Changing Economics and Clinical Ethical Decisionmaking: A View from the Trenches

2000 ◽  
Vol 9 (2) ◽  
pp. 284-287 ◽  
Author(s):  
ERNLÉ W. D. YOUNG
Keyword(s):  
Managed Care ◽  
Healthcare Professionals ◽  
Bad News ◽  
Good News ◽  
Fee For Service ◽  
Clinical Tests ◽  
Medical Interventions ◽  
Family Demands ◽  
The Cost ◽  
Ethical Decisionmaking

There is good news, and there is bad news. The good news is that in my experience, younger physicians generally are much more concerned about the cost of clinical tests and treatments, and about justly distributing finite medical resources, than were those who practiced medicine in the fee-for-service era. The bad news has at least three components. First, with respect to medically nonbeneficial treatment in the ICU, managed care has not yet given evidence of wanting to put the brakes on unrealistic family demands for aggressive medical interventions. Second, managed care is frustrating many healthcare professionals as well as patients. And third, managed care has no apparent interest in addressing, and may even have contributed to, the problem of medical indigence. Let me develop these propositions more fully.

Federal reimbursement to laboratories

1996 ◽  
Vol 42 (5) ◽  
pp. 817-821
Author(s):  
J Logue
Keyword(s):  
Managed Care ◽  
Payment System ◽  
Regulatory Change ◽  
Fee For Service ◽  
Medicare Payment ◽  
Laboratory Cost ◽  
Federal Laboratory ◽  
Clinical Laboratories ◽  
Private And Public ◽  
The Cost

Abstract The change from a predominately fee-for-service payment environment to managed care has significantly reduced revenues for many clinical laboratories. Medicare is rapidly becoming the most favorable payor in areas with high managed-care penetration. This trend has not gone unnoticed by Congress, and congressional and regulatory initiatives are rapidly moving to reduce federal laboratory reimbursement. The efforts by both the private and public payors to further restrict payments could have a profound effect on the scope of testing offered by hospital-based laboratories. On-site nonemergent testing capability will be dependent on the cost to provide the service and the level of reimbursement. Laboratory providers have an opportunity to influence the extent of laboratory cost-reducing initiatives. To effect congressional or regulatory change requires an understanding of the federal Medicare payment system and a well-organized effort.

scholarly journals Costs and Returns of Producing Outdoor Cut Flowers

HortScience ◽  
2006 ◽  
Vol 41 (4) ◽  
pp. 981A-981
Author(s):  
Robin Brumfield
Keyword(s):  
Cost Accounting ◽  
Farm Management ◽  
Bad News ◽  
Good News ◽  
Cut Flower ◽  
Cut Flowers ◽  
Flower Production ◽  
Link Type ◽  
Rutgers University ◽  
The Cost

Field–grown cut flower production, in general, is a low–overhead business. This is both good news and bad news. Good—because it doesn't require a lot of capital to get started in this business. Bad—because competition can develop rapidly, sometimes from marginal producers for whom profitability is a low priority. Thus, it is important for producers to know the costs of growing each product so that they can make profitable production and marketing decisions. A cost accounting program was developed to help producers calculate the cost of each crop. In addition, a series of benchmark budgets were developed for specialty cut flowers. These budgets are on the Rutgers University Farm Management Website (http://aesop.rutgers.edu/~farmmgmt).

scholarly journals Applying Fiduciary Responsibilities in the Managed Care Context

2000 ◽  
Vol 26 (2-3) ◽  
pp. 155-173
Author(s):  
Peter D. Jacobson ◽  
Michael T. Cahill
Keyword(s):  
Health Care ◽  
Managed Care ◽  
Conflicts Of Interest ◽  
Economic Incentives ◽  
Fee For Service ◽  
Health Care Needs ◽  
Care Needs ◽  
Economic Interests ◽  
Scarce Resources ◽  
The Cost

The cost containment innovations offered by managed care have been needed corrections to the excesses of the fee-for-service health care system. Yet, implementing these innovations raises inevitable questions about conflicts of interest regarding the allocation of resources under managed care. The inherent conflict faced by physicians and health plan administrators between the health care needs of individual patients and the need to preserve scarce resources for patient populations is at issue in the managed care era. The sources of the conflict are the economic incentives that underlie the managed care revolution, such as capitated funding arrangements, limitations on referrals to specialists, bonuses and withholds. In making individual clinical decisions, physicians and administrators potentially infuse their own economic interests into the process.

Do you want the good news or the bad news first?

2011 ◽  
Author(s):  
Angela Legg ◽  
Kate Sweeny
Keyword(s):  
Bad News ◽  
Good News
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