RTCrawford's Weblog

I don't make this stuff up. I'm not that smart.

Archive for the ‘Healthcare and Public Health Policy’ Category

Healthcare Camouflage

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Open the New York Times last weekend and there were two articles concerning healthcare quality in the United States.  The first recounts the efforts by New York State government to close or consolidate hospitals with high patient-harm rates.  The first indication that such closures are exceedingly difficult is the necessity of creating a special, independent commission.  When elected representatives lack the spine or the consensus to do that for which they were elected, an independent commission is often the solution of choice.

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Written by rcrawford

December 12, 2008 at 6:24 am

Tiered Healthcare System?

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In my Quality Controls class, a number of students have been debating the merits and detraction of a tiered healthcare system, where the wealthy have the option of buying high-end services and the poor get the quality of services their wallets and government support can afford.  Here is my take on the question.

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Written by rcrawford

September 21, 2008 at 10:02 pm

A New Blog is Born

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Over the last several weeks, I’ve been hard at work with the start of the new school year and semester at UNC.  For the first time, I am teaching Healthcare Policy for the Bachelors of Science in Public Health program, in addition to the Quality Improvement class for the Executive Masters students (Masters in Healthcare Administration, plus the occasional Masters of Public Health student).  After a summer focused on consulting projects, it is great to again have a chalk board at my back and brilliant students to my front.

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Written by rcrawford

September 9, 2008 at 8:21 am

Balance Billing — Grief for Everyone

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The practice of balance billing is increasing, according to this Los Angeles Times article.

Balanced billing is defined as “billing beneficiaries for amounts not reimbursed by payers (not including copayments and coinsurance amounts); this practice is prohibited by Medicare regulations,” according to “Understanding Health Insurance: a Guide to Billing and Reimbursement”, ninth edition, by Michelle Green and JoAnn Rowell.

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The Strategic Helix of CQI — Sherika Hill

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As time permits, I am posting final exam papers written by selected students of mine (with their consent, of course). In each case, they have addressed the question of whether the tools and techniques of continuous quality improvement work in healthcare settings. This seemingly simple question is abundantly difficult. My students, however, are brilliant, and I am frequently rewarded with “mind candy” such as that provided by Sherika Hill, who posits that the continuous improvement of Shewhart’s and Deming’s PDCA cycle is not necessitated by perfection’s impossibility but, instead, by the changing forces and influences of the informing environment.

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“Tragedy” of Coverage for Preventative Medicine

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The common churning of patients/customers between insurance companies every few years suggest that coverage of preventative medicine services is unlikely to render a benefit to the original payor. This becomes all the more problematic when realizing that most of the benefit of preventative medicine is likely to occur once the patient is of retirement age and covered by Medicare. As mentioned earlier with the Blue Cross Blue Shield description, this is changing but, like everything in healthcare, at an abysmally slow pace. Personally, I think that the likely model explaining this slow adoption is Garrett Harden’s “Tragedy of the Commons.”

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Are CFOs Taking Over Healthcare?

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CNBC’s Mike Huckman is reporting on an Ernst & Young survey of senior executives in the pharmaceutical industry, in which three quarters of respondents indicate an increasing role for the chief financial officers. As the report indicates, pipeline difficulties and increasing unwillingness by insurance to accommodate the rising cost of pharmaceuticals prompts the industry to focus on cost reduction. What the report does not indicate, but what my students and I identified back in 1999 as a likely trend, is the net effect of this strategic shift within the industry.

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