The Rise and Fall of HMOs: An American Health Care Revolution

by Jan Gregoire Coombs

Overview

“Excellent. . . . This detailed analysis of how the Marshfield Clinic struggled to balance competing priorities and interest groups nicely illustrates the adage ‘If you see one HMO, you’ve seen one HMO.’”—Joel D. Howell, The Journal of American History

Product Details

ISBN-13:	9780299202408
Publisher:	University of Wisconsin Press
Publication date:	04/04/2005
Edition description:	1
Pages:	430
Product dimensions:	6.00(w) x 9.00(h) x 1.20(d)

About the Author

Jan Gregoire Coombs is a medical historian living near Madison, Wisconsin. Her books on health care include You Can Help: Living with the Disabled.

Table of Contents

	Preface	xi
	Acknowledgments	xvii
	Introduction: American Health Care Insurance before 1970	3
1	Dreams of a Medical Utopia	13
2	The HMO Act and Its Aftermath	39
3	Health Care in Rural America	58
4	Affiliated Providers and Necessary Compromises	76
5	Emerging Problems with Medicare and Medicaid	86
6	Entering a Management Revolution	107
7	Assessing HMO Quality and Consumer Satisfaction in the 1980s	123
8	Idealism Confronts Realities	136
9	Competing Values Doom a Partnership	157
10	The Perils of Antitrust in the Health Care Marketplace	172
11	HMOs and Public Programs in the 1990s and Early 2000s	194
12	HMO Enrollment Growth in the Private Sector in the 1990s and Early 2000s	223
13	Demands for Accountability	238
14	Critics and Would-be Reformers	261
	Conclusion: Lessons from Marshfield	279
Appendix 1	The Meaning of Community Service at the Marshfield Clinic	292
Appendix 2	Acronym Definitions and Descriptions	300
	Notes	305
	Bibliographic Resources for American Health Care History and Policy	395
	Index	399

Editorial Reviews

"An authoritative account of HMO policy in the later twentieth century." —Edward Berkowitz,  author of Robert Ball and the Politics of Social Security

“HMOs once embodied the hopes of many health care reformers. Today they represent the limitations of American medicine. In this engaging and remarkably balanced book, Jan Coombs traces the revolution unleashed in the early 1970s. The Rise and Fall of HMOs should be required reading for anyone interested in understanding the continuing problems of health care in America.”—Ronald L. Numbers, coeditor of Sickness and Health in America

“Jan Coombs has an encyclopedic knowledge of broad health care trends in the United States since 1970. She has written an original, well-documented, thorough, and very readable book. The personalized story of the Marshfield Clinic, with often-anguished statements from participants, brings national trends to life and gives this book urgency and freshness.”—Rosemary Stevens, author of American Medicine and the Public Interest

From the Publisher

Alternating a broad historical overview of HMOs with a close analysis of one institution, the Marshfield Clinic in northern Wisconsin, medical historian Coombs (You Can Help: Living with the Disabled) paints a sobering portrait of American health care. A rural multispecialty clinic long admired for its quality of care, Marshfield is, for Coombs, "emblematic" of the failure caused by federal legislation that began in the early 1970s and continued through the end of the century. Coombs marshals an array of statistics, anecdotes and extended narratives that point to the detrimental effects HMOs have had on both patients and the providers. With a gift for deciphering and articulating complex scenarios, Coombs provides readers with the necessary historical background to understand HMOs. For instance, her deft treatment of the history of health-care economics and the political motivations behind the 1973 Health Maintenance Organization Act allows the reader to better grasp how employer-based systems, in her assessment, have led to care that is inequitable, wasteful and financially woeful when the benefits are evaluated against the costs. Coombs also offers prescriptions. Health-care policy makers and administrators will appreciate Coombs's thoroughness, and while the lay reader may struggle with pages devoted to arcane health-care legislation, this book makes a critical contribution to medicine and its literature. (Mar.) Copyright 2005 Reed Business Information.

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