Family Medicine and the Health Care Crisis in the United States

1972 ◽  
Vol 2 (2) ◽  
pp. 207-215
Author(s):  
R. Smith
Keyword(s):  
Family Medicine ◽  
Medical Care ◽  
Health Resources ◽  
Major Change ◽  
The United States ◽  
Cost Of Care ◽  
Flexner Report ◽  
New Feature ◽  
The Cost ◽  
Governmental Response

Many millions of Americans are deprived of medical care because of inadequate and poorly distributed health resources. The cost of care has become the most potent single cause for concern, and much of the current governmental response focuses on this issue. The plethora of bills before Congress is considered in this paper and three examples advocating a less or greater degree of change are studied. The universities are responding in a variety of ways, and these include expansion of their service and educational bases into the community. The widespread creation of departments of family medicine is a new feature of American medical education and could constitute a major change in direction equal in significance to change resulting from the Flexner Report. Though greater emphasis on primary medical care is clearly accepted as important by both government and educators, the future is uncertain. Barriers and shortages should disappear in the years ahead, and a great resurgence of family medicine should reintroduce many desired features into practice which are now missing.

scholarly journals Costs of medical care for mesothelioma

Rare Tumors ◽  
2019 ◽  
Vol 11 ◽  
pp. 203636131986349 ◽  
Author(s):  
Eric Borrelli ◽  
Zachary Babcock ◽  
Stephen Kogut
Keyword(s):  
United States ◽  
Medical Care ◽  
Medical Cost ◽  
The United States ◽  
Healthcare Research ◽  
Cost Of Care ◽  
Discharge Data ◽  
System A ◽  
The Cost ◽  
Mean Cost

Malignant mesothelioma is a rare and devastating form of cancer with an increasing economic burden. We sought to describe the direct cost burden of mesothelioma to the US health system. A systematic literature review was performed to locate published estimates of the medical cost of mesothelioma. In addition, we performed an analysis of hospital discharge data from the National Inpatient Sample, Healthcare Cost and Utilization Project, Agency for Healthcare Research and Quality. We also reviewed publicly available legal settlements. We found that published estimates of the cost of medical care for mesothelioma are sparse, and differ with respect to nation, timeframe, and types of cost included. For the year 2014 in the United States, we estimated a mean cost per mesothelioma hospitalization of US$24,124 (95% confidence interval: US$20,819–US$28,983) and a total cost for hospital care of US$44,214,835. In conclusion, we found that reports describing the direct medical cost of care for mesothelioma in the United States are lacking, yet the per-patient cost of care is substantial, as evidenced by analyses of inpatient care and legal settlements.

Physicians' Interactions with Pharmaceutical Companies

PEDIATRICS ◽  
1992 ◽  
Vol 90 (2) ◽  
pp. 281-282
Author(s):  
LEWIS H. MARGOLIS
Keyword(s):  
Medical Care ◽  
Cost Of Care ◽  
Pharmaceutical Companies ◽  
Cost Of Drugs ◽  
The Cost

In Reply.— In my essay1 I suggested that the acceptance of gifts from pharmaceutical companies violates a duty of justice because gifts represent resources inappropriately taken from patients through the added costs of the drugs that they buy. Dr Procopio raises the larger question of how other types of promotional activities increase the cost of drugs in particular and medical care in general. His letter makes clear, however, that the contribution of an activity such as the distribution of samples to the cost of care is difficult to determine because several different purposes are served.

scholarly journals Cost of prenatal versus postnatal myelomeningocele closure for both mother and child at 1 year of life

2019 ◽  
Vol 47 (4) ◽  
pp. E15
Author(s):  
Brice A. Kessler ◽  
Michael P. Catalino ◽  
Carolyn Quinsey ◽  
William Goodnight ◽  
Scott Elton
Keyword(s):  
Gestational Age ◽  
The United States ◽  
Cost Of Care ◽  
Charge Ratio ◽  
Median Cost ◽  
Hospital Perspective ◽  
Hydrocephalus Treatment ◽  
The Cost ◽  
Gestational Age At Birth ◽  
Age At Birth

OBJECTIVEPrenatal myelomeningocele (MMC) closure has been performed in the United States for 2 decades. While prior work has focused on clinical outcomes of prenatal MMC closure, the cost of this procedure in comparison with that of postnatal MMC closure is unclear. The authors’ aim was to compare the cost of prenatal versus postnatal MMC closure for both the child and mother at 1 year.METHODSA prospective database of patients undergoing prenatal and postnatal MMC closure between 2011 and 2018 with 1-year follow-up was retrospectively reviewed. Charge data for relevant admissions were converted to a cost estimate using the authors’ institution’s Medicare hospital-specific cost-to-charge ratio. Children, mothers, and mother/child pairs were considered separately. The primary outcome was cost. Secondary outcomes included the need for hydrocephalus treatment, length of stay (LOS), and readmissions. Other covariates included gestational age at birth, MMC lesion level, and obstetric complications.RESULTSThe median cost of care for children in the prenatal group was greater, although not significantly so, at $58,406.71 (IQR $16,900.24–$88,951.01) compared with $49,889.95 (IQR $38,425.18–$115,163.86) for children in the postnatal group (p = 0.204). The median cost for mothers in the prenatal group was significantly greater at $24,548.29 (IQR $20,231.55–$36,862.31) compared with $5087.30 (IQR $4430.72–$5362.56) (p < 0.001). The median cost for mother/child pairs in the prenatal group was $102,377.75 (IQR $37,384.30–$118,527.74) compared with $55,667.82 (IQR $42,840.78–$120,058.06) (p = 0.45). Children in the prenatal group had a lower gestational age at birth (235.81 days vs 265.77 days, p < 0.001) and fewer readmissions (33.3% vs 72.7%, p < 0.001), and hydrocephalus treatment was less common (33.3% vs 90.9%, p < 0.001). Index LOS did not differ between children in the prenatal and postnatal groups (26.8 days vs 23.5 days, p = 0.63). Mothers in the prenatal group had longer LOS (15.92 days vs 4.68 days, p < 0.001) and more readmissions (18.5% vs 0.0%, p = 0.06).CONCLUSIONSThe median cost of prenatal versus postnatal MMC closure did not significantly differ from a hospital perspective at 1 year, although variability in cost was high for both groups. When considering the mother alone, prenatal MMC closure was costlier. Future work is needed to assess cost from a patient and societal perspective both at 1 year and beyond.

American Society of Clinical Oncology Guidance Statement: The Cost of Cancer Care

2009 ◽  
Vol 27 (23) ◽  
pp. 3868-3874 ◽  
Author(s):  
Neal J. Meropol ◽  
Deborah Schrag ◽  
Thomas J. Smith ◽  
Therese M. Mulvey ◽  
Robert M. Langdon ◽  
...  
Keyword(s):  
United States ◽  
Health Care ◽  
Clinical Oncology ◽  
Cancer Care ◽  
Cost Effective ◽  
The United States ◽  
Cost Of Care ◽  
High Quality ◽  
American Society ◽  
The Cost

Advances in early detection, prevention, and treatment have resulted in consistently falling cancer death rates in the United States. In parallel with these advances have come significant increases in the cost of cancer care. It is well established that the cost of health care (including cancer care) in the United States is growing more rapidly than the overall economy. In part, this is a result of the prices and rapid uptake of new agents and other technologies, including advances in imaging and therapeutic radiology. Conventional understanding suggests that high prices may reflect the costs and risks associated with the development, production, and marketing of new drugs and technologies, many of which are valued highly by physicians, patients, and payers. The increasing cost of cancer care impacts many stakeholders who play a role in a complex health care system. Our patients are the most vulnerable because they often experience uneven insurance coverage, leading to financial strain or even ruin. Other key groups include pharmaceutical manufacturers that pass along research, development, and marketing costs to the consumer; providers of cancer care who dispense increasingly expensive drugs and technologies; and the insurance industry, which ultimately passes costs to consumers. Increasingly, the economic burden of health care in general, and high-quality cancer care in particular, will be less and less affordable for an increasing number of Americans unless steps are taken to curb current trends. The American Society of Clinical Oncology (ASCO) is committed to improving cancer prevention, diagnosis, and treatment and eliminating disparities in cancer care through support of evidence-based and cost-effective practices. To address this goal, ASCO established a Cost of Care Task Force, which has developed this Guidance Statement on the Cost of Cancer Care. This Guidance Statement provides a concise overview of the economic issues facing stakeholders in the cancer community. It also recommends that the following steps be taken to address immediate needs: recognition that patient-physician discussions regarding the cost of care are an important component of high-quality care; the design of educational and support tools for oncology providers to promote effective communication about costs with patients; and the development of resources to help educate patients about the high cost of cancer care to help guide their decision making regarding treatment options. Looking to the future, this Guidance Statement also recommends that ASCO develop policy positions to address the underlying factors contributing to the increased cost of cancer care. Doing so will require a clear understanding of the factors that drive these costs, as well as potential modifications to the current cancer care system to ensure that all Americans have access to high-quality, cost-effective care.

scholarly journals The challenge of determining appropriate care in the era of patient-centered care and rising health care costs

2018 ◽  
Vol 24 (3) ◽  
pp. 201-206 ◽  
Author(s):  
Ian Coulter ◽  
Patricia Herman ◽  
Gery Ryan ◽  
Lara Hilton ◽  
Ron D. Hays ◽  
...  
Keyword(s):  
Patient Preferences ◽  
The United States ◽  
Patient Centered Care ◽  
Cost Of Care ◽  
Patient Centered ◽  
Inappropriate Care ◽  
Appropriateness Of Care ◽  
Centered Care ◽  
The Cost ◽  
Care Costs

Appropriateness of care is typically determined in the United States by evidence on efficacy and safety, combined with the judgments of experts in research and clinical practice, but without consideration of the cost of care or patient preferences. The shift in focus towards patient-centered care calls for consideration of outcomes that are important to patients, accommodation of patient preferences, and incorporation of the costs of care in patient-provider shared clinical decisions. The RAND/UCLA Appropriateness method was designed to determine rates of appropriate or inappropriate care, but the method did not include patient preferences or costs. This essay examines how methods of studying appropriateness can be made more patient-centered by describing a modification of the RAND/UCLA method by including patient outcomes, preferences, and costs.

Abstract TP423: Trends of Hospitalization Cost of Aneurysmal Subarachnoid Hemorrhage in the United States

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Sumul Modi ◽  
Kavit Shah ◽  
Muhammad Affan ◽  
Rizwan Tahir ◽  
Panayiotis Varelas ◽  
...  
Keyword(s):  
United States ◽  
Ischemic Stroke ◽  
Subarachnoid Hemorrhage ◽  
Respiratory Failure ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
The United States ◽  
Male Gender ◽  
Cost Of Care ◽  
Hospitalization Cost ◽  
The Cost

Background: Recent large scale studies describing the trends of hospitalization cost secondary to aneurysmal subarachnoid hemorrhage (aSAH) in the United States are lacking. We performed this study to discover these trends and the factors affecting the cost of hospitalization. Methods: The Nationwide Inpatient Sample of the Healthcare Cost and Utilization Project from year 2002 to 2013 was searched for patients with a primary diagnosis of subarachnoid hemorrhage International Classification of Diseases - Ninth Revision (ICD-9) code 430) who underwent either clipping or coiling of an aneurysm. Patients with traumatic intracranial hemorrhage, arteriovenous malformation, arteriovenous fistula, cost of care ≤ 0, discharge to another hospital, and any missing variables were excluded. The cost of hospitalization was calculated using total charge and cost-to-charge ratio provided by HCUP, and then was adjusted for inflation (for the year 2016) utilizing the Consumer Price Index inflation calculator. Univariate and multivariable linear regression analysis was performed on selected variables to identify the factors associated with a higher cost of care. The multivariable model was adjusted for calendar year, medical comorbidities (using the Charlson Comorbidity Index), hospital location (urban or rural) and hospital teaching status (teaching or non-teaching). Results: We identified 20,905 patients with aSAH over the course of the 12 years. The mean and the median costs of hospitalization were $80,859 and $66,274, respectively. The median cost increased from $53,697 in 2002 to $73,901 in 2013 (p<0.001). Cost was also noted to increase by $2690 with the male gender, $18,877 with the presence of an acute ischemic stroke, $33,942 with the presence of respiratory failure and $18,464 with the requirement of ventriculostomy (all p<0.001). Every decade increase in age was associated with $3022 reduction in the cost (P<0.001). Conclusion: Among the factors we studied, higher hospitalization cost was independently associated with the male gender and the presence of ischemic stroke, respiratory failure and the requirement of ventriculostomy. Older age was associated with a lower hospitalization cost.

scholarly journals Evolution of Physician-Centric Business Models Under the Patient Protection and Affordable Care Act

2016 ◽  
Vol 15 (1) ◽  
Author(s):  
Tanya Nix ◽  
Lynn Szostek
Keyword(s):  
United States ◽  
Medical Care ◽  
Affordable Care Act ◽  
Business Models ◽  
Healthcare Delivery ◽  
The United States ◽  
New Paradigm ◽  
Medical Specialties ◽  
Patient Protection ◽  
The Cost

For decades, the cost of medical care in the United States has increased exponentially. United States citizens spend twice as much as their European counterparts on medical care. Congress enacted the Patient Protection and Affordable Care Act (PPACA) to ensure affordable healthcare to the citizens of the United States. PPACA legislation is creating a new paradigm in healthcare delivery and provider business models. The purpose of this case study was to explore physicians’ perspectives regarding physician-centric business models evolving under the requirements of the PPACA legislation. Data were gathered through semistructured interviews and questionnaires with a purposive sample of 75 participants across 20 medical specialties within the United States. Three universal themes emerged including (a) use of midlevel practitioners, (b) changes to provider practices, and (c) enhanced business education. Healthcare leaders may use the findings to advance the evolution of physician business models that meet the needs of healthcare stakeholders.

scholarly journals Financing the Fourth Year: Experiences of Required 4-Year Family Medicine Residency Programs

2021 ◽  
Vol 53 (3) ◽  
pp. 195-199
Author(s):  
Alan B. Douglass ◽  
Wendy B. Barr ◽  
Joe M. Skariah ◽  
Kelly J. Hill ◽  
Yadira Acevedo ◽  
...  
Keyword(s):  
Family Medicine ◽  
Health Center ◽  
Medical Center ◽  
Educational Innovation ◽  
Health Resources ◽  
The United States ◽  
Successful Implementation ◽  
Residency Programs ◽  
Family Medicine Residency ◽  
Curricular Model

Abstract: The optimal length of family medicine training has been debated since the specialty’s inception. Currently there are four residency programs in the United States that require 4 years of training for all residents through participation in the Accreditation Council for Graduate Medical Education Length of Training Pilot. Financing the additional year of training has been perceived as a barrier to broader dissemination of this educational innovation. Utilizing varied approaches, the family medicine residency programs at Middlesex Health, Greater Lawrence Health Center, Oregon Health and Science University, and MidMichigan Medical Center all demonstrated successful implementation of a required 4-year curricular model. Total resident complement increased in all programs, and the number of residents per class increased in half of the programs. All programs maintained or improved their contribution margins to their sponsoring institutions through additional revenue generation from sources including endowment funding, family medicine center professional fees, institutional collaborations, and Health Resources and Services Administration Teaching Health Center funding. Operating expense per resident remained stable or decreased. These findings demonstrate that extension of training in family medicine to 4 years is financially feasible, and can be funded through a variety of models.

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