"When it comes to healthcare, bigger isn't always better. The early-1990s rise of "megaproviders"-large, hospital-based healthcare systems that have become the norm in American medicine-brought promises of accessibility, cost savings, and excellence to the American healthcare experience. Today's megaproviders, following three decades of growth and consolidation, receive as much as two-thirds of healthcare spending in the United States. Big Med examines the rise of these megaproviders and their formative role in reducing American healthcare to its current shambles. As healthcare organizations have consolidated, they've increased their market power, and in doing so created a system in which the network sets the prices, insurance and pharmaceutical companies take the blame, and Americans suffer the costs. Drawing on seven decades of combined research in economics and sociology, Dranove and Burns consider the effects of this noncompetitive system on patients, doctors, and society more broadly. Physicians areforced to provide less attentive care to a larger number of patients; patients in turn pay more for lesser care. This leaves both parties alienated and disenchanted, and any motivations to improve the flawed system are stalled. Amid screeching public debate around the prospects and perils of Medicare-for-all, Big Med is a provocative, narrative-shifting account of who's really calling the shots-and causing harm-in American healthcare today"--
There is little debate that health care in the United States is in need of reform. But where should those improvements begin? With insurers? Drug makers? The doctors themselves? In Big Med, David Dranove and Lawton Robert Burns argue that we&;re overlooking the most ubiquitous cause of our costly and underperforming system: megaproviders, the expansive health care organizations that have become the face of American medicine. Your local hospital is likely part of one. Your doctors, too. And the megaproviders are bad news for your health and your wallet.
Drawing on decades of combined expertise in health care consolidation, Dranove and Burns trace Big Med&;s emergence in the 1990s, followed by its swift rise amid false promises of scale economies and organizational collaboration. In the decades since, megaproviders have gobbled up market share and turned independent physicians into salaried employees of big bureaucracies, while delivering on none of their early promises. For patients this means higher costs and lesser care. Meanwhile, physicians report increasingly low morale, making it all but impossible for most systems to implement meaningful reforms.
In Big Med, Dranove and Burns combine their respective skills in economics and management to provide a nuanced explanation of how the provision of health care has been corrupted and submerged under consolidation. They offer practical recommendations for improving competition policies that would reform megaproviders to actually achieve the efficiencies and quality improvements they have long promised.
This is an essential read for understanding the current state of the health care system in America&;and the steps urgently needed to create an environment of better care for all of us.
