An Analysis of Dranove’s The Economic Evolution of American Healthcare Essay Example

An Analysis of Dranove’s The Economic Evolution of American Healthcare Essay Example An Analysis of Dranove’s The Economic Evolution of American Healthcare Paper An Analysis of Dranove’s The Economic Evolution of American Healthcare Paper The Economic Evolution of American Health Care: from Marcus Welby to managed care was written by David Dranove. The book, published in 2002, was written to explore the history of health care in America and outline the changes that occurred beginning from the traditional health care practice that Dranove called as â€Å"Marcus Welby medicine† to the more modern managed care, all from the economic perspective. The paper covers a brief summary of the chapters and points made by Dranove and critical analysis with close attention to highlighting the main arguments of Dranove. Among the various points emphasized by Dranove in the book, the paper will discuss three ideas: the importance of trust in the patient-physician relationship, the valuable role of managed care in increasing access to health care services, and the means to ensure that managed care organizations deliver quality health care services and do not take advantage of Brief Summary The first chapter, The Rise of Managed Care, discussed traditional health care as portrayed in a television show Marcus Welby, M.D. The television show became popular in the 1960s and was about Marcus Welby, a primary care physician or PCP. The Marcus Welby medicine placed the physician as â€Å"the center of a medical care system† (p. 7). The physician manages an independent medical clinic, does house calls, make referrals, and make important decisions in the hospital setting. In traditional health care, the physician was instilled the right to make autonomous decisions.   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   After several decades, however, managed care was introduced and the physician was displaced as the policy and decision-maker. Dranove called managed care as â€Å"dispassionate and depersonalized†. The close and personal relationship between the physician and the patient was less prioritized and managed care organizations or MCOs became key policy and decision-makers. At this point, Dranove highlighted the shopping problem. The shopping problem caused a dilemma on the part of individuals who are unsure from where to seek medical care. In traditional health care, patients rely entirely on the decisions, advises, and referrals of the physician,   until managed care stepped in and   the commercialization of health products and services made health care a shopping culture that creates problems for patients, also considered as consumers. In the second and third chapters, The Origins of Managed Care and The Government Steps In respectively, Dranove discussed how managed care began especially the various factors that transformed the traditional health care system to a modern and economic-centered one. Managed care began as an outcome of traditional health care. Managed care organizations or MCOs became the middlemen between physicians and patients, consequently solving the shopping problem and issues concerning costly health care services. MCOs identified the needs of patients and fulfilled the responsibility of selecting health care services for them while promising cut rates to lower cost. The second part of the book talks about the modern health economy, primarily in the 20th century. The 5th, 6th, and 7th chapters of part two introduced very important details that stressed the advantages but most importantly the disadvantages of MCOs and why there is a need to address them. The modern health economy, according to Dranove, may have offered the American people accessible health care services primarily from health insurances, but the problem with managed care is the quality of services being provided by MCOs, the cost that individuals are paying for these services, and the depersonalization of business. The American people have already lost their trust on MCOs. In the remaining chapters of the book, Dranove (2002) discussed some important points about managed care and introduced several ways in order to address the problems and disadvantages of managed care. The Patient-Physician Relationship One of the most important issues that Dranove pointed out was the importance of developing a desirable patient-physician relationship. More than once, Dranove mentioned that the transition from traditional health care to managed care has led to the depersonalization of health care services. Furthermore, the negative side of managed care has caused the American people to lose their trust on the health care system. Most individuals believe that the health of the American people is not the first priority of MCOs. In fact, MCOs have created a new health care system where individuals needed to rely on the decisions of MCOs and simply choose from the goods and services that MCOs have to offer. The argument of Dranove is agreeable but the current health care system, and even the traditional health care system, cannot address trust issues. The Marcus Webley medicine did gained the trust of people. The relationship between the physician and the patient was ideal. The patient goes to a trusted physician and relied on him for advice, referrals, and recommendations. The physician, on the other hand, was hands-on and attentive to the needs of patients. As Dranove described it, the physician was the center of the health care system. The physician is also the center of the patient’s health. Dranove described the relationship between the physician and the patient as something that should be built on trust. Dranove quoted James Coleman, â€Å"in which the risk one takes depends on the performance of another actor† (p. 14). Patient trust also comes in different forms: 1. Trust that providers will act unselfishly, putting patients’ interests above their own; 2. Trust that providers have the technical competence necessary for proper diagnosis and treatment; and 3. Trust that providers can control and coordinate the resources necessary to deliver quality care. Patients entrust their lives to the hands of physicians and the latter should respond to the patients’ trust by providing them the best quality care. According to Dranove, the best advantage of the Marcus Welby medicine is that physicians value the trust that patients give them and provide the best possible quality of health care to them. â€Å"But the great advantage of the traditional health economy was that economics never stood in the way of quality† (p. 84) The problem, however, is the cost of health care services then. Being independent physicians who were in charge of almost everything, the cost of services asked of patients was too high. According to Dranove, from the 1960s until the early 1990s, health care was what Dranove the economy of the United States. The high cost of health care services became the primary source of revenue in the country, but on the contrary, limited access to these services. Health care services should be for all, as is the goal of the US government when it comes to health policies. Expensive health care services mean that not everyone will be able to afford health care. Readings of other books support this idea. The discussion by Brannon Feist (2009) on health care covered the ideas that Dranove discussed and I agree with, that expensive health care means limited access to it. â€Å"The cost of health care prevents many people from receiving proper treatment and care† (p. 59).