This book explores the impact of American values on the evolving design of health care. It gives us a fascinating picture of three machines--the iron lung, the dialysis machine, and the respirator--and three turning points in health policy: the rise of Blue Cross, the passage of Medicare, and the failure of the Clinton Health Security Act. By analyzing the links between medical technologies and legislative developments, this pioneering book clarifies the complex relationship between social values and public policy in the shaping of our health care system. It helps us to understand why middle-class Americans preferred to keep government out of health care, when they made exceptions to the rule, and how their preferences fit with their own experiences and served their self-interest. Beginnings Count argues that it is lived history, not an abstract commitment to marketplace forces or a reflexive opposition to big government, that has shaped the American Way in health care.
This volume contains the edited proceedings of a Totts Gap Colloquium held June 15 to 17, 1980 at Totts Gap Medical Research Laboratories in Bangor, Pennsylvania under the sponsorship of three neighboring community hospitals in the Lehigh Valley; St. Luke's Hospital of Bethlehem, Easton Hospital of Easton and Muhlenberg Medical Center of Bethlehem. The objective of the meeting was to examine from several points of view the impact of rapidly proliferating technology on medical education, practice and research, on hospitals and on the community at large. The participants were selected not only for their diversity of experience and point of view, but also for ability to listen as well as to speak. They were asked to examine, in an informal analytical dialogue, the effects on the quality and cost of health care and health education brought about by increasing reliance on medical technology. A further aim was to explore various strategies through which might be devised an affordable way to benefit fully from technological advances without compromising human initiative or diminishing emphasis on clinical judgment and effective communication between doctor and patient. The participants included a medical student, seasoned practitioners and medical educators, young specialists, researchers, administrators and members of boards of trustees of community hospitals and laymen as follows: Dr. Robert Ackerman, Associate Professor of Radiology, Harvard Medical School and Director of the Carotid Evaluation and Cerebral Blood Flow Laboratories at Massachusetts General Hospital. Dr. Paul B.
The culture of contemporary medicine is the object of investigation in this book; the meanings and values implicit in biomedical knowledge and practice and the social processes through which they are produced are examined through the use of specific case studies. The essays provide examples of how various facets of 20th century medicine, including edu cation, research, the creation of medical knowledge, the development and application of technology, and day to day medical practice, are per vaded by a value system characteristic of an industrial-capitalistic view of the world in which the idea that science represents an objective and value free body of knowledge is dominant. The authors of the essays are sociologists and anthropologists (in almost equal numbers); also included are papers by a social historian and by three physicians all of whom have steeped themselves in the social sci ences and humanities. This co-operative endeavor, which has necessi tated the breaking down of disciplinary barriers to some extent, is per haps indicative of a larger movement in the social sciences, one in which there is a searching for a middle ground between grand theory and attempts at universal explanations on the one hand, and the context-spe cific empiricism and relativistic accounts characteristic of many historical and anthropological analyses on the other.
The United States has the highest per capita spending on health care of any industrialized nation but continually lags behind other nations in health care outcomes including life expectancy and infant mortality. National health expenditures are projected to exceed $2.5 trillion in 2009. Given healthcare's direct impact on the economy, there is a critical need to control health care spending. According to The Health Imperative: Lowering Costs and Improving Outcomes, the costs of health care have strained the federal budget, and negatively affected state governments, the private sector and individuals. Healthcare expenditures have restricted the ability of state and local governments to fund other priorities and have contributed to slowing growth in wages and jobs in the private sector. Moreover, the number of uninsured has risen from 45.7 million in 2007 to 46.3 million in 2008. The Health Imperative: Lowering Costs and Improving Outcomes identifies a number of factors driving expenditure growth including scientific uncertainty, perverse economic and practice incentives, system fragmentation, lack of patient involvement, and under-investment in population health. Experts discussed key levers for catalyzing transformation of the delivery system. A few included streamlined health insurance regulation, administrative simplification and clarification and quality and consistency in treatment. The book is an excellent guide for policymakers at all levels of government, as well as private sector healthcare workers.
Getting the right diagnosis is a key aspect of health care - it provides an explanation of a patient's health problem and informs subsequent health care decisions. The diagnostic process is a complex, collaborative activity that involves clinical reasoning and information gathering to determine a patient's health problem. According to Improving Diagnosis in Health Care, diagnostic errors-inaccurate or delayed diagnoses-persist throughout all settings of care and continue to harm an unacceptable number of patients. It is likely that most people will experience at least one diagnostic error in their lifetime, sometimes with devastating consequences. Diagnostic errors may cause harm to patients by preventing or delaying appropriate treatment, providing unnecessary or harmful treatment, or resulting in psychological or financial repercussions. The committee concluded that improving the diagnostic process is not only possible, but also represents a moral, professional, and public health imperative. Improving Diagnosis in Health Care, a continuation of the landmark Institute of Medicine reports To Err Is Human (2000) and Crossing the Quality Chasm (2001), finds that diagnosis-and, in particular, the occurrence of diagnostic errorsâ€"has been largely unappreciated in efforts to improve the quality and safety of health care. Without a dedicated focus on improving diagnosis, diagnostic errors will likely worsen as the delivery of health care and the diagnostic process continue to increase in complexity. Just as the diagnostic process is a collaborative activity, improving diagnosis will require collaboration and a widespread commitment to change among health care professionals, health care organizations, patients and their families, researchers, and policy makers. The recommendations of Improving Diagnosis in Health Care contribute to the growing momentum for change in this crucial area of health care quality and safety.
America's health care system has become too complex and costly to continue business as usual. Best Care at Lower Cost explains that inefficiencies, an overwhelming amount of data, and other economic and quality barriers hinder progress in improving health and threaten the nation's economic stability and global competitiveness. According to this report, the knowledge and tools exist to put the health system on the right course to achieve continuous improvement and better quality care at a lower cost. The costs of the system's current inefficiency underscore the urgent need for a systemwide transformation. About 30 percent of health spending in 2009-roughly $750 billion-was wasted on unnecessary services, excessive administrative costs, fraud, and other problems. Moreover, inefficiencies cause needless suffering. By one estimate, roughly 75,000 deaths might have been averted in 2005 if every state had delivered care at the quality level of the best performing state. This report states that the way health care providers currently train, practice, and learn new information cannot keep pace with the flood of research discoveries and technological advances. About 75 million Americans have more than one chronic condition, requiring coordination among multiple specialists and therapies, which can increase the potential for miscommunication, misdiagnosis, potentially conflicting interventions, and dangerous drug interactions. Best Care at Lower Cost emphasizes that a better use of data is a critical element of a continuously improving health system, such as mobile technologies and electronic health records that offer significant potential to capture and share health data better. In order for this to occur, the National Coordinator for Health Information Technology, IT developers, and standard-setting organizations should ensure that these systems are robust and interoperable. Clinicians and care organizations should fully adopt these technologies, and patients should be encouraged to use tools, such as personal health information portals, to actively engage in their care. This book is a call to action that will guide health care providers; administrators; caregivers; policy makers; health professionals; federal, state, and local government agencies; private and public health organizations; and educational institutions.
In this reappraisal of public health and health promotion in contemporary societies, Deborah Lupton explores public health and health promotion using contemporary sociocultural and political theory, particularly that building on Foucault′s writings on subjectivity, embodiment and power relations. The author examines the implications of the new social theories for the study of health promotion and health communication to analyze the symbolic nature of public health practices, and explores their underlying meanings and assumptions.
This study has emerged from an ongoing program of trilateral cooperation between WHO, WTO and WIPO. It responds to an increasing demand, particularly in developing countries, for strengthened capacity for informed policy-making in areas of intersection between health, trade and IP, focusing on access to and innovation of medicines and other medical technologies.
Thanks to remarkable advances in modern health care attributable to science, engineering, and medicine, it is now possible to cure or manage illnesses that were long deemed untreatable. At the same time, however, the United States is facing the vexing challenge of a seemingly uncontrolled rise in the cost of health care. Total medical expenditures are rapidly approaching 20 percent of the gross domestic product and are crowding out other priorities of national importance. The use of increasingly expensive prescription drugs is a significant part of this problem, making the cost of biopharmaceuticals a serious national concern with broad political implications. Especially with the highly visible and very large price increases for prescription drugs that have occurred in recent years, finding a way to make prescription medicinesâ€"and health care at largeâ€"more affordable for everyone has become a socioeconomic imperative. Affordability is a complex function of factors, including not just the prices of the drugs themselves, but also the details of an individual's insurance coverage and the number of medical conditions that an individual or family confronts. Therefore, any solution to the affordability issue will require considering all of these factors together. The current high and increasing costs of prescription drugsâ€"coupled with the broader trends in overall health care costsâ€"is unsustainable to society as a whole. Making Medicines Affordable examines patient access to affordable and effective therapies, with emphasis on drug pricing, inflation in the cost of drugs, and insurance design. This report explores structural and policy factors influencing drug pricing, drug access programs, the emerging role of comparative effectiveness assessments in payment policies, changing finances of medical practice with regard to drug costs and reimbursement, and measures to prevent drug shortages and foster continued innovation in drug development. It makes recommendations for policy actions that could address drug price trends, improve patient access to affordable and effective treatments, and encourage innovations that address significant needs in health care.
The very rapid pace of advances in biomedical research promises us a wide range of new drugs, medical devices, and clinical procedures. The extent to which these discoveries will benefit the public, however, depends in large part on the methods we choose for developing and testing them. Modern Methods of Clinical Investigation focuses on strategies for clinical evaluation and their role in uncovering the actual benefits and risks of medical innovation. Essays explore differences in our current systems for evaluating drugs, medical devices, and clinical procedures; health insurance databases as a tool for assessing treatment outcomes; the role of the medical profession, the Food and Drug Administration, and industry in stimulating the use of evaluative methods; and more. This book will be of special interest to policymakers, regulators, executives in the medical industry, clinical researchers, and physicians.
