Presented
at the Annual Meeting of the Central Section of the American Federation
for Clinical Research, Chicago, IL September, 1991. Published in: Clinical
Research, vol 39, Sept. 1991.
"Clinical Freedoms within Proposed Medical Care Plans."
John H. Frenster, M.D.
Physicians' Educational Series
Atherton, CA 94027-5446
Many new plans for medical care have been proposed with emphasis
on cost containment, quality assurance and managed care, but with the question
of freedom-of-choice for patients and physicians minimally analyzed. The
present MediCare program and each of 14 new medical care plans were ranked
by matrix cognition decision-making microcomputer programs (Clinical Research,
vol. 39, 411A (April, 1991) for each of 10 criteria of clinical freedom
(choice of physician, choice of practice, choice of hospital, choice of
nurses, choice of work-up, choice of therapy, choice of referral, choice
of payment, choice of follow-up, choice of survival). Choices of physician,
of survival, and of therapy were the most favored clinical freedoms, with
the present MediCare program ranking intermediate in providing clinical
freedoms, the Canadian plan ranking the lowest in such freedoms, and the
double-voucher plan for patients and physicians ranking highest. It is
concluded that clinical freedoms are of diverse types, can be estimated
clinically, and can affect the acceptance of new plans for medical care.
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clinicalfreedom: "the ability of patients and physicians to do all
that is medically necessary without interference."