At 02:21 PM 13/1/96 -0500, DHurst1046@aol.com wrote:
>I am not sure that you can argue that decisions in the health system
>should be made at the clinical interface when the costs are not borne at
>that interface and the antecedent causes of the need for a decsion are
>complex and systemic. IMHO this is precisely the mechanism that has got us
>into trouble in our health systems.
Yes, there have been problems. But how can you argue that decisions can be
removed from the clinical interface when so much of the understanding of
the nature of the problem, the character and needs of the patient, and the
technical expertise is right there at the clinical interface.
By removing decisionmaking from the clinical interface, you are making the
basic Taylorist mistake by saying that workers can't understand the
economic issues, so must be dictated to. You also lead to bureaucratic
medicine.
Maybe it would be better to look at training, and ways in which economic
decisions can be factored into the clinical interface, rather than
removing decisions from the interface.
Why do we talk so much about empowering workers, and so gladly disempower
clinical workers?
Yours
Gray
-- Gray Southon Consultant in Health Management Research and Analsysis 15 Parthenia St., Caringbah, NSW 2229, Australia Ph/Fax +61 2 524 7822 em gsouthon@ozemail.com.au