Wounded Profession: American Medicine Enters the Age of Managed Care

Wounded Profession: American Medicine Enters the Age of Managed Care

Wounded Profession: American Medicine Enters the Age of Managed Care

Wounded Profession: American Medicine Enters the Age of Managed Care

Synopsis

"This new study explores how American health care evolved in the 1990s, as well as the changes in public support and policy. The '9Os saw the country moving toward a realization that health care had become unaffordable - or an enormous financial burden for people with otherwise adequate incomes. Health care providers and consumers alike worried than the problem was becoming uncontrollable. Doctors saw their autonomy and control eroded, employers saw their costs rising significantly, the costs began shifting to employees, and alternative approaches to cost containment were explored. By the mid-'9Os, consumer backlash and increased utilization of the courts to force change helped stimulate a reexamination of public health policy and new legislation to broaden coverage and flexibility. Birenbaum examines where the interests of consumers and professionals have dovetailed and where they differ. He considers the health care system's future and suggested ways the system must be adjusted to provide better and wider coverage at reasonable costs. This volume is essential reading for scholars, students, and professionals in the medical field, as well as general readers concerned with health care issues." Title Summary field provided by Blackwell North America, Inc. All Rights Reserved

Excerpt

This book is about the remaking of the health care system and the consequences of this effort for a major profession. It starts with the rise of medicine in America as a private and largely for-profit clinical practice, aided by the development of the modern academic medical center and financed by a system of indemnity insurance that became increasingly costly to employers, consumers, and government payers. At one time, mainly in the late 1960s and 1970s, medicine was a powerful and highly respected profession in the United States, without parallel. Although still respected, some of its control over its own destiny was lost. It was lost in a struggle with new players in health care—known as managed care organizations—as they came up with new ways of financing and organizing the health care delivery system in the United States.

Financing of health care has always had a strong effect on how the system was organized. Now payment comes with various restrictions on how to conduct medical practice and provide hospital care, calling into question the traditional ways of health care delivery. Managed care, as a way of paying doctors and other providers, is a kind of low-intensity war waged against the culture of private practice, especially specialty providers, and the academic medical centers that depend on patient admissions from their affiliated physicians.

Managed care, through cost shifting to plan participants, is a form of combat also against the indifference to cost displayed by consumers with insurance coverage but with no deductibles and co-payments in their policies. Making members of health care plans aware that visits to the . . .

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