Health care futures. Part 2: The future of physician executives? Panel discussion

What is the future of health care in America? This is Part 2 of The Physician Executive panel discussion that explores the future of health care in America. To narrow this ambitious focus somewhat, the future is defined as five to 10 years hence. In Part 1, which was published in the May/June issue, Russell C. Coile, Jr., Barbara LeTourneau, MD, MBA, FACPE, James Reinertsen, MD, Uwe Reinhardt, PhD, Marshall Ruffin, MD, MPH, MBA, FACPE, and David Vogel, MS, shared their opinions about what the future holds in managed care, information technology, and biotechnology. In Part 2, Susan Cejka, Barbara LeTourneau, MD, MBA, FACPE, John Henry Pfifferling, PhD, Uwe Reinhardt, PhD, and James Todd, MD, share their views on the future of medical education and physician executives.     

Has the rise in globalization reduced U.S. inflation in the 1990s?

This article investigates whether increased globalization of the U.S. economy has helped hold down inflation in the 1990s. Based on several measures, we find that globalization has increased. Further, we find that import prices exert a greater impact on prices of products in industries faced with greater import penetration. High foreign excess capacity accounts for much of the recent decline in U.S. inflation. Our results suggest that the decline in inflation is explained by the interaction of increased globalization and high excess foreign capacity. Globalization by itself does not lead to less inflation, just greater sensitivity to foreign economic conditions.     

The disruptive physician. A quality of professional life factor.

Medical leaders need to understand that attending to quality of professional life issues includes dealing with the insidious costs and stress associated with disruptive physician behavior. The disruptive physician or professional undermines practice morale, heightens turnover in the organization, steals from productive activities, increases the risks for ineffective or substandard practice, and causes distress among colleagues. Physician executives need to help reduce or prevent this behavior and develop accepted systems in which to manage, confront, and rehabilitate the person labeled "disruptive." Suggested strategies to consider in developing a system include: (1) Defining reasonable and competent interpersonal behavior; (2) educating in interpersonal skills; (3) evaluating interpersonal skills; (4) developing disruptive policy; and (5) assessing, confronting, and rehabilitating.     

Competition and privatization amidst weak institutions: evidence from Mongolia

Mongolia's mass privatization program was implanted in a country that lacked the very basic institutions of capitalism. This paper examines the effects of competition and ownership on the efficiency of the newly privatized enterprises, using a representative sample of enterprises and controlling for possible selection biases. Competition has quantitatively large effects; perfectly competitive firms having nearly double the efficiency of monopolies. Enterprises with residual state ownership appear to be more efficient than other enterprises, reflecting an environment where the government was pressured to focus on efficiency and institutions gave little voice to outsider owners.     

Ounces of malpractice prevention

The source of malpractice claims, contrary to widely held views, is not simply improper or inadequate medical care. In the majority of cases, malpractice litigation ensues because of negative nonclinical factors and the incidence of an unexpected result in medical treatment. High on the list of nonclinical causes are faults in the physician-patient relationship. Patients who are unhappy with the manner in which they have been treated by physicians are much more likely to sue when the outcome is even moderately untoward. Key to reducing the incidence of malpractice suits is helping physicians understand that attention has to be paid to their behavior.     

The managed care world order. The revolution is here

What are the belief clashes caused by the shift from a fee-for-service medical setting to a managed care environment? Right now, most physicians are enculturated in the old world order that emphasizes physician autonomy, control, security, and specialness. Physicians feel squeezed--by third-party payers wanting to be involved in the decision-making process of care delivery and by a new focus on teams versus the captain of the ship role. When traditional expectations clash with a changing reality, most people feel stressed. Physicians are no exception. If physicians have clear and realistic expectations, they can better cope with the uncertainties they face. And, the only realistic expectation in the medical profession is increasing uncertainty. Here are 10 predictions of what is happening in the health care industry--a list of the belief clashes that are so unsettling to those practicing medicine.