Policy Options and the Impact of National Health Insurance Revisited

1977 ◽  
Vol 7 (3) ◽  
pp. 503-509 ◽  
Author(s):  
Joseph P. Newhouse ◽  
Charles E. Phelps ◽  
William B. Schwartz
Keyword(s):  
Medical Care ◽  
Delivery System ◽  
Gross National Product ◽  
Care Delivery ◽  
Health Care Delivery System ◽  
Hospital Utilization ◽  
Insurance Program ◽  
Short Run ◽  
Basic Concepts ◽  
The Impact

In his discussion, Jonas demonstrates a misunderstanding of the basic concepts of our paper. We nowhere implied that if medical care is free to the user, the health care delivery system would be “wrecked”; rather, we said that ambulatory utilization would, in the short run, be rationed on a basis other than price, whereas hospital utilization would be relatively little affected by a new insurance program. Over a period of time, the delivery system (if free to respond) would adjust to the increased demands, with an eventual level of expenditure on medical care of some 11 percent of gross national product (if technology does not change). Evidence from Canada is consistent with our analysis.

The provision of basic medical care Health microplanning: a systems approach to appropriate technology

1977 ◽  
Vol 199 (1134) ◽  
pp. 61-68
Keyword(s):  
Health Care ◽  
Medical Care ◽  
Delivery System ◽  
Health Care Delivery ◽  
Systems Approach ◽  
Care Delivery ◽  
Health Care Delivery System ◽  
Appropriate Technology ◽  
Care Health ◽  
Basic Medical

A method of detailed technological planning is described in which a subsystem of the total health care delivery system is identified, and the components within it created and integrated with one another. The components produced are termed a microplan, since they concern planning for technical detail. A project for microplanning in Indonesia is discussed, and some of the promising features of the new method described.

Total Quality Management and the Silent Patient

2002 ◽  
Vol 12 (4) ◽  
pp. 481-504 ◽  
Author(s):  
Ann E. Mills ◽  
Mary V. Rorty
Keyword(s):  
Health Care ◽  
Quality Management ◽  
Total Quality Management ◽  
Delivery System ◽  
Health Care Delivery ◽  
Care Delivery ◽  
Health Care Delivery System ◽  
Total Quality ◽  
Quality Control Mechanism ◽  
The Impact

Abstract:This essay examines the impact of the imposition of businesses techniques, in particular, those associated with Total Quality Management, on the relationships of important components of the health care delivery system, including payers, managed care organizations, institutional and individual providers, enrollees, and patients. It examines structural anomalies within the delivery system and concludes that the use of Total Quality Management techniques within the health care system cannot prevent the shift of attention of other components away from the enrollee and the patient, and may even contribute to it. It speculates that the organization ethics process may serve as a quality control mechanism to prevent this shift and so help eliminate some of the ethically problematic processes and outcomes within the health care delivery system.

Copayment and National Health Insurance in the United States: A Critique of Work by Newhouse, Phelps, and Schwartz

1977 ◽  
Vol 7 (3) ◽  
pp. 489-501
Author(s):  
Steven Jonas
Keyword(s):  
Health Insurance ◽  
National Health Insurance ◽  
National Health ◽  
Care Delivery ◽  
The United States ◽  
Health Care Delivery System ◽  
Insurance Program ◽  
Health Insurance Program ◽  
Ambulatory Services ◽  
The Impact

In “Policy Options and the Impact of National Health Insurance,” Newhouse, Phelps, and Schwartz concluded that any national health insurance program which did not provide for high user copayments, particularly for ambulatory services, would swamp, and ultimately wreck, the health care delivery system, particularly for ambulatory services. This paper presents a detailed critique of their work. Three major points of criticism are raised:- First, Newhouse et al. have engaged in some questionable methodological practices. Second, they fall into a serious contradiction in gathering evidence to support their basic postulate. Third, they adopt a unidimensional view in proposing solutions to the problems which they predict will arise. From these criticisms, the conclusion is drawn that Newhouse et al. failed to prove their case.

Outcome measures in the rehabilitation of older adults

2001 ◽  
Vol 11 (1) ◽  
pp. 83-89 ◽  
Author(s):  
Chris MacKnight ◽  
Colin Powell
Keyword(s):  
Older Adults ◽  
Health Care ◽  
Medical Care ◽  
Delivery System ◽  
Health Care Delivery ◽  
Health Care Professionals ◽  
Care Delivery ◽  
Health Care Delivery System ◽  
Outcomes Of Care ◽  
Measuring Outcomes

Why measure?Before we consider what to measure and how to measure outcomes in the rehabilitation of frail older adults, an antecedent question is, why measure these things? Without an answer satisfactory for both measurers and measured, much effort and ingenuity will be expended with resultant perspiration and exasperation and little else.Traditionally, medical care, i.e. that identified by physicians, has assumed that its principal objective was patient care, i.e. that appreciated by patients. Outcomes of care from the viewpoint of the patient, of his or her informal supporters, of the involved health care professionals, and of the health care delivery system have to be clarified and made operationally explicit. This recognition requires definition and measurement. Thus a powerful reason for measuring outcomes for recipients and providers of health care, as well as the health care delivery system, is to know what is happening (the descriptive question) and with what effect (the analytical question).

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