Unhealthy cities: corporate medicine, community economic underdevelopment, and public health

The growing corporate dominance in U.S. medical care has been a major factor in the increasingly inequitable distribution of health care resources and the declining public health conditions in poor and minority urban communities. Alongside this trend has been a parallel phenomenon of economic disinvestment and political neglect in these same at-risk neighborhoods. This article analyzes these trends as related components of austerity, retrenchment, and capital consolidation policies that have characterized the U.S. political economy for several decades. Emphasized are the relationships among corporatization, capital consolidation, deindustrialization of the workforce, and medical indigence; the resulting economic stress placed upon community hospitals and other caregivers in poor and minority communities; and the marked discrepancy between conditions of development and underdevelopment in American cities. It is argued that the effects of these policies are pathogenic in nature: they place populations at risk for disease and social dysfunction, they reduce access to necessary preventive and curative services, and they weaken coping mechanisms. Community economic development, empowerment, and a direct challenge to the growing concentration of wealth and power in the corporate class are proposed as essential elements of public health policy.

A survey of faculty practices in U.S. dental schools

In addition to providing a mechanism for maintenance and enhancement of the clinical skills of the faculty, intramural faculty practices are seen as an increasingly important source of revenue for dental schools. In this paper, we report on a survey conducted during academic year 1993/94 of United States dental schools as to the existence, organization, physical structure, finances and governance of their faculty practices. Results showed that all dental schools surveyed had some form of faculty practice or plan to establish a faculty practice in the future. The mean gross income of schools with established faculty practices in the 1993/94 academic year was 1.55 million dollars. Almost all sub-disciplines were represented in these faculty practices. More than 90 percent of the practices are housed within the dental school. The major cost to the faculty practice was staff salaries, with approximately 40 percent of the gross going to faculty reimbursement. Although 60 percent of the faculty practices surveyed were under the direct control of the dental school administration, a significant number of faculty practices were either corporations or partnerships. The results of the survey indicate a continuing trend towards the establishment of dental school-based intramural practices as a means of supporting the dental school budget.

'Health law 2000': the legal system and the changing health care market

The failure of national health reform confirmed in many ways the conservative nature of the American legal system. Legislatures, regulatory agencies, and courts usually find themselves in a reactive posture, responding to groups and individuals aggrieved by changing circumstances. The rapid transformation of the U.S. health care system through managed care presents an extreme example of this phenomenon, involving billions of dollars, millions of lives, and thousands of existing laws. Over the next few years the legal system will face a host of difficult issues deriving from the integration of health care financing and delivery, and the consolidation of fragmented providers into large corporations and contractual networks. What emerges may be neither logical nor consistent but no doubt will reflect the intricate interplay of societal and individual interests in health care.

Structuring managed care joint ventures

Providers that undertake joint ventures to secure managed care contracts must understand the important governance, operational, legal, and political issues involved. Careful planning in all these areas can help ensure that the joint venture will meet its goals and avoid problems such as inappropriately negotiated contracts and legal violations.

Corporate values as related to occupation, gender, age, and company size

A mail survey was used to study the perceived importance of 15 corporate values among advertising personnel, CPAs, and business school professors. Excellent customer service, ethical behavior, and product quality were perceived as highly important by all groups. Political activity and contribution to the community were seen as relatively unimportant. There was general agreement that it was more important to make a fair profit than to maximize profits. A number of corporate values were significantly related to occupational group, gender, age, and company size.

Health service regionalization in New Brunswick, Canada: a bold move

New Brunswick moved swiftly in 1992 to regionalize hospital and physician services along with the reform and expansion of other health care services. The dissolution of 51 hospital and community health services center boards and the establishment of eight region hospital corporations to oversee services in the seven health regions set the tone for regionalization in the province. The plan provides the flexibility to meet specific regional needs. The initial regionalization of hospital services was followed by the determination of the appropriate number, mix, and distribution of physician resources for each region, also to be managed by the region hospital corporation. The provincial government's central role not only guides the regions, but also uses incentives and disincentives to ensure that regional goals are.met. While regionalization is not new and some components of the New Brunswick plan have been used elsewhere, the effort offers an integrated model for the regionalization of hospital and physician services, with the expansion of complementary services.

Choosing medical practice acquisition models

Various models have been used to carry out medical practice acquisitions. Each model results in a different degree of integration between physicians and purchasing organizations, and all involve potentially detrimental legal and business issues to be resolved. This article describes six models of medical practice acquisition and the most common legal and business problems associated with valuing medical practices.

The impact of two corporate lactation programs on the incidence and duration of breast-feeding by employed mothers

PURPOSE

The goal of this study was to examine the impact of two corporate lactation programs on breast-feeding behavior among employed women.

DESIGN

Breast-feeding behavior was measured for up to one year among women who had given birth during 1989, 1990, 1991, and 1992 and compared with national norms.

SETTING

The study was conducted at two corporations: a utilities company with 11,000 employees of which 22% were female with approximately 100 births each year and a space corporation with 3,900 employees of which 31% were female with approximately 30 births per year.

SUBJECTS

Participants were 187 employees returning to work following maternity leave for a medically uncomplicated birth.

INTERVENTION

Participants collected and stored breast milk using the worksite breast pump room at scheduled times during the workshift and were counseled by a lactation professional throughout the study.

MEASURES

A questionnaire was used to establish breast-feeding behavior. Duration was reported by the lactation professional.

RESULTS

Since program inception, 75% of the participants who returned to work while breast-feeding continued until their child was six months old. This represented 139 of the 187 mothers at the two companies. Average duration of breast-feeding overall was 8.1 months.

DISCUSSION

Participants were able to maintain a breast-feeding regimen for at least six months at rates equivalent to the statistical norms for women who are not employed outside the home. This was not an experimental study. Participants were self-selected and there was no control group. On a year-to-year basis, the numbers of participants were relatively small.(ABSTRACT TRUNCATED AT 250 WORDS)

Endoscopic ambulatory surgery centers and the corporate partner

The number of practice-based endoscopic ambulatory endoscopy centers has increased dramatically in the last 5 years as gastroenterologists have recognized the advantages of these centers both for their practice and their patients. A new trend of joining with a corporate partner in ownership of the center is emerging. Such a partnership has clear benefit for physicians, their practice, their patients, and the corporation. Many existing and most forming practice-based endoscopy centers are giving serious consideration to these physician/corporate partnerships. Reasons to consider such a partnership, as well as the risks, are discussed.