Private credentialing of health care personnel: an antitrust perspective. Part One

This Article explores the antitrust and other implications of private credentialing and accrediting programs in the health care industry. Although such programs are usually sponsored by powerful competitor groups, they serve the procompetitive purpose of providing useful information and authoritative advice to independent decision makers. Part One examines the risk that credentialing will sometimes be unfair to competitors and deceive consumers. Its survey of common-law, antitrust, and regulatory interventions to correct such unfairness and deception seeks to determine the degree of oversight to which credentialing and similar activities have been and should be subjected. In recommending that judicial or regulatory scrutiny should be limited to discovering whether standards and practices have a rational relation to a procompetitive purpose, the Article argues that greater intrusion into credentialing schemes would be inconsistent with market theory and first amendment values and would discourage line-drawing efforts that stimulate competition and facilitate consumer choice. By emphasizing throughout that personnel certification and institutional accreditation embody ideology and opinion as well as factual information, Part One sets the stage for the argument in Part Two that antitrust law can and should be used to contest the dominance of a single ideology of health care and to facilitate the development of alternative sources of consumer information. The Article's overall thesis is that, whereas the quality of advice given to the public about health care personnel and similar matters should not be closely regulated, neither should the supply of competing information and opinion be artificially curtailed.     

Draft guideline for infection control in health care personnel, 1997--CDC. Notice

This notice is a request for review of and comment on the Draft Guideline for Infection Control in Health Care Personnel, 1997. The guideline consists of two parts: Part 1. "Infection Control Issues for Health Care Personnel, an Overview" and Part 2. "Recommendations for Prevention of Infections in Health Care Personnel", and was prepared by the Hospital Infection Control Practices Advisory Committee (HICPAC), the National Center for Infectious Diseases (NCID), the National Immunizations Program, and the National Institute of Occupational Safety and Health (NIOSH), CDC.     

Private regulation in mental health

General hospitals are increasingly important sources of care for chronic and acute mental patients. Joint Commission on Accreditation of Hospitals (JCAH) standards for staffing in general hospitals require the same degree of physician supervision and control for all services, including mental health. This paper considers the economic impact of JCAH standards on the practice of psychologists in hospitals. The “voluntariness” of the standards is assessed and the evidence that these standards foster economic protectionism is considered. We conclude that in light of the demonstrated capability of nonphysician professionals, methods of quality control appropriate for physician health care in general hospitals should be reconsidered as these instutions diversify into mental health services.     

Rationing health care: it's a matter of the health care system's structure

The article examines two primary policy proposals for how the U.S. should allocate its limited health care dollars: a centralized model in which a commission establishes rationing guidelines, and a decentralized model in which rationing decisions are made by health care providers on a case by case basis. The author finds significant advantages with each position, leading the author to assert that a combination of each is key to an effective rationing policy: a centralized control of structure coupled with decentralized physician-level decision making. While mindful that formal rationing guidelines alone are unfeasible to effectuate cost-effective care, the author introduces two decentralized policies to control costs: the limitation of resources at physicians' disposal and elimination of physicians' personal incentive to provide high-cost care.     

Equity,health, and health care

Equity goals, such as equal treatment for equal need or equality of access, commonly take pride of place among the aims of health policy. But do these conceptions, or others derived from more fundamental philosophical systems such as those of the utilitarians or John Rawls, successfully capture the way in which the term equity is generally used? If not, is it possible to find some interpretation that can command a greater consensus? This paper answers no to the first question and yes to the second. It is argued that the standard conceptions of equity ignore the processes by which health states are determined and hence the extent to which they arise from factors beyond individual control. An alternative conception is proposed that directly incorporates these considerations.     

Prevalence of Demodex in health personnel working in the autopsy room

The health personnel working in the autopsy rooms and laboratories are considered among the professional groups carrying a high risk of contamination with infection. In this study, we have investigated the prevalence of Demodex, which provides a convenient environment for bacteria and acts as a vector for certain microorganisms, in the health personnel working in autopsy rooms. The study, which was cross-sectional, was conducted on 58 health personnel working in autopsy rooms. A questionnaire was administered to the individuals. Specimens were obtained from 4 different regions of the face using the standard skin-surface biopsy technique. The data obtained were then evaluated statistically. This study group consisted of 76% males and 24% females. The prevalence of Demodex was 26%. Demodex was found to occur more frequently in women. The most frequent occurrence of Demodex was seen among people with darker complexion and in cheek localizations. We believe that Demodex, which has a role in the pathogenesis of dermatologic diseases, provides a convenient environment for bacteria, and acts as a vector for some pathogenic microorganisms, poses a risk as far as individuals working in the autopsy room are concerned.     

The effects of health care advertising

This paper begins by assessing the current status of health care advertising and its potential for growth, arguing that this form of marketing is not just a passing fad among a few clinics and hospitals. It then describes the opposing schools of thought concerning the economics of advertising, and considers both theory and evidence on the effects of advertising on prices, profits, quality, utilization, and innovation.