Lessons for the health care industry from America's experience with public utilities.

In the United States, the traditional public utilities, power and telecommunications, along with health care, are being deregulated and becoming increasingly competitive, especially on price. Regulation of the public utilities has occurred for the past century not simply because they have been monopolies, but, more importantly, because they are "industries affected with the public interest," that is industries which: 1. provide an essential service, 2. benefit from public prequisites, and 3. would cause great public harm if mismanaged. Consequently, the presence of competition in these industries does not negate the need for regulation. Regulation of these industries is best understood as being along the three sides of a "triangle of public interests"--quality, public accountability, and universal service. Examples are provided of these types of regulation in power and telecommunications, even in current "deregulatory" legislation. Health care reform activists in the United States have lately paid attention mostly to the first two legs of the triangle; they are encouraged to focus creatively on the third leg--universal health care.

An appointment reminder system's effect on reducing the number of hypertension patients who drop out from care.

We evaluated the effects of an appointment reminder system on the appointment-keeping behavior and blood pressure control status of hypertensive patients receiving care in an urban medical clinic. The study population consisted of 973 adult hypertensive patients receiving medical care at a family practice clinic affiliated with the Wayne State University School of Medicine, Detroit, Michigan. Of the 973 patients enrolled in the study, 486 were randomly assigned to a group that received appointment reminder cards and telephone calls to reschedule missed appointments, and 487 were assigned to a nonintervention control group. Patients were followed-up with regard to their appointment-keeping behavior and blood pressure control status, five to eight months after being entered in the study. The study results indicate that patients in the appointment reminder group kept significantly more appointments and were less likely to drop out of treatment than patients in the control group. The dropout rate was 46 percent lower among patients in the appointment reminder group than in the control group. Patients in the appointment reminder group also demonstrated slightly better blood pressure control at the end of the study compared with patients in the control group, although none of the differences in blood pressure levels between groups were statistically significant at the 5 percent level.

The role of perceived price in physicians' demand for diagnostic tests.

This research examines the extent of physicians implicit price knowledge and its role in the physicians' demand for diagnostic tests. In particular, it examines the effect of perceived price on the quantity of test ordered. A group of 36 second and third-year residents and 23 clinical faculty members in three family practice centers affiliated with the Family Medicine Department of Wayne State University were randomly assigned to either a control group or an experimental group. They were asked to review four case studies and indicate on a test order form the tests they would order. The experimental group used a test order form that included the actual test prices and the control group used the same form but without the prices included. Subsequent to this, the control group (those without actual price information) was asked to estimate the price of all tests listed. Physicians' implicit price knowledge was measured by the number of underestimates, overestimates, and correct estimates and correlated with the total number of tests ordered. The results show the following tendencies: 1) physicians generally incorrectly estimate prices; 2) they tend to underestimate rather than overestimate; 3) they tend to underestimate the higher priced tests and overestimate the lower priced tests; 4) the greater the propensity to underestimate, the greater the number of tests ordered; 5) the greater the propensity to overestimate, the fewer the number of tests ordered; and 6) the greater the propensity to correctly estimate, the fewer the number of tests ordered. The results indicate that in the absence of actual prices, perceived prices enter the physicians' demand function and that physicians' demand for diagnostic tests might be categorized as rational.

The effects of price information on physicians' test-ordering behavior. Ordering of diagnostic tests.

This research evaluated the effects of providing physicians with information about the prices of diagnostic tests on their subsequent test-ordering behavior. The study population consisted of 36 second- and third-year residents and 23 clinical faculty in three family practice centers affiliated with the Department of Family Medicine at Wayne State University School of Medicine, Detroit, Michigan. Study participants were asked to review four case studies, each describing ambiguous symptoms, and to indicate on an attached test order form the tests they would order for each patient. Subjects were randomly assigned either to a group that received test order forms on which to prices of diagnostic tests were printed (price-information group) or to a group that received test order forms with no prices indicated (control group). The study results show that for each of the four cases, the average number of diagnostic tests ordered was significantly lower in the price-information group than in the control group. Our findings also show an average reduction in the cumulative cost of tests ordered per patient of 31.1 per cent related to the provision of price information is discussed and reviewed in light of other approaches that have been developed to modify physician behavior in ordering diagnostic tests.

Potassium loss associated with hydrochlorothiazide versus chlorthalidone.

A retrospective survey using chart review was conducted to determine the incidence of clinically significant hypokalemia resulting from therapy with chlorthalidone (CTLD) or hydrochlorothiazide (HCTZ). The frequency of hypokalemia, potassium less than or equal to 3.0 mEq/liter, was 4/29 patients (13.8%) in the CTLD once-daily group, 0/17 in the HCDL twice-daily group, and 0/31 in the HCTZ once-daily group. Using the Fisher exact probability test, a significant difference in the incidence of hypokalemia was observed between the CTLD once-daily and HCTZ once-daily groups. From the results, it is apparent that a diuretic's duration of actions, as represented by HCTZ (short-acting) and CTLD (long-acting), influences serum potassium concentrations; CTLD produced a greater incidence and degree of hypokalemia.