Description: This book presents the results and conclusions of a comprehensive four-year study of how 11 major healthcare systems are responding to the cost-containment pressures of managed care. It offers suggestions and recommendations for implementing a more integrated, cost-effective healthcare delivery system oriented to a model of community healthcare management.
Purpose: The purpose is to present the paradigm of organized (i.e., integrated) healthcare systems as an intermediate step in the evolution of community healthcare management systems. The objective is to describe a community-oriented model that (1) overcomes fragmentation that characterizes present delivery systems; (2) shows how to build community; (3) explains the development of competencies and capabilities required for a community healthcare management system; and (4) suggests ways to establish a local and national health policy that supports the transformation to a community model of healthcare delivery.
Audience: The authors denote four major audiences for this book: (1) healthcare policymakers at state and federal levels; (2) health services executives and clinical leaders; (3) insurers and payers; and (4) health service researchers. But almost anyone interested in the direction of healthcare will find the book of interest. Medical students and young physicians would benefit from reading it, because they will be practicing in tomorrow's environment of healthcare delivery. The authors are all expert in their respective fields and as a group are very well qualified to compile the text.
Features: The book is well composed and formatted as might be expected from the publisher, Jossey-Bass. The book contains a few line drawings as illustrations; more illustrations would have helped with some of the more complex concepts. There is an adequate number of references, and they are up-to-date. A comprehensive index is provided, and two appendixes yield brief descriptions of the institutions studied and the types of data collected. The writing is clear and succinct, and the book is a pleasure to read, especially because many of the concepts go well beyond the traditional paradigm of integrated delivery systems as models for managed care.
Assessment: This book presents the challenge of creating an environment that supports the evolution of the nation's healthcare system into a more integrated, community-wide approach that focuses on alliances, linkages, and partnerships with public health and social service agencies. It offers a conceptual framework for promoting the integration of finance, human resources, strategic planning, total quality management, and information systems into a new model of healthcare delivery. Anyone thinking about the future of healthcare and how individuals, institutions, and healthcare systems should position themselves to prepare for it should read this book. It will prove to be an invaluable resource to effective planning for the future.