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"[This book is] the most authoritative assessment of the advantages and disadvantages of recent trends toward the commercialization of health care," says Robert Pear of The New York Times. This major study by the Institute of Medicine examines virtually all aspects of for-profit health care in the United States, including the quality and availability of health care, the cost of medical care, access to financial capital, implications for education and research, and the fiduciary role of the physician. In addition to the report, the book contains 15 papers by experts in the field of for-profit health care covering a broad range of topics--from trends in the growth of major investor-owned hospital companies to the ethical issues in for-profit health care. "The report makes a lasting contribution to the health policy literature."--Journal of Health Politics, Policy and Law.
Contents
- Committee on Implications of For-Profit Enterprise in Health Care
- PREFACE
- ACKNOWLEDGMENTS
- INTRODUCTION TO THE VOLUME
- PART I. COMMITTEE REPORT
- 1. Profits and Health Care: An Introduction to the Issues
- 2. Changes in the Ownership, Control, and Configuration of Health Care Services
- 3. Financial Capital and Health Care Growth Trends
- 4. Investor Ownership and the Costs of Medical Care
- 5. Access to Care and Investor-Owned Providers
- 6. Quality of Care
- 7. Implications for Education and Research
- 8. Physicians and Entrepreneurism in Health Care
- 9. The Changing Nature of Physician Influence in Medical Institutions
- 10. Summary and Conclusions
- Supplementary Statement on For-Profit Enterprise in Health Care
- PART II. PAPERS ON FOR-PROFIT ENTERPRISE IN HEALTH CARE
- An Exchange on For-Profit Health Care
- Ethical Issues in For-Profit Health Care
- For-Profits Exacerbate the Problem of Access to Health Care
- For-Profits are Unfair Competition for Nonprofits
- For-Profits Treat Health Care as a Commodity to be Bought and Sold in the Marketplace Rather than as a Right of Every Citizen
- For-Profits Damage the Physician/Patient Relationship, Erode Trust, Create New Conflicts of Interest, and Diminish Quality of Care
- For-Profits Undermine Medical Education
- For-Profits and the Political Power of the Medical-Industrial Complex
- Conclusion
- Trends in the Growth of the Major Investor-Owned Hospital Companies
- The Effects of Ownership and Multihospital System Membership on Hospital Functional Strategies and Economic Performance
- Response to Financial Incentives Among Investor-Owned and Not-For-Profit Hospitals: An Analysis Based on California Data, 1978-1982
- Hospital Acquisitions and Their Effects: Florida, 1979-1982
- Hospital Ownership and Comparative Hospital Costs
- Medicare Patient Outcomes and Hospital Organizational Mission
- Compliance of Multihospital Systems with Standards of the Joint Commission on Accreditation of Hospitals
- Hospital Ownership and the Practice of Medicine: Evidence from the Physician's Perspective
- Physician Participation in the Administration and Governance Of System and Freestanding Hospitals: A Comparison by Type of Ownership
- Medical Staff Size, Hospital Privileges, and Compensation Arrangements: A Comparison of System Hospitals
- Hospitals and their Communities: A Report on Three Case Studies
- Investor-Owned Multihospital Systems: A Synthesis of Research Findings
- The Changing Structure of the Nursing Home Industry and the Impact of Ownership on Quality, Cost, and Access
NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The members of the committee responsible for the report were chosen for their special competences and with regard for appropriate balance.
This report has been reviewed by a group other than the authors according to the procedures approved by a Report Review Committee consisting of members of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine.
The Institute of Medicine was chartered in 1970 by the National Academy of Sciences to enlist distinguished members of the appropriate professions in the examination of policy matters pertaining to the health of the public. In this, the Institute acts under both the Academy's 1863 congressional charter responsibility to be an adviser to the federal government and its own initiative in identifying issues of medical care, research, and education.