Global ETD Search

1	The Paradox of Physician Privacy Jennings, Paige Megginson 21 August 2012 (has links) This Report examines the “paradox” of physician privacy: while physician privacy has been explicitly or implicitly invoked over the last century to defend physicians against greater transparency, proposals that might cause them economic harm, or interference by government or corporate entities, there has been little comprehensive work done to examine the substance and source of any privacy rights physicians may actually enjoy. This Report attempts to make three primary contributions with respect to physician privacy. First, the Report examines the current state of physician privacy and the legal framework that governs it. Second, the Report argues that physician “privacy” is not, and should not be considered, a unitary concept encompassing a singular meaning. Rather it is a broad umbrella term that encompasses not only a variety of legal protections for privacy, but guards against a variety of very different perceived harms. As a result, this Report argues that in evaluating policy initiatives, discussions about “privacy” implications can be counterproductive because the term obscures the real values, concerns, and policy judgments at play. To address this, the Report’s third aim is the proposal of an analytical framework that policymakers and others may use to consider the impact of various initiatives on the values and concerns that physician “privacy” actually protects: professional autonomy; economic considerations; personal dignity; and practical difficulties. / text Physicians Privacy Physician privacy Physician autonomy Physician authority Transparency Health Health care
2	The corporatization of health care in the New River Valley, Virginia Feman, Abby S. 13 February 2009 (has links) This thesis examines several recent transformations in the United States health care system and their effects on the role of physicians. Technology, specialization, ancillary health care workers, for-profit hospitals and managed care corporations have all expanded throughout the health care industry. These changes have resulted in an increase in bureaucratic, capitalist and corporate influences over the system. As a result of the increasing costs of medical practice, the corporatization of health care is occurring in which physicians must not only rely on corporations for access to the capital that they need, but also relinquish some of their power to the corporations. McKinlay and Arches (1985) assert that these changes have led to the proletarianization of the physician. Health maintenance organizations (HMOs) and other forms of managed care companies continue to grow throughout the United States. Therefore, physicians, who have historically dominated the health care system, no longer have the autonomy that they once had. To measure physicians' attitudes toward these changes, The Managed Care in the New River Valley survey was conducted. The findings show that although managed care is not as strong as it is in other parts of the country, physicians still believe that their control of health care is declining. The importance of managed care companies and other third party influences will continue to increase in the future, as they further extend to areas such as the New River Valley. / Master of Science Technology preferred provider organizations corporations managed care physician autonomy health maintenance organizations LD5655.V855 1996.F463
3	Developing Strategies of Organizational Sustainability for Solo and Small Business Medical Practices Anderson, Gerald Lloyd 01 January 2016 (has links) Recent trends point toward a decline in solo and small business medical practices, yet, the need and demand still exists for this model of health care. The purpose of this case study was to explore effective approaches to help physicians in solo practice and small medical group primary care practitioners (PCPs) retain their small business medical practices. The study included purposive sampling and face-to-face interviews: 11 physicians, predominately primary care practitioners, in the Baltimore-Washington metropolitan region, were interviewed until data saturation was reached. A component of systems theory (strategic thinking) and the dynamic capabilities concept were used to frame the study. Audio recordings were transcribed and analyzed to identify themes regarding effective competitive approaches to help small medical group physicians retain their practices. Four major themes emerged: need for flexibility and adaptability, need for higher levels of business acumen, need to fully embrace automation, and a focus on pursuing financial stability before pursuing growth and expansion of the medical practice. Results may benefit society by preserving and strengthening a source of patient-centered, effective, affordable health care for communities served by small business medical practices. Implications for social change include presenting methods to enhance stability and organizational sustainability of small business medical practices. dynamic capabilities medical practice sustainability physician autonomy small medical group practice solo practice physician strategic thinking Business Health and Medical Administration Organizational Behavior and Theory
4	Disruptive Transformations in Health Care: Technological Innovation and the Acute Care General Hospital Lucas, D. Pulane 24 April 2013 (has links) Advances in medical technology have altered the need for certain types of surgery to be performed in traditional inpatient hospital settings. Less invasive surgical procedures allow a growing number of medical treatments to take place on an outpatient basis. Hospitals face growing competition from ambulatory surgery centers (ASCs). The competitive threats posed by ASCs are important, given that inpatient surgery has been the cornerstone of hospital services for over a century. Additional research is needed to understand how surgical volume shifts between and within acute care general hospitals (ACGHs) and ASCs. This study investigates how medical technology within the hospital industry is changing medical services delivery. The main purposes of this study are to (1) test Clayton M. Christensen’s theory of disruptive innovation in health care, and (2) examine the effects of disruptive innovation on appendectomy, cholecystectomy, and bariatric surgery (ACBS) utilization. Disruptive innovation theory contends that advanced technology combined with innovative business models—located outside of traditional product markets or delivery systems—will produce simplified, quality products and services at lower costs with broader accessibility. Consequently, new markets will emerge, and conventional industry leaders will experience a loss of market share to “non-traditional” new entrants into the marketplace. The underlying assumption of this work is that ASCs (innovative business models) have adopted laparoscopy (innovative technology) and their unification has initiated disruptive innovation within the hospital industry. The disruptive effects have spawned shifts in surgical volumes from open to laparoscopic procedures, from inpatient to ambulatory settings, and from hospitals to ASCs. The research hypothesizes that: (1) there will be larger increases in the percentage of laparoscopic ACBS performed than open ACBS procedures; (2) ambulatory ACBS will experience larger percent increases than inpatient ACBS procedures; and (3) ASCs will experience larger percent increases than ACGHs. The study tracks the utilization of open, laparoscopic, inpatient and ambulatory ACBS. The research questions that guide the inquiry are: 1. How has ACBS utilization changed over this time? 2. Do ACGHs and ASCs differ in the utilization of ACBS? 3. How do states differ in the utilization of ACBS? 4. Do study findings support disruptive innovation theory in the hospital industry? The quantitative study employs a panel design using hospital discharge data from 2004 and 2009. The unit of analysis is the facility. The sampling frame is comprised of ACGHs and ASCs in Florida and Wisconsin. The study employs exploratory and confirmatory data analysis. This work finds that disruptive innovation theory is an effective model for assessing the hospital industry. The model provides a useful framework for analyzing the interplay between ACGHs and ASCs. While study findings did not support the stated hypotheses, the impact of government interventions into the competitive marketplace supports the claims of disruptive innovation theory. Regulations that intervened in the hospital industry facilitated interactions between ASCs and ACGHs, reducing the number of ASCs performing ACBS and altering the trajectory of ACBS volume by shifting surgeries from ASCs to ACGHs. Disruptive Disruptive Innovation Theory Disruptive Transformations Disruptive Innovation Innovation Technology Technological Innovation Medical Innovation Medical Technology Medical Advancement Laparoscopy Laparoscopic Surgery open surgery appendectomy cholecystectomy bariatric surgery weight loss surgery appendectomies cholecystectomies inpatient outpatient ambulatory ambulatory surgery ambulatory surgery center acute care general hospital hospital acute care hospital general hospital health care healthcare hospital industry health care industry Clayton Christensen Clayton M Christensen Michael Porter Harvard Business School Virginia Commonwealth University CMS Health policy public policy public administration organizational theory organization theory Population Ecology Theory Competitive Strategy policy analysis John Kimberly Organization Size Structural Inertia liability of smallness health spending health care cost specialty medical facility open system niche width dynamic outpatient department technology shift surgical setting surgical setting shift medical facility shift substitution threat health system system level analysis Ecological Approach hospital trends ambulatory surgery trends reimbursement rate Medicare CMS coverage decision P J DiMaggio DiMaggio and Powell w w Powell Hannan and Freeman M T Hannan Organizational change minimally invasive surgery less invasive surgery Prospective Payment System Outpatient Prospective Payment System entreprenuerial physician health care organization health care management Roice Luke Carl Ameringer new technology surgical utilization elective surgery Medicare Payment Advisory Commission MedPAC coverage decision trends in surgery abdominal surgery surgical variation physician-owned physician ownership physician autonomy outpatient clinic utilization trends unnecessary surgery Pfeffer Salancik technology diffusion redefining health care interdisciplinary research health care delivery panel design diffusion of hospital technology state variation regional variation local health care market government intervention medical facility health care capacity focused factory advances in health care physician organization relationship hospital competition medical specialization hospital expansion medical arms race integrated care integrated health system J E Wennberg health care transformation reimbursement scheme surgical volume Florida Wisconsin policy making health policy analysis competitive dynamics center of excellence intervening factor service line competition service-line competition surgical reimbursement innovative business model innovative technology environmental influence established firm new market entrant patient safety sophisticated technology Harvard Divinity School Social and Behavioral Sciences

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