Health policy and education最新文献

The role of the National Center for Health Statistics (NCHS) in providing data for health policy and planning at the national and local level is discussed. Four specific examples are considered. First, data from the Hospital Discharge Survey are used to identify surgical procedures with large increases between 1965 and 1976: 30 percent rise in the incidence of hysterectomy, 169 percent increase in cesarean section, 100 percent increase in lens extraction, and 35 percent increase in orthopedic surgery. The extent to which such increases represent unnecessary utilization and their impact on costs are discussed. Second, the combination of data from two sources (Health Interview Survey and Health and Nutrition Examination Survey) is illustrated by considering selected policy issues related to hypertension. Next, the problem of designating medically underserved areas is discussed in relation to the difficulties in implementing federal policies at the local level without local data. The potential for national data systems to provide guidance for these policies is also considered. The final example discusses the use of vital statistics to provide small area data for local health planning. In conclusion several areas are considered which need development in order to maximize the use of data for policy and planning: research on measurement of health status, with particular emphasis on how health policy can affect health status; research on appropriate levels of health resources and services; development of shared data systems to reduce cost and respondent burden; and training, especially at the undergraduate level and in interdisciplinary graduate programs.

In this article, the authors make use of some contemporary models of decision-making to show how the process of decision-making can become more self-conscious, and thus both more enlightened and more assured. The approach is an examination of several models examined both from the perspective of the steps in the process itself, as well as general observations about the decision-making process. The practical focus is on the medical school organization with its unique characteristics. This article also examines the decision-making process through a comparison of two types of organizational structure (pyramidal and matrix) found in most medical schools.

Certain constants emerge from this article that positively enhance good decision-making. These elements are:

• (1)

  the rapidity of change;

• (2)

  the critical need for a wide range of alternatives;

• (3)

  an understanding of both the organizational structure and human factors involved; and

• (4)

  the necessity of involving others in the decision-making process.

By analyzing various modes of decision-making and presenting options, this article should be of real assistance to administrators.

This paper examines the relationship between medical students' practice plans and residency plans. The paper concludes that most students surveyed knew where they wanted to practice and that, unless otherwise constrained, students who knew where they wanted to practice tended to apply to programs there. This finding suggests that the Weiskotten literature and its apparent policy implications should be evaluated critically. In particular, the results call into question the rationale for unrestricted subsidies of undergraduate and graduate medical education by the states.

Is there an impending physician surplus? The authors' position is that there is an impending surplus. Health planners must be cognizant of this eventuality. The federal government as one of the major authors of health policy guidelines is currently reacting to the surplus question. But federal reaction can at times be too swift, too dramatic, and not in the best interests of those who must maintain previous investments. Therefore, both the supporters of health-related educational institutions and those who are responsible for program implementation must attempt to define and reach a common understanding of the situation. Policy development and planning activities must be collaborative efforts that emphasize involvement.

In this paper, the authors present a brief review of federal policies relative to the production of physicians and other health professionals. It is hoped that one can better understand the current situation and more effectively plan the future if past developments are included. This should lead to a comprehensive analysis from a common perspective. The involvement of the Carnegie Commission (Carnegie Council) is also included for the same reasons.

All analyses lead to the current situation and the authors' position that there is an impending physician surplus. The central problem has shifted from physician supply to the problem of physician maldistribution, both geographically and by specialty.

Hospitals are traditionally centers for health care as well as institutions for health education. This latter function has been changing during the last few decades and continues to change with regard to both type and form of education offered. By providing clinical training sites, an increasingly involved association with higher education institutes has emerged. In this paper, it is argued that student, college, hospital and society all benefit from this cooperation.

Recent federal legislation established a Certificate of Need (CON) process by which health care providers must receive state approval before building or renovating a facility, or adding a new service. Certainly, strict regulation of cost and quality of home health care is needed, but it is asserted that CON is an ineffective way of organizing the delivery of services and limiting costs, and furthermore, that CON is biased in favor of institutionally-based providers and maintenance of the status quo. The authors feel that vested interests have a history of trying to use earlier state CON regulations to control their turf, limit competition, and consequently stifle innovation. Home health care should be incorporated into national health planning goals and integrated into state and regional health plans. Such planning must precede CON regulations and should not be confused with it.

Alternatives to CON can achieve quality service and moderate costs and include licensing of personnel, standards for provider accreditation, and utilization review. Planning for these alternatives should begin now to avoid fragmented expansion of home health care. Evidence suggests a comprehensive use of home health care as a cost-effective alternative for many levels of care given in hospitals and nursing homes.

This article describes the process of selecting medical students in the United States. Medical school applicants are assessed using both test scores and previous academic record as well as interviews and letters of evaluation. Both academic qualification and personal factors are relevant to medical school admissions decisions. But available measures of the former better predict medical school success. This article evaluates applicant assessment approaches and suggests ways to improve certain measures of personal characteristics of applicants.

The Finnish medical education system has recently undergone a major reform, in response to a very specific, national legal mandate for change. The new law was passed in response to perceived needs for change in the health care delivery system, and recommendations of the Pan-Scandinavian Nordic Council and the Finnish Ministry of Education pertinent to principles and practice in higher education. The reforms address primarily matters of curriculum. The law is quite specific in prescribing both the structure and content of medical school curriculae. Significant progress has been made in implementing the legislation, passed in 1975.

The United States medical education system faces a series of problems which to a certain extent parallel those observed in Finland. There are problems in the health care delivery system which relate, directly and indirectly, to what goes on in the medical education system. Furthermore, there are intrasystem problems of educational theory and practice which need to be met. Abraham Flexner provided the rationale for direct government intervention in the medical education system, which is what happened in Finland. There is a distinct possibility that this may happen in the United States as well