THE LIMITS OF HEALTH REFORM: The Search for Realism by Eli Ginzberg


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Like the contributors to John Knowles' commendable Doing Better and Feeling Worse (p. 393), Ginzberg recognizes the multifaceted nature of current health care issues, and his historical approach to these perplexities--along with some cautious proposals--should receive as much critical attention. Access to medical (not dental) care has increased largely because of the rise of insurance plans and, more recently, Medicare and Medicaid. Quality of care has improved substantially, although negligence can appear anywhere in the hospital hierarchy and technological innovations create other questions. Costs, of course, have skyrocketed, and political movements have dramatized the matter of equity and underserved groups. Establishing a national health system won't assure equal care for all, as Great Britain has discovered, but an acceptable level of treatment can be determined--and instituted without Draconian measures. Although finding goals is much easier than implementing methods to achieve them and conflicts of interest cannot be ignored, Ginzberg suggests a series of modifications worth pursuing: emphasis on ambulatory rather than inpatient treatment; regional coordination of health facilities; increased group (not solo) practice; regular physicians for clinic patients. Such ideas acknowledge tensions between conservatives and reformers and don't force alien values on patients or personnel His concern for human idiosyncrasy and the process of social change distinguishes Ginzberg's recommendations from those in Krause's Power and Illness (p. 325), and the clarity of his analysis distinguishes the book overall.

Pub Date: Nov. 11th, 1977
Publisher: Basic Books