Changing U.S. health care : a study of four metropolitan areas

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"The decade of the 1980s promised basic reform in the provision of health care services. Ronald Reagan, newly elected to the presidency on a pledge to minimize the role of government in domestic af...

"The decade of the 1980s promised basic reform in the provision of health care services. Ronald Reagan, newly elected to the presidency on a pledge to minimize the role of government in domestic affairs, committed his administration to the pursuit of freemarket strategies as the panacea for the costliness and inefficiency besetting the nation's health care system. Official and private rhetoric was replete with proposals for systemic change fueled by the competitive forces that would be unleashed by deregulation." "Once the federal government yielded its long-held place as innovator and reformer, it was inevitable that the states would be catapulted into positions of greater prominence in the shaping of health care policy. This book assesses the changes that have actually occurred in the U.S. health care system, analyzing the nation's four largest metropolitan centers, which together with their states account for 74 million persons, or roughly one-third of the nation's population." "The study delineates specific developments within each metro area, attempting to capture and analyze the many differences and the many parallels among the four that might illuminate the dynamics and the contours of change in the health care system. Among the areas selected for investigation are the following: alternative responses to the growing surplus of acute-care hospital beds; the potentiators of, and the impediments to, the elaboration of HMOs and other innovative forms of health care delivery; public and private responses to the uncompensated care issue; the establishment of new ambulatory care facilities and their interaction with existing hospitals; the responses of both the governmental and nongovernmental sectors to the growing surplus of physicians and the supply of other medical personnel; the impact of pressures imposed by declining hospital admissions and early discharges on the nursing home and home health care sectors; the principal consequences for local academic health centers (AHCs) of the more price-competitive environment and the shift from inpatient to ambulatory treatment; the degree of satisfaction/disappointment among the local business coalitions with progress toward their major goals and the modification of these goals with experience; and identification of health care issues that commanded the attention of the press, the public, and political groups, and the action taken in response to them." "Changing U.S. Health Care represents a major attempt to contrast the rhetoric and predictions prevalent in the 1980s with the realities facing the health care system today."--BOOK JACKET.

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