Chapter 10
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© 2008 Delmar Cengage Learning. Chapter 10 American Health Care: How it Became Inefficient, Inequitable, and Costly Donald W. Light
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Chapter 10. American Health Care: How it Became Inefficient, Inequitable, and Costly Donald W. Light. Early Competitors to a Profession on the Rise. Medical schools of questionable quality and standards arose across the country - PowerPoint PPT Presentation
Transcript of Chapter 10
© 2008 Delmar Cengage Learning.
Chapter 10American Health Care:
How it Became Inefficient,Inequitable, and Costly
Donald W. Light
© 2008 Delmar Cengage Learning.
2
Early Competitors to a Profession on the Rise
• Medical schools of questionable quality and standards arose across the country
• Massive quantity of medical schools soon fed a growing surplus of physicians– This lowered their prices for patient services
© 2008 Delmar Cengage Learning.
3
Early Competitorsto a Profession on the Rise
• Cities and local jurisdictions established dispensaries during the nineteenth century– Where the newest procedures from the leading
specialists were “tested” on supposed charity cases
© 2008 Delmar Cengage Learning.
4
Early Competitorsto a Profession on the Rise
• Dispensaries spread quickly in the face of rising immigration– Correspondingly meeting the greater need in
many communities
© 2008 Delmar Cengage Learning.
5
Early Competitorsto a Profession on the Rise
• Alternative healers offered care located outside incipient medical mainstream
• Until the 20th century:– Medical science offered little better than those
outcomes achieved by eccentric healers• Latter offered stout competition
© 2008 Delmar Cengage Learning.
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Early Competitors to a Profession on the Rise
• Many physicians contracted with mutual aid societies– Government bodies that provided care at low
prices
• Those outside of contract care felt such a practice placed considerable downward pressure on health care prices
© 2008 Delmar Cengage Learning.
7
Early Competitors to a Profession on the Rise
• Patent medicines and nostrums were common during much of the nineteenth century and into the twentieth
• Poor record of medical science up to that point fed demand
© 2008 Delmar Cengage Learning.
8
Combating Competition: The Medical Profession Fights Back
• From 1870 forward:– State licensing boards were established– “Captured” by local medical societies, which
selected members
© 2008 Delmar Cengage Learning.
9
Combating Competition: The Medical Profession Fights Back
• Revitalized AMA opened campaign to improve the scientific quality of medical schools
• Council on Medical Education’s Flexner Report led to the closure of many inferior institutions
© 2008 Delmar Cengage Learning.
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Combating Competition: The Medical Profession Fights Back
• Monetary support soon followed to schools that “passed the test”– This led to a decline in the number of newly-
minted physicians
© 2008 Delmar Cengage Learning.
11
Combating Competition: The Medical Profession Fights Back
• “Poor working conditions” of physicians under contract medicine were exposed– Contract doctors pressured to abandon such
practices
• Mutual aid societies switched from contract schemes to reimbursement of (physician-determined) medical costs
© 2008 Delmar Cengage Learning.
12
Combating Competition: The Medical Profession Fights Back
• Localities urged to leave the field of clinical medicine– Limiting role of free medicine in dispensaries
• Hospitals transformed from charitable institutions to scientific centers – Managed in the interests of physicians
© 2008 Delmar Cengage Learning.
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Combating Competition: The Medical Profession Fights Back
• As the medical profession established lists of approved drugs:– Nostrums and quack remedies sidelined
• Drugmakers prohibited from listing the ingredients on bottles and the diseases a drug was designed to treat– Allowed physicians to make that determination
© 2008 Delmar Cengage Learning.
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A Profession Consolidated
• By the 1920s– Organized medicine had established a legal
monopoly– Competition from any quarter was largely
vanquished
© 2008 Delmar Cengage Learning.
15
A Profession Consolidated
• Physician autonomy and a focus on treating those who could pay was effectively institutionalized
• Medical profession received further assistance from an amenable legal climate during a period of “professional authority”
© 2008 Delmar Cengage Learning.
16
Paying the Price of Success
• Private corporations soon realized the extent to which profits could be made– Became involved in the veritable health care
monopoly formed by physician leaders
• Payers soon rebelled against high health care costs– HMOs and other managed care schemes
expanded
© 2008 Delmar Cengage Learning.
17
Paying the Price of Success
• Physicians now face greater interference from private firms than they might possibly have encountered from the state under a system of national health insurance
© 2008 Delmar Cengage Learning.
18
Chapter 10 Summary
• Emergent medical profession was challenged by five sources of competition:
1. Proliferation of “medical schools”
2. Rise of free care at local dispensaries
3. Patent/quack medicine
4. Alternative healers
5. Contract medicine
© 2008 Delmar Cengage Learning.
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Chapter 10 Summary
• These forces of competition led to low income and prestige for the bulk of physicians
© 2008 Delmar Cengage Learning.
20
Chapter 10 Summary
• Proceeding years and decades were largely spent suppressing sources of competition
• By the end of the twentieth century:– Physicians paid the price of success as
professional autonomy came under fire from various payers
