Crisis in Health Care Delivery The Challenge of Managing

From the perspective of actual health care delivery, however, the picture is far less favorable. The United States is nearly alone among the developed industrial nations in lacking a national health insurance system. The existing system of private insurance, provided largely by employers, is badly broken.

Some 40 million Americans lack health insurance entirely. Unable to obtain routine medical care, their conditions often deteriorate until they are forced to go to emergency rooms, burdening the emergencycare system with problems that could have been dealt with earlier  and at vastly lower cost  in a doctor's office or clinic. Other health conditions are never properly treated, with the result that the US has poorer mortality and lifeexpectancy statistics than most other developed nations.

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s health care providers. Thus, "in origin and essence, manged care is a deeply progressive approach to health care" [Burton 911]. From small beginnings, managed care became widespread in the 1980s and early 1890s  and proceeded to oversell itself [Rodwin 1117]. While the (very real) benefits of early preventive care were emphasized, the quite necessary reality of constraints was in effect concealed, until it blew up in the form of media horror stories [Burton 915]. Moreover, managed care soon ceased to be in practice an option for consumers, and plans were chosen by employers whose interest was in minimizing cost rather than providing optimum service [Burton 917]. In fact, however, some "denials of care" are medically appropriate, such as avoiding unnecessary interventions [Bodenheimer 2]. Physicians and other providers, subject to the threat of malpractice suits, are tempted to order every possible test, whether or not justified. Moreover, the consumers of health care are in no position to make independent judgments about treatment. They have "diffuse interests" [Rodwin 1117], and rely on coalitions with providers to speak for them. Without constraint, a system of thirdparty payment could lead to unlimited expendit
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Approximate Word count = 1224
Approximate Pages = 5 (250 words per page)

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