Health Care Reform Now!: A Prescription for Change (英語) ハードカバー – 2007/8/17
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The United States spends more money on health care by far than any other country and yet nearly 50,000,000 Americans are uninsured at least part of the time each year.
Health Care Reform Now! is written for anyone who cares enough about our health care situation to consider serious alternatives to the current system.
In this book George Halvorson—an internationally known health care leader and author—offers a sensible approach to health care reform and universal coverage that can work for all stakeholders.
Step by step, George Halvorson outlines a game plan for a truly world-class health care system that will appeal to policy makers on both ends of the political spectrum and will deliver health care with improved quality, better access, provider accountability, performance transparency, consumer choice, and individual empowerment.
"He sets out one possible direction for health care reform." (BookNews, Feb 2008)
"…rich in insights and suggestions that make them compelling reading for anyone seriously concerned about U.S. Health Reform." (Health Affairs, Jan/Feb, 2008)
"This is a very readable book on the current status of reform possibilities facing the US health care system." (JAMA, Feb 2008)
"A management guru, Halvorson shows how the same principles Wal-Mart and Target use to lower consumer costs can be applied to health care." (www.outrageoustimes.com, 09/12/2007)商品の説明をすべて表示する
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As a health care professional for the past six years, I highly endorse this book to both novices and experts alike. The challenges that await health care reform are large and complex, but it is the articulate and well-though advice of veterans like George Halverson that will make long-term advancement possible.
For those of you familiar, this is a form of Scientific Managerialism which currently raging around the country as QI and continuous improvement models.
It ignores the medical physician's perspective and seeks to validate its preumption for efficiency' with catch phrases such as 'productive improvements' cost-reduction (profit margins gauged by cost shifts in the short term; (not
"price" reductions to patients); while "patient centered" customer satisfaction is indexed as target priorities (a whirlwind of critical instrumentation in that category). Thus it becomes possible to pick and choose illnesses where people have had bad experiences and project these as "reasons" change is necessary (particularizing truth). It does not follower, that such "truths" confirm Mr. Halvorson's conclusions or convictions. It becomes a "sales" job that essentially recognizes dissatisfaction and adopts it as a lead in to his premise and avoids connecting his conclusions as a non-sequitur to those categorical medical complaints.
In the end this is not reform at all but a "streamlining" process. It is not a Suppressio Veri of what already exists but it reframes it as manageable under consolidation (and perhaps more corporate concentration) from top down administrative directives. The obvious is presented as desirable outcome admitting modifications where obvious flaws can easyily be called "waste" and these appear to validate a new streamlined model of improvements. But the "improvements" centered upon monopolizing the revenue stream by private market efficiency promises not upon the continuous complexity of real life medical contingencies. Essentially this becomes a vertical integration of a progressive messy and increasingly exploitative market situation that has run amok. Such a consolidation and concentration begs the question under the premise that private equity and a their business model will make things run smoothly and expediently. It is not just wishful thinking, it is a sales job for a system prematurely being called Too Big to Fail. Mr Halvorson's resolve to that situation is to make it "bigger" but put it all under one roof. Meanwhile, the question of price control over cost effectiveness falls under the haze of market efficiency and the expedience of the profit motive to drive things right.
For people concerned about true reform, there are areas that counter the "conclusions" drawn by the business model presented here. Here are some perspectives and links to access that information:
Physicians for a National Health Program (PNHP), is an advocacy organization of some 18,000 American physicians, medical students, and health professionals co-founded in 1987 by David Himmelstein and Steffie Woolhandler that supports a single-payer (Canadian-style) system of universal national health insurance.
The group is best known for its influential proposals for national health insurance, which have been published in the New England Journal of Medicine and JAMA.
Single-Payer National Health Insurance
Single-payer national health insurance is a system in which a single public or quasi-public agency organizes health financing, but delivery of care remains largely private.
"The reason we spend more and get less than the rest of the world is because we have a patchwork system of for-profit payers. Private insurers necessarily waste health dollars on things that have nothing to do with care: overhead, underwriting, billing, sales and marketing departments as well as huge profits and exorbitant executive pay. Doctors and hospitals must maintain costly administrative staffs to deal with the bureaucracy. Combined, this needless administration consumes one-third (31 percent) of Americans' health dollars."
JAMA. 2003 Aug 13;290(6):798-805.
Proposal of the Physicians' Working Group for Single-Payer National Health Insurance.
Woolhandler S, Himmelstein DU, Angell M, Young QD; Physicians' Working Group for Single-Payer National Health Insurance.
Department of Medicine, Cambridge Hospital/Harvard Medical School, Cambridge, Mass 02139, USA.
The United States spends more than twice as much on health care as the average of other developed nations, all of which boast universal coverage. Yet more than 41 million Americans have no health insurance. Many more are underinsured. Confronted by the rising costs and capabilities of modern medicine, other nations have chosen national health insurance (NHI). The United States alone treats health care as a commodity distributed according to the ability to pay, rather than as a social service to be distributed according to medical need. In this market-driven system, insurers and providers compete not so much by increasing quality or lowering costs, but by avoiding unprofitable patients and shifting costs back to patients or to other payers. This creates the paradox of a health care system based on avoiding the sick. It generates huge administrative costs that, along with profits, divert resources from clinical care to the demands of business. In addition, burgeoning satellite businesses, such as consulting firms and marketing companies, consume an increasing fraction of the health care dollar. We endorse a fundamental change in US health care--the creation of an NHI program
Halvorson book was excellent. Well researched and written