Synopsis

In this readable and well-researched book, Ken Terry analyzes the current state of health care reform and finds it wanting. Instead of tackling the core problems in our failing system, he argues, politicians, insurance executives, and health care leaders have embraced ideologically driven initiatives that pursue impractical objectives or will take too long to bear fruit. Among these are such widely hailed trends as disease management, pay for performance, cost and price ìtransparency,î consumer-directed care, and health information technology, none of which will reverse the rising tide of health spending. What is creating this nightmare scenario, according to Terry, is the sheer profitability of the health care industry. Insurers, physicians, hospitals, pharmaceutical companies, and device manufacturers are all striving to maximize their profits, and there is no effective competition or regulation to restrain them. Only a complete overhaul of our system for financing and delivering health care can get us out of this mess, the author maintains. In the second half of his book, he presents a bold vision of how to do this: First, he says, all primary care physicians should join group practices that are large enough to take financial responsibility for professional services. And second, competition among those physician groups, based on cost and quality, should replace competition among health plans. There should be only one government-regulated insurer per region, he says, and it should have no role in managing care.

Reviewer: Carole Ann Kenner, PhD, MSN, BSN(Northeastern University Bouve College of Health Sciences)
Description: This book presents an analysis of the healthcare system and suggests possible solutions to improve outcomes.
Purpose: The purpose is to heighten awareness of the current state of healthcare in the U.S. It then challenges readers to consider possible solutions to provide good healthcare to all of the citizens in the U.S.
Audience: The book would be useful for anyone wanting more information about healthcare — its current state and possible reforms.
Features: From a definition of healthcare reform to the movement towards disease management, pay for performance, and self-management, on to the money driver, and finally healthcare solutions, the book provides a quick glimpse of healthcare policy issues. It covers disease management, electronic health records, and new roles such as hospitalists, as well as the ethical dilemma of rationing services. These are all areas of current concern that will define healthcare in the future. However, the book does not really address the Institute of Medicine (IOM) quality chasm series nor the Institute for Healthcare Improvement (IHI) in the depth expected from a book focusing on system solutions.
Assessment: Most of the healthcare reform books on the market focus on a specific aspect such as consumerism or malpractice (A Second Opinion: Rescuing America's Health Care, Relman (Public Affairs, 2007)) or redefining healthcare based on values and performance (Redefining Health Care: Creating Value-Based Competition on Results, Porter and Teisberg (Harvard Business School Press, 2006)). But none take the perspective of looking at failures and measuring proposed solutions against them. This is a unique angle from which to extrapolate possible reform measures.

Biography

Ken Terry, a senior editor of Medical Economics Magazine, the leading business publication for U.S. physicians, has won several journalism awards for his health care articles. In a previous incarnation, he was an editor for Billboard and Variety.