Quotes from Students Papers 2004
           University of Minnesota, Carlson School of Management
           Topics in Health Economics
           Masters in Health Administration MHA 6-755 

Additionally, the Reverend William Temple, the 98^th Archbishop of Canterbury, says:   

So, then, we shall not say that faith and health go literally hand in hand, but we shall say, I think, that a living faith is a predisposing cause of health, or one of the predisposing causes of health.  The causes of health, as the causes of sickness, are very many, but among the forces which will tend to keep us in health will be a faith which is extended to a real expectation of God’s goodness in every department of our being.  That will bring us either actual health or a greater power of triumphing over ill-health, and either of these are great blessings.  The way in which, as I think, faith chiefly promotes health is precisely by the creation of peace of mind beyond what can be reached in any other way, and especially beyond what can be reached by those who have much to distract them, whether in their circumstances or in their bodily condition.  It is not so much, as I think, by the direct action of faith in God that He will remove this or that cause of ill-health, but rather that faith has so formed the habit of our mind and thought and feeling that we are saved from the waste of energy that is brought about by nervous anxiety and nervous fret, and the peace of mind which it creates is a predisposing cause of health.

Another believer of this approach is Koenig, an associate professor of medicine and psychiatry who founded Duke’s Center for the Study of Religion/Spirituality and Health six years ago.  His recent studies suggest that people who attend church are less prone to disease, have healthier immune systems and live longer than people who don’t attend religious services regularly.

—    Steven Holman,

 Faith, Fact or Fiction.  Spirituality and Health: 

                                                                 A Judeo-Christian Perspective

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Technological advances will expand the proportion of resources consumed by radiology because our [radiologist] procedures are increasingly effective, minimally invasive, and characteristically safer than the invasive procedures that they replace.  -Lightfoote, J.B.

Baker, Birnbaum, Geppert, Mishol and Moyneur (2003) conducted a study to examine the relationship between the total spending for certain services and the availability of the technology.  They found that increases in the utilization of imaging services are frequently associated with the supply of diagnostic imaging centers.  Similar results relating to the availability of angiography and aggressive treatment such as cardiac catheterization, and their direct influence from factors such as the number of cardiac catheterization facilities, the number of physicians trained to perform aggressive treatments, and favorable reimbursement.  -Deyo, R.A.

Additional ethical concerns to a radiologist include the potential to cause harm to the patient if the patient goes on for additional studies based on false positive results and suffers any iatrogenic injuries due to cascading effects.  In medicine, a cascading effect refers to a ‘chain of events initiated by an unnecessary test, an unexpected result, or patient or physician anxiety, which results in ill-advised tests or treatments that may cause avoidable adverse effects and/or morbidity. –Deyo, R.A.

In using expert appropriateness criteria, 17% of coronary bypass procedures and 10% of angioplasty procedures that were recommended were inappropriate.  -Leape, as cited in Deyo, R.A.

Essentially, as advanced diagnostic imaging increases in the ability to detect smaller abnormalities, the detection thresholds lower and the prevalence rate of the disease studies increases significantly.  Black and Welch (1993) illustrate the issue using a metaphor through the question ‘How many islands surround Britain’s coast?’  They go on to answer that there the number of islands increases with the resolution of the map on which they are counted.

Harach et al., as cited in (Black & Welch, 1993), estimated in a study of thyroids of autopsy patients, that “the prevalence of histologically verifiable papillary carcinoma was close to, if not equal to, 100 percent if one could look at thin enough slices of the gland” (p. 1237).  These findings challenge the very definition of cancer in terms of whether or not findings of a presence alone are indicative of cancer, as we perceive the term, and are cause for intervention. 

—    David Monaghan,

 The Diffusion of Modern Medical Imaging Technology

 and its Impact on Health Outcomes and Costs in the United States 

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In 2000, the shortage of registered nurses was calculated to be 110,000 or 6% of the demand.  Based on current data and incorporating what is known about future need, the demand will continue to increase.  By 2010, the demand will increase to 12% with the shortage projected to be 29% by the year 2020 (Department of Health and Human Services, 2002).

First, the structure of nursing education as it is currently configured has not changed in the last sixty years, discussed previously.  The needs, complexity and expectations of the patients in the 1950’s are very different than those in 2003 and will be even more varied and diverse in future years.  Despite a very different environment in health care today, the curriculum in basic nursing education is essentially the same today as compared to the requirements for nurses graduating over the last several decades.

—    Debbi Honey,

 Mandatory Registered Nurse Staffing Ratios:

 Is it the Answer to Improve the Quality of Care?

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 In an interview with Les Grant, Director of the Center for Aging Services Management at the University of Minnesota, he stated that there are four distinct stages of culture change.  The first stage is a traditional medical model in which residents and staff have little control over their lives.  A hierarchical model of management is used.  The second stage is a transformational model in which awareness of the intended change spreads.  Permanent staff assignments are made and minimal environmental changes occur which make the atmosphere more welcoming.  More significant changes occur in stage three when the neighborhood model breaks up units into more functional areas with resident-centered dining.  The fourth stage is a household model with self-contained living arrangements for fewer people, and staff work in cross-functional, self-led work teams (Grant and Norton, 2003).

—    as quoted by Garth Rydland,

 Creating Competition in Long-Term Care:

Can Services be Provided to Prevent People from Ending Up in Nursing Homes?

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When competition is introduced to an industry, Porter and Teisberg (2004) state that “1) relentless improvements in processes and methods drive down costs; 2) product and service quality rise steadily; 3) innovation leads to new and better approaches; and 4) uncompetitive providers are restructured or go out of business.”

For competition to progress in the right direction, Porter and Teisberg (2004) have established ways that the health care industry should proceed and are as follows:

1)       Hospitals should not try to be all to everyone while still providing a wide array of services.  In this way, hospitals will develop uniqueness:

2)      Choice should be available at the disease or treatment level;

3)      Pricing should be available for all to see and the same price would be charged for the same medical condition;

4)      Price estimates should be given ahead of time and a single bill would be issued for each service bundle;

5)      Outcomes for the various providers should be available so consumers can evaluate and compare different providers;

6)      Risk pools should be developed for those that don’t receive health insurance from an employer;

7)      Standards for malpractice litigation should be changed;

8)      A mandate for minimum level of coverage should be established;

9)      Payers should be induced to compete for quality, not just a lower cost;

10)    Medicare should add a division, “Adoption of Innovation Fund” that would support promising new therapies (Porter and Teisberg, 2004).

—    Jill McCartney,

 Competition for the Consumer:

A Physical Therapy Perspective

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In Cody, Wyoming, in the northwest corner, they have lost a gynecologist, family practitioner, ear/nose/throat physician, and a psychiatrist.  The nearest healthcare facility is 100 miles away, in Billings, Montana.  Cody sits on the eastern boundary of Yellowstone National Park, which sees millions of visitors each summer and in the winter is very isolated.

—Pamela Foyster,

Effects on Rural Communities When Physicians Reduce or Close Medical Services

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Many of the hospitals that closed were converted to urgent-care clinics, home health agencies or long-term care facilities (Burda & Weissenstein, 1996).  Dollars that were being used to support an unprofitable hospital have been used to improve long-term care and ambulance service (Stensland, Mueller & Sutton, 2002).

Most communities, in spite of a hospital closing, continue to grow.  Among ten counties that lost their only hospital during the 1986 – 1996 time frame, eight had more jobs four years after closure than they did two years prior to closure (Stensland, Mueller & Sutton, 2002).

— Stephen Rapatz-Harr,

Rebounding from Hospital Closure:

 An Examination of Factors that Face Rural Communities

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In the article Bogeyman – The Truth is Offshoring, Drezner addresses the effects on the U.S. economy through the following excerpt from his essay:

“Protectionism would not solve the U.S. economy’s employment problems, although it would succeed in providing massive subsidies to well-organized interest groups.  In open markets, greater competition spurs the reallocation of labor and capital to more profitable sectors of the economy.  The benefits of such free trade – to both consumers and producers – are significant.  Cushioning this process for displaced workers makes sense.  Resorting to protectionism to halt the process, however, is a recipe for decline.  An open economy leads to concentrated costs (and diffuse benefits) in the short term and significant benefits in the long term.  Protectionism generates pain in both the short term and the long term.”

The attraction of moving abroad was directly related to U.S. quotas on sugar imports, which caused the price of sugar to increase 350 percent (higher than the world market price).  The reason for relocation of jobs from Midwest communities was cheaper sugar prices.

The situation started when the University of California/San Francisco Medical Center contracted with an offshore-outsourcing firm to transcribe medical records.  The store goes that the disgruntled worker threatened to post patient records on the Internet if she wasn’t given back pay she was owed by her employer.

— Barry Halm,

Offshoring – A Viable Option for Healthcare?

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Good management results in goals being achieved, whereas good leadership entails setting the right goals.  Leadership involves creativity, inspiration, entrepreneurship, and achieving a shared sense of commitment.  Good management isn’t possible without good leadership (Larson, 1999).

Linda Duxbury’s research indicates that workplace stress is becoming common place and showing up through increased absenteeism, employee turnover and decreased satisfaction (Duxbury, 2004).  In fact, this is relevant to health care specifically as health care workers are one-and-a-half times more likely to be absent from work due to illness or disability than workers in all other sectors (Dowdall, 2002).

It is a personal opinion that Drucker sums up what is being called emotional intelligence as merely having the common sense to know the importance of appropriate deportment when dealing with people.  He says, “Manners – simple things like saying ‘please’ and ‘thank you’ and knowing a person’s name or asking after her family— enable two people to work together whether they like each other or not.  Bright people often don’t understand this.” (Drucker, 2003).

—JoAnn Beckie,

 Creating Pearls of Performance:

The Difference One Leader Can Make

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I was driving a school bus loaded with the Oakland girls’ basketball team when I felt a pressure in my chest and down my arm.  Being a few miles from Oakland, I safely deposited the team and parked the bus.  As I was driving home, the pressure increased.  Once I got in the house, I knew I was in trouble and asked my wife to drive me to the hospital.  The trip was only 5-10 minutes, but it felt like a lifetime.  I received the clot-busting medication TNK and immediately had relief.  I would not be alive today if Oakland Memorial Hospital had not been there. (Randy Johnson, Mutual Insurance Salesman, 2004). 

—Karen Vlach,

 Have We Worn Out Our Welcome? 

  The Impact of Small Rural Hospitals on their Communities

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For example, some guidelines require the construction of new schools to have “acreage standards” in order to provide children with plenty of room to play.  However, these standards have also made it necessary for new schools to be built on the periphery of a community, occasionally a substantial distance from the neighborhoods where children live (Beaumont and Pianca, 2000).  Therefore, children become reliant upon a vehicle to reach school and home each day.  Thirty years ago, 61% of the children in the United States walked to school.  That number has now dropped to 14% (Dietzn, et.al., 2003). 

Once they are home, it has become unsafe in many neighborhoods for children to play outside.  As a result, they are forced to remain inside after school and on weekends rather than outside performing physical activity.  Studies have shown children living in poor socioeconomic neighborhoods have lower levels of physical activity and higher levels of television viewing than children living in richer neighborhoods (Lindquist, et.al., 1999).  Viewing greater than 11 hours per week of television has been linked with an increased risk of obesity in prepubescent children (Armstrong, et.al., 2003, and Proctor, et.al., 2003).  While viewing television, children have become targets of advertisements promoting candy, soft drinks, and fattening foods.  For example, food and food service companies spend more than $11 billion annually on direct media advertising (Nestle, 2002).  Meanwhile, the advertising budgets of Coca-Cola and PepsiCo approached $3 billion in the United States alone in 2001 (Advertising Age, 2001).

It is estimated that between 280,000 and 325,000 people die each year from obesity (Allison, et. al., 1999).

In a study conducted by Bowman et al, 30.3% of 6,212 children and adolescents who were surveyed eat fast food on any given day (2003).  Considering that those children who eat fast food consume, on average, an additional 187 kcal, theoretically, they would gain up to six additional pounds per year simply due to the fast food (Bowman et. al., 2003).

And while some parents have been concerned that more time in the gym means less time learning, the results of this study suggest that children actually perform better academically when they have had daily physical activity.

Dr. Ludwig agrees and notes that the percentage of children diagnosed with attention-deficit disorder and childhood depression have risen dramatically during the time when the number of physical education classes has declined.  He states, ‘It shouldn’t be so surprising that low physical activity levels would have adverse effects on a child’s emotional health.  Exercise benefits overall well-being, not just body weight’ (Wallis, 2004).

However, Jackie Tselikis, school health coordinator for a school in Portland, Maine, found otherwise.  They worked with Coca-Cola to replace soft drinks with water and fruit juice.  She also had the chips and cookies replaced with cereal, trail mix, pretzels, and fruit snacks.  Tselikis states, “Kids will buy whatever is there.  If you have soda, they’ll buy soda.  If you have water, they will buy water.”  The school district for which she works has not lost any revenue since making the switch (Vail, 2004).

—    Jason Helling,

 Cutting the Fat:

Our Schools’ Impact on Childhood Obesity

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·        Stephen Schondelmeyer (2003) of the University of Minnesota School of Pharmacy succinctly articulated the problem: “A drug that is not affordable is neither safe nor effective.”

·        The Canadian government does not set the price of drugs, but they do have guidelines that Canadian manufacturers must meet when setting their own prices:

·        Prices must not exceed the highest Canadian price of existing drugs used to treat the same disease.

·        For “breakthrough” drugs, which are unique and have no competitors, prices must be no higher than the median of the price for the same drug charged in seven other countries: Britain, France, Germany, Italy, Sweden, Switzerland and the United States.

·        Over time, prices cannot be increased beyond the general rate of inflation, as reflected in Canada’s consumer Price Index.

Tom Brogan, a former civil servant who helped write the 1987 law, explained, “Canadians would never tolerate an American-style system where those who can least afford it pay the highest price” (Barry, 2003).

Sixteen year old Ryan Haight, an honor student and athlete from La Mesa, California died February 12, 2001 from a mixture of hydrocodone, morphine, Valium and Oxazepam.  He obtained these narcotics from Internet pharmacies using a debit card his parents had given him in order to buy baseball cards online.  He obtained some of the drugs without a prescription, others he got from a doctor he had never met.

In fact, a customer purchasing sixty tablets of hydrocodone paid $199.00 through the physician’s Internet pharmacy.  On average, the same prescription would have cost $26.00 in a retail pharmacy.  The Internet price proved to be only slightly below the $6.00 per pill street rate when the pills are sought illicitly.

— Kris Giese,

 Internet Pharmacies

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“ We still see far too many patients trying desperately to cut short the process of dying, only to have their best efforts rebuffed by physicians.  This unwanted medicine is an arrogant usurpation of patients’ rights and serves neither the interests of the patient nor those of medicine as a profession.  In ancient Greece, the Hippocratic corpus stated that one of the primary roles of medicine was to refrain from treating hopelessly ill persons, lest physicians be thought of as charlatans” (Gilligan & Raffin, p. 138, 1996).

—    as quoted by Mary Beth White-Jacobs,

Informed Consent at End of Life – Does it Exist? 

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Pharmaceutical companies indicate that their intent is solely to generate good will with the medical industry.  Dr. Arnold Relman, a Harvard Medical School professor and the former editor of the New England Journal of Medicine, indicates that by the mere fact that pharmaceutical companies pay for medical education from their marketing budgets “should speak for itself”.

Patients who expect antibiotics to be prescribed are more likely to receive them, and physicians are ten times more likely to prescribe them when they perceive patients expect them (Butler, Rollnick, Pill, Maggs-Rapport, Stott, 1998).

The pharmaceutical influence in research extends to the control over the medical research and its results.  According to Dr. Angell, the industry designs the studies, keeps and analyzes the data and determines whether the data will be published.  Contracts are signed with the researchers enforcing the practice of preventing the publishing of work directly by the researchers unless they receive permission by the drug company (Klotter, 2001).

“However, according to Light & Lexchin (2003), of the drugs currently available on the market today, 96% of all medical problems requires only 320 drugs.  The National Science Foundation determined that 18% of the total R&D budget for the pharmaceutical industry is spent on basic research (NSF, 2003) while the remaining 82% is spent toward derivatives of existing drugs (Light & Lexchin, 2003).

Brand name drugs, “. . .consumed $129.7 billion or 92% of the total retail cost of prescription drugs in 2000” (Frederick, 2002).

—Mary Shaw,

 No Free Lunches:

The Economic and Ethical Implications of the Pharmaceutical Industry on Medical Profession Practices

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This is no surprise to Lee Groesik, who attributes this pricing differential to the fact that the Canadian government negotiates with drug manufacturers, something that is expressly forbidden by the U.S. government, except for a very select group, that he nicknames the “3 C’s” for Congressmen, Colonels and Convicts.

—Randall Gross,

 Drug Bust:

Minnesota’s Response to the Crisis in Affordable Prescription Drugs

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