Using the tools of competitive strategic analysis, this text identifies and explores the five forces transforming the health care system - horizontal consolidation, vertical integration, industrialization, medical/financial risk assumption, and consumerism. Using these five forces to describe the health care system most likely to emerge in the next decade, it predicts very different fortunes and fates for the medical professions, and hospital, pharmaceutical, medical device, and managed care industries.
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Though it's my third book about health care, Catching Babies is my first published novel. I started researching and writing Catching Babies in 2003 as a non-fiction expose of the messy and often fierce technical, moral, and cultural conflicts at the heart of high-risk obstetric medicine and womens' health. Earlier study of the clinical practice patterns of childbirth and gynecologic surgery, combined with fortuitous friendships with physicians and midwives at critical moments in their training, coalesced in a stark idea I had yet to encounter in the health services literature: obsterics and gynecology stand at ground zero of a broader health care system pulled apart by polarizing forces that often have little to do with medicine, ethics, or patients' real needs.
Our nation's permanent civil war over abortion rights--electrified with religious passion, political hypocrisy, and gruesome rhetoric scarcely related to the clinical and behavioral realities of abortion--is the most glaring example of how America's philosophical and psychological conundra play themselves out in our health care system. Our neurotic obsession with breast cancer, highly out of proportion with the disease's actual prevalence and lethality, is one of the more subtle examples of the same phenomenon. The political, financial, and legal fights over the way we care for women and deliver their babies are the supercharged versions of this spillover effect, of America's most intractable conflicts perennially finding their angriest voices in arguments about health care. For clearest proof, one look no further than the often bizarre rhetoric spewed during the 2009-2010 health care reform debate - and the jarring fact that passage of the entire legislation hinged, in the 11th hour, on the funding of abortion.
Catching Babies was originally intended as a clinically detailed study of how these wildly problematic and deeply misunderstood medical subjects play out in the real world. It was conceived as the general public's first hard look behind the medical curtain into the practice, politics, and often bizarre culture of obstetrics and gynecology, as smashed together into a single specialty and "organized" in the most disorganized health care system in the world. It would also map out the complex turf war between most (but not all) OB/GYNs and the growing and diverse ranks of midwives.
As I dug more deeply into these cases and their often unlikely outcomes, I noticed the recurrence of an odd phenomenon that has confounded health researchers for decades: medical decisions and outcomes often have less to do with what the patient needs or even what society demands, and more to do with what's eating at the doctor, what's making the patient act out, or what's wrong back at either one's home. Fast-forward through a few rough drafts and a few rough years, and suddenly the medical cases I had assembled to illustrate some of health care's thornier problems struck me as far more interesting than the problems themselves. Many of the cases began and ended not with medical facts, economic prerogatives, or philosophical positioning, but with the full spectrum of human impulses: fear, control, compassion, repression, projection, self-hatred, self-aggrandizement, the search for meaning, the leap of faith. The human compulsions at work in these cases begged questions not only about a unique patient's irrational response to her medical situation, but also about the pathological drives of her caregiver.
Who exactly are these physicians, midwives and nurses all thrown--as forcefully as their pregnant patients--into a maddening system not of their own design and often in conflict with their most deeply held values? The systematic brutalization of these caregivers, in particular OB/GYNs during their long and difficult training, has turned many into heroes, some into detached technicians, and a few into monsters--each, of course, in his or her own exquisite way. The closer I looked for patterns, the more elusive such patterning became, until I had crossed, perhaps inevitably, into the realm of narrative fiction. Fast-forward through a few more years and my own terrifying encounter with the realities of the health care system, and the "medical cases" had metamorphosed into human stories.
Catching Babies still seeks to tell the larger story of how and why we deliver most babies and care for most women in the odd and often maddening ways we do. But somewhere in the long process of research, composition, revision and reflection, I discovered that the real story is best told through the myriad fractures and fissures of the human drama - through the doctors, nurses, midwives, patients, family members and others struggling inside the system as they have found it.
In the meanwhile, I'll still be struggling there too! In my "day job," I'm a medical economist, author, and patient advocate. I've helped create four health care information organizations, served as a health care business columnist for the Wall Street Journal, and advised both sides of the political aisle on health policy and legislation. In 2004, I established the Omnimedix Institute, the Portland-based non-profit that helped define, lead and safeguard the way for patients' access to their own medical information on the Web. I also helped establish Health Grades, a health care information company based in Denver, and HCIA (now Solucient), the nation's pioneering health care database research company.
I've been a regular contributor to the policy journal, Health Affairs and The Wall Street Journal. My work has also appeared in JAMA, Barron's, the British Medical Journal, Modern Healthcare, and numerous other publications. My first book, Bleeding Edge: The Business of Health Care in the New Century (Aspen, 1998) was a foundational textbook for many physician-executive MBA programs and health administration graduate programs in the U.S. My follow-up, Oxymorons: The Myth of a US Health Care System (Wiley, 2001), was a scathing and oft-cited criticism of what is wrong with the health insurance industry, and one of the earliest calls for systemic health care reform.
Our nation's permanent civil war over abortion rights--electrified with religious passion, political hypocrisy, and gruesome rhetoric scarcely related to the clinical and behavioral realities of abortion--is the most glaring example of how America's philosophical and psychological conundra play themselves out in our health care system. Our neurotic obsession with breast cancer, highly out of proportion with the disease's actual prevalence and lethality, is one of the more subtle examples of the same phenomenon. The political, financial, and legal fights over the way we care for women and deliver their babies are the supercharged versions of this spillover effect, of America's most intractable conflicts perennially finding their angriest voices in arguments about health care. For clearest proof, one look no further than the often bizarre rhetoric spewed during the 2009-2010 health care reform debate - and the jarring fact that passage of the entire legislation hinged, in the 11th hour, on the funding of abortion.
Catching Babies was originally intended as a clinically detailed study of how these wildly problematic and deeply misunderstood medical subjects play out in the real world. It was conceived as the general public's first hard look behind the medical curtain into the practice, politics, and often bizarre culture of obstetrics and gynecology, as smashed together into a single specialty and "organized" in the most disorganized health care system in the world. It would also map out the complex turf war between most (but not all) OB/GYNs and the growing and diverse ranks of midwives.
As I dug more deeply into these cases and their often unlikely outcomes, I noticed the recurrence of an odd phenomenon that has confounded health researchers for decades: medical decisions and outcomes often have less to do with what the patient needs or even what society demands, and more to do with what's eating at the doctor, what's making the patient act out, or what's wrong back at either one's home. Fast-forward through a few rough drafts and a few rough years, and suddenly the medical cases I had assembled to illustrate some of health care's thornier problems struck me as far more interesting than the problems themselves. Many of the cases began and ended not with medical facts, economic prerogatives, or philosophical positioning, but with the full spectrum of human impulses: fear, control, compassion, repression, projection, self-hatred, self-aggrandizement, the search for meaning, the leap of faith. The human compulsions at work in these cases begged questions not only about a unique patient's irrational response to her medical situation, but also about the pathological drives of her caregiver.
Who exactly are these physicians, midwives and nurses all thrown--as forcefully as their pregnant patients--into a maddening system not of their own design and often in conflict with their most deeply held values? The systematic brutalization of these caregivers, in particular OB/GYNs during their long and difficult training, has turned many into heroes, some into detached technicians, and a few into monsters--each, of course, in his or her own exquisite way. The closer I looked for patterns, the more elusive such patterning became, until I had crossed, perhaps inevitably, into the realm of narrative fiction. Fast-forward through a few more years and my own terrifying encounter with the realities of the health care system, and the "medical cases" had metamorphosed into human stories.
Catching Babies still seeks to tell the larger story of how and why we deliver most babies and care for most women in the odd and often maddening ways we do. But somewhere in the long process of research, composition, revision and reflection, I discovered that the real story is best told through the myriad fractures and fissures of the human drama - through the doctors, nurses, midwives, patients, family members and others struggling inside the system as they have found it.
In the meanwhile, I'll still be struggling there too! In my "day job," I'm a medical economist, author, and patient advocate. I've helped create four health care information organizations, served as a health care business columnist for the Wall Street Journal, and advised both sides of the political aisle on health policy and legislation. In 2004, I established the Omnimedix Institute, the Portland-based non-profit that helped define, lead and safeguard the way for patients' access to their own medical information on the Web. I also helped establish Health Grades, a health care information company based in Denver, and HCIA (now Solucient), the nation's pioneering health care database research company.
I've been a regular contributor to the policy journal, Health Affairs and The Wall Street Journal. My work has also appeared in JAMA, Barron's, the British Medical Journal, Modern Healthcare, and numerous other publications. My first book, Bleeding Edge: The Business of Health Care in the New Century (Aspen, 1998) was a foundational textbook for many physician-executive MBA programs and health administration graduate programs in the U.S. My follow-up, Oxymorons: The Myth of a US Health Care System (Wiley, 2001), was a scathing and oft-cited criticism of what is wrong with the health insurance industry, and one of the earliest calls for systemic health care reform.
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Most Helpful Customer Reviews
14 of 14 people found the following review helpful:
5.0 out of 5 stars
Exceptional perspective about health care industrialization.,
By jramorrow@chks.co.uk (London, England) - See all my reviews
This review is from: Bleeding Edge: The Business of Health Care in the New Century (Hardcover)
This is a well thought out viewpoint about one of the last to be industrialized market sectors. It provides new and provocative viewpoints about an industry which is full of growth, alive with change but smitten with anguish as it touches nearly all humans in very personal ways; all around the world. Bleeding Edge is also a business book, with current and timely information about some of the most dramatic changes in health care since '95. The book is not a history of health care, thank goodness, it is a view into and reasoning for, the continued revolution of the health care sector. This book is a "must read" for everyone doing business in health care as either a provider or supplier. Many lessons to be learned from this piece and an easy read chocked full of bits and pieces of data and sound bites for forward thinkers. Well worth the investment!
13 of 13 people found the following review helpful:
5.0 out of 5 stars
Required reading for all health care participants.,
By A Customer
This review is from: Bleeding Edge: The Business of Health Care in the New Century (Hardcover)
I enjoyed the authors attempt to predict the future of health care which is unpredictable and which is provoking considerable anxiety in the medical field. While I'm not sure I agree with all the author's points, he presents interesting arguments supporting his forecasts. I shared this book with my colleagues, and they not only enjoyed it, but were willing to discuss many aspects of the book. The book does ignore the balance budget act, and doesn't address differences in regional variation in health care. I intend to read it again as soon as I get my copy back. This book can make a strong impression on its readers, especially physician readers, and it can provoke long conversations.
2 of 8 people found the following review helpful:
4.0 out of 5 stars
Interesting observations on industry directions.,
By gmertz@pilot.infi.net (Virginia Beach, VA) - See all my reviews
This review is from: Bleeding Edge: The Business of Health Care in the New Century (Hardcover)
This book has thought-provoking comments on the future configuration and incentives in the industry. Klenke is a clear beleiver in Star's 80's observations, but so are many who are watching his predictions come true.The book drags at times but, overall, a must read!
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