Book Reviews - Health Care Reform as Social Change
Richard E. Thompson, MD
American College of Physician Executives, Tampa, FL
1993, 179 pp., $29 (member), $34 (nonmembers), (paperback)
Healthcare reform — a serious topic for sure — is not always taken so seriously in this upbeat, enthusiastic book. Cartoons and sidebars from the author and other sources made the material humorous and held my attention. Given all that has been said in learned texts and in the media, one might question if anything worthwhile could be added. But this aggregation of facts, opinions, anecdotes, and recommendations for physician executives is useful. The book's subtitle, "Why Successful Physicians and Health Care Executives are Retooling the Health Care Industry" should help potential readers decide whether to add this work to their library.
The first chapter is a compendium of conventional wisdom regarding the "Symptoms of a Seriously Sick System." The author follows with a 20-year review of the health-regulation creep that occurred between 1974 and 1993. He implies that the competition which pitted hospital and physician providers against each other, whether through certificates of need or diagnosis-related groups, started the healthcare system on the negative slope that, in part, has caused today's dilemmas.
Having described the ills of the healthcare system, Richard E. Thompson, MD, reviews proposed cures, asking whether the experience of other nations and their healthcare systems are applicable to the situation in the United States. This is a useful exercise for those of us who have not studied how other Western-style cultures provide and pay for health services.
The author next gets more personal, stating his opinions about the driver of federal health policy — the political system. He describes government leaders as "position takers given seats at the table before problem solvers." What follows next is a criticism of the pumped-up public expectations (fostered by marketers and government hype) and the effect of these unrealistic expectations on our health system's problems.
Chapter 6 is about how the values of people in business create a money-flow versus a money-drain economy. This chapter caught my attention because it is unique. However, I found it too cryptic and brief. The chapter "Lack of Leadership" was textbookish. Physicians, many of whom enjoy positions of short-term medical staff authority, might find the chapter useful but not always relevant to a health system.
What follows next is a diatribe about the use of third parties in problem resolution and planning — lawyers and consultants. Acid in tone, this chapter missed the mark in my opinion. It is up to boards of directors and health executives to control the use and role of surrogates; it is too much to ask fee-for-service planning consultants and lawyers to control themselves. After a criticism of the costs of consultants, the author discusses cost drivers such as executive compensation and drug detailing. Thompson then introduces a new spin on iatrogenic complications — disappointed physicians. I found that this perspective helps administrators better understand physicians' frustrations.
I did not find the comments on the characteristics of the sought-after physician future oriented. Although Thompson described many avenues for provider collaboration, he did not expect short-term results from these opportunities. I advocate that including a spirit of collaboration among the characteristics of the sought-after physician from this point forward could produce better results.
The author wraps up his contribution with useful but less-developed comments on the effect of total quality management and continuous quality improvement, medical education, Joint Commission on Accreditation of Healthcare Organizations, workers' compensation, and some other facets of healthcare — all of importance to the physician executive.
Health Care Reform as Social Change is replete with references and questions at the end of each chapter. These help the reader delve deep into healthcare reform issues. Unfortunately, the binding does not allow for frequent use.
This sincere work is generally well thought out and an excellent text for new physician executives.
Raymond F. Crerand
Chief Executive Officer
Providence Health System-Puget Sound
Copyright © 1995 by the Catholic Health Association of the United States
For reprint permission, contact Betty Crosby or call (314) 253-3477.