Title: The corporate practice of medicine: competition and innovation in health care
Author: Robinson, James C 1953-
Published: University of California Press,  1999
Subjects: Politics | Public Policy | Medicine | Economics and Business
Publisher's Description: One of the country's leading health economists presents a provocative analysis of the transformation of American medicine from a system of professional dominance to an industry under corporate control. James Robinson examines the economic and political forces that have eroded the traditional medical system of solo practice and fee-for-service insurance, hindered governmental regulation, and invited the market competition and organizational innovations that now are under way. The trend toward health care corporatization is irreversible, he says, and it parallels analogous trends toward privatization in the world economy.The physician is the key figure in health care, and how physicians are organized is central to the health care system, says Robinson. He focuses on four forms of physician organization to illustrate how external pressures have led to health care innovations: multispecialty medical groups, Independent Practice Associations (IPAs), physician practice management firms, and physician-hospital organizations. These physician organizations have evolved in the past two decades by adopting from the larger corporate sector similar forms of ownership, governance, finance, compensation, and marketing.In applying economic principles to the maelstrom of health care, Robinson highlights the similarities between competition and consolidation in medicine and in other sectors of the economy. He points to hidden costs in fee-for-service medicine - overtreatment, rampant inflation, uncritical professional dominance regarding treatment decisions - factors often overlooked when newer organizational models are criticized.Not everyone will share Robinson's appreciation for market competition and corporate organization in American health care, but he challenges those who would return to the inefficient and inequitable era of medicine from which we've just emerged. Forcefully written and thoroughly documented, The Corporate Practice of Medicine presents a thoughtful - and optimistic - view of a future health care system, one in which physician entrepreneurship is a dynamic component.   [brief]
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Title: Life without disease: the pursuit of medical utopia 
Author: Schwartz, William B 1922-
Published: University of California Press,  1998
Subjects: Science | Medicine | Economics and Business | History and Philosophy of Science | Public Policy
Publisher's Description: The chaotic state of today's health care is the result of an explosion of effective medical technologies. Rising costs will continue to trouble U.S. health care in the coming decades, but new molecular strategies may eventually contain costs. As life expectancy is dramatically extended by molecular medicine, a growing population of the aged will bring new problems. In the next fifty years genetic intervention will shift the focus of medicine in the United States from repairing the ravages of disease to preventing the onset of disease. Understanding the role of genes in human health, says Dr. William B. Schwartz, is the driving force that will change the direction of medical care, and the age-old dream of life without disease may come close to realization by the middle of the next century. Medical care in 2050 will be vastly more effective, Schwartz maintains, and it may also be less expensive than the resource-intensive procedures such as coronary bypass surgery that medicine relies on today.Schwartz's alluring prospect of a medical utopia raises urgent questions, however. What are the scientific and public policy obstacles that must be overcome if such a goal is to become a reality? Restrictions on access imposed by managed care plans, the corporatization of charitable health care institutions, the increasing numbers of citizens without health insurance, the problems with malpractice insurance, and the threatened Medicare bankruptcy - all are the legacy of medicine's great progress in mastering the human body and society's inability to assimilate that mastery into existing economic, ethical, and legal structures. And if the average American life span is 130 years, a genuine possibility by 2050, what social and economic problems will result?Schwartz examines the forces that have brought us to the current health care state and shows how those same forces will exert themselves in the decades ahead. Focusing on the inextricable link between scientific progress and health policy, he encourages a careful examination of these two forces in order to determine the kind of medical utopia that awaits us. The decisions we make will affect not only our own care, but also the system of care we bequeath to our children.   [brief]
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Title: Big doctoring in America: profiles in primary care 
Author: Mullan, Fitzhugh
Published: University of California Press,  2002
Subjects: Medicine | Health Care | Sociology
Publisher's Description: The general practitioner was once America's doctor. The GP delivered babies, removed gallbladders, and sat by the bedsides of the dying. But as the twentieth century progressed, the pattern of medical care in the United States changed dramatically. By the 1960s, the GP was almost extinct. The later part of the twentieth century, however, saw a rebirth of the idea of the GP in the form of primary care practitioners. In this engrossing collection of oral histories and provocative essays about the past and future of generalism in health care, Fitzhugh Mullan - a pediatrician, writer, and historian - argues that primary care is a fascinating, important, and still endangered calling. In conveying the personal voices of primary care practitioners, Mullan sheds light on the political and economic contradictions that confront American medicine. Mullan interviewed dozens of primary care practitioners - family physicians, internists, pediatricians, nurse practitioners, and physician assistants - asking them about their lives and their work. He explains how, during the last forty years, the primary care movement has emerged built on the principles of "big doctoring"--coordinated, comprehensive care over time. This book is essential reading for understanding core issues of the current health care dilemma. As our country struggles with managed care, market reforms, and cost containment strategies in medicine, Big Doctoring in America provides an engrossing and illuminating look at those in the trenches of the profession.   [brief]
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Title: Public health law and ethics: a reader
Author: Gostin, Larry O. (Larry Ogalthorpe)
Published: University of California Press,  2002
Subjects: Law | Medicine | Health Care
Publisher's Description: This incisive selection of government reports, scholarly articles, and court cases is designed to illuminate the ethical, legal, and political issues in the theory and practice of public health. A companion to the internationally acclaimed Public Health Law: Power, Duty, Restraint, this collection encourages debate and discourse about how courts, scholars, and policy makers respond to the salient legal and ethical dilemmas. The excerpts and commentaries in the reader analyze the legal and constitutional foundations of public health, juxtaposing them with the emerging importance of public health ethics and human rights. The book offers a systematic account of public health law, ethics, and human rights in promoting the common good. Gostin provides thoughtful commentary on the field of public health and carefully explains the meaning and importance of each selection. Scholars, legislators, and public health professionals, as well as faculty and students in schools of law, public health, medicine, nursing, government, and health administration, will benefit from the contemporary case studies covering a wide range of topics from bioterrorism to public health genetics.   [brief]
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Title: Power and illness: the failure and future of American health policy 
Author: Fox, Daniel M
Published: University of California Press,  1993
Subjects: Sociology | Medicine | History | American Studies | United States History
Publisher's Description: During most of this century, American health policy has emphasized caring for acute conditions rather than preventing and managing chronic illness - even though chronic illness has caused most sickness and death since the 1920s. In this provocative and wide-ranging book, Daniel Fox explains why this has been so and offers a forceful argument for fundamental change in national health care priorities.Fox discusses how ideas about illness and health care, as well as the power of special interest groups, have shaped the ways in which Americans have treated illness. Those who make health policy decisions have increased support for hospitals, physicians, and medical research, believing that people then would become healthier. This position, implemented at considerable cost, has not adequately taken into account the growing burden of chronic disabling illness. While decision makers may have defined chronic disease as a high priority in research, they have not given it such a priority in the financing of health services.The increasing burden of chronic illness is critical. Fox suggests ways to solve this problem without increasing the already high cost of health care - but he does not underestimate the difficulties in such a strategy. Advocating the redistribution of resources within hospital and medical services, he targets those that are redundant or marginally effective.There could be no more timely subject today than American health care. And Daniel Fox is uniquely able to address its problems. A historian of medicine, with knowledge of how hospitals and physicians behave and how health policy is made at government levels, he has extensively researched published and unpublished documents on health care. What he proposes could profoundly affect all Americans.   [brief]
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Title: Colonizing the body: state medicine and epidemic disease in nineteenth-century India
Author: Arnold, David 1946-
Published: University of California Press,  1993
Subjects: Asian Studies | South Asia | Asian History | Medicine | History
Publisher's Description: In this innovative analysis of medicine and disease in colonial India, David Arnold explores the vital role of the state in medical and public health activities, arguing that Western medicine became a critical battleground between the colonized and the colonizers.Focusing on three major epidemic diseases - smallpox, cholera, and plague - Arnold analyzes the impact of medical interventionism. He demonstrates that Western medicine as practiced in India was not simply transferred from West to East, but was also fashioned in response to local needs and Indian conditions.By emphasizing this colonial dimension of medicine, Arnold highlights the centrality of the body to political authority in British India and shows how medicine both influenced and articulated the intrinsic contradictions of colonial rule.   [brief]
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Title: Just doctoring: medical ethics in the liberal state 
Author: Brennan, Troyen A
Published: University of California Press,  1991
Subjects: Philosophy | Ethics | Medicine
Publisher's Description: Just Doctoring draws the doctor-patient relationship out of the consulting room and into the middle of the legal and political arenas where it more and more frequently appears. Traditionally, medical ethics has focused on the isolated relationship of physician to patient in a setting that has left the physician virtually untouched by market constraints or government regulation. Arguing that changes in health care institutions and legal attention to patient rights have made conventional approaches obsolete, Troyen Brennan points the way to a new, more aware and engaged medical ethics.The medical profession is no longer isolated, even theoretically, from the liberal, market-dominated state. Old ideas of physician beneficence and altruism must make way for a justice-based medical ethics, assuming a relationship between equals more compatible with liberal political philosophy. Brennan offers clinical examples of many of today's most challenging medical problems - from informed consent to care rationing and the repercussions of the HIV epidemic - and gives his recommendation for a new ethical perspective. This lively and controversial plea for a rethinking of medical ethics goes right to the heart of medical care at the end of the twentieth century.   [brief]
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Title: Policies, plans, & people: foreign aid and health development
Author: Justice, Judith
Published: University of California Press,  1989
Subjects: Anthropology | Art and Architecture
Publisher's Description: Judith Justice uses an interdisciplinary approach to show how anthropologists and planners can combine their expertise to make health care programs culturally compatible with the populations they serve.
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Title: Healing the masses: Cuban health politics at home and abroad
Author: Feinsilver, Julie Margot
Published: University of California Press,  1993
Subjects: Latin American Studies | Politics | Medicine | Public Policy
Publisher's Description: How has Cuba, a small, developing country, achieved its stunning medical breakthroughs? Hampered by scarce resources and a long-standing U.S. embargo, Cuba nevertheless has managed to provide universal access to health care, comprehensive health education, and advanced technology, even amid desperate economic conditions. Moreover, Cuba has sent disaster relief, donations of medical supplies and technology, and cadres of volunteer doctors throughout the world, emerging, in Castro's phrase, as a "world medical power."In her significant and timely study, Julie Feinsilver explores the Cuban medical phenomenon, examining how a governmental obsession with health has reaped medical and political benefits at home and abroad. As a result of Cuba's forward strides in health care, infant mortality rates are low even by First World standards. Cuba has successfully dealt with the AIDS epidemic in a manner that has aroused controversy and that some claim has infringed on individual liberties - issues that Feinsilver succinctly evaluates.Feinsilver's research and travel in Cuba over many years give her a unique perspective on the challenges Cuba faces in this time of unprecedented economic and political uncertainty. Her book is a must-read for everyone concerned with health policy, international relations, and Third World societies.   [brief]
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Title: American medicine: the quest for competence
Author: Good, Mary-Jo DelVecchio
Published: University of California Press,  1995
Subjects: Medicine | Science | Medical Anthropology | Public Policy
Publisher's Description: What does it mean to be a good doctor in America today? How do such challenges as new biotechnologies, the threat of malpractice suits, and proposed health-care reform affect physicians' ability to provide quality care?These and many other crucial questions are examined in this book, the first to fully explore the meaning and politics of competence in modern American medicine. Based on Mary-Jo DelVecchio Good's recent ethnographic studies of three distinct medical communities - physicians in rural California, academics and students involved in Harvard Medical School's innovative "New Pathway" curriculum, and oncologists working on breast cancer treatment - the book demonstrates the centrality of the issue of competence throughout the medical world. Competence, it shows, provides the framework for discussing the power struggles between rural general practitioners and specialists, organizational changes in medical education, and the clinical narratives of high-technology oncologists. In their own words, practitioners, students, and academics describe what competence means to them and reveal their frustration with medical-legal institutions, malpractice, and the limitations of peer review and medical training.Timely and provocative, this study is essential reading for medical professionals, academics, anthropologists, and sociologists, as well as health-care policymakers.   [brief]
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Title: What I learned in medical school: personal stories of young doctors
Author: Takakuwa, Kevin M
Published: University of California Press,  2004
Subjects: Medicine | Sociology | Ethnic Studies | Gender Studies | Anthropology | Health Care
Publisher's Description: Like many an exclusive club, the medical profession subjects its prospective members to rigorous indoctrination: medical students are overloaded with work, deprived of sleep and normal human contact, drilled and tested and scheduled down to the last minute. Difficult as the regimen may be, for those who don't fit the traditional mold - white, male, middle-to-upper class, and heterosexual - medical school can be that much more harrowing. This riveting book tells the tales of a new generation of medical students - students whose varied backgrounds are far from traditional. Their stories will forever alter the way we see tomorrow's doctors. In these pages, a black teenage mother overcomes seemingly insurmountable odds, an observant Muslim dons the hijab during training, an alcoholic hides her addiction. We hear the stories of an Asian refugee, a Mexican immigrant, a closeted Christian, an oversized woman - these once unlikely students are among those who describe their medical school experiences with uncommon candor, giving a close-up look at the inflexible curriculum, the pervasive competitive culture, and the daunting obstacles that come with being "different" in medical school. Their tales of courage are by turns poignant, amusing, eye-opening - and altogether unforgettable.   [brief]
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Title: Colonising Egypt 
Author: Mitchell, Timothy 1955-
Published: University of California Press,  1991
Subjects: Politics | Middle Eastern Studies | Cultural Anthropology | Middle Eastern History | Intellectual History | Postcolonial Studies
Publisher's Description: Extending deconstructive theory to historical and political analysis, Timothy Mitchell examines the peculiarity of Western conceptions of order and truth through a re-reading of Europe's colonial encounter with nineteenth-century Egypt.
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Title: Promoting human wellness: new frontiers for research, practice, and policy 
Author: Jamner, Margaret Schneider
Published: University of California Press,  2001
Subjects: Medicine | Public Policy | Anthropology | Aging | Education
Publisher's Description: This book is a state-of-the-art educational resource on the latest research and public-policy developments in the fields of wellness promotion and disease prevention. Based on award-winning lectures by University of California faculty on nine campuses as part of the Wellness Lectures Program jointly funded by The California Wellness Foundation, Health Net, and the University of California, the volume aims to widen the scope of health care research and policy to promote wellness rather than focus on illness and disease, and to incorporate proactive, interdisciplinary approaches to health care. The volume also contains chapters by distinguished scholars inthe fields of wellness promotion and disease prevention. Many of these articles fall outside the scope of what we conventionally call health promotion, bringing new perspectives to research and policy possibilities. Promoting Human Wellness is organized around core themes such as the importance of disease prevention programs that address multiple health risks, the link between poverty and minority status and disease susceptibility, and the challenge of evaluating health benefits and cost-effectiveness. The articles discuss such timely issues as genetic determinism as a paradigm in wellness promotion, adolescent health promotion and teen pregnancy prevention strategies, racial differences in cancer epidemiology, the California smokers' helpline, strategies for reducing youth violence, HIV/AIDS prevention, domestic violence education and prevention srategies, and the future of women's health research. Presented within the framework of social ecology, several of the chapters in this volume address new ideas and approaches in the wellness field that are only now beginning to be understood such as the social construction of variables including race, class, and gender. Promoting Human Wellness will be essential reading for health practitioners, policymakers, and others seeking to expand the ways we define and achieve health. Keywords: Public health, community health, medicine, nursing, social welfare, health education, health psychology, social ecology, public policy, aging, health promotion.   [brief]
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Title: Experiencing politics: a legislator's stories of government and health care
Author: McDonough, John E. (John Edward)
Published: University of California Press,  2000
Subjects: Politics | Public Policy | Medicine
Publisher's Description: John E. McDonough affords a rare glimpse into the practice of state politics in this insider's account of the fascinating interface between political science and real-life politics. A member of the Massachusetts House of Representatives for thirteen years and a skilled storyteller, McDonough eloquently weaves together stories of politics and policy with engaging theoretical models in a way that illuminates both the theory and the practice. By providing a link between scholarship and the world of experience, he communicates much about the essence of representative democracy. In the process, he demonstrates how politics extend beyond the public sphere into many aspects of life involving diverse values and interests. McDonough describes the nature of conflict, the role of interests, agenda setting, the nature and pace of change, the use of language, and more. Accessible, insightful, and original, his stories touch on a broad range of issues - including health care politics, campaigns, and elections; a street gang called the X-men; the death penalty; campaign finance reform, and tenants versus landlords. To the author, politics is everywhere and political dynamics are universal. While the setting for this book is one legislature, the lessons and insights are intended for everyone.   [brief]
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Title: When capitalists collide: business conflict and the end of empire in Egypt 
Author: Vitalis, Robert 1955-
Published: University of California Press,  1995
Subjects: Politics | Ancient History | Middle Eastern Studies | Middle Eastern History
Publisher's Description: Robert Vitalis's empirically rich study challenges the left-nationalist paradigm through which twentieth-century Egyptian history and politics has generally been interpreted. He argues with those who explain Egyptian economic development primarily in terms of class and of power struggles between British and Egyptian entrepreneurs and politicians.Vitalis offers a rare, detailed view of the objectives and political strategies of both international firms and Egypt's own big business rivals. He highlights the career of Muhammad Ahmad 'Abbud, modern Egypt's most successful businessman. Vitalis's argument can be effectively applied to many other Third World countries and his book makes a major contribution to ongoing debates regarding class, underdevelopment, and nationalism.   [brief]
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Title: A different shade of colonialism: Egypt, Great Britain, and the mastery of the Sudan
Author: Powell, Eve Troutt
Published: University of California Press,  2003
Subjects: History | Middle Eastern Studies | Postcolonial Studies | European History
Publisher's Description: This incisive study adds a new dimension to discussions of Egypt's nationalist response to the phenomenon of colonialism as well as to discussions of colonialism and nationalism in general. Eve M. Troutt Powell challenges many accepted tenets of the binary relationship between European empires and non-European colonies by examining the triangle of colonialism marked by Great Britain, Egypt, and the Sudan. She demonstrates how central the issue of the Sudan was to Egyptian nationalism and highlights the deep ambivalence in Egyptian attitudes toward empire and the resulting ambiguities and paradoxes that were an essential component of the nationalist movement. A Different Shade of Colonialism enriches our understanding of nineteenth- and twentieth-century Egyptian attitudes toward slavery and race and expands our perspective of the "colonized colonizer."   [brief]
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Title: Public health law: power, duty, restraint
Author: Gostin, Larry O. (Larry Ogalthorpe)
Published: University of California Press,  2001
Subjects: Law | Medicine | Public Policy
Publisher's Description: Gostin's timely book offers the first systematic definition and theory of public health law. Basing his definition on a broad notion of the government's inherent responsibility to advance the population's health and well-being, he develops a rich understanding of the government's fundamental powers and duties. By analyzing constitutional powers and limits, as well as statutory, administrative, and tort law, Public Health Law vividly shows how law can become a potent tool for the realization of a healthier and safer population.   [brief]
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Title: From the fat of our souls: social change, political process, and medical pluralism in Bolivia
Author: Crandon-Malamud, Libbet
Published: University of California Press,  1991
Subjects: Anthropology | Latin American Studies | Politics | Medical Anthropology | Medicine
Publisher's Description: From the Fat of Our Souls offers a revealing new perspective on medicine, and the reasons for choosing or combining indigenous and cosmopolitan medical systems, in the Andean highlands. Closely observing the dialogue that surrounds medicine and medical care among Indians and Mestizos, Catholics and Protestants, peasants and professionals in the rural town of Kachitu, Libbet Crandon-Malamud finds that medical choice is based not on medical efficacy but on political concerns. Through the primary resource of medicine, people have access to secondary resources, the principal one being social mobility. This investigation of medical pluralism is also a history of class formation and the fluidity of both medical theory and social identity in highland Bolivia, and it is told through the often heartrending, often hilarious stories of the people who live there.   [brief]
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Title: Intensive care: a doctor's journal
Author: Murray, John F. (John Frederic) 1927-
Published: University of California Press,  2000
Subjects: Medicine | Aging
Publisher's Description: Intensive Care is an affecting view from the trenches, a seasoned doctor's minute-by-minute and day-by-day account of life in the Intensive Care Unit (ICU) of a major inner-city hospital, San Francisco General. John F. Murray, for many years Chief of the Pulmonary and Critical Care Division of the hospital and a Professor at the University of California, San Francisco, takes readers on his daily ward rounds, introducing them to the desperately ill patients he treats as well as to the young physicians and medical students who accompany him. Writing with compassion and knowledge accumulated over a long career, Murray presents the true stories of patients who show up with myriad disorders: asthma, cardiac failure, gastrointestinal diseases, complications due to AIDS, the effects of drug and alcohol abuse, emphysema. Readers will come away from this book with a comprehensive understanding of what an ICU is, what it does, who gets admitted, and how doctors and nurses make decisions concerning life-threatening medical problems. Intensive care for critically ill patients is a new but well-established and growing branch of medicine. Estimates suggest that 15 to 20 percent of all hospitalized patients in the United States are treated in an intensive or coronary care unit during each hospital stay, so there is a real possibility that the reader will either be admitted to an ICU himself or herself or knows someone who will be. Murray not only offers a real-time account of the diagnosis, treatment, and progress of his patients over the course of one month but also conveys a wealth of information about various diseases and medical procedures in succinct and easy-to-understand terms. In addition, he elaborates on ethical dilemmas that he confronts on an almost daily basis: the extent of patient autonomy, the denial of ICU care, the withdrawal of life support, and physician-assisted suicide. Murray concludes that ICUs are doing their job, but they could be even better, cheaper, and--most important--more humane. His chronicle brings substance to a world known to most of us only through the fiction of television.   [brief]
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Title: Managing the medical arms race: public policy and medical device innovation 
Author: Foote, Susan Bartlett
Published: University of California Press,  1992
Subjects: Politics | Medicine | Public Policy | Economics and Business
Publisher's Description: The allure of medical innovation is powerful - it holds out the promise of perfect health, the end of pain, the deferral of death. Our insatiable appetite for costly new technologies, fed by a profusion of innovations and the profits they generate, has led to what has been dubbed the medical arms race. During the last several decades government has been called upon to manage the escalation of this race.Foote has written the first comprehensive examination of the profound influence of government policies on medical innovation. She explains how these policies have proliferated to affect every stage of the innovative process in medical device technology - from the first research idea to the patient's bedside. Drawing on case studies of technologies as diverse as lasers, cardiac pacemakers, CT scanners, and IUDs, she traces the interaction between the industry and government institutions, including the National Institutes of Health, the FDA, and the Medicare and Medicaid programs.Public policies during the 1950s and 1960s, Foote discovers, tended to promote innovation, while the regulation and cost controls of the 1970s and 1980s began to inhibit it. For the 1990s and beyond she proposes incremental policy improvements that will rationalize and streamline government intervention. She cautions that we must recognize the limits of medical technology and public policy to cure all ills.Medical innovation is a crucial part of health care reform, a subject of increasing complexity and controversy. Written clearly and accessibly, Managing the Medical Arms Race is an invaluable source for medical, industry, and policy professionals, but it also has much to say to anybody concerned with how we as a society choose to take care of our health.   [brief]
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