Product specification: the fifth discipline of health care

In any given year, less than 50 percent of the total eligible population takes advantage of illness benefits. This certainly raises the issue of undercare. By specifying the periodic examination schedule for screening and preventive care, the product specification approach to quality medicine can preclude underservice of the beneficiaries. In addition, protocols and practice guidelines for care should lead to increased quality of care and better treatment outcomes. Elimination of the need for inspection will have a significant effect on the excessive administrative costs in the system, and the electronic medical record will eliminate duplication, provide for electronic fund transfer, and minimize administrative costs. Improved quality and lower costs will probably result from integrating the fifth discipline of product specification into health management.

Lymphocele in a cat

A 21-month-old spayed domestic shorthair cat was examined to determine the cause of a chronic fluctuant swelling involving the left hind limb. A lymphocele was tentatively diagnosed on the basis of results of blood tests, radiography, and cytologic examination. Lymphangiography revealed the lymphocele and 2 tortuous collateral lymphatic channels. The lymphocele and a mass of fatty tissue were excised and 3 aberrant lymphatic vessels were ligated. Histologic examination did not reveal evidence of neoplasia. The cyst wall was composed of a layer of collagen and fibroblasts. The mass was an inflammatory nodule incorporating a lymphatic vessel. The authors believe this cat had an acquired lymphocele. The exact cause of lymphoceles is uncertain, but acquired lymphoceles have been reported secondary to tissue trauma or surgery in human beings. Treatment has included aspiration, tube drainage, open drainage and second-intention healing, surgical excision, ligation of lymphatic vessels, and chemical sclerosis of the cyst.

Defining the health care product to ensure quality and manage costs

The frenzy of health care reform activity now led by the Clinton Administration's American Health Security Act of 1993 might end in the worst of all possible outcomes: a new government entitlement program financed by business and a global budget. Unbridled entitlement could drive utilization of benefits to the maximum and, with a budget cap, guarantee rationing. So far, the administration has talked about expanding access and controlling costs--not about the health care product. Given the threat that change poses for vested interests, time will undoubtedly lapse before final implementation of a new system. Unless physicians involved in health management seize the opportunity during this window of opportunity to help shape the future of health care delivery, the likelihood of preserving the U.S. health care delivery system as we know it will be dim indeed.

Preparing for what's ahead

With healthcare reform on the horizon, healthcare companies and providers are positioning themselves for a new environment in which cost-effective medical treatment is the Holy Grail. Not only will providers be required to measure the efficiency of their treatments, but all parties in the medical-care delivery system will need to share financial risk. In the following pages Modern Healthcare staff members look at how specific industry segments are preparing to face the changes expected during the rest of the 1990s. Industry experts also express their views.