Why is our health care system so fragmented in the care it gives patients? Why is there little coordination amongst the many doctors who treat individual patients, who often even lack access to a common set of medical records? Why is fragmentation a problem even within a single hospital, where errors or miscommunications often seem to result from poor coordination amongst the myriad of professionals treating any one individual patient? Why is health care fragmented both over time, so that too little is spent on preventive care, and across patients, so that resources are often misallocated to the patients who need it least? The Fragmentation of U.S. Health Care: Causes and Solutions approaches these broad questions with a highly interdisciplinary approach. The articles included in the work address legal and regulatory issues, including laws that mandate separate payments for each provider, restrict hospitals or others from controlling or rewarding the set of providers treating a patient to assure coordinated care, and provide affirmative disincentives for coordinating care by paying more for uncoordinated care that requires more services. Business reasons for the current form of hospital organization are considered, and efficiency and design are examined and compared to other industries. The economics of current hospital organization are also taken into account. The authors examine and propose various reforms that make our health care system less fragmented, more efficient, and more medically effective.

Table of Contents

OUR FRAGMENTED HEALTH CARE SYSTEM: CAUSES AND SOLUTIONS; WHY WE SHOULD CARE ABOUT HEALTHCARE FRAGMENTATION AND HOW TO FIX IT - EINER ELHAUGE; HEALTH CARE FRAGMENTATION: WE GET WHAT WE PAY FOR -- DAVID HYMAN; ORGANIZATIONAL FRAGMENTATION AND CARE QUALITY IN THE US HEALTH CARE SYSTEM -- RANDAL CEBUL, JAMES REBITZER, LOWELL J. TAYLOR, & MARK VOTRUBA; CURING FRAGMENTATION WITH INTEGRATED DELIVERY SYSTEMS: WHAT THEY DO, WHAT HAS BLOCKED THEM, WHY WE NEED THEM, AND HOW TO GET THERE FROM HERE -- ALAIN ENTHOVEN; DEFRAGMENTING HEALTH CARE DELIVERY THROUGH QUALITY REPORTING -- KRISTIN MADISON; COMPETITION POLICY AND ORGANIZATIONAL FRAGMENTATION IN HEALTH CARE -- THOMAS GREANEY; OF DOCTORS AND HOSPITALS: SETTING THE ANALYTICAL FRAMEWORK FOR MANAGING AND REGULATING THE RELATIONSHIP -- JAMES BLUMSTEIN; PROPERTY, PRIVACY AND THE PURSUIT OF INTEGRATED MEDICAL RECORDS -- MARK A. HALL; VALUE-BASED PURCHASING OPPORTUNITIES IN TRADITIONAL MEDICARE: A PROPOSAL AND LEGAL EVALUATION -- LAWRENCE CASALINO & TIMOTHY JOST; A MORE EQUITABLE AND EFFICIENT APPROACH TO INSURING THE UNINSURABLE -- ERIC HELLAND & JONATHAN KLICK; ENDING THE SPECIALTY HOSPITAL WARS: A PLEA FOR PILOT PROGRAMS AS INFORMATION-FORCING REGULATORY DESIGN -- FRANK PASQUALE; FRAGMENTATION IN MENTAL HEALTH BENEFITS AND SERVICES: A PRELIMINARY EXAMINATION INTO CONSUMPTION AND OUTCOMES -- BARAK RICHMAN, DAN GROSSMAN, & FRANK SLOAN; FROM VISIBLE HARM TO RELATIVE RISK: OVERCOMING FRAGMENTED PHARMACOVIGILANCE? -- ARTHUR DAEMMRICH; THE US HEALTHCARE SYSTEM: A PRODUCT OF AMERICAN HISTORY AND VALUES -- DAVID JOHNSON & NANCY KANE; AMERICAN HEALTH CARE POLICY AND POLITICS: IS FRAGMENTATION A HELPFUL CATEGORY FOR UNDERSTANDING HEALTH REFORM EXPERIENCE AND PROSPECTS? -- THEODORE MARMOR

Reviews

"This book provides an outstanding analysis of the need for reform of the U.S. health care system and why much work remains to be done even with the recent efforts by Congress to improve health care access and delivery. The distinguished group of authors carefully documents a key failing of the health care system- the extent to which insufficient integration of medical services saddles Americans with serious inefficiencies in care. We pay too much for care whose quality is not nearly as high as it could be. Anyone interested in health care reform in the United States will find critically important insights and should consider this book a must read."
--David Orentlicher, Samuel R. Rosen Professor of Law and Co-director of the William S. and Christine S. Hall Center for Law and Health, Indiana University School of Law - Indianapolis
"Providers often fail to deliver treatments that are cheap and effective, while offering many treatments that are unproven, ineffective or ex