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Based on 1994 and 1995 data, the rates at which Medicare patients die in the hos

ID: 127415 • Letter: B

Question

Based on 1994 and 1995 data, the rates at which Medicare patients die in the hospital correlate closely with the number of hospital beds per thousand residents in their community. Researchers call this correlation the “Field of Dreams Effect,” after the line in the 1989 movie about a baseball field: “If you build it, they will come.”

While there is little evidence to show that patients are helped or harmed by the more intensive care they receive in Boston, Memphis, and other high-use areas of the country, the differences in use have a major impact on medical care costs. For example, the average hospital bill for each Medicare enrollee’s final six months of life was $16,571 in the New York City borough of Manhattan, as opposed to an average of only $6,793 in Portland, Oregon.12 In the Boston–New Haven comparative study, Boston’s per capita hospital expenditures were about double those of New Haven.13

Wennberg does not specifically argue that conflict of interest or pecuniary motives enter into decisions that determine use rates of medical services. However, many studies suggest that financial considerations may enter into some physicians’ medical decision making. For example, there is evidence that when physicians stand to profit from the performance of diagnostic tests, they are much more likely to order such tests. Until the practice was outlawed by Congress, physicians who owned an interest in clinical laboratories were more likely to refer patients for laboratory tests than similar physicians who referred patients to labs in which they had no financial interest.14 Similarly, physicians who own diagnostic imaging equipment are more likely to use it than comparable physicians who must refer patients elsewhere for such examinations. Physicians in Japan, who are legally permitted to sell prescription drugs directly to patients (unlike in the United States), appear to favor higher-profit drugs.15,16 A recent surge in complex spinal-fusion operations has been linked to the high rates Medicare will pay to surgeons and hospitals, although there is no evidence that the procedure is more effective at curing back pain than laminectomies or even less invasive approaches.17

(Schneider 451)

1. Describe how "The Field of Dreams" relates to healthcare.

2. Metro Detroit Area has a number of hospitals. Do you think that they are experiencing the Field of Dreams there?

Answer a or b depending on if you said yes or no to #2

3. Depends on your answer for #2.

3a. If your answer was yes to #2, then why are there still disparities in health care in Detroit? Is there a reason why you think the Field of Dreams left this part of the region out?

3b. If your answer was no to #2 and knowing that our area has disparities in health care, what do you think could be done to close these gaps? (is there a way to attract more health care professionals to Detroit? Is that the right answer?)

Explanation / Answer

Describe how "The Field of Dreams" relates to healthcare.

Physicians frequently fail to hold a multifaceted info system, may not see its significance to their practices, and are typically unenthusiastic to capitalize the time and vigor to be trained in its use. Why is extensive physician buy-in so difficult to achieve? From physicians overcome with alteration to failing to begin with a passable physician base of provision, this discovers some of the details that physicians prove little buy-in to this process and proposals to help create a more fruitful application. Conducts to build receipt include admitting the rank of physicians as customers and exercise them primary and often.

Metro Detroit Area has a number of hospitals. Do you think that they are experiencing the Field of Dreams there?

No. A dangerous issue in the success of health data systems that share data across patient sites is understanding how longitudinal patient information is retrieved by clinicians, and how to advance admission. If clinician workflow subjects are not unspoken and spoke, the odds of achievement are greatly reduced.

Depends on your answer for #2, if your answer was no to #2 and knowing that our area has disparities in health care, what do you think could be done to close these gaps? (is there a way to attract more health care professionals to Detroit? Is that the right answer?)

Rendering to the compliance leader, government forms like the school panel must comprise in their conference agenda the subject substance to be careful in bolted session. Such sign must cover enough data for the community to distinguish whether the subject matter is official for closed meeting. Many healthcare facility schemes suffer from choice creep, a marvel where a project develops too big for reality as it permits through every complicated party's list of stresses. Unimpeded, this principals to the building of overbuilt medical amenities that do not obtain the amount of cases essential to endure themselves

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