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ARTICLE |

The Reconfiguration of US Medicine FREE

Thomas Bodenheimer, MD, MPH; Kevin Grumbach, MD
[+] Author Affiliations

Edited by Drummond Rennie, MD, Deputy Editor (West).

Corresponding author: Kevin Grumbach, MD, University of California, San Francisco, Box 1364, San Francisco, CA 94143-1364.


JAMA. 1995;274(1):85-90. doi:10.1001/jama.1995.03530010099050
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When one of us opened a private medical practice in 1980, the world of medicine was a simpler place. We could send our patients to any specialist and could admit to any hospital we chose. We referred our patients for diagnostic tests and specialty consultations without asking permission. We were paid a fee for each service we provided. No hospital employee pressured us to discharge our patients, and no insurance company sent us computer printouts of the costs we incurred per patient per month. But underneath this freedom of action, a time bomb was ticking: the costs of medical care were relentlessly rising.

In the same private practice of 1995, choice of specialists is determined by lists provided by various health maintenance organizations (HMOs). The HMOs tell us to which hospital their (not our) patients must be admitted. We obtain prior authorization before referring patients to specialists or for expensive

REFERENCES

Grumbach K, Bodenheimer T.  The organization of health care. JAMA . 1995;;273:160-167.
Starr P. The Social Transformation of American Medicine . New York, NY: Basic Books; 1982;.
Law SA. Blue Cross: What Went Wrong? New Haven, Conn: Yale University Press; 1974;.
Weiss LD. No Benefit: Crisis in America's Health Insurance Industry . Boulder, Colo: Westview Press; 1992;.
Grumbach K, Bodenheimer T.  Mechanisms for controlling costs. JAMA . 1995;;273:1223-1230.
Bodenheimer T, Grumbach K.  Paying for health care. JAMA . 1994;;272:634-639.
Castells M. The Economic Crisis and American Society . Princeton, NJ: Princeton University Press; 1980;.
Bodenheimer T, Grumbach K. Understanding Health Policy: A Clinical Approach . Norwalk, Conn: Appleton & Lange; 1995;.
Kuttner R. Revolt of the Haves . New York, NY: Simon and Schuster; 1980;.
Sapolsky HM, Altman D, Greene R, Moore JD.  Corporate attitudes toward health care costs. Milbank Q . 1981;;59:561-585.
Cantor JC, Barrand NL, Desonia RA, Cohen AB, Merrill JC.  Business leaders' views on American health care. Health Aff (Millwood) . 1991;;10( (1) ):98-105.
Bergthold L.  The fat kid on the seesaw: American business and health care cost containment, 1970-1990. Annu Rev Public Health . 1991;;12:157-175.
Sullivan CB, Miller M, Feldman R, Dowd B.  Employer-sponsored health insurance in 1991. Health Aff (Millwood) . 1992;;11( (4) ):172-185.
Bergthold L. Purchasing Power in Health . New Brunswick, NJ: Rutgers University Press; 1990;.
Harris N.  Managed care is right course, employers say. Business Health . 1992;;10( (8) ):32-41.
Bodenheimer T, Grumbach K.  Reimbursing physicians and hospitals. JAMA . 1994;;272:971-977.
Califano JA. America's Health Care Revolution . New York, NY: Random House; 1986;.
Iglehart JK.  The new law on Medicare's payments to physicians. N Engl J Med . 1990;;322:1247-1252.
Iglehart JK.  The American health care system: managed care. N Engl J Med . 1992;;327:742-747.
Johnsson J.  PHOs, friends or foes? Am Med News . (August 9) , 1993;:3, 47.
Hagland MM, Cerne F.  Fast forward into the future. Hospitals . (March 20) , 1993;:26-28.
Albertson D.  Blues plans seek links to improve competitive edge. Physicians Financial News . (September 15) , 1993;:1, 18.
Group Health Association of America. 1993 National Directory of HMOs . Washington, DC: Group Health Association of America; 1993;.
Pear R.  Health industry is moving to form service networks. New York Times . (August 21) , 1993;:1, 7.
Hudson T.  Florida health care. Hospitals Health Networks . (August 5) , 1993;:19-22.
Findlay S.  Networks of care may serve as a model for health reform. Business Health . 1993;;11( (2) ):27-31.
Clements B.  Group practice: a profile. Am Med News . (September 7) , 1992;:17.
Stevens S.  Health plans seen favoring groups over solo doctors. Physicians Financial News . (May 15) , 1993;:1, 29.
Schaumburg R.  One plan too many? Managed Care . 1992;;1( (3) ):22-32.
Freudenheim M.  Physicians are selling practices to companies as changes loom. New York Times . (September 1) , 1993;:1, 8.
Kerr P.  Betting the farm on managed care. New York Times . (June 27) , 1993;;section 3:1, 6.
Albertson D.  Providers seen losing control of managed care. Physicians Financial News . (November 15) , 1991;:1, 32.
Relman AS.  The new medical-industrial complex. N Engl J Med . 1980;; 303:963-970.
Estes CL, Harrington C, Davis S.  The medical-industrial complex.  In: Harrington C, Estes CL, ed. Health Policy and Nursing . Boston, Mass: Jones and Bartlett; 1994;.
Relman AS.  The health care industry: where is it taking us? N Engl J Med . 1991;;325:854-859.
Langwell KM.  Structure and performance of health maintenance organizations. Health Care Financing Rev . 1990;;12( (1) ):71-79.
Marion Merrell Dow Inc. Managed Care Digest, HMO Edition, 1990 . Kansas City, Mo: Marion Merrell Dow Inc; 1990;.
Relman AS. The Choices for Healthcare Reform . Camp Hill: Pennsylvania Blue Shield Institute; 1992;.
Ellwood PM, Anderson NN, Billings JE, et al.  Health maintenance strategy. Med Care . 1971;;9:291-296.

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Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

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Grumbach K, Bodenheimer T.  The organization of health care. JAMA . 1995;;273:160-167.
Starr P. The Social Transformation of American Medicine . New York, NY: Basic Books; 1982;.
Law SA. Blue Cross: What Went Wrong? New Haven, Conn: Yale University Press; 1974;.
Weiss LD. No Benefit: Crisis in America's Health Insurance Industry . Boulder, Colo: Westview Press; 1992;.
Grumbach K, Bodenheimer T.  Mechanisms for controlling costs. JAMA . 1995;;273:1223-1230.
Bodenheimer T, Grumbach K.  Paying for health care. JAMA . 1994;;272:634-639.
Castells M. The Economic Crisis and American Society . Princeton, NJ: Princeton University Press; 1980;.
Bodenheimer T, Grumbach K. Understanding Health Policy: A Clinical Approach . Norwalk, Conn: Appleton & Lange; 1995;.
Kuttner R. Revolt of the Haves . New York, NY: Simon and Schuster; 1980;.
Sapolsky HM, Altman D, Greene R, Moore JD.  Corporate attitudes toward health care costs. Milbank Q . 1981;;59:561-585.
Cantor JC, Barrand NL, Desonia RA, Cohen AB, Merrill JC.  Business leaders' views on American health care. Health Aff (Millwood) . 1991;;10( (1) ):98-105.
Bergthold L.  The fat kid on the seesaw: American business and health care cost containment, 1970-1990. Annu Rev Public Health . 1991;;12:157-175.
Sullivan CB, Miller M, Feldman R, Dowd B.  Employer-sponsored health insurance in 1991. Health Aff (Millwood) . 1992;;11( (4) ):172-185.
Bergthold L. Purchasing Power in Health . New Brunswick, NJ: Rutgers University Press; 1990;.
Harris N.  Managed care is right course, employers say. Business Health . 1992;;10( (8) ):32-41.
Bodenheimer T, Grumbach K.  Reimbursing physicians and hospitals. JAMA . 1994;;272:971-977.
Califano JA. America's Health Care Revolution . New York, NY: Random House; 1986;.
Iglehart JK.  The new law on Medicare's payments to physicians. N Engl J Med . 1990;;322:1247-1252.
Iglehart JK.  The American health care system: managed care. N Engl J Med . 1992;;327:742-747.
Johnsson J.  PHOs, friends or foes? Am Med News . (August 9) , 1993;:3, 47.
Hagland MM, Cerne F.  Fast forward into the future. Hospitals . (March 20) , 1993;:26-28.
Albertson D.  Blues plans seek links to improve competitive edge. Physicians Financial News . (September 15) , 1993;:1, 18.
Group Health Association of America. 1993 National Directory of HMOs . Washington, DC: Group Health Association of America; 1993;.
Pear R.  Health industry is moving to form service networks. New York Times . (August 21) , 1993;:1, 7.
Hudson T.  Florida health care. Hospitals Health Networks . (August 5) , 1993;:19-22.
Findlay S.  Networks of care may serve as a model for health reform. Business Health . 1993;;11( (2) ):27-31.
Clements B.  Group practice: a profile. Am Med News . (September 7) , 1992;:17.
Stevens S.  Health plans seen favoring groups over solo doctors. Physicians Financial News . (May 15) , 1993;:1, 29.
Schaumburg R.  One plan too many? Managed Care . 1992;;1( (3) ):22-32.
Freudenheim M.  Physicians are selling practices to companies as changes loom. New York Times . (September 1) , 1993;:1, 8.
Kerr P.  Betting the farm on managed care. New York Times . (June 27) , 1993;;section 3:1, 6.
Albertson D.  Providers seen losing control of managed care. Physicians Financial News . (November 15) , 1991;:1, 32.
Relman AS.  The new medical-industrial complex. N Engl J Med . 1980;; 303:963-970.
Estes CL, Harrington C, Davis S.  The medical-industrial complex.  In: Harrington C, Estes CL, ed. Health Policy and Nursing . Boston, Mass: Jones and Bartlett; 1994;.
Relman AS.  The health care industry: where is it taking us? N Engl J Med . 1991;;325:854-859.
Langwell KM.  Structure and performance of health maintenance organizations. Health Care Financing Rev . 1990;;12( (1) ):71-79.
Marion Merrell Dow Inc. Managed Care Digest, HMO Edition, 1990 . Kansas City, Mo: Marion Merrell Dow Inc; 1990;.
Relman AS. The Choices for Healthcare Reform . Camp Hill: Pennsylvania Blue Shield Institute; 1992;.
Ellwood PM, Anderson NN, Billings JE, et al.  Health maintenance strategy. Med Care . 1971;;9:291-296.
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