Some trends affecting the organization of health services.

Economic forces present many challenges to the health care delivery systems. This study identifies national and international trends which will shape the future organization of health care delivery in the United States. The author advocates competition with health organizations developing from individual communities. He also suggests that physicians aggregate on a large scale in health maintenance organizations to compete technologically with hospitals to increase efficiency.

Reflections on change in medical practice. The current trend to large-scale medical organizations.

The trend in the provision of medical care to large-scale organizations is clear. While this has been most conspicuous in hospitals, nursing homes, and renal dialysis treatment centers, it is gathering momentum in the practice of medicine itself. The competitive pressures for cost containment, the ability of large medical organizations to contract efficiently with third parties, the ample supply of newly trained physicians seeking immediate practice, and new capital financing opportunities are some of the many reasons for this rapid aggregation. This will in time structurally change medical practice and the way in which it is perceived by patients and the public.

Survey findings of health education in Health Maintenance Organizations.

A questionnaire was mailed to all HMOs which were either federally qualified or applying for federal qualification, as of May 1978. The survey, which attained a 77% response rate, collected information on the frequency, providers, methods and health problem areas of health education programs in HMOs as well as other health education information. Survey findings show that certain program areas such as nutrition education and weight reduction programs have received greater emphasis than other patient education areas. Certain organizational factors are shown to be useful in describing differences in plans' commitments to health educations. Recommendations are made for further research to identify clearer relationships between health education and other HMO characteristics. HMOs are recommended to assess the health education needs of their memberships and to educate staff regarding their own health risks, health education skills and member expectations and rights.

An alternate approach to hospital cost control: the Rochester project.

The rapid escalation in health care costs has demonstrated a need to control costs in general and hospital costs in particular. In New York State, efforts at control have followed one of several paths, including reduction of Medicaid program expenditures, elimination of hospital beds, and prospective reimbursement of hospital costs. Although some success has been achieved in each of these areas, hospital costs containment has not been as successful as had been hoped. A new project called MAXICAP, being developed in the Rochester region, seeks to link payment with regional hospital planning. MAXICAP represents a voluntary attempt by hospitals, third party payers, planners, consumers, and governmental agencies to devise a prospective hospital payment system. Under this system community hospital plans in the Rochester region would be integrated and a cap imposed on both revenues and expenses for acute hospital care. The principal advantage of the MAXICAP is that it offers a mechanism for linking hospital planning with payment functions on a regional basis. The principal disadvantage is that the success of the MAXICAP depends upon the voluntary cooperation of the vast majority of the acute care hospitals in the area--hospitals that may be scattered throughout a relatively large region.

The effect on future physician requirements of an HMO policy after national health insurance.

The questions examined in this paper are: What effect will the Health Maintenance Organization (HMO) have on future physician manpower? What is the likelihood of there being a substantial movement of medical practice to the HMO form? Answers indicate that national health insurance will produce a more regulated and constrained resource allocated to health services and, hence, the demonstrated efficiencies of the HMO form will have strong appeal. The reduced physician manpower use of this type of organization is described. The result of these interactions will probably be a substantial reduction in the ratio of physicians needed 20 years from now.