Health-Care Models - Old and New
Kevin O'Rourke, St Louis Post-Dispatch (MO)
Even people who are more or less bystanders realize that health care is changing. The theorists of health care interpret these changes in terms of paradigms; that is, they maintain that the fundamental model, blueprint or archetype for health care is changing.
For years, the paradigm for health care, the basic model for health care, revolved around highly trained physicians and well-equipped acute-care facilities. The paradigm could have been phrased in this manner: "Good health depends upon highly trained physicians and acute-care hospitals with state-of-the-art technology."
Guided by this paradigm, specialists outnumbered primary-care physicians, physicians' medical decisions usually were not subject to objective accountability, no effort was made to limit the number of physicians and cost was not a factor in evaluating quality care. High-tech surgical procedures such as transplants or cardiac angioplasty, which benefit a comparative few, became the standard for excellence when evaluating acute-care hospitals.
But this paradigm did not respond to the needs of the American public. It resulted in a continual spiral of expenses, and it neglected health needs of several segments of the public, such as the poor and elderly.
What is the new paradigm for health care? It seems that two paradigms are vying for acceptance. The first paradigm might be expressed as follows: "Health care is a business, and everything should be structured with a view to making the greatest profit." Those who accept this paradigm bargain with health-care professionals, whether physicians or acute-care hospital administration, to accept less remuneration for their efforts. In other words, cutting the cost of health care and making a profit receive top priority, even though quality care and patient satisfaction are also mentioned as secondary objectives.
However, cutting costs in this new paradigm is an ambiguous concept. Physicians and health-care facilities agree to work for less under the influence of the for-profit paradigm, but the same amount of money is expended for health care. It seems the money that used to go to health-care professionals and hospitals now goes to insurance companies. For example, Barron's Weekly reported last August that the chief operating officers of the 10 leading health-care insurance groups each received more than $7 million in salary and stock options in 1995. …