Hej Pokernet.
I plejer sgu altid at være så kloge når det kommer til ting og er sgu lidt på bar bund i den her. Jeg er p.t. igang med at tage et kursus i Theory and Practice of Argument herovre i USA, men vores lærer har givet os en opgave som virkeligt skaber problemer for mig. Jeg skal identificere de seks punkter i Toulmin modellen, hvilket er: "Claim, Sub-claims, Grounds, Warrant, Qualifier and Rebuttal". Jeg forstår udemærket hvad de her ting er og har også læst jeg ved ikke hvor mange bøger nu omkring det, men kan stadig ikke udlede hvad der er hvad i den 'editorial', som vores lærer siger vi er påkrævet at analysere. Editorialen der skal analyseres kan ses herunder:
EDITORIAL
Paying Doctors for Performance
Published: January 27, 2013
In line with the goals of national health care reform, New York City’s public hospital system has embarked on a radical change in the way it will pay doctors. Instead of granting automatic pay increases, it will pay them based on how well they reduce costs, increase patient satisfaction and improve the quality of care. The Health and Hospitals Corporation, which runs the city’s 11 public hospitals, deserves praise for an ambitious proposal that will need to be refined as it is put into practice.
The move toward paying for performance was described by Anemona Hartocollis in The Times on Jan. 12 and confirmed by the corporation (the corporation that runs New York City’s public hospitals). The system’s doctors, who are all salaried employees, had been awarded an annual cost-of-living increase and could earn additional bonuses based on the volume of services they provided.
The corporation has now jettisoned that approach in new contracts with three “affiliates” — the New York University School of Medicine, the Mount Sinai School of Medicine and the Physician Affiliate Group of New York — which together employ more than 3,300 doctors who deliver care in the public hospitals. There will be no cost-of-living increases for the next three years. Instead, the contracts will give annual bonuses to the affiliates if their doctors do well in meeting performance goals, like improving the coordination of care and reducing the average length of stay.
One flaw is that there will be times when the doctors who actually provide the services cannot through their own efforts meet some of the standards by which they will be judged. One standard holds emergency room doctors responsible for reducing the time between deciding that a patient needs hospitalization and sending the patient out of the emergency room. Yet the patient cannot leave the emergency room unless there is a bed available, the room is clean, the head nurse on the floor agrees to accept the patient and an orderly arrives to transport the patient.
The system’s leaders say they will do all they can to ensure that all members of the health care team work together to achieve the same performance goals. The system as a whole is already committed to achieving many of the same performance measures to comply with national health care reform.
The doctor’s union is still seeking a wage increase or at least a guarantee of part of the bonus. It also wants to determine bonuses partly by measuring performance against a hospital’s previous record rather than against a national standard that might be harder to meet. Such issues must not be allowed to disrupt this important move to pay doctors based on how well they perform.
Jeg håber der er nogen kloge hoveder, som kan kaste lidt lys over det. Har selvfølgelig lavet noget selv, som jeg dog overhovedet ikke er sikker på, da der virkeligt ikke er særligt meget data (grounds) i den her editorial. Jeg føler nemlig bare at det er en gennemgang af ting uden, at man ligger belæg for hvorfor man mener at de fortjener anerkendelse for at tage forslaget ind, samt hvorfor de små ting ikke må sætte en kæp i hjulet for den her reform. Eller er det kun mig?
Redigeret af Guldmageren d. 04-02-2013 22:05