals. Beverage alcohol in the United States must be prepared from cereal grains or other natural products. The U.S. industrial alcohol market has remained relatively stable for several years at approximately 300 million gallons annually. Most of this has been produced synthetically from petroleum raw material (gas and oil). These raw materials are experiencing major price increases and are in short supply. The production of ethyl alcohol from cereal grains and cellulosic raw materials by fermentation is technically feasible and has been proven. Alcohol produced from all such materials is equal to synthetic alcohol in quality and performance. Competitive economics have controlled the basic raw materials used. The major potential new ethyl alcohol market is as a component of automobile fuels. A 10% alcohol-gasoline blend in the United States would annually require over 10 billion gallons of anhydrous alcohol. Use of alcohol for this purpose is technically feasible. However, alcohol has not been economically competitive to date.

Cellulose↗
PubMed1988

Hospital quality competition and the economics of imperfect information.

Competition in the health care industry has traditionally focused on indices of quality rather than price. Even in a period of vigorous price competition, the issue of quality remains central, given patient uncertainty. Quality in the future will be assessed, however, not only on the basis of structural characteristics--such as the acquisition of new clinical technologies--but also in terms of patient outcomes. Because outcome statistics are influenced by the severity of the patient's disease at the time of treatment, it is likely that health plans and medical care institutions may accelerate their preference for healthier patients. Pure price competition may have only a modest role to play.

Community Participation↗
PubMed1990

Choledochoscopy. A cost-minimization analysis.

Although choledochoscopy for the prevention of retained bile duct stones has been postulated as cost effective, no economic evaluation exists to substantiate this claim. We performed a cost-minimization analysis on 287 patients who underwent choledochoscopy during operations for biliary tract calculi between 1981 and 1987 to assess the economic impact of choledochoscopy versus noncholedochoscopic alternatives in obtaining a stone-free duct. Common duct exploration was positive for calculi in 75% of patients. Choledochoscopy-detected residual stones after duct exploration in 10% of patients. Residual stones were more frequent after positive (12.5%) than negative (2.7%) duct explorations. retained stones occurred in 4.5% of patients after operation. Sensitivity, specificity, and negative predictive values of choledochoscopy were 67%, 100%, and 95%, respectively. Cost-minimization analysis showed that total cost of either selective ($75,250) or routine ($110,450) choledochoscopy significantly exceeded the total cost of obtaining a stone-free duct for patients with retained stones via either extraction through a T-tube tract ($17,545) or by endoscopic papillotomy ($45,675). Because choledochoscopy was not economically competitive with noncholedochoscopic, nonoperative alternatives, reduction of choledochoscopy fees was implemented to economically justify continued use of choledochoscopy. We conclude that choledochoscopy is clinically efficacious in obtaining a stone-free duct, but endorsement of either routine or selective choledochoscopy by cost-minimization analysis requires careful assessment of fee structure to make choledochoscopy competitive economically.

Aged↗
PubMed1985

Differential pricing of pharmaceuticals and retail competition under the Robinson-Patman Act.

Emphasis on cost containment by third-party payors has intensified economic competition within the health care system, creating powerful market forces which retail pharmacists had not envisioned a few years ago. Hospitals and alternative delivery systems now sell prescription drugs in direct competition with retail pharmacists. These entities are able to purchase their pharmaceuticals from manufacturers at prices far below those of the retailers. Retail pharmacist plaintiffs allege that such activities violate the Robinson-Patman Act which prohibits price discrimination. Retail pharmacists have achieved landmark victories in decisions establishing that nonprofit, state and local governmental hospitals reselling pharmaceuticals in competition with retail pharmacies are not exempt from the Act. This Article demonstrates that despite these victories, plaintiffs will have difficulty proving an actual violation of the Act by manufacturers and hospitals. Plaintiffs must establish competitive injury as well as refute the meeting competition defense. Retail pharmacists might discover that the Robinson-Patman Act is not the ally they had hoped for; instead, they should concentrate on innovative alternatives which will allow them to compete in an evolving health care system.

Economic Competition↗
PubMed1978

[The desire to have children (author's transl)].

During the past fourtytwo years the birth statistics of Bavaria show that the percentage of intramarital first children increased from 1/3 to 1/2 of all children born within marriages. The percentage of the marital second born children increased relatively less from 25% in 1935 to around 30% in 1977. During the same time the percentage of third and fourth children decreased from 38,8% to 19,2% by approxiamately 1/2. For some time now close correlation exists between economic competition and achievement stress and social, sexual, and generative behaviour. Not the modern contraceptives are responsible for the random and sensitive characteristics of the desire for children in couples since contraceptives only increase the planning of children but the vagaries of the future expectations in a dubious economic and social system are responsible.

Birth Rate↗
PubMed1980

Physician extenders, the law, and the future.

The process of Physician Extender authorization through general delegatory and regulatory-authority model legislation in the various states is examined in this paper. In light of past legislative and professional developments, the likelihood of independent practice patterns emerging among both nurse practitioners and physicians's assistants is assessed. It is concluded that current trends in physician manpower supply and distribution make the establishment of a physician extender group serving in competition with primary care physicians unlikely at this time. Rather, it is more likely that a clearly defined role may be established either in the employer/employee setting or through a position quite distinct from that of the primary care physician. Physician extenders functioning in this more independent role could contract with primary care and other physicians for their services without engendering economic competition for patient services.

Family Practice↗
PubMed1985

The two "faces" of Antillean prostitution.

Prostitutes who operate in the refinery town of St. Nicholas, the second largest urban center in Aruba, Netherlands Antilles, fall into two categories: temporary migrants from Colombia, who live and work for 3-month periods in the saloon-cribs along the main street; and permanently resident Dominican Republicans, who live and work in the village ghetto. The Colombians receive encomia, the Dominican Republicans, opprobria. In addition to addressing the differential statuses, prognoses, and earnings of the two groups, this paper also examines the historical background to the development of the differential assessments and offers ethnographic support for the continuation of the structural oppositions that separate the two groups. It is suggested that local perceptions of "other" people (including prostitutes) are tied to specific social and economic circumstances. Variables such as economic competition, ethnicity, length of employment in a low-status occupation, and the generally favored position accorded to "people like us," in contrast to the negative attitude held toward "people like them," are examined in terms of their relevance to the differential status of the two groups. It is also suggested that the underlying as well as the overt bases for these stereotypical ascriptions may have broader applicability: differential rather than unilateral assessments may indeed be the norm rather than a peculiarly Antillean perception.

Colombia↗
PubMed1986

Development of a computerized reference retrieval system: a behavior therapy training tool.

The vastness of the behavior therapy literature base often poses problems for beginning therapists who need greater familiarity with assessment and intervention literature. Hence a computerized reference retrieval system was developed for trainees to access behavior therapy references efficiently. The system contains over 1600 references from 158 problem categories and is economically competitive with commercial systems. Similar systems can be established using currently available microcomputer technology. The present system is primarily used by doctoral and masters students to assist in case conceptualizations and decision making during practicum courses.

Behavior Therapy↗
PubMed1989

Economics of practice and inpatient care.

The nature and structure of inpatient psychiatric services are rapidly evolving. This article identifies and explores how these changes are being influenced by four interrelated areas: rapid growth in general and private hospital psychiatric practice; increased connections of public, private, and voluntary sectors of care; the emergence and quick acceptance of capitated and managed care programs; and dramatic change and growth in the insurance industry. These four interrelated areas further the development of a two-tier system in psychiatry: one for those with insurance, and one of the poor and the severely disabled. The changes in these four areas have also led to greater demand for increased economic competition among services, and new alliances and innovations in the delivery of treatment. This article discusses how the four areas have combined to support a two-tier system and how they are likely to affect the future evolution of general and private hospital inpatient psychiatric practice.

Cost Control↗