Is health care ready for a full menu of prices?

Examine the emerging trend of price transparency in health care and learn what some states are doing to make prices widely available on the Web.     

Is a powerful rival a right partner?

This paper explores why powerless firms are faced with the dilemma of whether or not to collaborate with other powerful firms. Two natures of power, competitive and cooperative natures, are compared to study such an imbalance between firms in market power and social power. Testing the syndicated underwritings in the U.S. from 1998 to 2009, we find that egos of low market power are less likely to partner with alters of high market power. In contrast, egos of low social power are more likely to collaborate with alters of high social power. Moreover, the results show that collaborations with powerful partners are not necessarily beneficial or detrimental for the performance of powerless focal firms; only when the high power partners possess a high network constraint which constrains opportunism and facilitates trust, do collaborations with such partners help the performance of powerless focal firms.     

Defined contribution health care: future direction or fantasy?

Will payers embrace defined contribution plans as an alternative to traditional health insurance or is this new approach a pipe dream? Are consumers truly ready to make informed decisions on purchasing their own health care? This article explores barriers to defined contribution health plans, including consumer reluctance to take ownership of buying insurance and a preference for the cost predictability of liberal coverage in employer-sponsored programs versus MSAs or higher co-payment arrangements. For the ultimate form of defined contribution health care to work, several tax and insurance barriers must be overcome. As a practical matter, the author argues that the current employer-sponsored approach is the most efficient system for large employers.     

Veteran's health care: time for a change?

The Department of Veterans Affairs' mission is "to care for him who are shall have borne the battle for his widow and orphan." The Veterans Health Administration comprises 172 hospitals that are the hub of the health care delivery system. It is the largest provider of graduate medical education, and one of the major research organizations in the United States. The medical care budget exceeds $17 billion annually. Most of the persons cared for are not legally entitled to this health care based on service connected disability. The utilization of acute care hospital beds appears excessive when compared to that obtainable with managed care for Medicare or commercial insurance beneficiaries--the cost per member per month is three times higher. There may also be exploitation of the Veterans Administration hospitals by university medical schools. The Veterans Health Administration is a very expensive way to deliver care to entitled service connected veterans. Therefore, it is suggested that privatization be considered as an alternative vehicle for delivering health care.     

Is the American health care delivery system ready for change?

In October 1992, the American College of Physician Executives sponsored a study tour to Berlin, Germany, and Amsterdam, Holland. Meetings were held with government officials, third-party payers, and providers, and on-site visits were made at hospitals, clinics, and academic centers. The purpose was to study the health care delivery system in those countries and to share some insights with the countries' hosts on the U.S. system. In a series of reports that began in the July issue of the journal, 5 of the 10 study tour participants describe their impressions of the tour and of the health care systems in the countries that were visited. In this final report, the implications of the German and Dutch systems for reform of the U.S. health care system are discussed.     

The physician-patient privilege: friend or foe?

The physician-patient privilege that has been enacted in most states has usually been seen as having the benign, even salutary, effect of protecting confidences that patients have entrusted to their physicians in the course of obtaining medical care and treatment. However, case decisions in one state have turned the privilege into a sword that plaintiffs can use to interfere with physicians' and hospitals' defense of cases against them by denying their counsel access to key defense witnesses. This development could occur in many other states that have taken a similar general approach in analyzing the privilege.     

The electronic medical record system: health care marvel or morass?

The author considers the potential advantages and disadvantages, as well as possible unintended consequences, of introducing electronic medical record systems in health care organizations. Special consideration is given to the issues such information systems raise concerning privacy, confidentiality, and quality of care from both patient and provider perspectives. The potential gains from computerizing medical records include the benefit of instantaneous availability of patients' medical history, treatment regimes, and current health status in routine and emergency clinical situations. Ease of access to this information should reduce adverse outcomes. The added value of a complete and up-to-date medical record immediately available to medical caregivers seems undeniable. The potential disadvantages include issues around patient confidentiality and unauthorized access to records, the enormous capital investment for computer hardware, and system maintenance.     

Strategic planning in health care: the results are everything...or are they?

Strategic planning needs to be simple, time-limited, realistic and accurate. It cannot be the unending, purposeless exercise that many organizations experience.     

TQM in health care: mistaken identity?

Total Quality Management is a powerful tool in health care today. The definition of quality improvement in the medical literature focuses on improving patient outcomes. However, most quality initiatives in the health care field focus on improving productivity, cost-effectiveness, market share, employee morale, and efficiencies of processes. This disparity between the medical definition of quality and the actual application of quality improvement may have the effect of alienating many physicians, the very people who must be involved. The semantics are important to address in a TQM initiative.     

Where does informatics fit in health care organizations?

Why is medical informatics important to health care leaders? As an emerging science, informatics focuses on applying computing and communication technology to decision making for clinicians and managers. It enhances the understanding of how information and communication systems can impact the work health care managers must accomplish. As the cost of technology for digital information management continues to decline, organizations and individuals will look for ways to offset the human costs of managing and conveying information. The way of the paper medical record is being replaced by the less expensive and more efficient digital information systems. Leaders of health care organizations need to look for every opportunity to deploy networks and computers to reduce the labor costs of data collection, storage, retrieval, and analysis.     

Is leadership born or made?

Is leadership born or made? By profiling three colleagues who made the transition from clinician to top-flight executive in a health care organization, the author provides case studies from which to discuss leadership issues. An evolutionary pattern has developed with respect to physicians changing careers: The first model was the medical director, followed by the vice president for medical affairs, and finally the move to managing the health care system, group practice, or managed care organization. Are physician executives fundamentally different from clinicians in terms of leadership characteristics? What are the essential qualities needed to lead health care organizations? These questions are explored in-depth.     

Biotechnology: will it break the health care bank?

Pharmaceuticals traditionally have been viewed as a cost-effective component in medicine's technological armamentarium. The use of pharmaceuticals has been estimated to account for 6-8 percent of the nation's total expenditures on health care. The first wave of pharmaceuticals/biologicals that has been produced by the biotechnology industry has offered therapies that can provide much benefit to patients, but it has also raised concern about the cost of these new recombinant drugs. In addition to pricing, methods of promotion and modifications in the FDA approval process have raised concerns.     

Is HRD in need of an ethics of care?

Human Resource Development (HRD) operates within competitive global environments and the changing expectations of societal moral values, which can be in conflict with organizational values, performance, and profit. These are underpinned by the unquestioning acceptance and ‘orthodoxy’ of free‐market economics, legalism, and codes of conduct that result in a lack of ethical analysis within HRD practice. In response to the forgoing, it will be argued that the ethics of care that espouses the values of human relationships, empathy, dignity, and respect is a legitimate approach to free-market lead ethical rule-based rationality that is often presented as the de facto position for HRD professional practice. It presents the ethical debates in which HRD operates within, before arguing for the ethics of care. Three case examples from practice are offered illustrating how HRD practice might respond through the lens of an ethics of care. Reflections and implications for HRD in the form of objections and responses are considered. It concludes that HRD professionals are faced with many difficulties when making decisions, and that the ethics of care offer is an alternative perspective for HRD practitioners.     

The ascendancy of primary care: permanent or temporary?

The conventional wisdom strongly suggests a health care provider food chain for the future: Primary care physicians (PCPs), principally family practitioners, on the top playing the lead role, distantly followed by specialists, with hospitals and other ancillary services even further down the line. Is this a reasonable expectation? Will PCPs dominate the new systems? Or will they be but one of many equally necessary components of these developing integrated health care delivery organizations? Looking at the various models now developing, it would seem that future integrated delivery systems will utilize both PCPs and specialists, but with strong augmentation from a diverse assortment of other health care professionals, including nonphysician providers, educators, and administrators. To separate the illusion of primary care dominance of the coming health care system from the likely reality, we should first determine what is driving the apparent present demand for primary care physicians. Next, we will examine the possible and probable reactions to that demand from an economic standpoint and from the points of view of both health care professionals and the public. Finally, we must try to picture how health care provider organizations of the future are likely to look and how they will integrate their health care professionals.