The ethics of health care system reform

The United States is now engaged in a momentous national debate about health care. How can we provide the best care possible while simultaneously containing cost (to promote the general economic integrity of society) and somehow maintain a semblance of a free health care marketplace. This is not just a political question; it is also a question of ethics. It is an ethical consideration because the current debate is not just about designing or promoting health care systems that can best address our concerns for costs, quality, and accessibility. It appears that at least some participants in the debate would not stop at arguing their beliefs as valid; they would make their beliefs law. Some urge the creation of the right to health care as a matter of law. There are significant differences between beliefs and rights, however, and they need to be considered carefully in the ongoing debate over the future of this country's health care delivery and financing system.     

Exchange rate regimes and the cross-country distribution of the 1997 financial crisis

We study variations in the severity of the 1997 financial crisis in a sample of 25 developing countries. We use both currency depreciation and stock market returns as crisis measures. Our key findings are that countries that started 1997 with an exchange rate peg experienced significantly greater currency depreciation and significantly lower stock returns than would be predicted from the levels of various macroeconomic indicators.     

Toward better care and improved payment.

Current medical-business literature often suggests that the rule for hospitals' economic survival under Medicare's prospective pricing system (PPS) is delivery of minimally acceptable care. Extensive investigation of, or care for, illness not related to the primary cause of admission may erode margins or even generate losses. In at least some diagnostic groupings, however, more rather than less investigation can be not only beneficial to the patient but also fiscally advantageous to the hospital.     

Medicare's physician payment reform

The Omnibus Budget Reconciliation Act (OBRA) of 1989 continues the recent tradition of including far-reaching legislation in what ostensibly is a budget act. The Physician Payment Reform section of OBRA '89 amends Part B of Title XVIII of the Social Security Act by the addition of Section 1848. This article reviews the major substance of the amendment and analyzes the economic effects of the new section on the stakeholders (payers, providers, and consumers).     

Medicare's ESRD program, Part 2: Transplantation.

In Part 1 of this discussion (Long, H. "Medicare's ESRD Program, Part 1: Dialysis. "Physician Executive 15(2):24-26, March-April 1989), the focus was on the various forms of dialysis for patients with end stage renal disease (ESRD). In this article, we turn our attention to the alternative therapy-transplantation.     

Emergency departments need aggressive management.

Medicare's prospective pricing system has fostered much cost-consciousness in hospitals regarding inpatient activities. But hospital managers must also examine other activities in search of opportunities to decrease expenses. Managers can minimize the large loss potential in emergency departments by developing detailed protocols and ensuring their consistent application through well-trained employees. This is particularly true for emergency departments having especially acute loss potential because of the volume of care provided to indigents.