Policy Challenges in Modern Health Care

By David Mechanic; Lynn B. Rogut et al. | Go to book overview

CHAPTER 4
Entrepreneurial Challenges
to Integrated Health Care

JAMES C. ROBINSON

The U.S. health care system is an ongoing experiment in the effort to achieve social goals through market mechanisms— to pursue the public good through private interests. The era of managed care encouraged competition among insurers, capitation contracting between health plans and providers, and the organizational integration of physicians and hospitals to contain costs and foster access to primary care. The ensuing consumer and provider backlash and the failure of many diversified organizations to deliver improvements in quality and efficiency have today substituted a different set of social goals. These include the unwinding of many consolidated organizations, unconstrained access to specialty services, and a commensurate reversion to broad insurance networks and fee-for-service payments. As before, much of the energy for change comes from the private sector. Rather than focus on reducing costs and integrating organizations, however, the entrepreneurial emphasis today is on enhancing revenue and creating niche organizations such as ambulatory surgery centers and single-specialty hospitals.

The record of the private sector during managed care was mixed. That sector marshaled the energy to overcome the organizational fragmentation of the indemnity era but then engaged in overconsolidation. The contemporary drive toward specialization is producing an analogous mix of desirable and undesirable effects. Unbundled services foster managerial and clinical focus, learning-curve efficiencies, and competition within an otherwise consolidated industry. Yet entrepreneurial entrants are targeting only services and patients whose payment rates exceed treatment costs, thereby undermining the implicit subsidies for underpaid services and underinsured patients.

Specialized niche firms also threaten to create a new form of corporate conglomerate by establishing chains of facilities across geographic regions and the nation. Despite talk of focus, the entrepreneurial drive for more revenue is pushing firms into new markets and new products, with the axis of growth shifting from diversification across services within markets (the integrated physicianhospital organization) to diversification across markets within service lines (chains of ambulatory centers and specialty hospitals).

-53-

Notes for this page

Add a new note
If you are trying to select text to create highlights or citations, remember that you must now click or tap on the first word, and then click or tap on the last word.
One moment ...
Default project is now your active project.
Project items

Items saved from this book

This book has been saved
Highlights (0)
Some of your highlights are legacy items.

Highlights saved before July 30, 2012 will not be displayed on their respective source pages.

You can easily re-create the highlights by opening the book page or article, selecting the text, and clicking “Highlight.”

Citations (0)
Some of your citations are legacy items.

Any citation created before July 30, 2012 will labeled as a “Cited page.” New citations will be saved as cited passages, pages or articles.

We also added the ability to view new citations from your projects or the book or article where you created them.

Notes (0)
Bookmarks (0)

You have no saved items from this book

Project items include:
  • Saved book/article
  • Highlights
  • Quotes/citations
  • Notes
  • Bookmarks
Notes
Cite this page

Cited page

Style
Citations are available only to our active members.
Sign up now to cite pages or passages in MLA, APA and Chicago citation styles.

(Einhorn, 1992, p. 25)

(Einhorn 25)

1

1. Lois J. Einhorn, Abraham Lincoln, the Orator: Penetrating the Lincoln Legend (Westport, CT: Greenwood Press, 1992), 25, http://www.questia.com/read/27419298.

Cited page

Bookmark this page
Policy Challenges in Modern Health Care
Table of contents

Table of contents

Settings

Settings

Typeface
Text size Smaller Larger Reset View mode
Search within

Search within this book

Look up

Look up a word

  • Dictionary
  • Thesaurus
Please submit a word or phrase above.
Print this page

Print this page

Why can't I print more than one page at a time?

Full screen
/ 276

matching results for page

Cited passage

Style
Citations are available only to our active members.
Sign up now to cite pages or passages in MLA, APA and Chicago citation styles.

"Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences." (Einhorn, 1992, p. 25).

"Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences." (Einhorn 25)

"Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences."1

1. Lois J. Einhorn, Abraham Lincoln, the Orator: Penetrating the Lincoln Legend (Westport, CT: Greenwood Press, 1992), 25, http://www.questia.com/read/27419298.

Cited passage

Welcome to the new Questia Reader

The Questia Reader has been updated to provide you with an even better online reading experience.  It is now 100% Responsive, which means you can read our books and articles on any sized device you wish.  All of your favorite tools like notes, highlights, and citations are still here, but the way you select text has been updated to be easier to use, especially on touchscreen devices.  Here's how:

1. Click or tap the first word you want to select.
2. Click or tap the last word you want to select.

OK, got it!

Thanks for trying Questia!

Please continue trying out our research tools, but please note, full functionality is available only to our active members.

Your work will be lost once you leave this Web page.

For full access in an ad-free environment, sign up now for a FREE, 1-day trial.

Already a member? Log in now.