The Medical Delivery Business: Health Reform, Childbirth, and the Economic Order

The Medical Delivery Business: Health Reform, Childbirth, and the Economic Order

The Medical Delivery Business: Health Reform, Childbirth, and the Economic Order

The Medical Delivery Business: Health Reform, Childbirth, and the Economic Order


Americans at the end of the twentieth century worried that managed care had fundamentally transformed the character of medicine. In The Medical Delivery Business, Barbara Bridgman Perkins uses examples drawn from maternal and infant care to argue that the business approach in medicine is not a new development. Health care reformers throughout the century looked to industrial, corporate, and commercial enterprises as models for the institutions, specialties, and technological strategies that defined modern medicine. In the case of perinatal care, the business model emphasized specialized over primary care, encouraged the use of surgical procedures, and unnecessarily turned childbirth into an intensive care situation. Active management techniques, for example, encouraged obstetricians to use labor-accelerating treatments such as oxytocin in attempts to augment their productivity. Despite the achievements of the women's health movement in the 1970s, aggressive medical intervention has remained the birth experience for millions of American women (and their babies) every year. The Medical Delivery Business challenges the conventional view that a dose of the market is good for medicine. But while Perkins is sympathetic to the goals of progressive and feminist reformers, she questions whether their methods will succeed in making medicine more equitable and effective. She argues that the medical care system itself needs to be "reformed, " and the reform process must include democracy, caring, and social justice as well as economic theory.


Competing for the
Birth Market
Providers, Procedures, and Paradigms

As the economic organization of specialty medicine described in chapters 2 and 3 shaped medical intervention in the first third of the century, economic developments in the last third continued to shape childbirth intervention. Competition, multiplication of strategic business units, corporate organization, financial management, and quality management continued to inflate capital and technologic intensity in maternal and neonatal care.

Competing Providers and Treatments

Different providers used medical interventions differently in their competition for the birth market. Obstetricians developed routine technological and surgical procedures to differentiate their specialty and confer competitive advantages upon it. Family physicians competed either by adopting specialty procedures themselves or by developing alternative low-intensity strategies and philosophies. Midwives and independent birthing centers also took a lower-intensity approach. Each competing profession developed concepts of risk that paralleled its position in the levels system and its intervention activities.

Competing Physicians

Joseph DeLee and his contemporaries made significant strides in the 1920s toward raising the economic value as well as the academic status of . . .

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