The Medical Delivery Business
The Medical Delivery Business
Health Reform, Childbirth, and the Economic Order
Americans at the end of the twentieth century worried that managed care had fundamentally transformed the character of medicine. In The Medical Delivery Business, Barbara Bridgman Perkins uses examples drawn from maternal and infant care to argue that the business approach in medicine is not a new development. Health care reformers throughout the century looked to industrial, corporate, and commercial enterprises as models for the institutions, specialties, and technological strategies that defined modern medicine.
In the case of perinatal care, the business model emphasized specialized over primary care, encouraged the use of surgical and technological procedures, and unnecessarily turned childbirth into an intensive care situation. Active management techniques, for example, encouraged obstetricians to accelerate labor with oxytocin to augment their productivity. Despite the achievements of the childbirth and women’s health movement in the 1970s, aggressive medical intervention has remained the birth experience for millions of American women (and their babies) every year.
The Medical Delivery Business challenges the conventional view that a dose of the market is good for medicine. While Perkins is sympathetic to the goals of progressive and feminist reformers, she questions whether their strategies will succeed in making medicine more equitable and effective. She argues that the medical care system itself needs to be fundamentally "re-formed," and the reforms must be based on democracy, caring, and social justice as well as economics.
A prodigiously researched and well-written account of the influence of business thinking on the practice of medicine. Informative, lively, and insightful.
A prodigiously researched and well-written account of the influence of business thinking on the practice of medicine. Informative, lively, and insightful.
This book provides a well-documented counter-analysis to the prevailing models that market and economic considerations did not really begin to shape the structure of health care delivery until after World War II. A fine work of contemporary medical history.
This is the analysis we've all been waiting forùPerkins has put it all together, showing us the historic roots and contemporary consequences of the economic and industrial approach to childbirth. No matter how much you have read in the childbirth literature, you won't fully understand what is happening until you have read this!
Abbreviations
One Introduction: Business Models and Medical Interventions
Part I Medical Specialism and Early-Twentieth-Century Economic Organization
Two Academic Specialty Departments and Scientific Management
Three Dividing Labor, Industrializing Birth
Part II Designing Delivery Systems
Four The Committee on the Costs of Medical Care and Corporate Organization of Medicine
Five Regional Health Planning and Economic Organization of the Medical Industry
Six Perinatal Regionalization and Economic Order
Part III The Economic Production of Childbirth
Seven Competing for the Birth Market: Providers, Procedures, and Paradigms
Eight Capital Intensive Medicine and Academic Practice Plans
Nine Managing Birth: Managed Care and Active Management of Labor
Ten Conclusion: Re-forming Medicine, Reforming Reform
Notes
Index
