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Am Fam Physician. 1999;59(7):1725-1726

Study Shows That Some Public Hospital Conversions Have Worked Well

State and local public hospitals account for almost 25 percent of all community hospitals in the United States. According to a January 1999 study by the Economic and Social Research Institute (ESRI), one of these hospitals has closed and two others have converted to private ownership or management annually for the past 10 years. The study, commissioned by the Kaiser Family Foundation, found that the number of community public hospitals at the beginning of 1985 was 1,681, but that number had decreased to 1,387 by 1995.

While the closing and conversion trend is clear, the causes are not. ESRI did not find significant relationships between hospital closures and conversions and the explanatory variables that were matched in the study. The report also features case studies of five public hospital conversions—four to nonprofit entities and one to a state-created quasi-public organization. The findings that these conversions maintained access to low income patients (for the most part) as well as to intact treating programs, may not be any more representative of such closings than the entities to which these five hospitals were transferred. ESRI sees the results of this conversion as validation that modern business practices are comparable with a social mission. A full copy of the report (no. 1450) is available by calling 800-656-4533, or it may be downloaded at

National Colorectal Cancer Action Campaign Is Launched

The Centers for Disease Control and Prevention (CDC), the Health Care Financing Administration and the National Cancer Institute have launched a nationwide campaign to educate Americans over age 50 about colorectal cancer. The goal of the Screen for Life campaign is to inform persons in this age group about the importance of colorectal cancer screening tests for early detection and prevention of the disease. Colorectal cancer is second only to lung cancer as a cause of cancer-related death in the United States. The CDC recently released data showing that only 41 percent of men and women over age 50 receive either of the two most commonly recommended screening tests—fecal occult blood tests or sigmoidoscopy/proctoscopy—within the recommended time intervals. The Screen for Life campaign includes public service announcements and information materials. The campaign will promote the new Medicare coverage of colorectal cancer screening procedures. More information is on the Screen for Life Web site at; materials may be ordered by calling 888-842-6355.

Family Physicians Urge Passage of Managed Care Reform Act

For the second year in a row, a major emphasis of the American Academy of Family Physicians (AAFP) will be to press Congress and the Administration to pass a managed care reform act that secures basic rights for patients in managed care organizations. Among the provisions that the AAFP would like included in such a bill are the following: a requirement that basic information about covered and excluded benefits, financial obligations, plan providers, experimental benefits and other important plan provisions must be available to all plan enrollees; a requirement that each plan should have an internal and external appeals process enabling meaningful and prompt access to patients and their physicians; a requirement that each plan should have a prudent layperson standard enabling patients to secure emergency care out of plan without prior authorization; a requirement that is as strong as the standard established for Medicare beneficiaries in the Balanced Budget Act of 1997; a requirement that each plan protect the right of each physician and other staff to communicate freely with all patients; a requirement that each plan have a policy protecting physicians who advocate on behalf of their patients for needed medical benefits; and a requirement that self-funded ERISA plans be able to be held responsible for medical outcomes, as are other plans, within any given state.

AAFP concerns about provisions in some bills pending before Congress include the following: establishing a definition of women's health care services for purposes of ensuring access to care that excludes family physicians from becoming such providers of women's care; requiring plans, under some circumstances, to designate a limited specialist as a “primary care” physician when that specialist does not have the breadth of training and experience to fulfill that role; mandating hiring procedures of plans, and otherwise inappropriately limiting the ability of plans to make business decisions; mandating extensive data gathering and analysis that would be difficult and expensive for plans, especially smaller ones, such as gathering outcomes data on a physician-by-physician basis; and establishing a national entity to set or recommend medical quality standards for the health industry.

COLA Laboratories Listed on the Internet

The Commission on Office Laboratory Accreditation (COLA) Web site now allows visitors to search for COLA-accredited laboratories by zip code. The feature was created to help patients verify that their physician has a COLA-accredited laboratory or to assist health care consumers when selecting a quality health care clinician. The list names participants who are enrolled or are accredited by COLA, a national health care accreditation organization whose mission is to promote quality health care. The COLA Web site also allows visitors to learn about COLA programs and educational products, obtain answers to frequently asked questions and access the latest health care information relating to laboratories and medical practices. It offers technical support and educational information to COLA program participants and the health care community. The Web site address is

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Copyright © 1999 by the American Academy of Family Physicians.

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