Money and Medicine

The Medline database contains many articles of interest related to prosthetic and orthotic practice, although they are generally from the physician's perspective rather than that of the CPO. I prefer to access these journal summaries through Medscape. Interested readers can obtain a free membership at www.medscape.com that will allow searching the massive Medline database, which includes almost every medical article published in the English language.

Medscape also offers the option of subscribing to an electronic newsletter highlighting recent medically-related publications of general interest. One of the recent issues summarized five articles on the business of health care under the heading "Money and Medicine".

The second article reviewed, from the New England Journal of Medicine, noted the remarkable improvement in patient care within the Veteran's Administration since 1994, and attributed much of this accomplishment to relatively straightforward changes in policy, such as the institution of routine quality measurements for high priority conditions such as diabetes and heart disease and the public disclosure of the results. Equally noteworthy, these improvements occurred during years when there was essentially zero increase in the VA's budget while the number of patients increased 40%.

Another summary discussed the possibility that the US will move to a single payer National Health system in the future, noting that public dissatisfaction with Managed Care is rapidly increasing as we enter the third consecutive year of double digit premium increases despite cost containment promises. Private studies and a 1990 Government Accounting Office study have concluded that a single payer system would streamline claims processing and extend coverage to more Americans.

To quote the summary, "The working formula for single-payer models relies on several key factors: Tapping the huge sum of money already spent on healthcare and applying it more equitably; throwing out managed care organizations and their higher administrative costs and profits; and providing basic healthcare for the poor who now receive treatments mainly at expensive emergency departments."

Not everyone is convinced that a single payer system would be a panacea, and one of the critical questions is what treatment and services would be covered. Since more and more Managed Care companies are excluding prosthetic and orthotic care or applying ridiculously low lifetime limits that effectively deny care, our patients might be better served by universal coverage that specifically included appropriate P&O services.

The final article reviewed discusses the impact of a growing trend toward "Consumer Driven Health Care" that replaces the gatekeeper who restricted access in the original Managed Care model with the notion of empowering the insured to make such decisions. Some experts predict that as many as half of all Americans will have the option of choosing such insurance in the future.

Many of these trends will impact P&O practice in the future. Click here to read the summaries and to link to the full text of the articles. [Some publications charge a fee for the full article unless you are a subscriber, but they can usually be obtained without charge from your community medical library.]

Reader Comments: Read all user comments Ertl procedure Thank you, John Michaels for continuing to discuss the Ertl procedure in your column. I had the Ertl procedure as a revision surgery three years ago. Until I had the Ertl procedure, I was unable to walk without pain. Since I have had the su... read more - Lauri Ramsey   9/10/2003 Esperamos La Esquina de John Michael de Septiembre. Ciudad de Mexico 4 de Septiembre, 2003. Estimado John Michael CPO, FAAOP, FISPO: Estamos en espera de La Esquina de John Michael del mes de Septiembre. Sus articulos son muy interesantes incluyendo la historia del procedimiento Ertl. S... read more - Alberto E. Castillo Moreno O.P.   9/4/2003 Esperamos La Esquina de John Michael de Septiembre. Ciudad de Mexico 4 de Septiembre, 2003. Estimado John Michael CPO, FAAOP, FISPO: Estamos en espera de La Esquina de John Michael del mes de Septiembre. Sus articulos son muy interesantes incluyendo la historia del procedimiento Ertl. S... read more - Alberto E. Castillo Moreno O.P.   9/4/2003 Re: Esperamos La Esquina de John Michael de Septiembre. Thanks Sr. Castillo- I assume the folks at OANDP.COM are running a little behind due to the holiday but that September's corner will be posted shortly. --John Michael CPO - John Michael   9/4/2003 Project_insole I’m student of Orthoses and Prostheses at University in Argentine. I have one project about diabet insole and I searching related works and investigator groups to exchange experience and information. Contact me for more information - Emerson Roberto Bovo   9/2/2003 project I’m student of Orthoses and Prostheses at University in Argentine. Nowadays I’m in one investigation group about standards in orthoses and orthoses - rehabilitation area. I’m searching related works and investigator groups to exchange... read more - Emerson Roberto Bovo   9/2/2003 Ertl Procedure John Michaels, Thank you for revisting the Ertl discussion in your August column . Your initial post in May O&P Edge certainly generated tremendous support for the procedure from surgeons,patients and prosthetists.Perhaps you would co... read more - Anthony T. Barr   8/21/2003 Re: Ertl Procedure I have read the comments written by John Michael, CPO regarding the Ertl amputation procedure. I must differ somewhat with John’s opinion of the Ertl amputation procedure. Over time, I have been involved in no less than 50 cases. I was fi... read more - Raymond Francis, C.P.   9/2/2003 Re: Re: Ertl Procedure Thanks for the invitation and for sharing your experience, Ray. Your wealth of experience is well known and well respected among your peers. My experience with patients with Ertl procedures is quite similar to yours although much less ext... read more - John Michael   9/3/2003 Re: Re: Re: Ertl Procedure In 1992, I was badly injured in a military operation and suffered major pain issues and associated problems for eight years before deciding there had to be a better way. Through several strange quirks of fate I met Mr. Raymond Francis and ... read more - Larry Corley   9/8/2003 Re: Ertl Procedure Thanks for your comments, Tony. The links will remain "live" indefinitely, and the series will continue for at least a few more months, so I anticipate ongoing interest and debate on the topic. Rather than repost the same comments month a... read more - John Michael   8/21/2003 Osseointergration Greetings, I have been a below knee amputee for nearly thirty years, it has caused me a huge amount of pain and reduced mobility to the extent that suicide has been a good option. My pain comes from the soft tissue where there is only a th... read more - Billy Mckee   8/3/2003 Re: Osseointergration Hello Mr.McKee- With a well-fitting prosthesis, it is very unusual to have the chronic, severe pain you describe unless there is some underlying cause. Often, the cause[s] can be indentified and addressed. It might be prudent for you to ... read more - John Michael   8/5/2003