If HMOs Want Evidence-Based Medicine, They Should Pay for Studies!

PEDIATRICS ◽  
1995 ◽  
Vol 96 (6) ◽  
pp. A40-A40
Author(s):  
J. F. L.
Keyword(s):  
Health Care ◽  
Managed Care ◽  
Insurance Industry ◽  
Puget Sound ◽  
Experimental Medicine ◽  
Kaiser Permanente ◽  
Health Official ◽  
The Public ◽  
Based Medicine ◽  
Support Research

Some managed-care organizations are keen to support research. Kaiser-Permanente (which started life in California during the 1930s and now operates in many states) and Group Health Co-operative of Puget Sound (in Seattle) have for decades entered their patients in NIH-sponsored trials and conducted their own studies ... Several newer managed-care firms have followed suit. ... In the insurance industry, attitudes to research range from lukewarm to hostile. Lee Newcomer, medical director of United Health Care, a huge managedcare organization based in Minneapolis, says his firm would be more enthusiastic about paying for it if fewer clinical trials were "too small, too poorly designed, and too poorly organized" to answer questions about which treatments—particularly the most complex and costly—are worthwhile. William Roper, a former health official in the Reagan and Bush administrations who is now Dr Newcomer's counterpart at the Prudential Health Care System in Roseland, New Jersey, goes further. He agrees that research is important, but he also argues that researchers have been too little accountable for how they have spent the public dollars that have flowed their way. "Why," he asks, "should society be paying extra for the delivery of health care at academic institutions merely on the presumption that it is getting something of value?" Prudential's position—unless Congress decides to tax all managed-care companies to support research—is that it will not pay for experimental medicine.

scholarly journals Autonomy and automatons: managed care in the USA

1998 ◽  
Vol 22 (12) ◽  
pp. 765-768
Author(s):  
Kwame McKenzie
Keyword(s):  
Health Care ◽  
New York ◽  
Managed Care ◽  
San Francisco ◽  
Evidence Based Medicine ◽  
Cost Effective ◽  
Evidence Based ◽  
The Usa ◽  
Based Medicine

Managed care is a phrase on the lips of every US psychiatrist. Some believe that this revolution in health care has brought US doctors kicking and screaming into the age of ‘cost-effective’, ‘evidence-based medicine’ (Mechanic, 1997). But most psychiatrists I interviewed from Boston, San Francisco and New York, thought it had transformed them from autonomous professionals to automatons.

A review of literature and perspectives on management knowledge

2018 ◽  
Author(s):  
Ewan Ferlie ◽  
Sue Dopson ◽  
Chris Bennett ◽  
Michael D. Fischer ◽  
Jean Ledger ◽  
...  
Keyword(s):  
Health Care ◽  
Public Management ◽  
The Political ◽  
Evidence Based ◽  
Science Literature ◽  
Knowledge Use ◽  
The Public ◽  
Management Knowledge ◽  
Political Economic ◽  
Based Medicine

This chapter presents the different theoretical texts that informed our study and interpretation of empirical data. We review selected health services and social science literature to provide insights on the mobilization of knowledge in the health care sector, with specific attention to practice-based examples. We include a critical reading of perspectives on evidence-based management (EBMgt) which takes its lead from evidence-based medicine (EBM). Drawing on insights from the strategic management literature, and the Resource-Based View (RBV), we discuss how knowledge is understood as a valuable asset, and explore some implications for public services and health care settings. We conclude by contributing a novel perspective on the political economy of public management knowledge production—a macro-level analysis that seeks to explore how interactions at the political, economic, and policy levels shape the institutional context for management knowledge use in the public sector.

Slouching Toward Managed Care Liability: Reflections on Doctrinal Boundaries, Paradigm Shifts, and Incremental Reform

2001 ◽  
Vol 29 (3-4) ◽  
pp. 253-277 ◽  
Author(s):  
Wendy K. Mariner
Keyword(s):  
Health Care ◽  
Managed Care ◽  
Health Care System ◽  
Legal Profession ◽  
Paradigm Shifts ◽  
The Public ◽  
History Of ◽  
Things Fall Apart ◽  
Care System ◽  
Second Coming

Following the seemingly endless debate over managed care liability, I cannot suppress thoughts of Yeats’s poem, “The Second Coming.” It is not the wellknown phrase, “Things fall apart; the centre cannot hold,” that comes to mind; although that could describe the feeling of a health-care system unraveling. The poem’s depiction of lost innocence — “The best lack all conviction, while the worst/Are full of passionate intensity” — does not allude to the legislature, the industry, the public, or the medical or legal profession. What resonates is the poem’s evocation of humanity’s cyclical history of expectation and disappointment, with ideas as grand as justice and occupations as pedestrian as managed care. Writing in 1919, Yeats described the end of an era with images of war’s destructive forces. The poem expresses a universal desire for some miraculous rebirth or resolution of all problems: “Surely some revelation is at hand.” But instead, the brutish Sphinx-like creature emerges, possibly the Antichrist. New gods displace old gods in the cycle of civilization, and man must muddle on.

scholarly journals Vicarious Liability: Relocating Responsibility For The Quality Of Medical Care

2000 ◽  
Vol 26 (1) ◽  
pp. 7-29
Author(s):  
Clark C. Havighurst
Keyword(s):  
Health Care ◽  
Managed Care ◽  
The United States ◽  
Delivery Of Care ◽  
The Public ◽  
Vicarious Liability ◽  
Managed Health Care ◽  
Quality Of Medical Care ◽  
Public Reaction

AbstractManaged health care has recently generated a great deal of distrust, even anger, in the public mind. To be sure, much of this public reaction is based on anecdotal evidence and one-dimensional thinking. But many unbiased experts observing managed care today are themselves unhappy with the health care industry's performance. While these observers find little justification for the current political backlash against managed care, they are also disappointed that today's health plans have not made a more positive difference. Indeed, informed observers commonly regret that the new arrangements for the financing and delivery of care have done so little to get physicians to adopt truly efficient practices, achieving not only cost reductions but also substantial improvements in health status and patient outcomes— that is, in the quality of care. Although managed care has not demonstrably harmed the overall quality of health care in the United States, it has done little to improve it.

HMOS—ANOTHER ROADBLOCK FOR ALZHEIMER'S DRUG

PEDIATRICS ◽  
1994 ◽  
Vol 93 (3) ◽  
pp. A51-A51
Author(s):  
J. F. L.
Keyword(s):  
Health Care ◽  
Health Reform ◽  
Liver Toxicity ◽  
Puget Sound ◽  
Cost Effective ◽  
Point Of View ◽  
American People ◽  
Northern California ◽  
Kaiser Permanente ◽  
Physician Visits

The first Cognex auguries are not promising. These signs of resistance come from two of the nation's largest HMOs, Northern California Kaiser Permanente and the Group Health Cooperative of Puget Sound. Northern California Kaiser has already decided to ban Cognex from its formulary... Cognex is expected to cost about $1,300 to $1,500 annually per patient, and this does not include the costs of blood tests and physician visits required to guard against side effects. Against this Kaiser argues that Cognex helps only some victims of Alzheimer's Disease; the gain is not very great in many patients; and some who take Cognex suffer liver toxicity that the HMOs would have to treat. So from an HMO's point of view, Cognex is not "cost-effective," the magic mantra of HMO health care. But for anyone who's aware of the living hell in which many Alzheimer's patients and their families live, this argument does not wash... Americans still expect their doctors to put patients' interests first. As the Cognex incident at the two major HMOs shows, that expectation need not be satisfied in HMO health care. Mr. Clinton, his health reform, and the American people can only benefit if the president takes specific measures to ensure that patients' expectations and HMO reality are congruent.

Law and the German Universal Healthcare System: A Brief Contemporary Overview

2005 ◽  
Vol 6 (8) ◽  
pp. 1143-1171 ◽  
Author(s):  
Ursula Weide
Keyword(s):  
Health Care ◽  
Managed Care ◽  
Health Care System ◽  
Cost Containment ◽  
Standard Of Care ◽  
Health Care Expenditures ◽  
The United States ◽  
The Public ◽  
Ethical Conflicts ◽  
Care System

How to reform the American health care system, now dominated by a decreasing number of multi-billion dollar managed care corporations, has occupied the public debate for many years. Recent news reports hefty increases in managed care premiums, benefit reductions, and an ever-growing number of managed care organizations refusing to treat Medicare patients. Numerous “patients’ bills” have been submitted in Congress, attempting to rein in some of the managed care cost containment practices. None have been adopted so far. At best, such bills would superficially treat some of the symptoms of an ill-functioning health care delivery system, poorly serving the population, insured and uninsured, and creating a plethora of ethical conflicts for providers battling to preserve an acceptable standard of care. Since the Clinton health care reform efforts failed in 1994, no one has proposed a fundamental revision of the system, and the United States remains the only industrialized nation without a universal health care system. The literature mainly reports on those – English-language – countries whose cost containment measures have resulted in overburdening the public health care system. There are, however, numerous European governments which succeed in stabilizing health care expenditures by mandating some sacrifices by all participants in the health care system while preserving universal access, comprehensive coverage, and the standard of care.

Comparing Public and Private Choices of Managed Health Care Plans: Rhetoric versus Reality

2007 ◽  
Vol 36 (3) ◽  
pp. 223-245
Author(s):  
Christopher G. Reddick
Keyword(s):  
Health Care ◽  
Public Sector ◽  
Managed Care ◽  
Private Sector ◽  
Health Benefits ◽  
Health Plans ◽  
Public And Private ◽  
Health Maintenance ◽  
The Public ◽  
Care Plans

The rhetoric is that the public sector provides broader coverage and more affordability of health benefits to its employees than the private sector. This study examines the reality of public and private health plans. It focuses specifically on the three types of managed care plans: Health Maintenance Organizations (HMO), Preferred Provider Organizations (PPO), and Point-of-Service (POS) plans. An examination of health care benefits is especially important given the double-digit rise in premiums since 2001. This article first focuses on the literature showing differences in health benefits in the public sector compared with the private sector. The literature on the factors that influence choice of managed care plans are also examined. The results reveal that public sector health care costs are slightly higher and fewer plans are offered to its employees. There are fewer alternative health care options, such as high deductible health plans and health savings accounts, as compared with what is offered by the private sector. In addition, the logistic regression results reveal that there are significant differences between the public and private sectors in types of plans offered, controlling for organizational and community factors, characteristics of health care plans, and opinions of human resources (HR) managers on controlling costs.

Promoting Consumers' Demand for Evidence-Based Medicine

1998 ◽  
Vol 14 (1) ◽  
pp. 97-105 ◽  
Author(s):  
Gianfranco Domenighetti ◽  
Roberto Grilli ◽  
Alessandro Liberati
Keyword(s):  
Health Care ◽  
Health Care Professionals ◽  
Evidence Based ◽  
The Public ◽  
Practice Of Medicine ◽  
Vested Interests ◽  
Clinical Environments ◽  
Using Data ◽  
Based Medicine ◽  
Evidence Based Health Care

AbstractThe widespread implementation of rationing and priority-setting policies in health care opposes the stochastic practice of medicine induced by professional uncertainty and professional vested interests in market-oriented clinical environments. It also clashes with consumers' overly optimistic and “mythical” view of the effectiveness of medicine, which is bound to support a potentially unlimited provision of health services. Thus, for consumers and society at large, it is necessary to create conditions favorable for a more conscious demand of evidence-based health care. In pursuit of this goal, we suggest the adoption of a community-oriented strategy based upon delivery of information to the public in order a) to generate greater awareness (“healthy skepticism”) among consumers, through disclosure of data on the true effectiveness of health care interventions and on the existing variation in their utilization, and b) to provide tools to empower consumers in dealing better with both the uncertainty in their own individual patient-physician relationships and with the health policy issues to be faced in the future. Such a community-oriented strategy could also reinforce and support, through the generation of a “bottom-up” pressure from consumers toward physicians, a wider adoption of evidence-based interventions by health care professionals. This paper, using data from surveys on public opinions and attitudes toward the practice of medicine, focuses on how consumer demand for more evidence-based medical practice can be promoted.

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