Reengineering the Health Care Industry

The nursing profession has argued that a high nurse-to- persevering ratio (i.e., nurses responsible for too many patients) passel limit care (O'Neil & Riley, 1996). Indeed, one need not make up recourse to the professional literature to encounter heard in-person anecdotes about the difficulty hospital patients have in get the attention -- let alone care -- of floor nurses.

much(prenominal) generally, health-care staffing works on patients in complex ways because of the institutional character of health care in the climate of mergers and acquisitions. On one hand, Schenck-Yglesias (1995) cites a study showing that the U.S. pull up stakes have a glut of 165,000 physicians by 2005 because managed-care entities such as HMOs will be able to employ fewer doctors to serve more patients in the clinical setting. They may be "carrying patient stacks of 700." But the institutional nature of large organizations will enable them to pick and choose among the glut of doctors providing first care. It is the fate of the patient, in that context, to take a number and hope for the best in individuated care. On the another(prenominal) hand, some doctors have responded to the institutional structures of managed and consolidate health care by tending toward specialization quite an than family practice/ primary feather care. Specialization, after all, positions the practitioner as an nice whose marketplaceplace price for services can go up based on his or her expertise. O'Neil and Riley (1996) cite legislative ef

There are persistent reports of an undersupply of nurses in the managed-care context, representing a danger for patients. One aspect of this is that the highest-qualified nurses, RNs, are oft hit by downsizing and cost cutting that take after M&A activity, since organizations can replace RNs with slight(prenominal) qualified, less trained, and above all less costly care providers (Rose, 1999).

another(prenominal) aspect of nurse undersupply is that, as doctors carry increased patient loads on the institutional books, they actually have less patient time because, in the managed-care environment, many of their former cite duties are assumed by less costly RNs, physicians assistants, and other providers (e.g., nutritionists). In that regard, the U.S. Bureau of Labor Statistics predicted in 1995 that between 1995 and 2005, the broad(a) pool of physician-support personnel will have grown by 43%, to 3.5 million, compared to a 28% increase, to 1.2 million, for doctors and dentists (Schenck-Yglesias, 1995).

forts in California to decree increased medical residency slots for primary care in state medical-school systems and the decrease the slots for subspeciality physicians. But this does not prevent market forces from encouraging specialization and discouraging general practice, because the former carries " fire benefits of clinical income" (O'Neil & Riley, 1996) compared to the latter. When one considers that more physicians prefer specialization to primary care as a resistance strategy against institutional/managed-care control of their professional practice, while more patients need primary care t
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