Chapter 10 Bottenheimer

Chapter 10 Bottenheimer - The likelihood of patients being...

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The likelihood of patients being harmed by medical negligence is almost three times as great in hospitals serving largely low-income and minority patients than in hospitals with more affluent populations. Adequate scientific knowledge- a great deal of what physicians do has never been evaluated by rigorous scientific experimentation, and many therapies have not been adequately tested for side effects. Treatments of uncertain safety and efficacy may cause harm and cost billions of dollars each year. Medical negligence is defined as failure to meet the standard of practice of an average qualified physician practicing in the same specialty. Fee-for-service reimbursement encourages physicians to perform more services, whereas capitation payment rewards those who perform fewer services. The quest for high quality care must include a search for financially neutral clinical decision making. The introduction of new technology in the hands of specialists, expanded insurance coverage, and unregulated fee-for-serve payments are combined to rapidly increase the flow of money into the health care system, and thus sowed the seeds of a new, profit- driven industry. The rates of use for MRI and CT scans were higher for physician-owned compared with nonphysician-owned facilities. Physicians order more diagnostic tests if they profit from so doing. Payment by capitation, or salaried employment by a for-profit business, may create a climate hostile to the provision of adequate services. The prepaid health plans (PHPs) received a lump sum for each patient enrolled, meaning that the lower the cost of the services actually provided, the greater the PHP’s profits. In California in the 1970’s this resulted in scandal when a message was written to health care providers saying “Do as little as you possibly can for the PHP patient.” How health care systems and institutions are organized has a major impact on health care incomes. For example, intensive care units that did not require daily rounds by an ICU physician were associated with a threefold increase in in-hospital mortality in abdominal aortic surgeries. Quality improves with the experience of those providing the care. Real improvement
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This note was uploaded on 08/20/2010 for the course PSC 192 taught by Professor Robertbetz during the Spring '10 term at GWU.

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Chapter 10 Bottenheimer - The likelihood of patients being...

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