Eli Ginzberg - The Metropolitan Academic Medical Center: Its Role in an Era of Tight Money and Changing Expectations

The Metropolitan Academic Medical Center: Its Role in an Era of Tight Money and Changing Expectations — read online for free the complete book (whole text) full work

Below is the text of the book, divided by pages. System saving the place of the last page read, allows you to conveniently read the book "The Metropolitan Academic Medical Center: Its Role in an Era of Tight Money and Changing Expectations" online for free, without having to search again every time where you left off. Put a bookmark, and you can go to the page where you finished reading at any time.

Light

Font size:

↓

↑

Georgia Tahoma Arial Verdana

Reset

Interval:

↓

↑

Bookmark:

Make

1234567...32

The Metropolitan Academic Medical Center

First published 1995 by Westview Press

Published 2019 by Routledge

52 Vanderbilt Avenue, New York, NY 10017

2 Park Square, Milton Park, Abingdon, Oxon OX14 4RN

Routledge is an imprint of the Taylor & Francis Group, an informa business

Copyright 1995 by Cornell University Medical College

All rights reserved. No part of this book may be reprinted or reproduced or utilised in any form or by any electronic, mechanical, or other means, now known or hereafter invented, including photocopying and recording, or in any information storage or retrieval system, without permission in writing from the publishers.

Notice:

Product or corporate names may be trademarks or registered trademarks, and are used only for identification and explanation without intent to infringe

Library of Congress Cataloging-in-Publication Data

The Metropolitan Academic Medical Center : its role in an era of tight
money and changing expectations / edited by David E. Rogers and Eli
Ginzberg.

p. cm.

This is the Ninth Cornell University Medical College Conference on
Health Policy.

Includes bibliographical references and index.

1. Health care reformUnited States.2. Academic medical
centersUnited States.I. Rogers, David E. (David Elliott), 1926-.

II. Ginzberg, Eli, 1911-.III. Cornell University Medical
College Conference on Health Policy (9th)

RA395.A3M468 1995

362.110973dc20

94-43239

CIP

ISBN 13: 978-0-367-29382-6 (hbk)

Contents

, David E. Rogers

, Eli Ginzberg

, Roger J. Bulger

Robert G. Petersdorf and Kathleen S. Turner

, Kenneth I. Shine

, James A. Block

, Ron J. Anderson

, Robert Michels

, Bruce C. Vladeck

, Donald S. Fredrickson

James R. Tallon

, David E. Rogers

Guide

Tables

Figures

David E. Rogers

This year, our focus on urban academic health centers represented our ninth conference on health policy. Although we started planning it over a year ago, its timing was exquisite. The concerns about how those academic medical centers (AMCs) located in urban areas should or will conduct themselvesindeed, whether they could survive in an era of tight money, changing expectations, and looming health care reformwas very much on the minds of many. The papers were provocative, and some fine intellects focused intensely on that question over a two-day period.

Though we did not settle the deceptively simple questions posed, the discussion provided new insights into how these remarkable institutions can preserve what is precious about them as they adapt to some very different times.

This subjectthe fate of medical academehas long concerned me. During my fifteen years at the Robert Wood Johnson Foundation, my colleagues and I looked intensely at the mission, the health, and the trajectory of AMCs. Fifteen years ago I published a paper with Dr. Robert Blendon entitled, The Academic Medical Center: A Stressed Institution. In that paper we concluded that we seemed to be witnessing a progressive dissolution of what had been an unusually productive symbiotic partnership between government and medical academe. That symbiosis had allowed AMCs to become the worlds largest and most sophisticated biomedical research enterprises, as well as major referral centers for the provision of complex tertiary hospital care. They were also a critical source of care for the urban poor. They trained all of the U.S. physicians and many of the other health professionals needed to care for the sick and did research and developed the technology required for a better future.

But even then there were indications that this wonderful relationship had begun to go awry. It was increasingly the view within government circles and the broader community that AMCs, once believed to be the solution to the nations health problems, had become a big part of the problem. Certain dilemmas apparent even then were threatening their future.

First was the problem posed by their unique contact with the public. Not only were the AMCs the educators of all physicians trained in the United States and the generators of most of the new biomedical knowledge, they also carried disproportionate responsibilities for providing medical care to the poor and the uninsured. In 1978 teaching hospitals connected to AMCs had only about 6 percent of the acute care beds, yet they provided almost 50 percent of the free care. This situation remains virtually unchanged today.

Second, and now very much on everyones minds, were the problems posed by their locations. More than one-quarter of the 126 AMCs are located in inner cities, where they face some of the most wrenching social and transmedical agonies of our day. Problems posed by their size and by the uncontrolled drift toward subspecialties and away from general medicine, were even then becoming worrisome.

Last, AMCs faced some serious problems, not of their own making, created by the consistent failure of government and private medicine to fix responsibilities for the equitable delivery of medical care. These problems remain. But even then this failure had led to governmental pressure on AMCs alone, rather than on medicine as a whole, to get the health care job done.

That statement shows my track record as an economic futurologist; we plowed ahead almost exactly along line A. But I was more accurate in forecasting what might happen if medical schools failed to plan carefully to be more responsive to an increasingly troubled public and tried simply to continue business as usual. If this happened, I suggested, the following scenario would ensue:

1. Major teaching hospitals would begin to desert the academic ship. The pressures for cost containment would cause them to make every effort to divest themselves of medical school activities such as ongoing support of research or ambulatory care programs for the poor.

The Health Sector Growth Curve: National Health Expenditures as Percent of GNP, 19501990

• 2. There would be a steady erosion in the gains we were then making in training more generalist physicians.
• 3. The pressure for revenues would force academic medical institutions to increase the amount of private practice assumed by their faculty, and they would do so by developing increasingly specialized faculty members who would use large amounts of high-cost technology and draw high-paying patients. As a result, faculty primarily involved in clinical research or in the delivery of more generalist forms of care would have a progressively more difficult time maintaining their positions in academe.
• 4. Last, the pressures of practice would allow faculty less time for teaching medical students, and the tensions between those who generated income and those who were involved in less time-dependent, hence less reimbursable, academic pursuits would steadily escalate.

Alas, all of those things have happened. Despite increasing evidence of public and government disenchantment with the directions AMCs were taking and the kinds of health professionals we were producing, we marched resolutely onward. But now change is in the air. Every AMC is now looking anxiously inward to decide how it might best position itself to fit into a very different scheme of things.

Next page

1234567...32

Light

Font size:

↓

↑

Georgia Tahoma Arial Verdana

Reset

Interval:

↓

↑

Bookmark:

Make

Similar books «The Metropolitan Academic Medical Center: Its Role in an Era of Tight Money and Changing Expectations»

Look at similar books to The Metropolitan Academic Medical Center: Its Role in an Era of Tight Money and Changing Expectations. We have selected literature similar in name and meaning in the hope of providing readers with more options to find new, interesting, not yet read works.

Eli Ginzberg

Medical Gridlock And Health Reform

Pilar Ordonez-Lopez

Medical Discourse in Professional, Academic and Popular Settings

Eli Ginzberg

Urban Medical Centers: Balancing Academic And Patient Care Functions

Judy C. Stribling

The Clinical Medical Librarians Handbook

Jill B. Delston

Medical Sexism: Contraception Access, Reproductive Medicine, and Health Care

Rachel Basco

Medical Language for Modern Health Care

Robert Bloomberg

Tufts Medical Center

Bart Penders

Collaboration across Health Research and Medical Care: Healthy Collaboration

Arnab Ray

Cybersecurity for Connected Medical Devices

Walter Reed Army Medical Center

Run, dont walk: the curious and chaotic life inside Walter Reed Army Medical Center

Illich

Limits to medicine: medical nemesis: the expropriation of health

Charles Leslie

Paths to Asian Medical Knowledge (Comparative Studies of Health Systems and Medical Care)

Discussion, reviews of the book The Metropolitan Academic Medical Center: Its Role in an Era of Tight Money and Changing Expectations and just readers' own opinions. Leave your comments, write what you think about the work, its meaning or the main characters. Specify what exactly you liked and what you didn't like, and why you think so.