Medicare New Directions in Quality Assurance Proceedings (1991) / Chapter Skim
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10. A Response
10. A Response
Pages 73-78
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From page 73... ...
The more we engage this issue, the more optimistic I am that some of the major problems now confronting our medical policy have a solution that goes back to the question of patient demand. I have always been skeptical about the notion that our cost containment crisis was a product of patient demand and medical progress, being much more impressed by the features of supplier-induced demand and professional uncertainty about the value of medical treatments the fact that physicians often disagree on what works in medicine.
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From page 74... ...
In our search for definitions, therefore, modification is needed. As a house staff officer, we thought the words appropriate care meant necessary care.
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From page 75... ...
This will allow us to do for other common conditions what it has been possible to do for BPH, namely, to clarify the outcome probabilities and begin to bring that information to patients and physicians to improve the scientific and ethical basis of clinical decisionmaking. I predict that, as in the BPH example, most of the conditions will provide people with clear choices between treatments depending on their attitudes toward risk and their concern about various outcome states.
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From page 76... ...
, beds in higher-bed areas are used almost exclusively to treat patients with a set of medical conditions that I have come to call "high variation." Surgical procedure rates are not correlated with bed supply, nor are the admission rates for heart attacks, strokes, and acute gastrointestinal hemorrhages. The kind of admissions that are more frequent when beds are more common are pneumonias, bronchitis and asthma, otitis media, and hypertension.
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From page 77... ...
QUALITY, RESOURCES, AND PRACTICE PATTERNS When I read the IOM report, I agreed with its message, but I did not see in it mechanisms by which the quality movement could affect the overall aggregate supply in market areas. Yet, if we are going to achieve reallocation, we are going to have to pay close attention to the question of whether structural changes are actually harming patients.
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From page 78... ...
Pp. 63-72 in Medicare: New Directions in Quality Assurance.
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