The Baxter health policy review最新文献

Physician workforce issues were among the most hotly debated components of the recent national health care reform effort. What are the United States' goals for its physician workforce? Will market forces be adequate to achieve these goals, or will regulatory intervention be needed? This chapter provides public and private policymakers with a framework for arriving at reasonable conclusions about this important subcomponent of national health policy. Physician supply and requirements are discussed first. A picture of the current U.S. physician workforce is presented, together with details of its size and the physician-to-population ratio. Future growth of the physician workforce is projected, and future requirements are discussed along with the potential for both surpluses and shortages in some areas. Graduate medical education, a crucial topic in this discussion, is covered. The issue of substitution of nonphysician providers for physicians is considered next, with special attention paid to the capabilities of nonphysician providers in performing certain tasks, as well as the productivity and cost-effectiveness questions involved. While the physician supply in the United States may be adequate overall, gaps in service and problems with access to services persist in many rural and inner-city areas. The geographic distribution of the physician workforce and the balance of subspecialists and generalists are addressed. Other topics of discussion include the need for greater minority representation in the physician workforce and the evolving role of the physician executive. Finally, this chapter ends with a wrap-up of policy considerations and themes central to the new delivery system of the twenty-first century. These themes include market forces versus regulation, cost containment and workforce cost-effectiveness, the global role of the United States, and nonfinancial barriers to access to care, as well as the impact of technology and the role of physician scientists.

A distinguishing feature of American health care is its emphasis on advanced technology. Yet today's changing health care environment is overhauling the engine of technological innovation. The rate and direction of technological innovation are affected by a complex of supply- and demandside factors, including biomedical research, education, patent law, regulation, health care payment, tort law, and more. Some distinguishing features of technological innovation in health care are now at increased risk. Regulatory requirements and rising payment hurdles are especially challenging to small technology companies. Closer management of health care delivery and payment, particularly the standardization that may derive from practice guidelines and clamping down on payment for investigational technologies, curtails opportunities for innovation. Levels and distribution of biomedical research funding in government and industry are changing. Financial constraints are limiting the traditional roles of academic health centers in fostering innovation. Despite notable steps in recent years to lower regulatory barriers and speed approvals, especially for products for life-threatening conditions, the Food and Drug Administration is under great pressure from Congress, industry, and patients to do more. Technology gatekeeping is shifting from hundreds of thousands of physicians acting on behalf of their patients to fewer, yet more powerful, managed care organizations and health care networks. Beyond its direct effects on adoption, payment, and use of technologies, the extraordinary buying leverage of these large providers is cutting technology profit margins and heightening competition among technology companies. It is contributing to unprecedented restructuring of the pharmaceutical and medical device industries, leading to unprecedented alliances with generic product companies, health care providers, utilization review companies, and other agents. These industry changes are already having considerable effects on investment patterns and the development, adoption, and use of new technologies. Until recently, new technologies that offered the prospect for health benefit, however, marginal or unproven, were paid for with little or no regard to cost. Technical wizardry alone no longer carries the day in health care. Today's health care market increasingly demands what other markets do--measurable improvements in benefits at acceptable costs--and innovators have begun to respond accordingly. Even so, certain key venues for health care innovation are at risk.