A. Hospitals: Casualties of Managed
Care
Narrator: This is Science Today.
One of the casualties of the health care revolution
has been your local hospital. Health economist James
Robinson of the University of California, Berkeley
says that managed care is leading to shorter hospital
stays and more outpatient treatment. In California,
hospitals are closing -- and that state is leading
a national trend.
Robinson: In the past decade, about 20 percent
of hospitals in California have closed down. The
remaining hospitals are only about half full. The
decline in hospital utilization has been so dramatic
that we now have a very serious excess capacity,
and I predict that there will be further closures
of hospitals.
Narrator: Often, a for-profit hospital
chain will buy a non-profit chain and close parts
of it down.
Robinson: Usually they do that in those instances
where the non-profits are going broke. Non-profits
are not adjusting well to the new environment. The
new environment says reduce your costs, the non-profits
are not good at that. And the for-profits are better
at that, frankly. So I do believe we will see a
continued growth of the for-profit sector at the
expense of the non-profit sector.
Narrator: For Science Today, I'm
Steve Tokar.
B. A New Generation Looks at the
New Generation
Narrator: This is Science Today.
Roy Filly, a radiologist at the University of California,
San Francisco, is working with a new generation
of ultrasound, or sonograph, machines. Sonography
can see the soft tissue that x-rays can't, and the
new machines work at a higher resolution than the
old ones.
Filly: Sort of the bottom line of it is that
the images are now clearer. Which means that the
doctor interpreting your particular sonogram gets
to do it from a more advanced perspective and with
better information.
Narrator: Filly says ultrasound
is particularly useful with newborns -- especially
babies born prematurely.
Filly: They cannot take advantage of some
very sophisticated imaging tests like echo-planar
MRI and spiral CT scanners because they're simply
too fragile to move out of the intensive-care nursery.
Narrator: : But ultrasound can
do it right at the bedside.
Filly: And ultrasound is a technology that
I can wheel up there and perform with the same level
of excellence that I can if the patient comes down
to the ultrasound section.
Narrator: : For Science Today,
I'm Steve Tokar.
C. Micro-Machines at the Cutting
Edge
Narrator: This is Science Today.
Engineer Chih-Ming Ho of UCLA is working on the
forefront of a new technology -- the creation of
extremely small machines called micro-machines.
Ho: Micro-machine is a new technology developed
about say ten years ago. By using that technology
we are able to make mechanical parts in the size
of about a micron.
Narrator: A human hair is fifteen
microns across, so these machines are actually microscopic.
One practical application will be micro-sensors
on airplane wings. Tiny pockets of turbulence create
drag on the wing, slowing the plane down and using
extra fuel. Micro-sensors connected to micro-flaps
can sense and control air flow.
Ho: It's a very small sensor, and then we
can use the sensor signal to control the flow and
reduce the drag on the airplane.
Narrator: Ho predicts another use
will be in surgery. Microscopic tubes will send
out jets of air at supersonic speeds, which will
act as micro-scalpels able to cut individual human
cells. For delicate procedures such as eye surgery,
micro-machines will be truly cutting edge. For Science
Today, I'm Steve Tokar.
D. No Insurance? Go Directly
to the Hospital
Narrator: This is Science Today.
If you don't have a regular doctor, you're more
likely to be hospitalized unnecessarily. Dr. Andrew
Bindman of the University of California, San Francisco
found that people with chronic conditions such as
asthma were more likely to be hospitalized, rather
than treated and sent home, when they didn't have
a regular primary care provider.
Bindman: Individuals from lower income communities
were more likely to be admitted to the hospital
with these conditions. African Americans as well
-- as compared to whites -- were more likely to
be admitted with these conditions.
Narrator: However, Bindman says
that while poor and inner city neighborhoods do
have fewer doctors, that's not the only factor.
Bindman: I think health insurance is another
important part of it. There are many people who
live in communities where there are plenty of doctors
around, but because of the nature of the type of
work that people do, or their income, they do not
have health insurance and so they do not have real
access to those providers even though they may not
be physically very far from them.
Narrator: Bindman says unnecessary
hospitalizations cost about a billion dollars a
year in California alone. For Science Today, I'm
Steve Tokar.
E. TB: Not Your Usual Epidemic
Narrator: This is Science Today.
Epidemics are frightening things. But for most diseases,
at least they're over quickly. Not tuberculosis.
Researcher Sally Blower of the University of California,
San Francisco has discovered that for TB, the conventional
rules don't apply.
Blower: With most other diseases such as
flu or measles or chickenpox, infectious diseases,
they come in pretty quickly, the epidemics peak
and they decline, so epidemics that we tend to think
about usually operate over weeks or months.
Narrator: But the pattern for TB
is very different.
Blower: Some people who become infected with
tuberculosis get tuberculosis very quickly, within
a year or two, and then there are other people who
get infected and then they don't develop TB for
years later, it can be up to 20 years later over
their lifetime.
Narrator: Which means that a TB
epidemic can last for generations, because people
remain infectious for so long. Blower and her team
are using mathematical models to try and discover
how this longest-lived of diseases can be controlled
and eradicated. For Science Today, I'm Steve Tokar.
