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For-Profit Enterprise in Health Care

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"[This book is] the most authoritative assessment of the advantages and disadvantages of recent trends toward the commercialization of health care," says Robert Pear of The New York Times. This major study by the Institute of Medicine examines virtually all aspects of for-profit health care in the United States, including the quality and availability of health care, the cost of medical care, access to financial capital, implications for education and research, and the fiduciary role of the physician. In addition to the report, the book contains 15 papers by experts in the field of for-profit health care covering a broad range of topics—from trends in the growth of major investor-owned hospital companies to the ethical issues in for-profit health care. "The report makes a lasting contribution to the health policy literature." —Journal of Health Politics, Policy and Law.


Suggested Citation

Institute of Medicine. 1986. For-Profit Enterprise in Health Care. Washington, DC: The National Academies Press.

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Publication Info

580 pages |8.5 x 11
ISBN: 978-0-309-07863-4

Table of Contents

skim chapter
Front Matter i-xxiv
Part I: Committee Report 1-2
1 Profits and Health Care: An Introduction to the Issues 3-25
2 Changes in Ownership, Control, and Configuration 26-46
3 Financial Capital and Health Care Growth Trends 47-73
4 Investor Ownership and the Costs of Medical Care 74-96
5 Access to Care and Investor-Owned Providers 97-126
6 Quality of Care 127-141
7 Implications for Education and Research 142-150
8 Physicians and Entrepreneurism in Health Care 151-170
9 The Changing Nature of Physician Influence in Medical Institutions 171-181
10 Summary and Conclusions 182-206
Part II: Papers on For-Profit Enterprises in Health Care 207-208
1 An Exchange on For-Profit Health Care 209-223
2 Ethical Issues in For-Profit Health Care 224-249
3 Trends in the Growth of the Major Investor-Owned Hospital Companies 250-259
4 The Effects of Ownership and Multihospital System Membership on Hospital Functional Strategies and Economic Performance 260-289
An Analysis Based on California Data, 1978-1982 290-302
6 Hospital Acquision and Their Effects: Florida, 1979-1982 303-321
7 Hospital Ownership and Comparative Hospital Costs 322-353
8 Medicare Patient Outcomes and Hospital Organizational Mission 354-374
9 Compliance of Multihospital Systems with Standards of the Joint Commission on Accreditation of Hospitals 375-384
10 Hospital Ownership and the Practice of Medicine: Evidence from the Physician's Perspective 385-401
11 Physicial Participation in the Administration and Governance of System and Freestanding Hospitals: A Comparison by Type of Ownership 402-421
12 Medical Staff Size, Hospital Privileges, and Compensation Arrangements: A Comparison of System Hospitals 422-457
13 Hospitals and Their Communities: A Report on Three Case Studies 458-473
14 Investor-Owned Multihospital Systems: A Synthesis of Research Findings 474-491
15 The Changing Structure of the Nursing Home Industry and the Impact of Ownership on Quality, Cost, and Access 492-542
Index 543-556

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