Various items for preadmitted students to review and discuss.
October 21, 2002
AAMC sponsors campaign to reduce health care disparities
The Henry J. Kaiser and Robert Wood Johnson foundations, along with the AAMC and nine other co-sponsoring health care associations, have launched a $1 million campaign to reduce racial and ethnic disparities in health care. This national initiative includes an outreach effort to engage physicians in dialogue; an advertising campaign in major medical publications; and a review of the evidence on racial/ethnic disparities in healthcare. The campaign begins with a focus on cardiac care and, as part of the effort, the American College of Cardiology and the Kaiser Foundation recently released a report listing racial and ethnic disparities in cardiac care.
Information: Go to http://www.kff.org
The National Medical Association and the National Hispanic Physicians Association are sponsors
National Medical Association http://www.nmanet.org/
National Hispanic Medical Association
http://jama.ama-assn.org/issues/v281n18/ffull/jmn0512-3.html and http://home.earthlink.net/~nhma/webdoc2.htm
American Academy of Family Physicians www.aafp.org is one of the sponsors also.
From site 68 out of 81 studies do show disparities
Types of Problem Solving You Have Done and Will Do
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Problem solving
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Research |
Patient Care |
Community |
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Develop interest, passion, begin to pursue methods and learn more about situation |
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Gather information |
Unique perspective or source or combine concepts, develop method |
History and Physical (past, family, social, review systems), Lab, tests, other people, community |
Windshield tour, interviews, surveys, |
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Analysis |
Crunch data |
Critical thinking to narrow down 5 to 4 to best diagnosis |
Prioritize area of need that can be addressed |
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Action |
Presentation, article, fund grant |
Plan of action, follow up |
Gather funding, support, |
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Next cycle |
Refine question, new question |
Changes in patient, health |
Assessment and re-planning |
Career Choice - what problem solving did you do?
Develop Interest
Passion is better term
Gather information
Unique perspective
Unique source
Combining concepts
Discussions of their background and career and the kind of problem solving that they have done
Expectations of minority families, communities are high. Lots of obstacles. Lots of determination. Lots of leadership and maturity already shown in the students.
Also desire to maintain the kind of education ethic and family role that they were given, but realize the challenge of maintaining this as a young professional. Perhaps even more of a challenge for the females.
Apology given as asked to be a mentor to others coming after them, as well as to seek a mentor from those going before.
Cost and Quality
Those who want to save funds would do well to apply the actual resource expenditures in rural areas to urban locations. In the US the spread for Medicare was less than $200 per month per patient in rural areas of Nebraska vs some $700 in Miami and New York. Also same for education where education expenses can run from $3000 to 8000 per student per year.
Studies by Wennburg are noting that the major difference seems to be overuse of physicians in urban areas and more visits per patient with no health gain. see Kaiser reference below
I look at health expenditures as a "Frank Starling" Heart pump curve. At the lower end or poor health quality, you have great improvement in quality with any increase in expenditure. Eventually the curve flattens and in some cases goes south with too much expenditure.
Health Quality axis Quality vs Cost plot
Higher Quality
x b
x
x
x
c
a
x
z
x
Lower
Costs/Expenses/Resources Axis - increasing --- >
A. at point "a" we have some rural and underserved areas, usually those without political clout enough to get what they need. Point a is also common with mental health in some states. Other states have even less expenditure and quality like at point z. At this point almost any increased expenditure would improve quality. Also it is likely that the lack of expenditures is pulling down other related components, for instance lack of mental health resources would impede education and also increase prison and legal and health resources needed (more dimensions than I can show graphically).
B. at point b we have the flat part of the curve where slight increase or decreases in expeditures mean little - this tends to be managed care or governmental care where access and resources are not a problem
C. at point c we have actually too much resources or access and too much is done with a slightly higher chance of a bad result. A possible example is health care for those who work in medical centers.
Ask for equity that all in the province be given the same resources. Be sure to include all sources of health expenditure, including public health which is grossly maldistributed.
One of the Canadian studies on prenatal care noted that the per capita number of physicians was related to better birth outcomes, although most other studies do not show a change in birth outcomes with just about every variable. Might have been Cremieux P-Y Ouellette P Health Care Spending as Determinants of Health Outcomes, Health Economics, 1999, 8:627-39 where a 10 % higher level of spending was associated with .4 to .5 % lower mortality rates
More studies on indigent and uninsured and Medicaid at http://www.kff.org/content/2002/20020510/ from Kaiser Foundation study on poor and uninsured, some application to underinsured.
Rural Public Health expenditures report
Robert C. Bowman, M.D, Email: rbowman@unmc.edu http://www.ruralmedicaleducation.org
