Important new Health Policy Articles; Uof P Study

Ann Okerson wrote:
>From ann.okerson@yale.edu  Mon Jun 26 14:09:23 2000
X-Authentication-Warning: mars.its.yale.edu: okerson owned process doing -bs
Date: Mon, 26 Jun 2000 14:27:58 -0400 (EDT)
From: Ann Okerson <ann.okerson@yale.edu>
X-Sender: okerson@mars.its.yale.edu
To: "James J. O'Donnell" <jod@ccat.sas.upenn.edu>
Subject: Important new Health Policy Articles; Uof P Study  
Message-ID: <Pine.GSO.4.10.10006261427150.19328-100000@mars.its.yale.edu>
MIME-Version: 1.0
Content-Type: TEXT/PLAIN; charset=US-ASCII

For NewJour.

---------- Forwarded message ----------
Date: Wed, 14 Jun 2000 13:40:34 -0400
From: "Stephen Miles Sacks, Ph.D." <Scipolicy@att.net>
Reply-To: "Stephen Miles Sacks, Ph.D." <Editor@Scipolicy.net>
To: news@Scipolicy.net
Subject: Important new Health Policy Articles; Uof P Study 

Dear Colleague,

Scipolicy, is a new peer reviewed journal on science and health policy.
The premier issue is Fall 2000, and the articles are ready for your
inspection and consideration for adoption for class use in the forthcoming
academic year. Abstracts are given below.

The Journal is available by subscription, individual issue, or article
reprints. Articles are low cost and they are excellent materials for
courses, research, and background information for executives, managers,
policy makers, researchers, and professional practitioners.

The premier issue focuses on "The Future of Large-scale Health Systems."
Future issues in the coming year will focus on the continuing effects of
science on longevity, domestic manufacturing, and the enterprise of
medicine and science.

The Journal is published semi-annually, fall and spring - corresponding to
the academic year, plus an occasional special issue or two. We invite you
the science and health faculty, researchers, practitioners, analysts, and
administrators to contribute articles

Your proposals, manuscripts, and comments are welcome. Please send them
via e-mail to: editor@Scipolicy.net . Our website is
http://www.Scipolicy.net .

Stephen Miles Sacks

Stephen Miles Sacks, Ph.D.

Editor and Publisher, Editor@Scipolicy.net

Abstracts of Journal Articles, Fall 2000,

      ScipolicyT

      The Journal of Science & Health Policy
     

Premier Issue - The Future of Large-scale Health Systems

 Articles are germane to courses in Governance, Health Administration,
Health Policy, Health Financing, Health Services, Community Services,
Institutional Ethics and Norms, Institutional Leadership and Enterprise,
Public Policy, Public Administration, Psychology, Science Policy, Science
and Technology Studies, Medical Affairs, Research Administration

Health Systems Federalism in the United States, Stephen Miles Sacks, MPA,
Ph.D, Scipolicy-The Journal of Science and Health Policy

The term "national health care system" is commonly used to describe the
arrangement of hospitals, physicians, health facilities, and third party
payers in the country. Some describe the arrangement as haphazard,
chaotic, and the result of supply-side economics. However, in this article
the arrangement is identified as "health system federalism." It is an
on-going and dynamic process as well as a form of governance. The
participants, including units of government and individual citizens, share
power in a compact/covenant in furtherance of their mutual health,
economics, political, and cultural goals. Presently, one-third of national
health expenditures is for hospital care of which about two-thirds is paid
by governments, and there are demands that government pay for all of
portion that is not paid by health plans and the uninsured. The realm of
health care is as much federalism with a plethora of intergovernmental
relations and private enterprise as is the larger American Partnership
itself. Federalism considers the collective and interactive activities of
local, state, and national governments, corporations, interest groups, and
individual citizens to be the form and process of self-government. Nothing
less than the health of citizens, the economy, and national development
are at stake. A paradigm of health system federalism gives a more accurate
and fuller explanation of the state of American health care presently than
was available before.

A Triple Helix of University-Industry-Government Relations Loet
Leydesdorff, Ph.D., University of Amsterdam, Science & Technology Dynamics

University-industry-government relations increasingly provide the
knowledge infrastructure of society. Public health systems, for example,
are continuously reshaped by new scientific developments, by the
introduction of new products on the markets, and by new policies at
regional, local, and national levels. The knowledge infrastructure is not
static, but operates in terms of mutual expectations. These expectations
and their exchange in communications (institutionalized or not) can be
considered as a distributed and reflexive overlay on top of the
institutional divisions of labor. Global communication at the Internet
reinforces this communication overlay; the underlying arrangements can be
assessed in terms of their functionality from different perspectives, and
perhaps be reconstructed. The expectations, however, are updated without a
priori synchronization. The patterns in these evolving communication
systems can be studied both empirically and by using simulations.

Economic Issues In Hospital Mergers and Health Systems Erwin Blackstone,
Ph.D., Temple University Department of Economics and Joseph Fuhr, Jr.,
Ph.D., Widener University Department of Economics

The hospital industry is undergoing substantial merger activity. In small
cities monopoly hospitals now exist. In large metropolitan areas like St.
Louis, Missouri and Philadelphia, Pennsylvania a few hospital systems have
obtained large market shares. In general mergers among hospitals have
ranged from large networks to two small rural hospitals and have resulted
in oligopoly and even monopoly.The purpose of this paper is to give an
overview of the issues in hospital mergers. Some issues associated with
hospital mergers are the relevant product and geographic market, the
non-profit status of hospitals, and the extent of efficiency gains. The
judicial expansion of the definition of the geographic market has made it
easier for the hospitals to merge. The Federal government has lost its
last five merger challenges. Further, states have been increasingly
willing to approve hospital mergers subject to the hospitals accepting
restrictions on their behavior and monitoring by state authorities.

About Large-scale Health Systems, Stephen Miles Sacks, Ph.D., Editor and
Publisher

The recent trend of health facility and physician practice mergers and
acquisitions has created large-scale health systems that integrate medical
services, medical research, and medical education within a single
organizational structure. Such systems handle over 1 million patients
annually and have billion dollar budgets. The organizations are more like
industrial conglomerates that engage in capital accumulation and global
financial markets, and they organize and further enterprises to
commercialize the advances of research. The large-scale systems typically
run large losses yet they pay very high compensation packages in the
$500,000 to $1.5 million or more to their "health czars" who
simultaneously occupy multiple university, medical school, and medical
center top management positions. The large-scale systems also engage in
major construction and renovations programs incurring billions of dollars
in bonds obligations and refunding interest over the long-term, most of
which is charged to patients bills. The trend is associated with gaining
larger share of the market to produce huge revenues to fund continued
medical research, uncompensated care, and the compensation packages of the
officials. The haphazard trend occurs without community strategic design
although a major revolution in medical services is occurring which is
changing patient use of facilities and causing them to become obsolete
very fast. A several year moratorium in mergers and acquisitions to permit
macro strategic planning to occur is seen as a rational approach to the
problems caused by the large-scale systems.

Integrated Delivery Systems A Possible Cure for the Ills of Health Care,
John C. McMeekin, MBA, President and CEO, Crozer-Keystone Health System

Experience suggests much of the answer to health care reform lies in the
development of community-based integrated delivery systems, capable of
providing a comprehensive array of acute, restorative and health promotion
services in a coordinated, user-friendly way. A seamless and comprehensive
array of health care services under a single, integrated organizational
structure would go a long way in addressing the complaints of our patients
and caregivers. Crozer-Keystone Health System is one model of an
integrated delivery system. Integrated systems do offer us an opportunity
to restructure and re-prioritize how community health is better organized.
It offers those of us who would prefer a largely community-based, private
sector health care environment a maybe last chance to better meet the
growing demands of our society before they turn in desperation to a
totally government controlled system.

Academia Interrupted: Normative Change in Science, Henry Etzkowitz, Ph.D.
Science Policy Institute, State University of New York at Purchase and
Center for Policy Research, University at Albany

This paper discusses effects of rising university enterprises on academic
practices and scientific norms. An explanation of why the social norms of
science have changed to support entrepreneurship, instead of
entrepreneurial scientists being defined as deviant, is offered. Academic
scientists increasingly take account of the economic value of research
findings as the university moves into a more central institutional
position in society as an equal partner with industry and government in
efforts to promote technological innovation. The enterprise norm is
especially evident in commercialization of new discoveries in the physical
sciences, life sciences, and medical research.

Dichotomy of Ethics of Health Systems, Stephen Miles Sacks, Ph.D., Editor
and Publisher

Contemporary health systems manifest Charles Dickens dichotomy of the best
and worst of times. A host of ethical issues are analyzed pertaining to:
benefits to society; costs and equality; historical problems and public
corruption; the contemporary situation; politics and hospital costs;
financial abuses and fraud; hospitals and health systems as private
interests; public access to information and accountability; hospitals and
election contributions; emphasis on construction over research; clinical
trials and approvals of drugs; "just enough health care;" and, health
systems federalism and the need to replace bad laws.

The Case of the University of Pennsylvania Health System, Stephen Miles
Sacks, Ph.D. Editor and Publisher

The University of Pennsylvania Health System (UPHS) is an example par
excellence of a contemporary large-scale health system that integrates
medical services, medical and life sciences research, medical education,
and commercial enterprise within a unified model of organization that
seeks to maximize its revenues. As an institution, it deserves credit for
its excellent historical and continuing contributions to humanity, however
some of its problems and difficulties became institutionalized. Oligarchic
regime and accountability issues, excessive facilities construction,
questionable mergers and acquisitions, conflicts of interest,
commercialization aspects, and pecuniary norm are problematic and some of
the conditions continue presently. The article includes 23 tables and 8
charts for financial and patient data 1995-1999 with some prior and later
data. The data and analysis in this article give a poignant perspective
about UPHS operations over time that is useful in studying health systems
administration, state, and national policy. Lessons to be earned and
antitheses to the problems conclude the article.

Toward New Understanding of Illness - Depression as A Behavioral Shutdown
Mechanism: Disease or Evolved Defensive Strategy? Health Services
Implications, Gregg Henriques, Ph.D., University of Pennsylvania,
Department of Psychiatry

How depression is conceptualized is a major public health issue. The
prevailing model in psychiatry is that Major Depressive Disorder (MDD) is
a disease of the brain. However, recent developments in evolutionary
theory suggest that negative emotions and depression are likely evolved
strategies that facilitated behavioral solutions to problems in the
ancestral environment. A Behavioral Shutdown Model (BSM) of depression is
offered and explored. The model proposes that depressive reactions are
passive, avoidant behavioral strategies that have been fashioned by
evolution and are activated in response to situations that are chronically
dangerous, humiliating, or repeatedly result in failure to achieve one's
goals. The BSM challenges the disease model because it suggests that many
instances of MDD do not involve biological dysfunctions. Instead, this
analysis suggests that Major Depression is conceptually more akin to pain
than to a disease. The BSM concept and implications for health policy are
discussed.

Price List

#2000-1 Health Systems Federalism in the United States, Stephen Miles
Sacks, 28 pages, $2. or $19/doz.

#2000-2 2 Articles: About Large-scale Health Systems, Stephen Miles
Sacks;and, Integrated Delivery Systems: A Possible Cure for the Ills of
Health Care, John C. McMeekin, total of 31 pages, $2 or $19/doz.

#2000-3 Issues In Hospital Mergers and Health Systems, Erwin Blackstone
and Joseph Fuhr, Jr., 26 pages, $2; or $19/doz..

#2000-4 Dichotomy of Ethics of Health Systems; and, The Case of the
University of Pennsylvania Health System, Stephen Miles Sacks, total of 56
pages, $5; or $49/doz.

#2000-5 Collection of Health Systems Articles - 6 Articles,
#2000-1,2,3,and 4, total of 141 pages, $15 or $149/doz.

#2000-6 2 Articles: Academia Interrupted: Normative Change in Science,
Henry Etzkowitz, 2000; and, A Triple Helix of
University-Industry-Government Relations, Loet Leydesdorff, 46 pages, $4
or $39/doz.

#2000-7 New Understanding Of Illness Series - Depression As A Behavioral
Shutdown Mechanism: Disease Or Evolved Defensive Strategy? Health Services
Implications. Gregg Henriques, 20 Pages, $2 or $19 doz.

Ordering Information

Copying and Republication- For instant processing of requests to copy or
republish articles from the Journal for course or class packs, libraries,
E-reserves, distance learning, organizational use, or republication
contact: The Copyright Clearance Center Inc., Tel: 978-750-8400;
http://www.copyright.com.

Send subscriptions and orders to orders@Scipolicy.net.

For e-mail examination copies of articles, send request to
articles@Scipolicy.net. Annual Subscriptions - Professionals $25
Institutions-/organizations $20, individual $20.

Single Issues- Professional $15, Institutions/organizations $10,
Individual $10. Prices include US shipment via book mail; $2 extra for 1st
class; add $2 extra for international postage.

Regular Article Reprints- priced separately + $1 postage per article or $3
postage per doz.

All amounts are in US dollars. Send cash, check, money order to
SacksPublications/Scipolicy, Box 504, Haverford, PA 19041.

To order on-line, go to http://www.Scipolicy.net .