Health affairs
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Randomized Controlled Trial
The costs of nonbeneficial treatment in the intensive care setting.
Ethics consultations have been shown to reduce the use of "nonbeneficial treatments," defined as life-sustaining treatments delivered to patients who ultimately did not survive to hospital discharge, when treatment conflicts occurred in the adult intensive care unit (ICU). In this paper we estimated the costs of nonbeneficial treatment using the results from a randomized trial of ethics consultations. We found that ethics consultations were associated with reductions in hospital days and treatment costs among patients who did not survive to hospital discharge. We conclude that consultations resolved conflicts that would have inappropriately prolonged nonbeneficial or unwanted treatments in the ICU instead of focusing on more appropriate comfort care.
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The Food and Drug Administration (FDA) approval of BiDil unleashed a vigorous commentary, mostly critical of the decision. The FDA was soon caught between biologists, who see research and clinical utility in using racial classifications, and social scientists (and many politicians), who fear the adversities of greater discrimination. Analyses rarely addressed the practical factors the FDA had to consider in reaching a decision. Much of the literature simply assigned the question to the domain of racial politics, failing to consider the ethics of professional care, the Hippocratic oath, and the marketplace efficiency in moving drugs quickly to those who might most benefit.
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U. S. citizens spent $5,267 per capita for health care in 2002--53 percent more than any other country. Two possible reasons for the differential are supply constraints that create waiting lists in other countries and the level of malpractice litigation and defensive medicine in the United States. ⋯ S. malpractice claims is estimated at $6.5 billion in 2001, only 0.46 percent of total health spending. The two most important reasons for higher U. S. spending appear to be higher incomes and higher medical care prices.
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This study builds on earlier work by assessing the long-term impact of a public hospital performance report on both consumers and hospitals. In doing so, we shed light on the relative importance of alternative assumptions about what stimulates quality improvements. ⋯ An earlier investigation indicated that hospitals included in the public report believed that the report would affect their public image. Indeed, consumer surveys suggest that inclusion did affect hospitals' reputations.
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How the Food and Drug Administration (FDA) responds to criticism of its drug safety process will determine whether drug safety actually improves. Propping up the Office of Drug Safety with more bureaucratic prominence or adding new requirements to the preapproval process will add to the cost of drug development and not make drugs safer. ⋯ This information could then be used to reach more definitive regulatory conclusions sooner. New incentives will be needed to entice payers and product developers to work on building a broader, more robust system for collecting data on drug safety.