Your cover story, "A good education," (March 1, p. 6) is deficient in describing the methodology of your reader survey and the respondents. As a result, the conclusions and discussion in the article are probably misleading and erroneous. This is most unfortunate when many of us are seeking clarity.
The survey was nonscientific with no attempt to obtain an accurate sample of readers or any of the key stakeholders. Further, the article does not describe the characteristics of the respondents. There is no way of determining when or under what conditions respondents transmitted their answers. Without this knowledge, we must be skeptical and extremely cautious about the results. At a minimum, the author should have acknowledged the limitations of the survey and its conclusions.
There are bases for concluding that the picture of satisfaction with health management programs is not as rosy as the article presents. A national summit attended by more than 200 leading practitioners and educators two years ago concluded that a transformation of health management education and practice was needed. A survey of executive search firms specializing in healthcare yielded many observations that the master's in health administration degree, accreditation and current credentials did not have the clout that many think they do. There are indications that the applicant pool for health management programs, particularly for minority groups, is slipping. The opportunities for postgraduate career development and enhancement are declining.
The recent attention and reporting on the issues in health management education are appreciated. There is clearly broad-based interest and concern. The outcomes of the current initiatives and discussion are absolutely critical to the future of health management education, to the career field and profession. The stakes are high. We need to have accurate and factual reporting to the broad audience to achieve a higher order of success.
Graduate program in health services management and policy
Ohio State University
HHS to blame for billing
In response to his Feb. 16 editorial on discounted charges for the uninsured, I say to Editor David Burda, come out of your office and look around ("Home to roost," p. 20).
I practiced surgery for more than 20 years charging patients what they could afford, including nothing, if that was all they could afford. I gave discounts to teachers, clergy, policemen, firemen and nurses because they did a public service and to college students because they were trying to improve their lot in life. As did so many other physicians, I often gave my services away.
When the government made it illegal to charge other patients less than Medicare and Medicaid patients, I had to change my whole practice philosophy under threat of fine or imprisonment. The hospitals oper-ated under the same threat and only recently has HHS Secretary Tommy Thompson considered lifting that part of the CMS ruling. Why not put the blame where it belongs?
Vice president of medical staff affairs
Warren Memorial Hospital
Front Royal, Va.
Mergers aren't paying off
Regarding your cover stories on a Federal Trade Commission complaint filed against Evanston (Ill.) Northwestern Healthcare and on a return-on-investment study by the American Hospital Association, it is curious to note that no real economies of scale have emerged in all the recent healthcare system mergers ("All's fair in competition?" Feb. 16, p. 6; "An ounce of prevention," Feb. 2, p. 6). Certainly few if any have been passed along to patients or payers.
Technology and labor expenses have been blamed for the disproportionate growth in hospital costs. However, except in hospitals, technology dramatically reduces the costs to consumers, particularly in services that depend heavily on labor. Certainly hospitals are one of the most expensive, labor-intensive services.
Perhaps the problem lies with the model of excellence adopted by many healthcare systems. Here is an odd paradox in popular management consulting that brings this problem to light. Businesses touted as excellent are those that run without apparent self-interest, like a true public service. However, public services that claim to be excellent strive to operate like businesses. Perhaps it is time for the swan to stop pretending it is a duckling, for public services to own what they are, accept their greater challenges and their duty to steward public resources. They achieve what no business could ever hope to approach.
Let us look forward to fewer emergency room diversions, more indigent care, efficiencies that go directly to the patient, and to lightening the burden upon society.
Colleagues Healthcare Consulting
To combat viruses, diversify
Your Feb. 23 Information Edge report, "Boosting IT immunity" (p. 40) did a great job of explaining the growing dangers of computer viruses on the very information technology infrastructure we rely on to improve healthcare processes and communications. What your article failed to point out is that, as far as personal computers go, we live in an IT monoculture with almost all PCs running the vulnerable Microsoft Windows operating system. This is a lot like having a human population all susceptible to the same common cold.
Computers running Linux or Mac OS X do not have the same vulnerability simply because there are not as many of them. As long as we run an IT infrastructure on the same PC operating system, we will be easy targets for malicious programmers.
Diversifying into alternate PC operating systems would easily thwart the effectiveness and proliferation of computer viruses.
E. Anthony Fay
Vice president of government affairs
Province Healthcare Co.
What do you think?
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