Postgraduate Medicine
ISSN: 0032-5481 (Print) 1941-9260 (Online) Journal homepage: http://www.tandfonline.com/loi/ipgm20
Can Medically Related Costs Be Cut? Allan J. Ryan To cite this article: Allan J. Ryan (1979) Can Medically Related Costs Be Cut?, Postgraduate Medicine, 65:6, 15-16, DOI: 10.1080/00325481.1979.11715163 To link to this article: http://dx.doi.org/10.1080/00325481.1979.11715163
Published online: 07 Jul 2016.
Submit your article to this journal
View related articles
Full Terms & Conditions of access and use can be found at http://www.tandfonline.com/action/journalInformation?journalCode=ipgm20 Download by: [Australian Catholic University]
Date: 23 August 2017, At: 04:38
EDITORIAL
POSTGRADUATE MEDICINE 6fi9
CAN MEDICALLY RELATED COSTS BE CUT? Downloaded by [Australian Catholic University] at 04:38 23 August 2017
Allan J. Ryan, MD
When the tide of a general inflation resists government attempts to contain and roll it back, a convenient device to divert public attention momentarily from the overall problem is to set up one segment of the economy as a whipping boy. The chosen segment is usually one in which everyone feels some stake, where costs have increased at least as rapidly as those in other areas,
VOL 65/NO 6/JUNE 1979/POSTGRADUATE MEDICINE
and whose problems lend themselves to easy oversimplification. Is it surprising then that the costs of medical and hospital care have currently been singled out for this inauspicious role? Costs of hospital care have indeed outstripped the current overall rate of inflation. The reasons are complex, however, and have to do with many more things than simply the purchase of expensive diagnostic tests, unnecessary hospitaliza-
tion and surgery, or duplication of facilities and services within a community, as we are so often led to believe. These are all part of the problem, to be sure, and many corrective steps have already been taken, but even if costs were completely controlled, many additional factors would still be working to increase them. For many years, hospital services were actually underpriced because they were so heavily subsidized by private and community financing. The costs have now risen, as all of us are well aware, but the number of services has not increased at the same rate as the costs and in some cases has decreased. Currently, third-party payers are staggering under the growing reimbursement loads, which they are less and less able to shoulder because of tightening restrictions on their incomes. The American Hospital Association's member institutions pulled themselves together in the last half of 1978 and actually reduced the rate of hospital cost increase to below the 1977 level, but still not sufficiently to meet federal guidelines. As a consequence, there will be a major effort to pass a hospital cost control bill in the current session of Congress. Costs of physicians' services have kept pace with inflation, stayed slightly behind it, or moderately exceeded it, depending on whose figures one is willing to accept. Many factors are involved, not the continued 15
CAFERGOT® (ergotamine tartrate and caffeine) tablets, NF (ergotamine tartrate and caffeine) suppositories, NF
EDITORIAL CONTINUED
CAFERGOT® P-B
Downloaded by [Australian Catholic University] at 04:38 23 August 2017
tablets/suppositories
Indications: CAFERGQT® tablets/suppositories-to abort or prevent vascular headache. CAFERGQT® P-B tablets/suppositories- to abort or prevent vascular headache complicated by tension and gastrointestinal disturbances. Contraindication&: Peripheral vascular disease, coronary heart disease, hypertension, impaired hepatic or renal function, sepsis, and pregnancy. Hypersensitivity to any of the components. Precautions: Although signs and symptoms of ergotism rarely develop even after long-term intermittent use of the orally or rectally administered drugs, care should be exercised to remain within the limits of recommended dosage. Adverse Reactions: Numbness and tingling of fingers and toes, muscle pains in the extremities, weakness in the legs, precordial distress and pain, transient tachycardia or bradycardia, nausea, vomiting, localized edema, and itching. Drowsiness may occur with Cafergot P-B. Adult Dosage: Orally-Two tablets at first sign of attack; if needed, 1additional tablet every half hour until relieved (maximum, 6 per attack or 10 per week). Rectally-One suppository as early as possible in attack; second in 1 hour, if needed (maximum, 2 per attack or 5 per week). Overdosaga: Symptoms include vomiting, numbness, tingling, pain and cyanosis of the extremities associated with diminished or absent peripheral pulses; hypertension or hypotension; drowsiness, stupor, coma, convulsions and shock. A case has been reported of reversible bilateral papillitis with ring scotomata in a patient who received five times the recommended daily adult dose over a period of 14 days. Treatment consists of induction of emesis, gastric lavage, and catharsis; maintenance of adequate pulmonary ventilation; correction of hypotension; and control of convulsions. Treatment of peripheral vasospasm should consist of warmth, but not heat, and protection of the ischemic limbs. Vasodilators may be used with benefit, but caution must be exercised to avoid aggravating an already existent hypotension. How Supplied: CAFERGQT® Tablets- Gynergen® (ergotamine tartrate, USP) 1 mg; caffeine, USP, 100 mg. Bottles of 250 and SigPak® (dispensing unit) packages of 30. CAFERGOT® SupposiWies-Gynergen® (ergotamine tartrate, USP) 2 mg; caffeine. USP, 100 mg; inactive ingredients: tartaric acid, NF, and cocoa butter, USP. Boxes of 12. CAFERGQT® P-B TabletsGynergen® (ergotamine tartrate, USP) 1 mg; caffeine. USP, 100 mg; Bellafoline® (levorotatory alkaloids of belladonna, as malates) 0.125 mg; sodillm pentobarbital, USP, (Warning: May be habit forming) 30 mg. Bottles of 250 and SigPak® (dispensing unit) packages of 30. CAFERGQT® P-B Suppositories- Gynergen® (ergotamine tartrate, USP) 2 mg; caffeine, USP, 100 mg; Bellafoline® (levorotatory alkaloids of belladonna, as malates) 0. 25 mg; pentobarbital, NF, (Warning: May be habit forming) 60 mg; inactive ingredillnts: tartaric acid, NF, malic acid, lactose, USP, and theobroma oil, USP. Boxes of 12. soz 9·363 Before prescribing, see packageA insert for full product information. ~~ SANDOZ PHARMACEUTICALS ~ EAST HANOVER, NJ 07936 SANDOZ
least of which are the heavy cost burdens of malpractice insurance and of filling out and submitting a bewildering variety of reports and forms for third-party reimbursement and to satisfy other requirements of local, state, and federal government agencies. Physicians themselves are very sensitive to the cost problem, as demonstrated in a telephone survey of I ,000 of their number by Market Opinion Research of Detroit on behalf of the American Medical Association. Fo!,lr out of 10 respondents named high medical care costs as the chief problem facing the profession, and 62% named it among several issues considered important. Nevertheless, two thirds of the polled physicians felt that the high quality of care now available justified these costs. National health insurance is proposed by some as the solution to the system's ills. Although a slight majority of physicians questioned in the AMA poll saw a need for some form of such insurance, only 40% felt strongly about it. The AMA supports the NHI concept, providing the actual outcome can be brought about on their terms (ie, a mixture of public and private funding with emphasis on coverage of catastrophic costs). National health insurance in any form enjoys less than majority support from office-based physicians, general practitioners, surgical specialists,
AMA members, and physicians over the age of 45. All groups of physicians polled agreed, however, that the quality of medical care would probably suffer under such a plan, even though they thought that access to care would be improved for some persons. All of these various positions strongly suggest a divided profession and one in which individual members are uncertain and confused by the issues under fire-a fertile setting for introduction of a federally controlled health plan. Given these circumstances, a dramatic cutback in costs of medical and related care does not appear likely. It may be possible, though, through unified efforts, such as those being undertaken by the AHA, to reduce the rate of increase somewhat. Too rapid an introduction of a comprehensive national plan would be likely to upset the balance that is still achievable and drive costs up even faster. The question is whether physicians can effectively join forces in a voluntary effort to control their fees before government intervention makes such action unnecessary or even inadvisable.
VOL 65/NO 6/JUNE 1979/POSTGRADUATE MEDICINE
ISSN: 0032-5481 (Print) 1941-9260 (Online) Journal homepage: http://www.tandfonline.com/loi/ipgm20
Can Medically Related Costs Be Cut? Allan J. Ryan To cite this article: Allan J. Ryan (1979) Can Medically Related Costs Be Cut?, Postgraduate Medicine, 65:6, 15-16, DOI: 10.1080/00325481.1979.11715163 To link to this article: http://dx.doi.org/10.1080/00325481.1979.11715163
Published online: 07 Jul 2016.
Submit your article to this journal
View related articles
Full Terms & Conditions of access and use can be found at http://www.tandfonline.com/action/journalInformation?journalCode=ipgm20 Download by: [Australian Catholic University]
Date: 23 August 2017, At: 04:38
EDITORIAL
POSTGRADUATE MEDICINE 6fi9
CAN MEDICALLY RELATED COSTS BE CUT? Downloaded by [Australian Catholic University] at 04:38 23 August 2017
Allan J. Ryan, MD
When the tide of a general inflation resists government attempts to contain and roll it back, a convenient device to divert public attention momentarily from the overall problem is to set up one segment of the economy as a whipping boy. The chosen segment is usually one in which everyone feels some stake, where costs have increased at least as rapidly as those in other areas,
VOL 65/NO 6/JUNE 1979/POSTGRADUATE MEDICINE
and whose problems lend themselves to easy oversimplification. Is it surprising then that the costs of medical and hospital care have currently been singled out for this inauspicious role? Costs of hospital care have indeed outstripped the current overall rate of inflation. The reasons are complex, however, and have to do with many more things than simply the purchase of expensive diagnostic tests, unnecessary hospitaliza-
tion and surgery, or duplication of facilities and services within a community, as we are so often led to believe. These are all part of the problem, to be sure, and many corrective steps have already been taken, but even if costs were completely controlled, many additional factors would still be working to increase them. For many years, hospital services were actually underpriced because they were so heavily subsidized by private and community financing. The costs have now risen, as all of us are well aware, but the number of services has not increased at the same rate as the costs and in some cases has decreased. Currently, third-party payers are staggering under the growing reimbursement loads, which they are less and less able to shoulder because of tightening restrictions on their incomes. The American Hospital Association's member institutions pulled themselves together in the last half of 1978 and actually reduced the rate of hospital cost increase to below the 1977 level, but still not sufficiently to meet federal guidelines. As a consequence, there will be a major effort to pass a hospital cost control bill in the current session of Congress. Costs of physicians' services have kept pace with inflation, stayed slightly behind it, or moderately exceeded it, depending on whose figures one is willing to accept. Many factors are involved, not the continued 15
CAFERGOT® (ergotamine tartrate and caffeine) tablets, NF (ergotamine tartrate and caffeine) suppositories, NF
EDITORIAL CONTINUED
CAFERGOT® P-B
Downloaded by [Australian Catholic University] at 04:38 23 August 2017
tablets/suppositories
Indications: CAFERGQT® tablets/suppositories-to abort or prevent vascular headache. CAFERGQT® P-B tablets/suppositories- to abort or prevent vascular headache complicated by tension and gastrointestinal disturbances. Contraindication&: Peripheral vascular disease, coronary heart disease, hypertension, impaired hepatic or renal function, sepsis, and pregnancy. Hypersensitivity to any of the components. Precautions: Although signs and symptoms of ergotism rarely develop even after long-term intermittent use of the orally or rectally administered drugs, care should be exercised to remain within the limits of recommended dosage. Adverse Reactions: Numbness and tingling of fingers and toes, muscle pains in the extremities, weakness in the legs, precordial distress and pain, transient tachycardia or bradycardia, nausea, vomiting, localized edema, and itching. Drowsiness may occur with Cafergot P-B. Adult Dosage: Orally-Two tablets at first sign of attack; if needed, 1additional tablet every half hour until relieved (maximum, 6 per attack or 10 per week). Rectally-One suppository as early as possible in attack; second in 1 hour, if needed (maximum, 2 per attack or 5 per week). Overdosaga: Symptoms include vomiting, numbness, tingling, pain and cyanosis of the extremities associated with diminished or absent peripheral pulses; hypertension or hypotension; drowsiness, stupor, coma, convulsions and shock. A case has been reported of reversible bilateral papillitis with ring scotomata in a patient who received five times the recommended daily adult dose over a period of 14 days. Treatment consists of induction of emesis, gastric lavage, and catharsis; maintenance of adequate pulmonary ventilation; correction of hypotension; and control of convulsions. Treatment of peripheral vasospasm should consist of warmth, but not heat, and protection of the ischemic limbs. Vasodilators may be used with benefit, but caution must be exercised to avoid aggravating an already existent hypotension. How Supplied: CAFERGQT® Tablets- Gynergen® (ergotamine tartrate, USP) 1 mg; caffeine, USP, 100 mg. Bottles of 250 and SigPak® (dispensing unit) packages of 30. CAFERGOT® SupposiWies-Gynergen® (ergotamine tartrate, USP) 2 mg; caffeine. USP, 100 mg; inactive ingredients: tartaric acid, NF, and cocoa butter, USP. Boxes of 12. CAFERGQT® P-B TabletsGynergen® (ergotamine tartrate, USP) 1 mg; caffeine. USP, 100 mg; Bellafoline® (levorotatory alkaloids of belladonna, as malates) 0.125 mg; sodillm pentobarbital, USP, (Warning: May be habit forming) 30 mg. Bottles of 250 and SigPak® (dispensing unit) packages of 30. CAFERGQT® P-B Suppositories- Gynergen® (ergotamine tartrate, USP) 2 mg; caffeine, USP, 100 mg; Bellafoline® (levorotatory alkaloids of belladonna, as malates) 0. 25 mg; pentobarbital, NF, (Warning: May be habit forming) 60 mg; inactive ingredillnts: tartaric acid, NF, malic acid, lactose, USP, and theobroma oil, USP. Boxes of 12. soz 9·363 Before prescribing, see packageA insert for full product information. ~~ SANDOZ PHARMACEUTICALS ~ EAST HANOVER, NJ 07936 SANDOZ
least of which are the heavy cost burdens of malpractice insurance and of filling out and submitting a bewildering variety of reports and forms for third-party reimbursement and to satisfy other requirements of local, state, and federal government agencies. Physicians themselves are very sensitive to the cost problem, as demonstrated in a telephone survey of I ,000 of their number by Market Opinion Research of Detroit on behalf of the American Medical Association. Fo!,lr out of 10 respondents named high medical care costs as the chief problem facing the profession, and 62% named it among several issues considered important. Nevertheless, two thirds of the polled physicians felt that the high quality of care now available justified these costs. National health insurance is proposed by some as the solution to the system's ills. Although a slight majority of physicians questioned in the AMA poll saw a need for some form of such insurance, only 40% felt strongly about it. The AMA supports the NHI concept, providing the actual outcome can be brought about on their terms (ie, a mixture of public and private funding with emphasis on coverage of catastrophic costs). National health insurance in any form enjoys less than majority support from office-based physicians, general practitioners, surgical specialists,
AMA members, and physicians over the age of 45. All groups of physicians polled agreed, however, that the quality of medical care would probably suffer under such a plan, even though they thought that access to care would be improved for some persons. All of these various positions strongly suggest a divided profession and one in which individual members are uncertain and confused by the issues under fire-a fertile setting for introduction of a federally controlled health plan. Given these circumstances, a dramatic cutback in costs of medical and related care does not appear likely. It may be possible, though, through unified efforts, such as those being undertaken by the AHA, to reduce the rate of increase somewhat. Too rapid an introduction of a comprehensive national plan would be likely to upset the balance that is still achievable and drive costs up even faster. The question is whether physicians can effectively join forces in a voluntary effort to control their fees before government intervention makes such action unnecessary or even inadvisable.
VOL 65/NO 6/JUNE 1979/POSTGRADUATE MEDICINE
