The impact of health care reform on anesthesiologists and their patients in the United States: an ergonomic perspective.

The current status of health care reform in the United States is discussed with a special emphasis on its impact on anesthesiology. The author then takes an ergonomic perspective to explore the premise that health care reform of any type may subtly or not so subtly affect the ability of clinical care providers to do their job. It is asserted that alterations in the structure of the health care delivery system, provider incentives, work schedules, production pressures, and other factors can adversely impact anesthesiologist performance. If this is the case then the cost of care actually may increase due to unanticipated inefficiencies or a higher incidence of either patient or provider morbidity. The potential role of human, environmental, equipment, and task factors on anesthesiologist performance are reviewed. The author concludes with a discussion of technology assessment and the role of new anesthesia drugs and devices in a cost-sensitive health care marketplace.