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This report addresses the question of whether the extensive use of physician's extenders--nonphysicians trained to perform some of the medical and administrative tasks traditionally performed by physicians--in Air Force hospitals is cost-effective. Specifically, it examines the productivity of extenders in outpatient care and the costs of procuring and using extenders. The authors focused on one type of extender, physician's assistants (PAs), who are typically Air Force corpsmen with one year of classroom and one year of clinical training. The general conclusions were the following: In typical Air Force primary adult medicine clinics, PAs can substitute for physicians one-to-one for 80-90 percent of the patients whose problems lie within the PA's expertise. Relying on PAs to perform most of the primary medicine workload is currently cost-effective, and will remain so until the earnings of civilian physicians decrease markedly relative to the earnings of PAs. (Author).
First multi-year cumulation covers six years: 1965-70.
Evaluates the quality of care of physician extenders (PEs) (23 physician assistants and seven primary care nurse practitioners) in Air Force primary medicine clinics, as part of an evaluation of PEs assuming care formerly provided by physicians. PEs performed at least as well as M.D.s on 25 out of 28 nonredundant process-of-care criteria. Nurse practitioners met the M.D. standard on 14 of 19 criteria. No major differences were found in PEs' use of ancillary services (laboratory and X-ray) or orders for further care when controlling for case-mix. As expected, PEs consulted M.D.s infrequently, but more often for serious complaints and at rates similar to those found in other PE studies. The study concludes that the Air Force can deliver the same quality of care when PEs treat a sizable proportion of patients formerly treated by M.D.s.
As U.S. military forces appear overcommitted and some ponder a possible return to the draft, the timing is ideal for a review of how the American military transformed itself over the past five decades, from a poorly disciplined force of conscripts and draft-motivated "volunteers" to a force of professionals revered throughout the world. Starting in the early 1960s, this account runs through the current war in Iraq, with alternating chapters on the history of the all-volunteer force and the analytic background that supported decisionmaking. The author participated as an analyst and government policymaker in many of the events covered in this book. His insider status and access offer a behind-the-scenes look at decisionmaking within the Pentagon and White House. The book includes a foreword by former Secretary of Defense Melvin R. Laird. The accompanying DVD contains more than 1,700 primary-source documents-government memoranda, Presidential memos and letters, staff papers, and reports-linked directly from citations in the electronic version of the book. This unique technology presents a treasure trove of materials for specialists, researchers, and students of military history, public administration, and government affairs to draw upon.
Health Economics combines current economic theory, recent research, and health policy problems into a comprehensive overview of the field. This thorough update of a classic and widely used text follows author Charles E. Phelps' thirteen years of service as Provost of the University of Rochester. Accessible and intuitive, early chapters use recent empirical studies to develop essential methodological foundations. Later chapters build on these core concepts to focus on key policy areas, such as the structure and effects of Medicare reform, insurance plans, and new technologies in the health care community. This edition contains revised and updated data tables and contains information throughout the text on the latest changes that were made to the Patient Protection and Affordable Care Act (PPACA).