The Economic Evolution of American Health Care —— From Marcus Welby to Managed Care

----- 美国医疗保健的经济演进：从马库斯·韦尔比到管理式保健

ISBN: 9780691102535 出版年：2009 页码：219 Dranove, David Princeton University Press

The American health care industry has undergone such dizzying transformation 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? The author, 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 practising physician - epitomised 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. The author 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 organisations 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. The author , 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. The author 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.