Health care restructuring : market theory vs. civil society / Lois Wright Morton.

Format:

Book

Author/Creator:

Morton, Lois Wright, 1951-

Language:

English

Subjects (All):

Medical policy--United States--Citizen participation.

Medical policy.

Health care reform--United States.

Health care reform.

Political participation.

United States.

Civil society.

Capitalism--United States.

Capitalism.

Physical Description:

xiv, 214 pages : illustrations ; 25 cm

Place of Publication:

Westport, Conn. : Auburn House, 2001.

Summary:

Challenges the prevailing idea that market-driven health care is the best way to resolve issues of cost, access, and health status. Civic community, a variation of civil society, is offered as an alternative paradigm for setting the rules by which health care is restructured.

Contents:

Part I. U.S. Health Care

1. Criteria for Achieving Health 3

What Does the United States Want and Expect from Restructuring? 4

Criteria for Successful Health Care Restructuring 5

2. A Brief History of U.S. Health Care 15

Changes in Life Expectancy 16

Health Disparities 17

Medicaid and Medicare: Third-Party Payments and Commodification 19

Rising Health Care Costs 19

Responses to Rising Health Care Costs 23

Research Propositions and Organization of the Book 25

Part II. Theoretical Structure and Propositions

3. Mapping the Existing Road: The Economics of Health Care 31

Health Production Viewed from an Economic Lens 32

Shortcomings of the Market Model 38

Managed Care Market Reality 40

New Health Care Systems 43

Health Care Markets and Principles of Restructuring 45

4. Reconstructing the Road Map to Health: Civic Community, a Variation of Civil Society 49

The Heart of the Dysfunction 49

Differentiation, Pluralism, and Solidarity/Mobilization 51

Civil Society 52

The Civic Community 54

Assumptions of Social Necessity 58

Propositions 60

The Nature of Evidence 61

Part III. Market-Driven Health Care

5. The Necessity of Market-Driven Health Care 67

The Captivity of Government 67

The "Necessity" of Market-Driven Health Care 68

Health Security Act of 1993 71

Government's Role 75

6. The Case of New York State 79

New York State: A Liberal and Egalitarian State 80

New York Health Care Reform 82

Escalating State Pressures 84

Local Pressures 85

The Squeeze 87

Part IV. Policy Intent and Reality: Facing the Disjunctures

7. Profitability and Health Goals 95

Indicators of Successful Health Restructuring 96

Profitability versus Health Status Goals 100

Profitability and Health Care Practices 105

8. Structural Constraints 115

Uninsurance, Poverty, and Other Population Characteristics 115

State Comparisons 121

Health Services Employment 126

Socio-Ecological Factors of Disease and Illness 129

Profitability and Structural Constraints: What Can We Conclude? 131

Part V. Civil Society in Decision Making

9. Civic Community: Redirecting the Counter-Movement 139

Counter-Movements to Market-Driven Health Care 141

A Third Way: Civic Community 143

Building Blocks of Civic Community 145

Individuals in Organizations Interacting with Other Individuals in Organizations 151

National Incentives to Civic Community 152

Emerging Civic Communities 154

10. Emerging Civic Community 159

Type I Macro-Design 159

Type II Micro-Designs 163

Shortcomings and Potential of Civic Community in Health Care Reorganization 169

Part VI. Civic Community and Markets

11. Evaluating Civic Community 175

Civic Community and Current Health System Disjunctures 175

Can Civic Community Achieve What a Market-Driven System Cannot? 180

12. A Question of Balance 187

Aligning Civic Community to the Health Function 188

Capacity of Civil Society 190

Implications of Civic Community 191

Competitive Markets and Civic Community: What Can Be Concluded? 192.

Notes:

Includes bibliographical references (pages [197]-210) and index.

ISBN:

086569303X

OCLC:

44075956