Improvements in the medical/technical ability to transplant human organs have led to similar--yet importantly different--societal and organizational responses among the nations of the "Atlantic Community." The highly decentralized system of organ procurement in the United States yields greater numbers; centrally directed European systems reflect lower wastage rates. An emerging convergence of the two approaches promises significant benefits and efficiencies in organ transplantation.
{"title":"Organ procurement in Europe and the United States.","authors":"J. Prottas","doi":"10.2307/3349899","DOIUrl":"https://doi.org/10.2307/3349899","url":null,"abstract":"Improvements in the medical/technical ability to transplant human organs have led to similar--yet importantly different--societal and organizational responses among the nations of the \"Atlantic Community.\" The highly decentralized system of organ procurement in the United States yields greater numbers; centrally directed European systems reflect lower wastage rates. An emerging convergence of the two approaches promises significant benefits and efficiencies in organ transplantation.","PeriodicalId":76697,"journal":{"name":"The Milbank Memorial Fund quarterly. Health and society","volume":"78 1","pages":"94-126"},"PeriodicalIF":0.0,"publicationDate":"1985-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83491116","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The statistical results concur closely with descriptive ones presented earlier, indicating that the latter are not results of random variations. The main effects of employment, the contingent effects of parenthood, and the time trends modeled here are the same as reported earlier. (Only two differences occur. First, among white married women, mothers have statistically more acute conditions than nonmothers. We saw this parenthood effect earlier for nonemployed married women, but not for employed ones [results were inconsistent]. The statistical analysis smooths those inconsistencies and reveals that employed mothers also experience more acute conditions than their nonmother peers. Second, among white married women, older housewives show statistically increased chronic limitation over time. Earlier we saw a rise for housewives without children. The latter parenthood effect is statistically smaller than the age effect.) The singular advantage of the statistical analysis has been its ability to highlight interaction effects among the variables, some of which were not considered in the descriptive section. Comparing the models, note how those for short- and long-term disability are very similar to each other but distinctly different from the acute-condition models. This means that social roles and age influence short- and long-term disability in the same way. Specifically, both are greater for older and nonemployed women, being especially high for older nonemployed women and housewives without children. By contrast, the most consistent factor affecting acute-condition incidence and impact is presence of children. Children increase their mothers' experience of acute problems but reduce the amount of recuperative time and medical care taken for them.
{"title":"Social roles and health trends of American women.","authors":"L. Verbrugge, J. Madans","doi":"10.2307/3349855","DOIUrl":"https://doi.org/10.2307/3349855","url":null,"abstract":"The statistical results concur closely with descriptive ones presented earlier, indicating that the latter are not results of random variations. The main effects of employment, the contingent effects of parenthood, and the time trends modeled here are the same as reported earlier. (Only two differences occur. First, among white married women, mothers have statistically more acute conditions than nonmothers. We saw this parenthood effect earlier for nonemployed married women, but not for employed ones [results were inconsistent]. The statistical analysis smooths those inconsistencies and reveals that employed mothers also experience more acute conditions than their nonmother peers. Second, among white married women, older housewives show statistically increased chronic limitation over time. Earlier we saw a rise for housewives without children. The latter parenthood effect is statistically smaller than the age effect.) The singular advantage of the statistical analysis has been its ability to highlight interaction effects among the variables, some of which were not considered in the descriptive section. Comparing the models, note how those for short- and long-term disability are very similar to each other but distinctly different from the acute-condition models. This means that social roles and age influence short- and long-term disability in the same way. Specifically, both are greater for older and nonemployed women, being especially high for older nonemployed women and housewives without children. By contrast, the most consistent factor affecting acute-condition incidence and impact is presence of children. Children increase their mothers' experience of acute problems but reduce the amount of recuperative time and medical care taken for them.","PeriodicalId":76697,"journal":{"name":"The Milbank Memorial Fund quarterly. Health and society","volume":"27 1","pages":"691-735"},"PeriodicalIF":0.0,"publicationDate":"1985-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84758772","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Programs of health care and economic assistance to the elderly already account for nearly half of all the federal government's domestic spending, and this proportion will rise rapidly over the next few decades. While conditions have improved for many persons, major subgroups--blacks, widowed women, and those aged 85 and over--are increasingly vulnerable. The political-economic agenda of the post-election period will have to reconsider: guns vs. canes; means testing vs. entitlement; and public insurance vs. private savings and pensions.
{"title":"An aging society and the federal deficit.","authors":"L. Etheredge","doi":"10.2307/3349835","DOIUrl":"https://doi.org/10.2307/3349835","url":null,"abstract":"Programs of health care and economic assistance to the elderly already account for nearly half of all the federal government's domestic spending, and this proportion will rise rapidly over the next few decades. While conditions have improved for many persons, major subgroups--blacks, widowed women, and those aged 85 and over--are increasingly vulnerable. The political-economic agenda of the post-election period will have to reconsider: guns vs. canes; means testing vs. entitlement; and public insurance vs. private savings and pensions.","PeriodicalId":76697,"journal":{"name":"The Milbank Memorial Fund quarterly. Health and society","volume":"44 1","pages":"521-43"},"PeriodicalIF":0.0,"publicationDate":"1984-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88292405","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
About one-third of the nation's poor lack insurance--public or private--against the costs of illness. Data from 1980 and 1982 show that a patchwork of state and local government charitable grants, and the disparate efforts of hospitals to provide free care, cannot mend the national "safety net." A prudent short-run approach to modifying charity care is advanced, although the long-run necessity for insuring the uninsured is inevitable.
{"title":"Falling through the cracks: poverty, insurance coverage, and hospital care for the poor, 1980 and 1982.","authors":"J. Feder, J. Hadley, R. Mullner","doi":"10.2307/3349836","DOIUrl":"https://doi.org/10.2307/3349836","url":null,"abstract":"About one-third of the nation's poor lack insurance--public or private--against the costs of illness. Data from 1980 and 1982 show that a patchwork of state and local government charitable grants, and the disparate efforts of hospitals to provide free care, cannot mend the national \"safety net.\" A prudent short-run approach to modifying charity care is advanced, although the long-run necessity for insuring the uninsured is inevitable.","PeriodicalId":76697,"journal":{"name":"The Milbank Memorial Fund quarterly. Health and society","volume":"61 1","pages":"544-66"},"PeriodicalIF":0.0,"publicationDate":"1984-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89398486","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Medicare aimed, above all, to improve access to health care services for the most disadvantaged elderly by removing distributional, attitudinal, and financial barriers. Legislative intent was based on sketchy statistical evidence of need and enriched by extensive testimony of hardship. By more precise measurements, the mature Medicare program is shown to have been largely successful. Yet, some problems of access remain, and some costly side effects are identified.
{"title":"Medicare and the disadvantaged elderly: objectives and outcomes.","authors":"S. H. Long, R. F. Settle","doi":"10.2307/3349839","DOIUrl":"https://doi.org/10.2307/3349839","url":null,"abstract":"Medicare aimed, above all, to improve access to health care services for the most disadvantaged elderly by removing distributional, attitudinal, and financial barriers. Legislative intent was based on sketchy statistical evidence of need and enriched by extensive testimony of hardship. By more precise measurements, the mature Medicare program is shown to have been largely successful. Yet, some problems of access remain, and some costly side effects are identified.","PeriodicalId":76697,"journal":{"name":"The Milbank Memorial Fund quarterly. Health and society","volume":"1 1","pages":"609-56"},"PeriodicalIF":0.0,"publicationDate":"1984-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79864532","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Most operational services within the reorganized British National Health Service are managed by local teams: medical specialist, general practitioner, nurse, administrator, and finance officer. Decision by consensus has worked well to integrate services in a complex and fiscally constrained system. As larger and more formal systems of health care emerge in the United States, the British experience may be relevant.
{"title":"Consensus management in the British National Health Service: implications for the United States?","authors":"R. Schulz, S. Harrison","doi":"10.2307/3349840","DOIUrl":"https://doi.org/10.2307/3349840","url":null,"abstract":"Most operational services within the reorganized British National Health Service are managed by local teams: medical specialist, general practitioner, nurse, administrator, and finance officer. Decision by consensus has worked well to integrate services in a complex and fiscally constrained system. As larger and more formal systems of health care emerge in the United States, the British experience may be relevant.","PeriodicalId":76697,"journal":{"name":"The Milbank Memorial Fund quarterly. Health and society","volume":"10 1","pages":"657-81"},"PeriodicalIF":0.0,"publicationDate":"1984-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81879681","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
to health care cost-containment, existing systems for regulating health professionals are being scrutinized. The federalized system of control mechanisms for credentialing, together with the procedures of accreditation, institutional rationing of practice privileges, peer review, malpractice actions, and the like, supplies a complex and often redundant array of regulations. These devices are manipulated by several federal agencies, each of the 50 states, professional groups, and several private organizations. These regulations are perceived by many to be a significant barrier to ongoing efforts to encourage costcontainment through more widespread use of competitive incentives in the health care industry. Health manpower regulations govern the locations and settings within which professionals can work and the activities of professionals in the course of their practice. The justification for these controls is the belief that the public interest will best be served if poorly trained, incompetent, and unethical people are kept from practicing. If these regulations are effective, they will ensure the patients' safe treatment by prohibiting some people from pursuing careers and will appropriately modify the behavior of practicing professionals. An unfortunate by-
{"title":"Regulating health professionals: a review of the empirical literature.","authors":"G. Gaumer","doi":"10.2307/3349858","DOIUrl":"https://doi.org/10.2307/3349858","url":null,"abstract":"to health care cost-containment, existing systems for regulating health professionals are being scrutinized. The federalized system of control mechanisms for credentialing, together with the procedures of accreditation, institutional rationing of practice privileges, peer review, malpractice actions, and the like, supplies a complex and often redundant array of regulations. These devices are manipulated by several federal agencies, each of the 50 states, professional groups, and several private organizations. These regulations are perceived by many to be a significant barrier to ongoing efforts to encourage costcontainment through more widespread use of competitive incentives in the health care industry. Health manpower regulations govern the locations and settings within which professionals can work and the activities of professionals in the course of their practice. The justification for these controls is the belief that the public interest will best be served if poorly trained, incompetent, and unethical people are kept from practicing. If these regulations are effective, they will ensure the patients' safe treatment by prohibiting some people from pursuing careers and will appropriately modify the behavior of practicing professionals. An unfortunate by-","PeriodicalId":76697,"journal":{"name":"The Milbank Memorial Fund quarterly. Health and society","volume":"28 1","pages":"380-416"},"PeriodicalIF":0.0,"publicationDate":"1984-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79242904","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
care services will undergo significant changes during the 1980s, in part as a result of purchaser efforts. This emerging purchaser revolution is largely a consequence of frustration with the past two decades of unrestrained growth in health care costs and a growing recognition by purchasers of their capability and responsibility for controlling health care costs. The existence of this "purchaser revolution" has been the subject of some debate. A frequently cited study of corporate attitudes concluded that the business community was not especially concerned about rising health care expenditures and saw little advantage in taking action to control them (Sapolsky et al. 1981). More recently, Iglehart directed our attention to the awakening of industry-the "slumbering giant"-to a new concern with health
保健服务将经历重大的改变在1980年代,部分由于购买者的努力。这一新兴的购买者革命主要是对过去20年医疗保健费用无限制增长的失望和购买者日益认识到他们控制医疗保健费用的能力和责任的结果。这种“购买者革命”的存在一直是一些争论的主题。一项经常被引用的关于企业态度的研究得出的结论是，企业界并不特别关注不断上升的医疗保健支出，并且认为采取行动控制这些支出没有什么好处(Sapolsky et al. 1981)。最近，伊格尔哈特把我们的注意力引向了工业的觉醒——“沉睡的巨人”——对健康的新关注
{"title":"Private-sector health care initiatives: a comparative perspective from four communities.","authors":"E. Tell, M. Falik, P. Fox","doi":"10.2307/3349857","DOIUrl":"https://doi.org/10.2307/3349857","url":null,"abstract":"care services will undergo significant changes during the 1980s, in part as a result of purchaser efforts. This emerging purchaser revolution is largely a consequence of frustration with the past two decades of unrestrained growth in health care costs and a growing recognition by purchasers of their capability and responsibility for controlling health care costs. The existence of this \"purchaser revolution\" has been the subject of some debate. A frequently cited study of corporate attitudes concluded that the business community was not especially concerned about rising health care expenditures and saw little advantage in taking action to control them (Sapolsky et al. 1981). More recently, Iglehart directed our attention to the awakening of industry-the \"slumbering giant\"-to a new concern with health","PeriodicalId":76697,"journal":{"name":"The Milbank Memorial Fund quarterly. Health and society","volume":"23 1","pages":"357-79"},"PeriodicalIF":0.0,"publicationDate":"1984-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76238412","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
in determining the safety, efficacy, and efficiency of drug utilization, relatively few studies have investigated approaches designed to improve the ways physicians make drug-use decisions. Quality assurance approaches, including those of the Joint Commission on Hospital Accreditation, often emphasize audit and identification of problems, but are less oriented toward the establishment of effective mechanisms to change the problems thus identified (Anderson and Shields 1982). Traditional continuing education programs, relying on voluntary participation of physicians, have generally failed to reach those physicians most in need of training (Lewis and Hassanein 1970). The pharmaceutical industry has taken a central role in continuing drug education for the practicing physician, but there is concern that the commercial origins of such efforts may have a biasing effect on the information thus provided (Avorn, Chen, and Hartley 1982). Medication use in hospitals accounts for a large proportion of the $25 billion spent annually on drugs in the United States (Freeland and Schendler 1983), and represents an important percentage of hospital expenditures.
在确定药物使用的安全性、有效性和效率方面，相对较少的研究调查了旨在改善医生做出药物使用决定的方法。质量保证方法，包括医院认证联合委员会的方法，往往强调审计和发现问题，但不太注重建立有效机制来改变由此发现的问题(Anderson和Shields, 1982)。传统的继续教育项目，依靠医生的自愿参与，通常无法达到那些最需要培训的医生(Lewis和Hassanein 1970)。制药行业在执业医师的继续药物教育中发挥了核心作用，但人们担心这种努力的商业来源可能会对所提供的信息产生偏见(Avorn, Chen, and Hartley, 1982)。在美国每年250亿美元的药品支出中，医院的药物使用占很大比例(Freeland and Schendler 1983)，在医院支出中占重要比例。
{"title":"Efficacy and cost-containment in hospital pharmacotherapy: state of the art and future directions.","authors":"S. Soumerai, J. Avorn","doi":"10.2307/3349860","DOIUrl":"https://doi.org/10.2307/3349860","url":null,"abstract":"in determining the safety, efficacy, and efficiency of drug utilization, relatively few studies have investigated approaches designed to improve the ways physicians make drug-use decisions. Quality assurance approaches, including those of the Joint Commission on Hospital Accreditation, often emphasize audit and identification of problems, but are less oriented toward the establishment of effective mechanisms to change the problems thus identified (Anderson and Shields 1982). Traditional continuing education programs, relying on voluntary participation of physicians, have generally failed to reach those physicians most in need of training (Lewis and Hassanein 1970). The pharmaceutical industry has taken a central role in continuing drug education for the practicing physician, but there is concern that the commercial origins of such efforts may have a biasing effect on the information thus provided (Avorn, Chen, and Hartley 1982). Medication use in hospitals accounts for a large proportion of the $25 billion spent annually on drugs in the United States (Freeland and Schendler 1983), and represents an important percentage of hospital expenditures.","PeriodicalId":76697,"journal":{"name":"The Milbank Memorial Fund quarterly. Health and society","volume":"145 1","pages":"447-74"},"PeriodicalIF":0.0,"publicationDate":"1984-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76782356","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
IN THE YEAR 1644, THE TOWNSHIP OF PORTSMOUTH, Rhode Island, delegated the care of "ould John Mott" to the town overseers. The overseers arranged for a caretaker who would provide for his "diett and washing" in exchange for 5s per week. These arrangements were made in spite of the fact that John Mott had a son. Rather than caring for his father personally, the son agreed to pay "A Cowe for ever and 5 bushels of Corne by the yeare so longe as the ould man shall live . . . that so he might be dischardged from any further Chardge" (Creech 1936). Old John Mott was clearly not self-reliant, and his son, while not abandoning his father entirely, relegated his care to members of the town, thus discharging himself from any further responsibility. The case of John Mott is not unique, not some historical anomaly that can be readily explained away. Yet a common theme among contemporary writers is that old age dependency was not a problem until the late nineteenth century and that older people either worked or were cared for by family, friends, or charity.' These conclusions,
{"title":"From poor laws to pensions: the evolution of economic support for the aged in England and America.","authors":"J. Quadagno","doi":"10.2307/3349859","DOIUrl":"https://doi.org/10.2307/3349859","url":null,"abstract":"IN THE YEAR 1644, THE TOWNSHIP OF PORTSMOUTH, Rhode Island, delegated the care of \"ould John Mott\" to the town overseers. The overseers arranged for a caretaker who would provide for his \"diett and washing\" in exchange for 5s per week. These arrangements were made in spite of the fact that John Mott had a son. Rather than caring for his father personally, the son agreed to pay \"A Cowe for ever and 5 bushels of Corne by the yeare so longe as the ould man shall live . . . that so he might be dischardged from any further Chardge\" (Creech 1936). Old John Mott was clearly not self-reliant, and his son, while not abandoning his father entirely, relegated his care to members of the town, thus discharging himself from any further responsibility. The case of John Mott is not unique, not some historical anomaly that can be readily explained away. Yet a common theme among contemporary writers is that old age dependency was not a problem until the late nineteenth century and that older people either worked or were cared for by family, friends, or charity.' These conclusions,","PeriodicalId":76697,"journal":{"name":"The Milbank Memorial Fund quarterly. Health and society","volume":"58 1","pages":"417-46"},"PeriodicalIF":0.0,"publicationDate":"1984-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79878701","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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