The Fragmentation of U.S. Health Care

The Fragmentation of U.S. Health Care : Causes and Solutions

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Why is our health care system so fragmented in the care it gives patients? Why is there little coordination amongst the many doctors who treat individual patients, who often even lack access to a common set of medical records? Why is fragmentation a problem even within a single hospital, where errors or miscommunications often seem to result from poor coordination amongst the myriad of professionals treating any one individual patient? Why is health care fragmented both over time, so that too little is spent on preventive care, and across patients, so that resources are often misallocated to the patients who need it least? The Fragmentation of U.S. Health Care: Causes and Solutions approaches these broad questions with a highly interdisciplinary approach. The articles included in the work address legal and regulatory issues, including laws that mandate separate payments for each provider, restrict hospitals or others from controlling or rewarding the set of providers treating a patient to assure coordinated care, and provide affirmative disincentives for coordinating care by paying more for uncoordinated care that requires more services. Business reasons for the current form of hospital organization are considered, and efficiency and design are examined and compared to other industries. The economics of current hospital organization are also taken into account. The authors examine and propose various reforms that make our health care system less fragmented, more efficient, and more medically more

Product details

  • Hardback | 396 pages
  • 165.1 x 241.3 x 27.94mm | 698.53g
  • Oxford University Press Inc
  • New York, United States
  • English
  • 019539013X
  • 9780195390131
  • 2,006,475

Review quote

"This book provides an outstanding analysis of the need for reform of the U.S. health care system and why much work remains to be done even with the recent efforts by Congress to improve health care access and delivery. The distinguished group of authors carefully documents a key failing of the health care system- the extent to which insufficient integration of medical services saddles Americans with serious inefficiencies in care. We pay too much for care whose quality is not nearly as high as it could be. Anyone interested in health care reform in the United States will find critically important insights and should consider this book a must read." --David Orentlicher, Samuel R. Rosen Professor of Law and Co-director of the William S. and Christine S. Hall Center for Law and Health, Indiana University School of Law - Indianapolis "Providers often fail to deliver treatments that are cheap and effective, while offering many treatments that are unproven, ineffective or expensive. Service levels vary from place to place without reason. Outcomes are rarely guaranteed. One-stop shopping is often impossible. Prices are invisible or meaningless. Patients arm themselves with advocates because they fear being harmed. Excessive fragmentation of health care delivery causes many of these problems. As Einer Elhauge observes, health care's law-driven business model isn't up to the task. This collection of essays will enlighten anyone who wants to understand the problems of health care delivery and will be especially valuable for public health researchers and health law teachers." --Charles Silver, McDonald Chair in Civil Procedure, University of Texas School of Law "This volume contains some of the most cogent thinking assembled to date on the defining characteristic of the U.S. health care system: fragmentation. Elhauge presents a nuanced portrait of the causes and consequences of atomized decision making in health care. At a time of national debate about the future shape of health policy, the essays contained in this book and the various paths to reform they demarcate constitute required reading." -- Meredith B. Rosenthal Associate Professor of Health Economics and Policy, Harvard School of Public Health "To make sense of our nonsensical healthcare system, Professor Einer Elhauge has assembled the nation's leading professors in law, medicine, economics, health, business, and political science. Their conversation offers a deeply incisive, nuanced, and accessible discussion. It should be required reading for every scholar of health policy and every member of Congress." -- Amitabh Chandra Professor of Public Policy, Harvard Kennedy School of Government "In The Fragmentation of U.S. Health Care, Professor Elhauge and his colleagues offer a rich and provocative collection of perspectives. Policymakers and researchers alike will learn from these reflections on a set of critical problems for health care reform. The volume could not be better timed." --Jill R. Horwitz Louis and Myrtle Moskowitz Research Professor of Business and Law, University of Michigan Law School "In this illuminating volume, Einer Elhauge has assembled a top-flight interdisciplinary group of scholars to explain the root causes of the dysfunctional structures of the U.S. health care system, and to suggest possible solutions. The book is essential reading for scholars and policymakers who seek to understand the complexities of health care delivery in the U.S. and identify avenues for systemic improvement." --Theodore W. Ruger Professor of Law, University of Pennsylvania Law Schoolshow more

About Einer Elhauge

Einer Elhauge is the Petrie Professor of Law at Harvard Law School and founding director of the Petrie-Flom Center for Health Law Policy, Biotechnology and Bioethics. He served as Chairman of the Antitrust Advisory Committee to the Obama Campaign and member of Various Health Policy Advisory Committees to that campaign. He teaches a gamut of courses ranging from Antitrust, Contracts, Corporations, Legislation, and Health Care Law. Before coming to Harvard, he was a Professor of Law at the University of California at Berkeley, and clerked for Judge Norris on the 9th Circuit and Justice Brennan on the Supreme Court. He received both his A.B. and his J.D. from Harvard, graduating first in his law school more

Table of contents

Our Fragmented Health Care System: Causes and Solutions ; Why We Should Care About Healthcare Fragmentation and How to Fix It - Einer Elhauge ; Health Care Fragmentation: We Get What We Pay For - David Hyman ; Organizational Fragmentation and Care Quality in the US Health Care System - Randal Cebul, James Rebitzer, Lowell J. Taylor, & Mark Votruba ; Curing Fragmentation With Integrated Delivery Systems: What They Do, What Has Blocked Them, Why We Need Them, And How To Get There From Here - Alain Enthoven ; Defragmenting Health Care Delivery Through Quality Reporting - Kristin Madison ; Competition Policy and Organizational Fragmentation in Health Care - Thomas Greaney ; Of Doctors and Hospitals: Setting the Analytical Framework for Managing and Regulating the Relationship - James Blumstein ; Property, Privacy and the Pursuit of Integrated Medical Records - Mark A. Hall ; Value-Based Purchasing Opportunities in Traditional Medicare: A Proposal and Legal Evaluation - Lawrence Casalino & Timothy Jost ; A More Equitable and Efficient Approach to Insuring the Uninsurable - Eric Helland & Jonathan Klick ; Ending the Specialty Hospital Wars: A Plea for Pilot Programs as Information-Forcing Regulatory Design - Frank Pasquale ; Fragmentation in Mental Health Benefits and Services: A Preliminary Examination into Consumption and Outcomes - Barak Richman, Dan Grossman, & Frank Sloan ; From Visible Harm to Relative Risk: Overcoming Fragmented Pharmacovigilance? - Arthur Daemmrich ; The US Healthcare System: A Product of American History and Values - David Johnson & Nancy Kane ; American Health Care Policy and Politics: Is Fragmentation a Helpful Category for Understanding Health Reform Experience and Prospects? - Theodore Marmorshow more

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