A Study in Institution
Building
Laura Anne Schmidt
CCOP Working Paper #2000-08
January, 2000
In the last three decades,
the American health care system has undergone revolutionary change.
What was for much of the 20th century a cottage industry dominated
by a monopolizing medical profession is now a sprawling, price-competitive
market dominated by large, integrated health care firms. Medicine's
traditional ethos of community service and fiduciary ethic seem
to have given way to the unbridled spirit of corporate capitalism.
And the organizations that now populate the landscape of the health
care system seem radically unfamiliar. Gone are the autonomous
community hospitals and solo medical practices that most Americans
grew up with. Entrepreneurs and venture capitalists have replaced
them with a whole menagerie of integrated delivery systems, managed
care plans, provider networks and national health care chains.
Perhaps the most striking
changes are in the medical profession. For much of the 20th century,
medicine was an heroic exception to the otherwise waning tradition
of independent professionalism in America. But in recent decades,
much of the profession has succumbed to the iron rule of the large
corporation and bureaucracy. The majority of young physicians
today work in jobs as the employees of organizations. And most
practicing physicians, young and old, work under contracts with
firms that actively monitor and control what they do by making
them accountable to outside standards of cost-effectiveness. Today,
medical trade journals debate if and how physicians could "take
back" medicine.
