Do Health Maintenance Organisations deliberately neglect, or even kill off, their unprofitable patients? You may well think so when you read this book. There is a new world of medicine in the United States. It pulsates to the impersonal and incessantly driving rhythms of profit. Patients are not important in this world. They are little more than data entries in elaborate schemes to cut costs and bolster profits as much as possible. Jennifer Gigliello's case was all too typical. Instead of a caring and competent health care system, what the Gigliello family found in the largest American HMO was, among other discrepancies: A staff totally untrained to deliver the type of care that was required; A system unwilling to consult a specialist to determine the true cause of her excruciating pain; A system which was tactless, cruel, heartless and mean in the extreme; A system whose maximum financial liability in case of the death of a patient -- 250,000 -- was far less than the cost of caring for the patient, thus making it cheaper to let Jenny die than to continue to treat her. This book explores Jennifer Gigliello's medical tragedy and the family's impassioned search to find meaning in the totally needless death of their daughter at the hands of America's largest HMO.
When the end of life makes its inevitable appearance, people should be able to expect reliable, humane, and effective caregiving. Yet too many dying people suffer unnecessarily. While an "overtreated" dying is feared, untreated pain or emotional abandonment are equally frightening. Approaching Death reflects a wide-ranging effort to understand what we know about care at the end of life, what we have yet to learn, and what we know but do not adequately apply. It seeks to build understanding of what constitutes good care for the dying and offers recommendations to decisionmakers that address specific barriers to achieving good care. This volume offers a profile of when, where, and how Americans die. It examines the dimensions of caring at the end of life: Determining diagnosis and prognosis and communicating these to patient and family. Establishing clinical and personal goals. Matching physical, psychological, spiritual, and practical care strategies to the patient's values and circumstances. Approaching Death considers the dying experience in hospitals, nursing homes, and other settings and the role of interdisciplinary teams and managed care. It offers perspectives on quality measurement and improvement, the role of practice guidelines, cost concerns, and legal issues such as assisted suicide. The book proposes how health professionals can become better prepared to care well for those who are dying and to understand that these are not patients for whom "nothing can be done."
When his teenaged son Christopher, brain-damaged in an auto accident, developed a 106-degree fever following weeks of unconsciousness, John Campbell asked the attending physician for help. The doctor refused. Why bother? The boy's life was effectively over. Campbell refused to accept this verdict. He demanded treatment and threatened legal action. The doctor finally relented. With treatment, Christopher's temperature subsided almost immediately. Soon afterwards he regained consciousness and today he is learning to walk again. This story is one of many Wesley Smith recounts in his groundbreaking new book, The Culture of Death. Smith believes that American medicine ''is changing from a system based on the sanctity of human life into a starkly utilitarian model in which the medically defenseless are seen as having not just a 'right' but a 'duty' to die.'' Going behind the current scenes of our health care system, he shows how doctors withdraw desired care based on Futile Care Theory rather than provide it as required by the Hippocratic Oath. And how ''bioethicists'' influence policy by considering questions such as whether organs may be harvested from the terminally ill and disabled. This is a passionate, yet coolly reasoned book about the current crisis in medical ethics by an author who has made ''the new thanatology'' his consuming interest.
Court, a nationally recognized consumer advocate and founder of a health care watchdog project, and Smith, an attorney and president of a public policy consulting firm, expose appalling practices of HMOs and the corrupt world of managed care. They telltrue stories of patient victims who got caught and killed in the system, and expose the profit motive behind the misery, revealing the collusion of the insurance industry's powerful lobbyists with Congress and state legislatures to block any serious reforms. They supply an HMO patients' self-defense kit to help patients overcome HMO stonewalling.
Many Americans believe that people who lack health insurance somehow get the care they really need. Care Without Coverage examines the real consequences for adults who lack health insurance. The study presents findings in the areas of prevention and screening, cancer, chronic illness, hospital-based care, and general health status. The committee looked at the consequences of being uninsured for people suffering from cancer, diabetes, HIV infection and AIDS, heart and kidney disease, mental illness, traumatic injuries, and heart attacks. It focused on the roughly 30 million-one in seven-working-age Americans without health insurance. This group does not include the population over 65 that is covered by Medicare or the nearly 10 million children who are uninsured in this country. The main findings of the report are that working-age Americans without health insurance are more likely to receive too little medical care and receive it too late; be sicker and die sooner; and receive poorer care when they are in the hospital, even for acute situations like a motor vehicle crash.
"Drawing upon a wealth of research, Coombs compares HMOs throughout the nation with the one in Marshfield, which came as close as any HMO to realizing the ideal of early advocates. This book is a resource for specialists in the fields of health policy research and analysis, health care management, health law and politics, public health, and social and organizational history of medicine. It will also appeal to many readers who are disturbed by the current stae of America's health care system and are curious about its future."--BOOK JACKET.
Medicare costs have grown rapidly during the 1990s, & are estimated to increase an average of 8.4% a year through FY 2002. To slow this growth rate, proposals have been made to encourage beneficiaries to join managed care plans. This report examines the inconsistency between the expectation that HMOs would save Medicare money & research findings that HMOs increase the program's costs. It identifies conditions under which Medicare's method can yield payment rates that are too high & suggests improvement directed at problems fostering excess payments. Charts & tables.
With current recommendations calling for infants to receive multiple doses of vaccines during their first year of life and with sudden infant death syndrome (SIDS) the most frequent cause of death during the postneonatal period, it is important to respond to concerns that vaccination might play a role in sudden unexpected infant death. The committee reviewed epidemiologic evidence focusing on three outcomes: SIDS, all SUDI (sudden unexpected death in infancy), and neonatal death (infant death, whether sudden or not, during the first 4 weeks of life). Based on this review, the committee concluded that the evidence favors rejection of a causal relationship between some vaccines and SIDS; and that the evidence is inadequate to accept or reject a causal relationship between other vaccines and SIDS, SUDI, or neonatal death. The evidence regarding biological mechanisms is essentially theoretical, reflecting in large measure the lack of knowledge concerning the pathogenesis of SIDS.
Experts estimate that as many as 98,000 people die in any given year from medical errors that occur in hospitals. That's more than die from motor vehicle accidents, breast cancer, or AIDSâ€"three causes that receive far more public attention. Indeed, more people die annually from medication errors than from workplace injuries. Add the financial cost to the human tragedy, and medical error easily rises to the top ranks of urgent, widespread public problems. To Err Is Human breaks the silence that has surrounded medical errors and their consequenceâ€"but not by pointing fingers at caring health care professionals who make honest mistakes. After all, to err is human. Instead, this book sets forth a national agendaâ€"with state and local implicationsâ€"for reducing medical errors and improving patient safety through the design of a safer health system. This volume reveals the often startling statistics of medical error and the disparity between the incidence of error and public perception of it, given many patients' expectations that the medical profession always performs perfectly. A careful examination is made of how the surrounding forces of legislation, regulation, and market activity influence the quality of care provided by health care organizations and then looks at their handling of medical mistakes. Using a detailed case study, the book reviews the current understanding of why these mistakes happen. A key theme is that legitimate liability concerns discourage reporting of errorsâ€"which begs the question, "How can we learn from our mistakes?" Balancing regulatory versus market-based initiatives and public versus private efforts, the Institute of Medicine presents wide-ranging recommendations for improving patient safety, in the areas of leadership, improved data collection and analysis, and development of effective systems at the level of direct patient care. To Err Is Human asserts that the problem is not bad people in health careâ€"it is that good people are working in bad systems that need to be made safer. Comprehensive and straightforward, this book offers a clear prescription for raising the level of patient safety in American health care. It also explains how patients themselves can influence the quality of care that they receive once they check into the hospital. This book will be vitally important to federal, state, and local health policy makers and regulators, health professional licensing officials, hospital administrators, medical educators and students, health caregivers, health journalists, patient advocatesâ€"as well as patients themselves. First in a series of publications from the Quality of Health Care in America, a project initiated by the Institute of Medicine
THE MENTAL HEALTH AND WELLBEING OF HEALTHCARE PRACTITIONERS Explore this innovative new volume covering the growing mental health crisis amongst healthcare practitioners In The Mental Health and Wellbeing of Healthcare Practitioners, accomplished researchers and authors Esther Murray and Jo Brown deliver an insightful exploration of the theoretical and practical aspects of implementing mental health improvement within the healthcare system through a range of practical examples and cases. The book also explores the possibilities available to professionals to talk about their mental health using “borrowed” words and concepts, and uncovers structural and social concerns that prevent practitioners from accessing the time and space they need to address their mental health concerns. Readers will also benefit from the inclusion of topics such as: Borrowed words in emergency medicine and how moral injury makes spaces for talking Finding a voice through medical student engagement in creative enquiry Using language and discourse to explore queer identities in medicine Stress and mental wellbeing in emergency medical dispatchers and paramedics Perfect for healthcare students, professionals, and researchers in the fields of medicine, medical education, psychology, and sociology, The Mental Health and Wellbeing of Healthcare Practitioners will also earn a place in the libraries of healthcare management professionals and regulators.
