Epidemic of Care: A Call for Safer, Better, and More Accountable Health Care (Hardcover)

~ (Author), George J. Isham MD (Author) "Health care costs are exploding in America..." (more)
Key Phrases: miracles cost money, medical best practices, unproven care, United States, Kaiser Permanente, Great Britain (more...)

Editorial Reviews

From The New England Journal of Medicine

Health care costs are out of control, the quality of health care is frightfully low, and far too many people are uninsured. The solution, according to George Halvorson and George Isham, is managed care. This is not your father's managed care. It is the new managed care, in which health plans focus more on improving the quality of care and less on rationing care. Halvorson and Isham worked together doing just that at HealthPartners, a Minnesota-based health plan. Halvorson now heads Kaiser Permanente. After exploring the behaviors of providers, consumers, and health plans that led to the current state of affairs, the authors lay out a seven-point national plan for increasing the value of health care. Not surprisingly, health plans have a large role. Improving the quality of care and patient safety tops the list. Other items include improving the efficiency of health care markets, addressing population health, developing a workable plan for the uninsured, and supporting research. Along the way, Halvorson and Isham correct some misperceptions about health maintenance organizations. The authors' focus on the value of health care is refreshing. Increasing value demands a delicate balance of frugality and innovation. The right mix of these elements is an equation that needs to be solved for each new advance in medicine, with what we gain in health weighed against the opportunities we give up to achieve those gains. Improving health outcomes is the most interesting part of Halvorson and Isham's plan for increasing the value of health care. The authors believe that automated record keeping is a prerequisite for any widespread improvement in quality. Automated medical records make information instantly available to doctors when they need it and provide a platform for real-time education about the latest treatment guidelines, possible drug interactions, and other features that can improve the quality of care in the increasingly complex and harried world that physicians inhabit. The possibilities for innovation seem almost limitless. The idea of automated record keeping, coupled with other strategies, gives a clear direction for improving treatment outcomes. Not so clear is who will pay the cost of these improvements or how they can be implemented nationwide. On the cost side, Halvorson and Isham turn to the strategies economists typically use in failed markets: enforcement of antitrust laws to make markets more competitive, improvement of information on the quality and outcomes of health care, and creation of incentives for patients and employers to shop for the best value. But their assertion that "it generally costs less to do care right," which is a pillar of their plan for increasing value, seems more wish than fact. For example, they cite a newspaper article as evidence that counseling for obesity will reduce the incidence of diabetes and its concomitant costs. A study reported in the Journal by Tuomilehto and colleagues (2001;344:1343-50) showed that counseling-based intervention to help prevent diabetes was neither simple nor inexpensive. Better health care often requires an initial investment, and the promised savings do not always materialize. There is much to like about this book. Health care providers and those who administer health plans will find many examples of what can be done to improve the quality of care by working together. Employers and others who purchase health insurance can learn how to get more value for their health care dollars. Policymakers may learn a thing or two about how insurers can help solve problems in health care. Everyone can have a role in Halvorson and Isham's plan. Robin E. Clark, Ph.D.
Copyright © 2003 Massachusetts Medical Society. All rights reserved. The New England Journal of Medicine is a registered trademark of the MMS.

Review

"The authors don't miss a trick; they have covered all the bases." -- Inquiry, Fall 2003

"There is much to like about this book. Everyone can have a role in Halvorson and Isham's plan." -- New England Journal of Medicine, August 28, 2003

“ This well-written book describes…in great depth the many problems that health care in the United States encounter…” (International Journal of Integrated Care, 2 August 2004)

"...one of the more lucid explanations of what is going on in US health care...the authors are well qualified to do the explaining..." (British Medical Journal, 12 July 2003)

"There is much to like about this book. Everyone can have a role in Halvorson and Isham's plan." (New England Journal of Medicine, August 28, 2003)

"The authors don't miss a trick; they have covered all the bases." (Inquiry, Fall 2003)

"...the writing style is very accessible, and the discussion includes points that may not be as commonly discussed outside of medical schools." (E-Streams, December 2003)

See all Editorial Reviews

Product Details

• Hardcover: 304 pages
• Publisher: Jossey-Bass; 1 edition (May 2, 2003)
• Language: English
• ISBN-10: 0787968889
• ISBN-13: 978-0787968885
• Product Dimensions: 9.1 x 6.1 x 1.2 inches
• Shipping Weight: 1.1 pounds (View shipping rates and policies)
• Average Customer Review: 4.5 out of 5 stars  See all reviews (6 customer reviews)
• Amazon.com Sales Rank: #263,805 in Books (See Bestsellers in Books)

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Customer Reviews

Most Helpful Customer Reviews

3 of 3 people found the following review helpful:

5.0 out of 5 stars Health care's diagnosis--and potential cure, August 26, 2003

By A Customer

In clear terms, Halvorson and Isham examine why the American health care "non-" system continues to deliver some of the best health care in the world-and some of the worst-at a price fewer and fewer people can afford. The authors do an excellent job of assessing the current health care landscape, how it got that way, and what health care decision-makers and consumers can do about it. In these days of "cost shifting" and "skinny" benefits, their emphasis on health care delivery redesign is a refreshing reminder that measuring and rewarding quality is the only way to truly solve the health care crisis.

5 of 6 people found the following review helpful:

3.0 out of 5 stars Epidemic of Care, August 28, 2003

By A Customer

Epidemic of Care provides a succinct overview of what presently ails our nations health care delivery system. It demonstrates how our health care delivery system is really a non-system with millions of independent, uncoordinated, and separately moving parts, priorities and vested interests. The result of this morass, more than forty million uninsured citizens, inconsistent and unaccountable care, and the fastest growing and most wasteful health care delivery economy in the world.

The authors argue that it is time for all parties -- payors, providers, consumers and policymakers -- to recognize that the U.S. is approaching a major health care crisis that is driven by the way we deliver, receive, and pay for care. Epidemic of Care offers a convincing portray how this impending crisis will impact nearly every segment of our society, including:
>> diminished take-home pay for America's workers
>> increases to the rate of uninsured as smaller companies drop health care coverage altogether
>> strains to senior's incomes as premiums for Medicare supplement plans and prescription drug costs climb
>> diminished quality resulting from inconsistent or uncoordinated care

The cure -- collaboration between payors, providers, consumers and policymakers to achieve a more accountable, efficient and affordable health care delivery system.

2 of 3 people found the following review helpful:

5.0 out of 5 stars Readable and timely, October 28, 2003

By	David Lockwood "spritegeezer" (Elk Grove, CA USA) - See all my reviews (REAL NAME)

This is an intellegently written synopsis of the current state of affairs in U.S. healthcare. Halvorson and Isham analyse the strengths and faults of the major attempts to bring the run away cost of health care into some affordable limits. They point out the strengths and weaknesses of each approach. They also have some suggestions for the future so we will not repeat the errors of the past.

Being in the Health Insurance business I have heard many alternatives proferred to correct our perceived need for health care reform. Mssrs. Halvorson and Isham have presented the best arguement I have seen so far for a workable solution.