William L. Kissick

Managing the Medical–Industrial Complex

Emerging trends toward competition, entrepreneurship, and incorporation within both nonprofit and proprietary health care organizations have been discussed in these pages with increasing frequency....

Health-Policy Directions for the 1970's

Abstract The health endeavor in the United States, a

Marxism, the Theory of Complementarity, and Medical Care

60,000,000,000 human-services enterprise, is in a state of crisis that challenges the continuation of its pluralistic, independent, voluntary nature. Health care, although still predominantly a private-sector activity, is no longer solely the private concern of the individual. The evolution of the role of the government has proceeded through four phases, beginning with categorical grants-in-aid (1935), investments in the development of health resources (1946), organization and delivery of health services (1963) and a transition to comprehensive health-care systems (1967). Health-policy deliberations during the 1970s, including the debates over National Health Insurance, must focus on the modification of financing mechanisms and patterns of organization if society is to realize the most effective utilization of its health resources to provide health care for a population projected to reach 250,000,000 by the end of the decade.

OR Practice-Policy Decision Modeling of the Costs and Outputs of Education in Medical Schools

Excerpt Niels Bohr, the Danish 1922 Nobel Laureate in Physics, advanced the theory of complementarity to explain light as a wave or a pulse. Although theories of physics are tested by precise instr...

Issues of the Future in Health

This paper presents the results of a project designed to develop a methodology to aid policy decision making in statewide medical education systems. The methodology requires the development of quantitative models that project the states future investment in medical education, as well as the effects of potential policy proposals on the costs of medical education, on state costs, and on physician manpower supply. To build these models, we collected and analyzed extensive data from one statewide medical education system. We discuss the development of our methodology, its application in the strategic planning by the states educational leaders, its significance in the policy formulation process, and we offer guidelines for future research.

Book Review: Epidemic of Care: A Call for Safer, Better, and More Accountable Health Care

Care of the patient, institutionalization, cost effectiveness, and quality control are the issues of the future in the field of health. With health expenditures projected to reach between

Madness and Government: Who Cares for the Mentally Ill?

156 and

The Painful Prescription: Rationing Health Care

189 billion (8 to 9.8 percent of the Gross National Product) by 1980, the national policy on health care, both present and future, will be of major concern to the body politic. The patient will be seeking hegemony over the health care system to influence it to meet his needs. Institu tionalization of the system will yield greater effectiveness and efficiency. A new emphasis on cost effectiveness will necessi tate an evaluation of all methods of care by objective criteria that are concerned both with productivity of resources and with end results. Quality control of health care will become a new concern of the public, superseding the individual responsi bility of the single practitioner. Taken together, these devel opments will characterize efforts to attain the practical manage ment of a highly complex and diversified social endeavor con cerned with the supplying of human services.

Managing the MedicalIndustrial Complex

This book is a compelling statement by the authors, who are former colleagues at Health Partners in Minnesota. The first half of the book is a detailed iteration of problems with our health care system. The authors don’t miss a trick; they have covered all the bases. The chapter titles (with my comments in parentheses) tell the story: 1) ‘‘Miracles cost money;’’ 2) ‘‘Unsafe at any cost’’ (inappropriate care can be even more costly); 3) ‘‘Who really pays for all of that care?’’ (every individual deserves the highest quality health care available provided somebody else pays); 4) ‘‘How Americans’ entitlement to care drives up costs’’ (no cost is too great to save a life or treat a disease); 5) ‘‘Care monopolies’’ (Adam Smith’s nemesis and warning); 6) ‘‘Does our government pay fair prices by world standards?’’ 7) ‘‘How the Internet is changing health care’’ (for better or worse, the authors ask); 8) ‘‘The coming growth in health care workers’’ (critical in a labor-intensive industry); 9) ‘‘Medical necessity’’ (probably the book’s most critical chapter, this begs the question: How do we ration? As Deep Throat advised in All the President’s Men, ‘‘Follow the money.’’) Midpoint in the book, the authors ask: Why not a single-payer system (like Medicare)? Although many in our society advocate this approach, the authors demur with articulate reasons, but leave open the possibility of something like Germany’s model. Next they ask, ‘‘Where do we go from here?’’ and propose seven major initiatives. First, improve the quality and safety of care. Second, address consumer choices to create an improved market model. Third, improve population health. Fourth, prevent monopolies and other anti-competitive behaviors. Fifth, create a workable framework for the uninsured. Sixth, provide adequate support for our health care delivery system by funding training, education, medical research, and a re-supply of health care workers. Finally, create an automated medical record. Based on a half-century in the field of health affairs, this reviewer endorses almost the entirety of the authors’ call but with the following reservation—how are the seven initiatives to be implemented and with what priority? Health care is a cultural affair and, therefore, transcends the biomedical sciences. Further, our health care system confronts 50 states, each with distinctive geography, governments, and cultures, and our country is inhabited by 275,000,000 people. Given this diversity, it should be recalled that no society in the world ever has had sufficient resources to provide all of the health services its population could utilize. Thus, we have a challenge of extraordinary proportions as we attempt to address the problems in how we organize, finance, and deliver health services. Where do we start? The authors’ suggestion for an automated record system looks promising. Health Partners and Kaiser, like various other health care organizations, have made significant progress in this technological area. But it’s not just a technological challenge; for example, it involves behavioral change. The move to an automated record system would be formidable. Quality is the first concern of the authors. Perhaps we need to recognize that our health care system seems to chase miracles. In medical