상세정보

There is little debate that health care in the United States is in need of reform. But where should those improvements begin? With insurers? Drug makers? The doctors themselves? In Big Med, David Dranove and Lawton Robert Burns argue that we're overlooking the most ubiquitous cause of our costly and underperforming system: megaproviders, the expansive health care organizations that have become the face of American medicine. Your local hospital is likely part of one. Your doctors, too. And the megaproviders are bad news for your health and your wallet.

Drawing on decades of combined expertise in health care consolidation, Dranove and Burns trace Big Med's emergence in the 1990s, followed by its swift rise amid false promises of scale economies and organizational collaboration. In the decades since, megaproviders have gobbled up market share and turned independent physicians into salaried employees of big bureaucracies, while delivering on none of their early promises. For patients this means higher costs and lesser care. Meanwhile, physicians report increasingly low morale, making it all but impossible for most systems to implement meaningful reforms.

In Big Med, Dranove and Burns combine their respective skills in economics and management to provide a nuanced explanation of how the provision of health care has been corrupted and submerged under consolidation. They offer practical recommendations for improving competition policies that would reform megaproviders to actually achieve the efficiencies and quality improvements they have long promised.
This is an essential read for understanding the current state of the health care system in America--and the steps urgently needed to create an environment of better care for all of us.

정보제공 :

Preface vii

Introduction 1

Chapter 1 The Evolution of the Modern Hospital 11

Chapter 2 From Hospital to Health System 31

Chapter 3 Why Integration Failed 53

Chapter 4 The Fall and Rise of the Antitrust Agencies 81

Chapter 5 History Repeating: The Second Wave of Integration 106

Chapter 6 Integration Is Still Failing 125

Chapter 7 New Antitrust Challenges 152

Chapter 8 Countervailing Power 179

Chapter 9 Will Disruptors Save the Health Economy? 198

Chapter 10 Recommendations for Competition Policy 226

Chapter 11 Recommendations for Management Policy 250

Epilogue 277

Acknowledgments 279

Notes 281

Index 319