Medical directors: U.S. needs universal insurance

Inappropriate use of resources and waste top the list of problems in managed care, say a group of medical directors surveyed by the Medical Care Management Corporation of Bethesda, MD, and the National Association of Managed Care Physicians of Richmond, VA. The third problem is the increased number of uninsured.1

Among the practical changes that would most improve America’s health care system: universal, basic, affordable health insurance (31% of the respondents), and more information on a given intervention’s cost effectiveness/benefit and patient outcome data (23%). The respondents perceive patients’ most pressing concerns about managed care as: access/barriers to care (24%), loss of trust in the system/physicians (18%), covered services/benefits reductions and limitations (11%), and loss or limitation of choice of physician (11%).

The survey population of 158 consisted of medical directors employed by managed care organizations and self-insured employers, as well as administrative heads of the medical components of organizations. Excluded were medical directors of hospitals, long-term care facilities, and other provider institutions. Clearly, managed care is a work in progress, the report observes. The authors note that while managed care deserves credit for slowing rising health care expenditures, they wonder whether the savings are sustainable.

In the short run, mergers of managed care organizations and providers may contain costs and prolong the life of many facilities, But in the long run, the authors warn, "consolidation may be accompanied by right-sizing, resulting in layoffs and in lowering the skill level of the remaining work force."


1. Goldschmidt PG, Liao JC. Trends in managed care: Results of the 1996/97 medical directors survey. J Managed Care Medicine 1998; 2(1):36-43.

Guidelines released for pediatric ED equipment

Now you can provide your emergency department with the latest list of essentials for giving crisis care to children.

"These guidelines establish a national consensus about what equipment is necessary to provide high-quality care for children," says Marianne Gausch, MD, member of the development committee of the Washington, DC-based American College of Emergency Physicians, "and they allow for modification to address different severity levels of patient populations." Additionally, the guidelines contain charts of pediatric resuscitation medications.

The list is arranged in five sections. Following are selected items from each section:

1. Miscellaneous — infant formula and oral rehydrating solutions, pediatric restraining devices, resuscitation board.

2. Specialized pediatric trays — thoracostomy tube with water seal drainage capability; lumbar puncture (spinal needle sizes 20-, 22-, and 25-gauge).

3. Meconium aspirator; surgical airway kit. Fracture management — cervical immobilization equipment (sizes child to adult).

4. Extremity splints — femur splints (child and adult sizes).

5. Desirable equipment and supplies — medical photography capability.

For further information on the pediatric emergency guidelines, see: Committee on pediatric equipment and supplies for emergency departments, National emergency medical services for children resource alliance. Guidelines for pediatric equipment and supplies for emergency departments. Ann emerg med 1998; 31:54-57.

For a copy of the article, send your request with a self-addressed envelope to: American College of Emergency Physicians, 1111 19th St., NW, Suite 650, Washington, DC 20036.