The American health care industry has undergone such dizzying
transformations since the 1960s that many patients have lost confidence
in a system they find too impersonal and ineffectual. Is their distrust
justified and can confidence be restored? David Dranove, a leading
health care economist, tackles these and other key questions in the
first major economic and historical investigation of the field. Focusing
on the doctor-patient relationship, he begins with the era of the
independently practicing physician--epitomized by Marcus Welby, the
beloved father figure/doctor in the 1960s television show of the same
name--who disappeared with the growth of managed care. Dranove guides
consumers in understanding the rapid developments of the health care
industry and offers timely policy recommendations for reforming managed
care as well as advice for patients making health care decisions.
The book covers everything from start-up troubles with the first managed
care organizations to attempts at government regulation to the mergers
and quality control issues facing MCOs today. It also reflects on how
difficult it is for patients to shop for medical care. Up until the
1970s, patients looked to autonomous physicians for recommendations on
procedures and hospitals--a process that relied more on the patient's
trust of the physician than on facts, and resulted in skyrocketing
medical costs. Newly emerging MCOs have tried to solve the shopping
problem by tracking the performance of care providers while obtaining
discounts for their clients.
Many observers accuse MCOs of caring more about cost than quality, and
argue for government regulation. Dranove, however, believes that market
forces can eventually achieve quality care and cost control. But first,
MCOs must improve their ways of measuring provider performance, medical
records must be made more complete and accessible (a task that need not
compromise patient confidentiality), and patients must be willing to
seek and act on information about the best care available. Dranove
argues that patients can regain confidence in the medical system, and
even come to trust MCOs, but they will need to rely on both their
individual doctors and their own consumer awareness.
