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Fixin' Healthcare

Saturday, December 02, 2006

The Lifestyle Chronicles - Tending The Garden

The academic health science centers and teaching hospitals have played a curious and influential role in the development of the health care system. Policy makers and those interested in reform of health care would do well to study this situation as an object lesson.

The subdividing of academic units in the health sciences has been underway for at least 50 years. Specialties and sub-specialties have developed in association with the increase of scientific knowledge and development of technology.

The awarding of government research funds to speciality units solidified their separate academic identity and fueled their growth. However, the largest source of funds have come from patient care. In that regard, academic health science centers and teaching hospitals are major players in the health care delivery system. But, they are very special players with significant advantages and tremendous influence.

Academic health science centers and teaching hospitals exert leverage in the patient care arena with the manpower provided by residency and fellowship training programs. With the funding of Medicare and Medicaid, the large patient population cared for in the clinics became a source of revenue in addition to referrals sent to specialty units.

There is no organization more decentralized than academic medicine. The period of rapid revenue growth was uneven throughout the organization and the revenue has leveled or is decreasing in most areas. The academic units have expanded to the limit or beyond the resources allocated and everything is viewed as absolutely necessary for a mission that was outgrown long ago.

The secret is to avoid throwing the baby out with the bath water. There will be pain but some centers will carve out new missions early and lead health care reform.

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