Tag: health care delivery

an ambulance parked at the entrance of an emergency department

Psychiatric Care in Crisis

The Petrie-Flom Center Staff Leave a comment

By Zainab Ahmed

Psychiatric care in the Emergency Department is all-or-nothing and never enough. Often, legal holds are the only intervention available, and they rarely are therapeutic. Upon discharge, our patients are, once again, on their own.

The ED acts as a safety-net for a failing health system, one that places little value on mental health services, either preventative or follow-up. The demand for acute psychiatric care is high; however, EDs have little physical capacity for psychiatric patients.

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Empty hospital bed.

Do No Harm: A Call for Decarceration in Hospitals

The Petrie-Flom Center Staff Leave a comment

By Zainab Ahmed

In an era of mass suffering, some still suffer more than others. What’s worse, there is nothing natural about it. It is human made.

As an emergency medicine resident at a large academic hospital in Los Angeles, I see how incarcerated patients’ suffering is sanctioned by hospitals and medical professionals, despite their pledge to do no harm.

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Game of whack-a-mole.

Stop Playing Health Care Antitrust Whack-A-Mole

The Petrie-Flom Center Staff Leave a comment

By Jaime S. King

The time has come to meaningfully address the most significant driver of health care costs in the United States — the consolidation of provider market power. 

Over the last 30 years, our health care markets have consolidated to the point that nearly 95% of metropolitan areas have highly concentrated hospital markets and nearly 80% have highly concentrated specialist physician markets. Market research has consistently found that increased consolidation leads to higher health care prices (sometimes as much as 40% more). Provider consolidation has also been associated with reductions in quality of care and wages for nurses. 

In consolidated provider markets, insurance companies often must choose between paying dominant providers supracompetitive rates or exiting the market. Unfortunately, insurers have little incentive to push back against provider rate demands because they have the ability to pass those rate increases directly to employers and individuals, in the form of higher premiums. In turn, employers take premium increases out of employee wages, contributing to the growing disparity between health care price growth and employee wages. As a result, rising health care premiums mean that every year, consumers pay more, but receive less. 

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Child safeguarding: the National Health Service (NHS) can do much better

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By John Tingle

Our children are our future and we need to look after them well. There is however a lot of evidence to suggest that we are failing our children in a number of key health areas. UNICEF in a report put the UK in 16th position – below Slovenia, the Czech Republic and Portugal – in a league table of child well-being in the world’s richest countries. The report considers five dimensions of children’s lives – material well-being, health and safety, education, behaviours and risks, and housing and environment – as well as children’s subjective well-being.

There are a number of health and other child well-being challenges for the UK to meet. The UNICEF report provides some useful context from which to view the recently published Care Quality Commission (CQC) report on the arrangements for child safeguarding and healthcare for looked after children in England.The CQC is the independent regulator of health and social care in England.Whilst the report does contain some positive findings, when read as a whole, these seem subsumed by the large number of negative findings, some of which are very worrying. Read More

College Athletic Trainers Report Being Bullied

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By Christine Baugh

A recent study indicates that college athletic trainers feel bullied on the job. The study, published in the Journal of Athletic Training, surveyed 723 collegiate athletic trainers, and found that approximately 15% of them felt that they were the victim of workplace harassment and about 20% had witnessed an instance of workplace bullying. Although there were no differences found in who was bullied, the bullies were identified as predominantly male and were most often coaches. A related examination of the perceptions of bullying in this environment, consisting of semi-structured qualitative interviews with select collegiate athletic trainers, identified structural factors associated with increased bullying and suggested workplace training as a potential solution.

The findings of these studies are in line with previous work describing the college sports medicine working environment as fraught with conflicts of interest (discussed in a previous blog post: here). However, the prevalence of bullying found in this study is actually lower than found in other studies examining bullying in other medical workplaces. That said, NCAA guidance suggests that medical professionals, including athletic trainers, should be given “unchallengeable authority” with regards to medical decision-making in the college sports medicine setting. Bullying in the college sports medicine setting occurred more frequently, according to the recent studies, when there was administrative indifference that allowed individuals who “lack respect for the athletic training professional” to act on his feelings.

Given the primary role of the athletic trainers as healthcare providers in the college sports medicine setting, it is possible that the hostility experienced in the workplace ultimately affects collegiate athlete health outcomes. Future research examining the interaction between athletic trainer workplace experience and athlete health outcomes is needed, as are interventions to ensure that athletic trainers are allowed to provide healthcare to collegiate athletes without external impediment.