a. I was surprised to read that increased competition among practitioners may lead to practice changes such as increased office hours, home visits, and more time spent with patients. This makes sense, but because each chapter up to this point discussed how the medical field expanded in a way that wasn't beneficial to patients always, it was interesting to learn about a shift which may occur in the opposite direction.
b. I agree that the independent small businessman is "firmly rooted in the American imagination." Many people think of this as the "American Dream." I also agree with the author that large corporations have kicked him out of the American economy, if he ever had a place in it.
c. I disagree with the author's statement that "images of the future are usually caricatures of the present." I do not think this is true. Many people extrapolate on events of the past and present to predict the future.
d. Something I have witnessed is the diminishing resources which the author discusses in this chapter. We have seen that the NC state budget has been frozen in terms of raises for several years. Programs are being cut from state colleges, and HMOs are becoming more popular as ways of managing financial expenditures.
e. I am looking forward to observing the rise of corporate enterprises in health services. In the last chapter, the author discusses how this might effect the medical field. This will likely result in savings. Corporate enterprises tend to know how to manage money, and may be a good intermediary between government programs and the health care field. This savings in money may come at a cost to other services, but there may also be a shift to saving money in the long-run, such as through preventative care.
Thursday
Chapter 10: End of a Mandate
a. I was surprised to learn that three quarters of heads of families agreed that there was a health crisis in the 70's. It seems an odd time to have a crisis, but after reading about increased costs and population growth in the rest of the chapter, it seems less surprising.
b. I agree with the sudden shift to curb the expansion of medicine's "apparently insatiable appetite for resources." The fact that a "happy sufficiency" was never reached is due to many things, not the least of which include medicine's rapid expansion, population growth, urbanization, economic growth and inflation, and transportation.
c. I disagree that the dynamics of the health care system are easy to follow. I agree with the author that people want to receive the best care possible, and that providers want to make as much money as possible, but the relationship is more complex and involve many more dynamics, such as personal lifestyle, environmental factors, socioeconomic factors, and ethical and legal decisions. I disagree with Feldstein's statement that increases in the "components" of costs related to health care were the result of and not the cause of higher prices. I don't think this makes sense, in that the market drives costs, in terms of supply and demand. The costs were more likely to be in relation to higher demand than to higher expectations, in my opnion.
d. One aspect of the book that I have witnessed is the overexpansion in some services, and the inadequate availability of others. Some fields of practice, such as specialized surgery, have an abundance of physicians, while others, such as primary care physicians in rural areas, have very little supply.
e. Something I will be aware of moving forward is the affect that public medical programs and services, such as Medicare and Medicaid, have on local and state governments. The author mentions how public funding hurt public medical services, by draining money from their budgets.
b. I agree with the sudden shift to curb the expansion of medicine's "apparently insatiable appetite for resources." The fact that a "happy sufficiency" was never reached is due to many things, not the least of which include medicine's rapid expansion, population growth, urbanization, economic growth and inflation, and transportation.
c. I disagree that the dynamics of the health care system are easy to follow. I agree with the author that people want to receive the best care possible, and that providers want to make as much money as possible, but the relationship is more complex and involve many more dynamics, such as personal lifestyle, environmental factors, socioeconomic factors, and ethical and legal decisions. I disagree with Feldstein's statement that increases in the "components" of costs related to health care were the result of and not the cause of higher prices. I don't think this makes sense, in that the market drives costs, in terms of supply and demand. The costs were more likely to be in relation to higher demand than to higher expectations, in my opnion.
d. One aspect of the book that I have witnessed is the overexpansion in some services, and the inadequate availability of others. Some fields of practice, such as specialized surgery, have an abundance of physicians, while others, such as primary care physicians in rural areas, have very little supply.
e. Something I will be aware of moving forward is the affect that public medical programs and services, such as Medicare and Medicaid, have on local and state governments. The author mentions how public funding hurt public medical services, by draining money from their budgets.
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