The Hippocratic Predicament: Affordability, Access, and Accountability in American Medicine

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Product Details

  • ISBN-13: 9780123973702
  • Publisher: Elsevier Science & Technology Books
  • Publication date: 10/1/1992
  • Pages: 275

Table of Contents

Overview and Executive Summary 1
What Is the Problem? 2
Proposed Solutions 2
A General Health Policy Model 3
The Oregon Experiment 5
Ethical Issues Raised by the Oregon Experiment 7
Where Do We Go from Here? 9
Conclusions 11
Ch. 1 Three Problems Contributing to the Crisis in American Health Care 13
Common Misconceptions to Be Challenged 15
The Medical Care Crisis at the University of California: A Case Study 20
Guidelines and Models 21
Cost Shifting 28
Who Is Concerned about the Problem? 35
The Hippocratic Predicament 39
Summary 40
Ch. 2 Look at Solutions 41
Simple Solutions 42
The Alphabet Soup of Policies to Control Costs 50
Summary 57
Ch. 3 Review of Current Proposals 59
A Dozen Solutions 59
The Current Major Alternatives 68
Synthesis 72
Current Active Proposals 73
Summary 78
Ch. 4 A General Health Policy Model for Setting Priorities in Health Policy 79
Utility 80
Is More Better? 80
Apples versus Oranges 81
Measurement of Health Status 82
Comparisons across Diagnoses - The Incremental Outcome Problem 82
A General Health Policy Model 84
Applying the Model: Step by Step 87
Summary 101
Ch. 5 Selected Applications of the General Health Policy Model 103
Examples of Clinical Problems 104
The Tight Control of Insulin Dependent Diabetes Mellitus 106
Auranofin Treatment for Patients with Rheumatoid Arthritis 107
Coronary Artery Bypass Grafts 109
Adherence to Antihypertensive Medications 111
The Neonatal Circumcision Controversy 114
Screening for Breast Cancer 116
Tobacco Tax 123
Comparisons across Different Programs 128
Summary 128
Ch. 6 The Oregon Experiment 129
Health Care Issues in Oregon 129
Mechanism 131
Health Services Commission 132
Ranking Methodology 132
Departure from the Model - Alternative Methodology Subcommittee 149
What Went Wrong? 151
Clinical Contradictions 151
Duration 154
Summary 155
Ch. 7 Problems and Concerns 157
Technical Issues 157
Ethical Concerns 168
Targeting the Poor 172
Will the System Change the Way Medicine Is Practiced? 174
Other Legal and Ethical Challenges 175
Criticisms of the Use of Preferences 179
Department of Health and Human Services Rejection of Oregon Application 179
Summary 180
Ch. 8 Summary and Conclusions 181
Can an Outcomes-Oriented Approach Succeed? 182
Where Do We Go from Here? 185
Conclusions 187
Appendix: Oregon Prioritized Health Services 189
A User's Guide for Health Services Commission Working Document 189
Prioritized Health Services List of May 1, 1991 191
References 251
Index 265
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