Turning Doctors Into Employees

Matthew Anderson

Abstract


Background: Much of the contentious debate surrounding the Patient Protection and Affordable Care Act (“Obamacare”) concerned its financing and its attempt to guarantee (near) universal access to healthcare through the private insurance market.  Aside from sensationalist stories of “death panels,” much less attention went to implications of the bill for the actual provision of healthcare.

Methodology: This paper examines the "patient-centered medical home" (PCMH) model which has been widely promoted as a means of reviving and improving primary care (i.e. general internal medicine, family medicine, and pediatrics).

Argument: The PCMH and many of its components (e.g pay-for-performance, electronic medical records) were interventions that were implemented on a massive basis without any evidence of benefit. Recent research has not generally supported clinical benefits with the PCMH model. Instead it seems to designed to de-professionalize (make proletarians of) health care workers and enforce corporate models of health. The core values of professional work are undermined while the PCMH does nothing to address the structural marginalization of primary care within US health care.

Conclusions: The development of alternative models will require political changes. Both doctors and teachers are in a position of advocate for more progressive systems of care and education.


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References


Kafka, F. The Trial. Harmondsworth and London: Penguin,1953), 243.

Ehrenreich B, Ehrenreich J, Health/PAC. The American Health Empire: Power, Profits, and Politics. New York: Random House, 1970.

Health expenditure, total (% of GDP). The World Bank. Available at: http://data.worldbank.org/indicator/SH.XPD.TOTL.ZS. Accessed on January 13, 2014.

Ehrenreich and Ehrenreich. The American Health Empire.

Cuckler GA, Sisko AM, Keehan SP, et al. National health expenditure projections, 2012-22: Slow growth until coverage expands and economy improves. Health Aff (Millwood). 2013;32(10):1820-31.

Organisation for Economic Co-operation and Development. Health at a Glance 2011: OECD Indicators. OECD Publishing; 2011

Global Health Observatory: Life expectancy. World Health Organization. Available at: http://www.who.int/gho/mortality_burden_disease/life_tables/situation_trends/en/index.html. Accessed January 8, 2014.

Ehrenreich and Ehrenreich. The American Health Empire, 21.

Lobbying database. OpenSecrets.org. The Center for Responsive Politics. Available at: http://www.opensecrets.org/lobby/top.php?showYear=2013&indexType=c. Accessed January 8, 2014.

Starfield B, Shi L, Macinko J. Contribution of primary care to health systems and health. Milbank Q. 2005;83(3):457-502; Macinko J, Starfield B, Shi L. Quantifying the health benefits of primary care physician supply in the United States. Int J Health Serv. 2007;37(1):11.

Starfield B, Shi L, Grover A, Macinko J. The effects of specialist supply on populations’ health: assessing the evidence. Health Aff (Millwood). 2005;Suppl Web Exclusives:W5-97-W5-107.

OECD, Health at a Glance 2011.

Goodson JD. Unintended consequences of resource-based relative value scale reimbursement. JAMA. 2007;298(19):2308-10.

Sia C, Tonniges TF, Osterhus E, Taba S. History of the medical home concept. Pediatrics. 2004;113(5 Suppl):1473-8.

Stange KC, Nutting PA, Miller WL, Jaen CR, Crabtree BF, Flocke SA, et al. Defining and measuring the patient-centered medical home. J Gen Intern Med. 2010;25(6):601-12.

Van Herck P, De Smedt D, Annemans L, Remmen R, Rosenthal MB, Sermeus W. Systematic review: effects, design choices, and context of pay-for-performance in healthcare. BMC Health Serv Res. 2010;10:247.

DesRoches CM, Campbell EG, Vogeli C, Zheng J, Rao SR, Shields AE, et al. Electronic health records’ limited successes suggest more targeted uses. Health Aff (Millwood). 2010;29(4):639-46.

Hartzband P, Groopman J. Off the record--avoiding the pitfalls of going electronic. N Engl J Med. 2008;358(16):1656-8.

Patient Voice: Every Patient Matters. Every Voice Counts. Press Ganey. Available at: http://www.pressganey.com/ourSolutions/patient-voice.aspx. Accessed January 8, 2014.

Campbell DT. Assessing the impact of planned social change. Hannover, New Hampshire: Public Affairs Center, Dartmouth College; 1976. 71 p. Occasional Paper Series. Available at: https://www.globalhivmeinfo.org

/CapacityBuilding/Occasional Papers/08 Assessing the Impact of Planned Social Change.pdf. Accessed January 8, 2014.

Corporate partners. National Heart Lung and Blood Institute. Available at: http://www.nhlbi.nih.gov/educational/hearttruth/partners/corporate-partners.htm. Accessed January 8, 2014.

Campbell EG, Weissman JS, Ehringhaus S, Rao SR, Moy B, Feibelmann S, et al. Institutional academic industry relationships. JAMA. 2007;298(15):1779-86.

Carmichael M. Bitter Pills: Harvard Medical School and Big Pharma. Boston. November 2009.

http://www.bostonmagazine.com/2009/10/bitter-pills/. Accessed January 8, 2014.

Executive summary. AMSA PharmFree Scorecard 2013. http://www.amsascorecard.org/executive-summary. Updated April 9, 2013. Accessed January 8, 2014.

Hartocollis A. Harvard researcher chosen as new dean of Weill Cornell Medical College. New York Times. September 7, 2011. http://www.nytimes.com/2011/09/08/nyregion/laurie-h-glimcher-named-dean-of-weill-cornell-medical-college.html. Accessed January 8, 2014.

Stein J. Weill Cornell dean remains on corporate payrolls, sparking debate about industry’s role in academia. The Cornell Daily Sun. November 30, 2012. Available: http://cornellsun.com/blog/2012/11/30/weill-cornell-dean-remains-on-corporate-payrolls-sparking-debate-about-industrys-role-in-academia/. Accessed January 8, 2014.

Geiger HJ. Community-oriented primary care: a path to community development. Am J Public Health. 2002;92(11):1713-6.

Stewart M. The Management Myth: Why the Experts Keep Getting It Wrong. New York: W. W. Norton & Co.; 2009.

Brennan VM, editor. Free Clinics: Local Responses to Health Care Needs. Baltimore, MD: The Johns Hopkins University Press; 2013, ix.




DOI: https://doi.org/10.5195/rt.2014.104

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