The Future of Academic Medical Centers [Paperback]

Henry J. Aaron (Editor), Michael H. Armacost (Foreword)

Book Description

ISBN-10: 081570237X | ISBN-13: 978-0815702375 | Publication Date: September 2001

Academic medical centers provide cutting edge acute care, train tomorrows physicians, and carry out research that will expand the range of treatable and curable illnesses. But these centers themselves may need urgent careexperts generally agree that many are suffering acuteeven life-threateningfinancial distress. Many academic medical centers are suffering for several reasons: in-patient admissions are down, as many procedures that once required a hospital stay are now performed on an out-patient basis or in a physicians office; managed care plans have negotiated discounted fees that cut hospital operating margins; the Balanced Budget Act of 1997 curtailed Medicare reimbursements, lowered margins and pushed some into the red; the revolution in information technology is imposing large new capital costs; and the character of medical education is receiving its most thorough review in decades. While there is a general consensus that medical centers are under pressure, experts disagree about the depth and pervasiveness of the current financial distress. Are they whining about financial pressures other, less-favored sectors find routine; or is the high quality American teaching hospital becoming an endangered speciesthat could face extinction if nothing is done. Because academic medical centers perform such important jobs, it is critical to determine the true nature and depth of their current financial problemsand then fashion analytically sound and politically sustainable solutions. This book brings together chief executive officers of major medical centers, university presidents, senior members of Congressional and executive office staffs, and leading analysts. These experts address the keyissues and prescribe remedies both regulatory and legislative to ensure that the teaching hospital remains a picture of financial health. Contributors include Nancy Kane (Harvard School of Public Health), Jamie Reuter (Institute for Health Care Research Policy, Georgetown University), Peter van Etten (Juvenile Diabetes Foundation), Ralph Muller (University of Chicago Hospitals and Health System), James Robinson (School of Public Health, University of California, Berkeley), David Blumenthal (Institute for Health Policy, Massachusetts General Hospital), Edward Miller (Johns Hopkins University School of Medicine), Spencer Foreman (Montefiore Medical Center), Lawrence Lewin (Lewin Group), Gail Wilensky (Project HOPE), Robert Dickler (American Association of Medical Colleges), and Kenneth Shine (Institute of Medicine).

Editorial Reviews

From The New England Journal of Medicine

The Future of Academic Medical Centers sets forth the often divergent opinions of the nation's top experts on the destiny of academic medical centers. One opinion, the most pessimistic, was echoed by one of our colleagues who saw the title and commented, ``Must be a thin book.'' Indeed, since the early 1990s, academic medical centers in the United States have had to face unprecedented pressures, which may threaten their very existence. These include scaled-back Medicare payments, the squeeze of managed care, a disproportionate burden of the care of the uninsured, the rising cost of medical technology, and decreasing hospital-bed occupancy rates. The health plan of the Clinton administration (now abandoned) as well as hospital mergers and expansion are responses, but they have been largely unsuccessful.

To address these challenges and possible solutions, a group of hospital chief executive officers, university presidents, analysts, and executive- and congressional-office staff members gathered for a one-day conference. The four chapters that make up this book are the record of that conference. The book is filled with interesting, current, and authentic examples from some of this country's well-known academic medical centers. One of the most interesting features of the book is its format. Each chapter is written by a different participant and is followed by commentary from two other participants, which serves to broaden the perspective and to clarify some of the positions taken. These comments are not unlike two editorials on each chapter.

No one would argue that fiscal strength is not crucial to the future of academic medical centers, but this is not the only important factor. The complexity and variability of the infrastructure of academic medical centers must entail other factors, but these are not mentioned. Some of the notably absent or cursorily examined characteristics are the quality of graduate and undergraduate medical education, scientific and technological advancement, and the unique and unrivaled commitment to patient care in these centers and their surrounding communities. In this era of managed care, cost control, and the rising cost of caring for the uninsured, no one can argue that academic medical centers do not serve a crucial role in delivering care to the indigent, the unemployed, the young, and the old. In fact, these social and scientific obligations not only define success for the constituent physicians of academic medical centers but also form the basis of comparison among centers.

A physician seeking an overview of this topic and opening this book will plunge into graphic displays of economic analysis. This and the unique format of the book, which is designed to offer a comprehensive look at different viewpoints, will be exciting for health care experts but may be confusing to casual readers.

Holly J. Humphrey, M.D.
Copyright © 2002 Massachusetts Medical Society. All rights reserved. The New England Journal of Medicine is a registered trademark of the MMS. --This text refers to the Hardcover edition.

Product Details

• Paperback: 112 pages
• Publisher: Brookings Institution Press (September 2001)
• Language: English
• ISBN-10: 081570237X
• ISBN-13: 978-0815702375
• Product Dimensions: 9.1 x 6.3 x 0.4 inches
• Shipping Weight: 8 ounces (View shipping rates and policies)
• Amazon Best Sellers Rank: #2,043,828 in Books (See Top 100 in Books)