Changing health care systems and rheumatic disease / Committee on Changing Health Care Systems and Rheumatic Disease, Division of Health Care Services, Institute of Medicine, Frederick J. Manning and Jeremiah A. Barondess, editors.

Format:

Book

Author/Creator:

Institute of Medicine (U.S.). Committee on Changing Health Care Systems and Rheumatic Disease.

Contributor:

Manning, Frederick J.

Barondess, Jeremiah A., 1924-

Institute of Medicine (U.S.). Division of Health Care Services.

Language:

English

Subjects (All):

Rheumatoid arthritis--United States.

Rheumatoid arthritis.

Systemic lupus erythematosus--United States.

Systemic lupus erythematosus.

Managed care plans (Medical care)--United States.

Managed care plans (Medical care).

Outcome assessment (Medical care)--United States.

Outcome assessment (Medical care).

Chronic diseases--United States.

Chronic diseases.

Health care reform--United States.

Health care reform.

Medical care--United States.

Medical care.

Physical Description:

1 online resource (252 p.)

Edition:

1st ed.

Other Title:

Changing health care systems & rheumatic disease

Place of Publication:

Washington, D.C. : National Academy Press, 1996.

Language Note:

English

Summary:

Market forces are driving a radical restructuring of health care delivery in the United States. At the same time, more and more people are living comparatively long lives with a variety of severe chronic health conditions. Many such people are concerned about the trend toward the creation of managed care systems because their need for frequent, often complex, medical services conflicts with managed care's desires to contain costs. The fear is that people with serious chronic disorders will be excluded from or underserved by the integrated health care delivery networks now emerging. Responding to a request from the National Institute of Arthritis and Musculoskeletal and Skin Diseases, this book reflects the results of a workshop that focused on the following questions: Does the model of managed care or an integrated delivery system influence the types of interventions provided to patients with chronic conditions and the clinical and health status outcomes resulting from those interventions? If so, are these effects quantitatively and clinically significant, as compared to the effects that other variables (e.g., income, education, ethnicity) have on patient outcomes? If the type of health care delivery system appears to be related to patient care and outcomes, can specific organizational, financial, or other variables be identified that account for the relationships? If not, what type of research should be pursued to provide the information needed about the relationship between types of health care systems and the processes and outcomes of care provided to people with serious chronic conditions?

Contents:

Changing Health Care Systems and Rheumatic Disease

Copyright

Preface

Contents

1 Introduction

CHANGING HEALTH CARE SYSTEMS

CHRONIC DISEASE

RHEUMATIC DISEASE

PRACTICES AND ACHIEVEMENTS OF MANAGED CARE SYSTEMS

Hospital Use

Physician Use

Tests and Procedures

Home Health and Skilled Nursing Care

Social/Health Maintenance Organizations

WORK FORCE ISSUES

RESEARCH, EDUCATION, AND TRAINING

THE WORKSHOP

2 Opening Remarks

3 Keynote Address

CHANGING HEALTH CARE

HOSPITALS

MANAGED CARE

PHYSICIAN PAYMENT

SPECIALIST-GENERALIST INTERACTION

POLICY ISSUES

4 What Would Ideal Care Look Like?

INTRODUCTION

INVITED ADDRESS

INVITED REACTION

The Patient

The Role of The Physician and the Relationship Between the Primary Care Provider and the Specialist

Other Elements in An Ideal System of Care

Rehabilitation

Exercise

Nonrestrictive Drug Formularies

Alternative Delivery Mechanisms

Structured Care

Relationship Between Financing and Care

Measurement of Outcomes in an Ideal Care System

Access to an Ideal Care System

Conclusion

DISCUSSION

5 Managed Care and Rheumatoid Arthritis: Utilization and Outcomes Over 11 Years

Literature on Health Care Utilization and Outcomes in FFS and HMOs

Study Design

Results

Health Care Utilization

Health Outcomes

Summary of FFS-PGP Comparisons

Comparisons of Care Provided by Rheumatologists and Nonrheumatologists

Conclusions

6 Measuring Medical Outcomes: Longitudinal Data on the Differential Impact of Health Care Systems on Chronic Disease

DISCUSSION.

7 Changing Health Care Systems and Access to Care for the Chronically Ill

The Chronically Ill: Promises and Risks in An Era of Managed Care and Competitive Markets

Chronic Illness

Risk and Current Managed Care Market Dynamics

Capitation: Moving to the Provider Level?

Standards of Comparison

Inadequately Insured Chronically Ill: A Harsher Future

Vulnerable Populations

Policy Implications

8 Training and Utilization of Generalists and Subspecialists at the University of California, Los Angeles

Primary Care Physicians

Subspecialty and Specialty Consultation

Transportation Systems

Education Systems

Graduate Medical Education

Integrating Subspecialty Medicine Into General Internal Medicine

Continuing Medical Education

9 How Easily Do Health Care Systems Adopt New Knowledge, and What Are the Likely Future Developments?

10 Issues and Insights Regarding Research, Education, and Training

Research

Education

Training

11 Commentary on the Day's Papers

12 Conclusions and Recommendations

CONCLUSION 1

CONCLUSION 2

CONCLUSION 3

CONCLUSION 4

CONCLUSION 5

CONCLUSION 6

CONCLUSION 7

CONCLUSION 8

CONCLUSION 9

A FINAL NOTE

Appendix A Biographies of Committee Members and Speakers

Appendix B Workshop Guests.

Notes:

Bibliographic Level Mode of Issuance: Monograph

Includes bibliographical references.

ISBN:

9786610191772

9780309175074

0309175070

9781280191770

1280191775

9780309596749

0309596742

9780585085388

0585085382

OCLC:

43475712