re: Doug's question

["Fellows, Jeffrey" <jmf9@xxxxxxx>]

Jim:

It is my experience that HMOs use a rather long list of intermediate
outcomes to measure output. Health and illness are social constructs,
and their quantification and measurement at the individual level is very
difficult. So HMOs typically count services, such as the number of
mammograms or flu shots, as an output. Insofar as the output (health,
functional status, patient satisfaction, etc.) in health care is
difficult to quantify, standardizing intermediate outcomes and health
care production processes have been the primary focus in the emerging
capitalist health care delivery system. One "outcomes" measurement
method, called HEDIS, has only one actual health outcome (low birth
weight, which can also be thought of as intermediate) among a list of 20
or so intermediate outcomes.

The system is becoming capitalist in the sense that health care
providers are increasingly becoming separated from both the means of
production and the markets for their products. In the former structure,
docs were able to utilize their control over markets, i.e. direct access
to patients, to wield considerable control over hospitals, insurers, et
al. (V. Navarro properly characterized this control as one being granted
by capital interests as a means of veiling the social causes of illness
from the population). The past and present systems currently coexist and
the constantly changing features of health care delivery and policy
reflect an intense power struggle between managed care firms and
physicians over control of the industry. For anyone interested in
studying the capitalist transformation of an industry in real time, the
U.S. health care system is a very rich area.

The difficulty in measuring and quantifying health outcomes has been an
important factor leading to practice protocols' primary focus on cost
minimization. HMOs that directly employ physicians have been
particularly active in developing and rigidly implementing standardized
practice protocols, utilizing cheaper nonphysician substitutes in the
production of health care, and using the former as a means of increasing
the use of the latter  (i.e., standardization, fragmentation, and
substitution - sound familiar?). This relationship is based on my
micro-level empirical examination of young physicians' practice patterns
and employment/managed care relations.

Jeff Fellows


 ----------
From: James Devine
To: pen-l@xxxxxxxxxxxxxxxxxxx
Subject: re: Doug's question
Date: Sunday, December 07, 1997 8:53PM

Jason says: >While I concur, the medical industry is in shambles w.r.t.
"productivity."
Have you had a good experience with your HMO lately?<

You aren't responding to a quote from me, but I'll answer anyway: I have
a
hard time understanding what "productivity" means for HMOs. Number of
sick
people cured divided by the number of employee-hours hired?

Service industries are notorious for making the measurement of output --
and
thus produtivity -- difficult if not impossible. That's why I would
focus on
goods-producing industries, assuming that if prod. takes off there it
probably does so with services, too, but to a lesser extent because
service
labor is harder to supervise in many cases.

I'm agnostic about whether or not productivity is really coming back in
the
manufacturing industries. Like Doug, I don't have enough info... It's
possible, though, that all this high-tech stuff is finally paying off.
But
who knows?


Jim Devine
jdevine@xxxxxxxxxxxxxxx
http://clawww.lmu.edu/1997F/ECON/jdevine.html
Academic version of a Bette Midler song: "you are the hot air beneath my
wings."