Managing provider networks through expert systems: use of patterns of treatment to address overutilization

Among the most important contributors to rising health care costs is excess utilization of services. Sophisticated clinical criteria, encoded as an expert system in software, allow identification of probable excess utilization in large claims data sets. These systems can be used to adjudicate claims, resulting in direct cost savings, or to profile physicians and other providers, facilitating creation and maintenance of networks. These systems are used by traditional payers to promote quality, control costs, and enhance competitiveness and are beginning to be used by nontraditional payers, such as physician groups and hospital-based networks.     

Medical resource allocation: rationing and ethical considerations--Part I

The United States' system of high-quality but expensive and poorly distributed medical care is in trouble. Dramatic advances in medical knowledge and procedures, combined with soaring demands created by growing public awareness, the cost of private hospital and medical insurance, and Medicare and Medicaid, are burdening the medical care delivery systems. The costs of medical care have reached levels that can no longer be sustained. Government officials, insurance planners, labor leaders responsible for union health care benefits, and ordinary citizens are questioning whether it is acceptable to limit health care based on economic considerations. If health care is deemed a social good, the method of allocation must be addressed. Unless society decides that other priorities of the infrastructure are to be subjugated to health service delivery, difficult decisions will be forced upon us, consciously or by default. The discussion in this two-part article explores the ethical considerations of the more formalized approaches to resource allocation that presently exist in our society.     

Levi's corporate AIDS programme

AIDS is a contemporary phenomena that has been extensively covered by the media but its impact on the employers of the sufferers is only now being measured and assessed. This article describes the personnel policies that have been developed by one particular organization to deal with the problem. Educational and training programmes have been initiated and management given clear directives to ensure that high morale and productivity are maintained during potentially adverse situations.     

Essential Tiedeman: Anchoring the North Star for Human Development

In quantum physics, whatever is observed is changed; therefore, it is all perception. Given those findings and to save Tiedeman from interpretation, in this article, he speaks for himself in 5 areas: (a) his professional credo, (b) the Harvard Studies in Career Development, (c) the 1983 Assembly to Advance Career, (d) statistics of vocational guidance, and (e) transformation in his thought.     

The Rights and Responsibilities of Gay and Lesbian Parents: Legal Developments, Psychological Research, and Policy Implications

With the growing number of same-sex unions, the legal system must determine the rights and responsibilities of gay parents who decide to end a relationship. In 2005, the California Supreme Court found that a child's lesbian caregiver was a legal "parent" despite having no biological or adoptive relationship, while the Massachusetts Supreme Court in 2004 concluded the opposite. Psychologists can inform this debate by presenting research demonstrating that (a) children benefit from contact with two parents, and (b) children's well-being is unaffected by their parents' sexual orientation. Psychologists can further assist the legal system by conducting future research. In order for psychologists to impact laws and policies, legal actors must utilize this expertise .