Abstract
The ‘crisis’ in medical care in the United States is not a crisis of supply and demand. Rather, it is a crisis of accountability. This crisis has been exacerbated by increases in voluntary insurance and in government expenditures. Ironically, the increases in the resources available to pay for health care have led to less consumer sovereignty as practitioners and health care institutions have become less dependent upon funds from the individual consumer’s own resources. Accountability systems established by fiscal intermediaries have led to the proliferation of expenditure for lawyers, accountants, and experts by all participants with little increase in responsiveness to social needs. New methods must be developed to harness the energies and capabilities of the health care professions and institutions toward appropriate social goals.
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Notes
Indeed in 1952 the Chairman of the President’s Committee on the Health Needs of the Nation stated explicitly that ‘The building up of our health resources in terms of training more health personnel and providing more physical facilities must start from the ground up. We have recommended federal grants-in-aid to these and other necessary activities because we believe that the role of the federal government is to stimulate them, not to control them. Government must take the leadership in the promotion of good health; its major energies should go there rather than in extensive direct operation of health services.’ Odin Anderson, Health Care Can There Be Equity? ( John Wiley & Sons, New York, 1972 ) p. 72.
Rosemary Stevens, ‘Trends in Medical Specialization in the United States,’ Inquiry, viii, 1 (March 1971) p. 10. For an exhaustive discussion of the subject see her American Medicine and the Public Interest (Yale University Press, New Haven, 1971).
M. Pauly and M. Redisch, ‘The Not for Profit Hospital as a Physicians’ Cooperative,’ American Economic Review (March 1973) pp. 87–99, carry the assumption of physician control of the voluntary hospital to its logical limit. Maw Lin Lee, ‘A Conspicuous Production Theory of Hospital Behavior,’ Southern Economic Journal (July 1971), holds that status competition with very few cost constraints explains most hospital behavior.
Anne Somers, Hospital Regulation: The Dilemma of Public Policy ( Industrial Relations Section, Princeton University, 1969 ). There is an additional reason for specialists and other physicians to escalate standards and lengthen training time and that is so that supply can be constrained and those already in the system can charge more.
For an elaboration see John D. Thompson, ‘On Reasonable Costs of Hospital Services,’ Milbank Memorial Fund Quarterly (Jan. 1968) Part 2, pp. 33–51.
Elton Tekobste, ‘Medicare Strains Hospital-Payer Relations,’ Modern Hospital (1971) 65–7.
Anne Somers and Herman Somers, Medicare and the Hospitals ( Brookings Institution, Washington D.C., 1967 ).
For a discussion of the sorts of investment that take place in medicine and defense when the cost of capital becomes low or even negative see Richard R. Nelson, Issues and Suggestions for Study of Industrial Organization in a Regime of Rapid Technical Change,’ in Victor Fuchs (ed.), Policy Issues and Research Opportunities in Industrial Organization (National Bureau of Economic Research, 1972 ).
Anthony R. Kovner, ‘The Hospital Administrator and Organizational Effectiveness,’ in Basil Georgeopoulos, Organizational Research on Health Institutions ( Institute for Social Research, University of Michigan, 1972 ) pp. 355–76. Each hospital could aspire to be a medical center.
F. C. Spencer and B. Eismman, The Occasional Open Heart Surgeon,’ Circulation (Feb. 1965) 161–2, showed in 1961 even before Medicare and Medicaid that well under 15 percent of the 1,100 hospitals with open or closed heart surgical facilities did more than fifty operations annually.
Jeff Brown, ‘Public Utility Regulation of Health Maintenance Organizations in Connecticut,’ Yale Legislative Services, New Haven, Conn., 1974.
For a discussion of the Darling case and other cases extending the hospital’s liability see Anne Somers, Hospital Regulation: The Dilemma of Public Policy ( Industrial Relations Section, Princeton University, 1969 ).
See, for instance, Donald Riedel, Lee Brauer, Harvey Brenner, Phillip Goldblatt, Carol Schwartz, Jerome Myers, and Gerald Klerman, ‘Developing a System for Utilization Review and Evaluation in Community Mental Health Centers,’ Hospital and Community Psychiatry, vol. 22, no. 8 (Aug. 1971) pp. 17–20.
Robert Brook and Francis Appel, ‘Quality of Care Assessment: Choosing a Method for Peer Review,’ New England Journal of Medicine vol. 288, no. 25 (June 21, 1973) pp. 1323–9. They show that using different criteria from 1.4 to 63.2 percent of the care examined is judged acceptable.
Robb Burlage, New York City’s Municipal Hospital: A Policy Review ( Institute for Policy Studies, Washington, D.C., 1967 ) pp. 69–70.
Kenneth Arrow, ‘Uncertainty and the Welfare Economics of Medical Care,’ American Economic Review, lii, 5 (Dec. 1963).
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© 1975 Carnegie Corporation of New York
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Warner, D.C. (1975). Government Initiatives and Controls in American Medical Care. In: Smith, B.L.R. (eds) The New Political Economy: The Public Use of the Private Sector. Palgrave Macmillan, London. https://doi.org/10.1007/978-1-349-02042-3_8
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DOI: https://doi.org/10.1007/978-1-349-02042-3_8
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