Question

5. Explain multispecialty physician-firms. What issue(s) do they create? What are the possible solution(s)?

6. Explain why the doctor-patient relationship can be a principal-agent problem in economics. How does it relate to “induced demand” in health care? Also, explain what “induced demand” and “defensive medicine” are.

7. What differ between “induced demand model” and “spatial competition model” in explaining how doctors select a location?

8. Using a monopolistic competition framework, explain why price dispersion exists in medical market. You may draw the diagram from the slides to help you answer this question.

9. Based on what we learnt in class, explain in detail all the possible ways that a not-for- profit hospital uses its “profits”. In other words, who get the “profits” in a not-for-profit hospital?

Answer 1

Ans 5)  A multi-specialty physician firms are one in which doctors share facilities, administration, income and expenses, support staff and equipment. Doctors can specialize in associated medical practices or provide a wide range of specialties.

Issues regarding medical facilities of our country:

1) Too many avoidable patient days-

SUGGESTION OF THIS PROBLE

The number one opportunity for cost reduction was in avoidable patient days. Patient days can add up quickly if providers aren't focused on moving patients to other facilities or their homes once suitable. She says the hospital took several approaches to decrease patient days.

2) Desire for physician integration but very few employed physicians-

SUGGESTION OF THIS PROBLEM-

The vast majority of the facility's providers are independent. This echoes the traditional model of physician practice, but it can mean hospitals struggle to integrate physicians in order to take advantage of bundled payments.She says the hospital placed its faith in the independent physicians by saying, "If you want to run how clinical care is distributed in our hospital, come on down". Co-management helps integrate physicians with the system, she says. "Unlike the independent physician, who's doing his care for his patients the way he wants to, he has the opportunity to be part of an institute where the incentives are for the whole group to execute at the highest level," she says.

3) Unhealthy community-

SUGGESTION OF THIS PROBLEM-

Under the healthcare reform law, FMC is required as a non-profit hospital to perform an annual healthcare needs assessment of its community. One of our big issues is around healthy lifestyles, and more specifically, obesity and the disease stream it leads to. Even as the insurance coverage expands, the community members still have to make the effort to visit a physician and keep themselves healthy. In 2010, the hospital targeted drug and opiate addiction in the community, and in 2011, the hospital plans to target obesity.

4) Poor communication between providers-

SUGGESTION OF THIS PROBLEM

We need a nurse leader to increase communication between providers, patients will have a better healthcare experience with fewer redundancies, and physicians will have a better understanding of what happens to a patient when another provider takes over. A clinical nurse leader is the first new position in nursing in 40 years, and this is a post-masters trained nurse who is on track like an advanced practice nurse, except their training puts them in the hospital at the bedside. The hospital has appointed a clinical nurse leader to micro-units of around 12 beds throughout the hospital, where the CNL acts as a liaison between physicians and patients and mentors other nurses.

5) Physician and nurse shortages-

SUGGESTION OF THIS PROBLEM-

Hospitals across the country are preparing themselves for predicted provider shortages. To offset physician and nurse shortages in our hospitals. The hospital has employed a similar tactic to "grow" future physicians. The hospital currently has a family practice residency program and is hoping to build an internal residency program as well. We can take a example of Mount Caramel -this project benefits everyone: Mount Carmel doesn't have to build more space, Fairfield County students avoid a 50-mile drive and FMC has the opportunity to "grow their own" nurses.