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Changing Health Care Systems and Rheumatic Disease

Changing Health Care Systems and Rheumatic Disease

  • Author: Barondess, Jeremiah A.; Manning, Frederick J.
  • Publisher: National Academies Press
  • ISBN: 9780309056830
  • eISBN Pdf: 9780309596749
  • eISBN Epub: 9780309175074
  • Place of publication:  United States
  • Year of digital publication: 1997
  • Month: January
  • Pages: 253
  • Language: English

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?
  • 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
    • INVITED REACTION
    • 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
    • INTRODUCTION
    • INVITED ADDRESS
      • 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
    • INVITED REACTION
    • INVITED REACTION
    • DISCUSSION
  • 6 Measuring Medical Outcomes: Longitudinal Data on the Differential Impact of Health Care Systems on Chronic Disease
    • INTRODUCTION
    • INVITED ADDRESS
    • INVITED REACTION
    • INVITED REACTION
    • DISCUSSION
  • 7 Changing Health Care Systems and Access to Care for the Chronically Ill
    • INTRODUCTION
    • INVITED ADDRESS
      • 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
    • INVITED REACTION
    • INVITED REACTION
    • DISCUSSION
  • 8 Training and Utilization of Generalists and Subspecialists at the University of California, Los Angeles
    • INTRODUCTION
    • INVITED ADDRESS
      • Primary Care Physicians
      • Subspecialty and Specialty Consultation
      • Transportation Systems
      • Education Systems
      • Graduate Medical Education
      • Integrating Subspecialty Medicine Into General Internal Medicine
      • Continuing Medical Education
    • INVITED REACTION
    • INVITED REACTION
    • DISCUSSION
  • 9 How Easily Do Health Care Systems Adopt New Knowledge, and What Are the Likely Future Developments?
    • INTRODUCTION
    • INVITED ADDRESS
    • INVITED REACTION
    • INVITED REACTION
    • DISCUSSION
  • 10 Issues and Insights Regarding Research, Education, and Training
    • INTRODUCTION
    • INVITED ADDRESS
      • Research
      • Education
      • Training
      • Conclusion
    • INVITED REACTION
    • DISCUSSION
  • 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

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