Managed Health Care: Teaching Hospitals
Teaching hospitals have recently been faced with many new challenges. With the introduction of managed health care, medicine has entered a state of transition. In order to control costs, hospitals have begun to place considerable emphasis on primary care. Although such practices generally result in greater efficiency, they create problems for academic medical centers. Managed health care could, for example, threaten the centers' financial security: Tax-subsidized teaching hospitals might be made more accountable for their expenditures. Despite shifts in the political climate, widespread reform among academic medical centers is inevitable. There are many different ways that academic hospitals' operations could be improved. Reform might, for instance, involve reorganization and downsizing.
Health care in the United States is undergoing a transformation (Jones, 1993, p. 220). Up until about the late 19th century, "doctoring in America was a catch-as-catch-can business" (Flanigan, 1995, pp. D1, D6). With the eventual creation of high standards for treatment, however, medicine became a profession. By the mid-20th century, most physicians provided care on a fee-for-service basis and practically everyone had access to medical care. In recent years though, the health care system has become unacceptably expensive. Upward pressures on the medical economy include general inflation, high technology costs, and the need to care for an aging population (Hollowell, 1993, pp. 222-224).
Excessive costs have given rise to the concept of managed health care. A group of 61 university-based hospitals known as the University Hospital Consortium (UHC) recently devised a "market-evolution model to describe the four-stage process by which managed care becomes the dominant method of delivery and financing in a community" (Iglehart, 1993, pp. 1052-1056). The first stage of the model involve...