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Changing Health Care Systems and Rheumatic Disease (1996) / Chapter Skim
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2: Opening Remarks
Pages 17-20

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From page 17...
... Disease, in this construct, is a biological phenomenon, to be understood ultimately in structural, physiological, or biochemical terms, increasingly at the molecular level. Much of the clinically relevant output of research in recent decades and a great deal of clinical practice, as a result, have focused on the aberrant biology of disease processes.
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From page 18...
... In general, I think it is fair to say that from the point of view of the physician there is a perception of perverse incentives in the system, away from a primary focus on fiduciary responsibilities and in the direction of payment incentives, care giver selection that may be based on characteristics that are sometimes perverse, gag rules, issues of patient eligibility in care systems, and so on. From the point of view of some care givers, corporate priorities and the issues they brings in their wake amount to an unsought second opinion.
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From page 19...
... At the same time, managed care structures have the potential to bring some advantages, including a clearer focus on costs; the assembly of cohorts; of defined populations, perhaps allowing easier evaluation of interventions and outcomes; and the potential for greater accountability in the system. From the point of view of this workshop, focused as it is at the intersection of the patient and the care system, with particular reference to chronic disease, we should focus ultimately on patient welfare, patient outcomes, and the things that need to be done to enhance both; then we should know with some confidence whether we are in fact doing so.
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Key Terms

  • care arrangements
  • fiduciary responsibilities
  • patient outcomes
  • care institutions
  • fair amount

  • chronic care
  • particular reference
  • care structures
  • clearer focus
  • easier evaluation

  • central issues
  • yield enhanced
  • physician providers
  • evolving care
  • major shifts

  • wake amount
  • traditional fiduciary
  • care giver
  • sometimes perverse
  • ill health

  • gag rules
  • asymptomatic pulmonary
  • shifts taking
  • allowing easier
  • power structure

  • clinically relevant
  • rheumatoid arthritis
  • special prominence
  • perverse incentives
  • administrative professionals


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