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eBook Oxymorons: The Myth of a U.S. Health Care System epub

by J. D. Kleinke

eBook Oxymorons: The Myth of a U.S. Health Care System epub
  • ISBN: 0787959707
  • Author: J. D. Kleinke
  • Genre: Other
  • Subcategory: Medicine & Health Sciences
  • Language: English
  • Publisher: Jossey-Bass; 1 edition (September 27, 2001)
  • Pages: 272 pages
  • ePUB size: 1450 kb
  • FB2 size 1560 kb
  • Formats rtf lit lrf mbr


Oxymorons represents perceptions of the healthcare system at the time the book was written

Oxymorons represents perceptions of the healthcare system at the time the book was written. When Kleinke wrote Bleeding Edge, many healthcare leaders felt that managed care was going to rejuvenate the healthcare system in the US. Oxymorons reflects the failure of managed care to deliver a fix to the system and the disappointment that everyone felt at the time. It should be read as a reflective work which chronicles a point in time.

or not work? Why have hospitals become so complex?

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Oxymorons represents a major departure for Kleinke, a medical economist and one of the most outspoken champions of market-driven reform of the . It is a provocative, unflinching look at how the marketplace has failed to fix the fundamental economic and organization problems plaguing our health care system.

managing in health and social care. oxymorons the myth of a u s health care system. Kleinke's book is itself oxymoronic. He complains that the current "system" is not a normal market, but that by placing purchasing power in the hands of "consumers," a normal market will emerge. the australian health care system. the best laid plans health care s problems and pr. · the dynamics of disability measuring and monitori. to improve health and health care 2001 the robert. With rare exceptions, it is the supplier of medical services who determines the level of demand for those services.

The second is behavioural inertia among the dozens of layers of healthcare administration.

Oxymorons: The Myth of a US Health Care System. 982/a (Published 20 April 2002) Cite this as: BMJ 2002;324:982. The first is chaos, which he believes is a rule, not an aberration, in the delivery of medicine. The second is behavioural inertia among the dozens of layers of healthcare administration. And the third is what he calls the twaddle echo factor, which is what executives, pundits, consultants, and other thought leaders in health care think at any given time will solve the first two problems.

INQUIRY: The Journal of Health Care Organization, Provision, and Financing, Volume 39, pp 429-430; doi .

INQUIRY: The Journal of Health Care Organization, Provision, and Financing, Volume 39, pp 429-430; doi:10.

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The Moral-Hazard Myth: The Bad Idea Behind Our Failed Health-Care System . Gladwell, Malcolm (2005-08-29). Related Items in Google Scholar.

In this impassioned and often vitriolic book - a follow-up to the author's bestselling Bleeding Edge: The Business of Health Care in the New Century - U.S. health care industry expert J.D. Kleinke offers an unflinching look at our broken health care system. Throughout the book, Kleinke - who was once a vocal advocate of the managed health care system - explains what went wrong and attempts to answer such perplexing questions as: Who's in charge of the American health care system? How does managed care work . . . or not work? Why have hospitals become so complex? What are the prospects for reform? Does the Internet change anything? Can we solve the growing problem of the uninsured?
Comments: (6)
one life
J.D. Kleinke uses 90% of the book to describe the woes of the US healthcare system. The tone is very very negative and the author uses words such as "moronic" way too much. It is tiring to read so much unbalanced negativism. The critique may be warranted but is not properly structured; there is a lot of focus jumping from anecdotes about payers, providers, government, consumers, consultants, etc. Kleinke even tries to explain the problems using Complexity Theory about which he clearly knows nothing. (Attempting to draw analogies between our healthcare system and sets of stiff differential equations). In the last 10% of the book Kleinke presents a solution that he does not tell how could ever be implemented. It is a combination of old utopic ideas. In short, buy this book only if you need more reasons why our healthcare system is broke.
Maveri
Kleinke's book is itself oxymoronic. He complains that the current "system" is not a normal market, but that by placing purchasing power in the hands of "consumers," a normal market will emerge. WRONG. With rare exceptions, it is the supplier of medical services who determines the level of demand for those services. Compounding this perversion of ordinary market forces are two other significant realities: a). If potatoes are being purchased, the consumer would have a knowledge of the product and of its value that is fairly equivalent to the knowledge of the grocer. In medicine, the "consumer" usually has nothing approaching equivalent knowledge about the services to be provided, and must rely entirely on the word of the physician about the value of those services; b). The physician workforce in the U.S. is currently twice as large as would be optimal for the health status of the whole population, this according to an exhaustive study completed by the Pew Commission on the Health Professions, under the chairmanship of former Senator George Mitchell. The American people are paying for this huge oversupply in the physician workforce in lives as well as in money. Using publicly available Medicare data, the physician editors of The Dartmouth Atlas of Health Care have provided a specific characterization of the medical services that they have defined as being "supply sensitive:"
*Weak or absent scientific evidence for providing the service.
*Rather, care is provided under the assumption that more is better--or can't hurt.
*Use of the service is strongly associated with local supply.
The Atlas has established on hard evidence that the length of survival for Medicare beneficiary populations in areas of the United States that have a high concentration of "supply sensitive" physicians, hospital beds, and other medical service resources is shorter than for populations living in areas with an average or low concentration of such medical care resources:
"Medicare beneficiaries residing in regions with 4.5 beds or more per 1000 had a two percent increased risk of death compared to those living in regions with less than 2.5 beds per 1000. ...There were no population groups in whom greater hospital use was associated with improved survival. ...In conclusion, there are good reasons to be cautious about more medical care. In the absence of strong scientific evidence of benefit, there are real risks of harm that should be taken into consideration. ...[W]e see that increased capacity is generally devoted to care of uncertain benefit. Finally, we have no evidence of improved outcomes from greater use of supply sensitive care--and there is some research that suggests that residents of the highest intensity regions may be at risk of harm. ...[The] predicted impact of excess supply sensitive hospitalizations on Medicare mortality brackets the findings from our recent study--a three percent increase in mortality."
Other facts that underline the abnormality of the market forces at work in conventional American medicine include the following:
*The absence of effective clinical evaluative science is total.
*There is no general medical management. Specialists are dominant, and they function autonomously within their own field of practice.
*Barbara Starfield, MD, a faculty member of the Johns Hopkins University School of Public Health, published a Commentary in the June 2000 issue of the Journal of the American Medical Association in which she documents physician errors as being the third leading cause of death for Americans each year. Of course, this truth is never reported by the National Center for Health Statistics, but it is nonetheless a stubborn fact.
*The incidence of chronic disease is at epidemic levels in the American population. For example, with about four percent of the world's population, the United States accounts for twelve percent of new cancer cases each year.
*Since Nixon declared the "war on cancer," cancer deaths in the U.S. have risen from year to year without a single exception. Reporting by federal agencies has distorted this hard truth by utilizing "death rates" instead of the actual deaths.
*Although this fact has not been publicly stated, the medical profession has abandoned the search for a cure for cancer, and has concentrated its massive resources on devising new technologies for treating the large variety of malignant neoplasms now afflicting the population. For oncologists, treatment is where the profit lies. Cure would put them out of business.
I believe it was George Bernard Shaw who once said the height of political folly was reached by legislating financial incentives for surgeons to cut your leg off. In the United States, we have achieved this height. No physician can profit from fostering optimal levels of health in their patients. Profit flows almost entirely from illness or injury, and from the attendant diagnostic procedures. "Consumers" of medical services would be well advised not to pay attention to the angry ramblings of an "expert" like Kleinke. It is evident that he has no sound idea about what the problems are, much less about the changes that will be necessary to resolve them.
Musical Aura Island
Oxymorons is an outstanding book. It is very well written, interesting, comprehensive and insightful.
Kleinke makes a compelling case of what is wrong with our employer-based health care system (which he calls dysfunctional). He argues that the best answer for the U. S. is to get employers out of the picture and come up with a counsumer-choice plan (through tax credits or other means, consumers purchase their own health plans).
I especially liked Chapter 9 where Kleinke reviews where he is coming from. For a period of his life, he and his wife could not afford health insurance and were among the ranks of the uninsured. He tells what it is like to scrounge for antibiotics to fight a serious sinus infection, and other experiences in trying to receive health care without the ability to pay. Naturally, he is strongly in favor of some form of coverage for the 44 million people in the U. S. who are uninsured.
In the last sentence of the book, Kleinke says that only three elements in health care really matter -- patients, caregivers and medical technologies, including new drugs. I would add money, or finance. It seems to me that the payment system is the primary driver of the fragmentation we are experiencing, and that most proposals for change in health care relate to financing.
In conclusion, Kleinke has written a valuable book, and one that should generate plenty of discussion among those interested in the future of health care in the U. S.
Vinainl
Oxymorons represents perceptions of the healthcare system at the time the book was written. When Kleinke wrote Bleeding Edge, many healthcare leaders felt that managed care was going to rejuvenate the healthcare system in the US. Oxymorons reflects the failure of managed care to deliver a fix to the system and the disappointment that everyone felt at the time. It should be read as a reflective work which chronicles a point in time. As such, it delivers an interesting perspective and one that is helpful to remember as we track the evolution of healthcare in the US.
Zololmaran
Total opportunist, Kleinke has changed his tune 100 percent since his last book. Whatever sells is what he wants to sell; he sold a lot of his last book; in this new book, he provides a crazy critique that is full of utopian ideas that are of no help to anyone working in the health care system today. Some amusing anecdotes, but it seems Kleinke is more in love with his own writing and storytelling than in providing any useful insights.
Sharpbinder
If you buy and read this book, you will feel sick that you spent the money and the time on it. The author has done a complete flip-flop from his earlier book, but that's not all that is wrong with this book. While it has gathered some interesting points together, it leaves one with no useful recommendations and frankly, the author seems to have completely lost it. It's no wonder this book isn't popular. All song and dance, and no substance.
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