Medicine and Commerce. 1: Is Managed Care a “Monstrous Hybrid”?

Editorials15 March 1998Medicine and Commerce. 1: Is Managed Care a “Monstrous Hybrid”?Frank Davidoff, MD, EditorFrank Davidoff, MD, EditorSearch for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-128-6-199803150-00012 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail The intrusion of commerce into medicine during the past decade has had a great deal to do with creating the tangled web of administrative and financial systems that we know as managed care. Although these new systems have brought about new efficiencies and have slowed the rate of increase in medical costs [1], they have also brought with them a growing sense, both in the profession and the public at large, that something profoundly wrong is happening to medicine [2]. Various explanations for this “angst” have been advanced, many of them reasonable but none, in my view, sufficient to account ...References1. Woods D. The Future of the Managed Care Industry and Its International Implications. London: The Economist Intelligence Unit; 1997. Google Scholar2. For our patients, not for profits: a call to action. JAMA. 1997; 278:1733-8. Google Scholar3. Jacobs J. Systems of Survival: A Dialogue on the Moral Foundations of Commerce and Politics. New York: Random House; 1992. Google Scholar4. Rangachari PK. Evidence-based medicine: old French wine with a new Canadian label? J R Soc Med. 1997; 90:280-4. Google Scholar5. Balint M. The Doctor, His Patient, and the Illness. 2d ed. London: Pitman; 1964. Google Scholar6. Jacobs J. Systems of Survival: A Dialogue on the Moral Foundations of Commerce and Politics. New York: Random House; 1992:132. Google Scholar7. Kleinke JD. The industrialization of health care. JAMA. 1997; 278:1456-7. Google Scholar8. Eichenwald K. A makeover may change more than Columbia. New York Times. 8 Aug 1997: Section C1, 1-2. Google Scholar9. Pear R. Health insurers skirting new law, officials report. New York Times. 5 Oct 1997: 1, 30. Google Scholar10. Blumstein JF. What precisely is “fraud” in the health care industry? Wall Street Journal. 8 Dec 1997:A25. Google Scholar11. Easterbrook G. Healing the great divide. How come doctors and patients ended up on opposite sides? U.S. News and World Report. 13 Oct 1997:30-3. Google Scholar12. Moore JD Jr. Doctors against profits (except their own). Wall Street Journal. 17 Dec 1997. Google Scholar13. Jacobs J. Systems of Survival: A Dialogue on the Moral Foundations of Commerce and Politics. New York: Random House; 1992:106. Google Scholar14. Jacobs J. Systems of Survival: A Dialogue on the Moral Foundations of Commerce and Politics. New York: Random House; 1992:189. Google Scholar15. Jacobs J. Systems of Survival: A Dialogue on the Moral Foundations of Commerce and Politics. New York: Random House; 1992:175. Google Scholar16. Jacobs J. Systems of Survival: A Dialogue on the Moral Foundations of Commerce and Politics. New York: Random House; 1992:201. Google Scholar17. Swartz K, Brennan TA. Integrated health care, capitated payment, and quality: the role of regulation. Ann Intern Med. 1996; 124:442-8. Google Scholar18. Advisory Commission on Consumer Protection and Quality in the Health Care Industry. Consumer Bill of Rights and Responsibilities: Report to the President of the United States. November 1997. Google Scholar19. Hall MA, Berenson RA. Ethical practice in managed care: a dose of realism. Ann Intern Med. 1998; 128:395-402. Google Scholar20. Berwick D, Hiatt H, Janeway P, Smith R. An ethical code for everybody in health care. A code that covered all rather than single groups might be useful. BMJ. 1997; 315:1633-44. Google Scholar Author, Article, and Disclosure InformationAuthors: Frank Davidoff, MD, EditorAffiliations: PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited byA Physicians' Agenda for Partnering With Employers and Insurers: Fresh IdeasEthics and Skeptics: What Lies Behind Ethical Codes in Occupational HealthManaged Care and the Deprofessionalization of MedicineYou can't leap a chasm in two jumps: The institute of medicine health care quality reportEthical Principles for EveryoneFrank Davidoff, MDCaring and Cost: The Challenge for Physician AdvocacySteven D. Pearson, MD, MScEffective Clinical Practice: A New Journal, Another Point of ViewFrank Davidoff, MDThe 28th AmendmentFrank Davidoff, MD and Robert D. Reinecke, MD 15 March 1998Volume 128, Issue 6Page: 496-499KeywordsArmed forcesDrugsHealth careHospital medicinePrevention, policy, and public healthSmellSurgeryTaxesTouchTraditional medicine ePublished: 15 August 2000 Issue Published: 15 March 1998 Copyright & PermissionsCopyright © 1998 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...