TRANSFORMED

A book chronicles an ailing public academic health center’s transformation into an independent corporation.

In 1988, Dr. Peter Kohler became the president of Oregon Health & Science University, at the time beleaguered by problems. It was saddled with debt; state funding had all but dried up; its infrastructure was in desperate need of repair; its reputation was less than stellar; and it was divided by internecine disputes. Kohler believed that the way to a brighter future was through a radical reconfiguration of its operating model. This involved liberation from state regulatory manacles, which were prohibitively restrictive as well as nonsensical given the lack of support Oregon provided: “Withering state funding was the chief driver for OHSU to transform, not only because it needed more flexibility to compete in health care, but also because it made no sense to give the state regulatory authority over an institution it was no longer supporting.” Graves (co-author of Poisoned Apple, 1995) details the history of this metamorphosis, ultimately achieved in 1995, and all the hurdles—logistical, financial, and legislative—that had to be cleared in advance of it. Once an independent corporation, OHSU was permitted to raise funds from investors, improve and expand its facilities, attract top doctors and researchers, and bid for higher-paying patients, eventually rehabilitating its name. The author also considers the extent to which OHSU can be understood as a model for others to emulate and a bellwether of the future of academic health centers. Graves has covered health care and education as a journalist for more than 20 years, and his experience can be seen in his remarkably thorough investigative research and unfailingly clear, concise prose. More than just an institutional history, this is an intriguing mélange of profiles, especially the sensitive portrayal of Kohler. Furthermore, it would be impossible to adequately relate OHSU’s tale without also furnishing a history of Oregon’s approach to the financing of health care as well as federal funding, something Graves expertly supplies. But one of the principal virtues of the book—its unremittingly scrupulous attention to microscopic detail—is also its chief vice; there is no factoid so minute that the author considers it unworthy of protracted examination. For example, complex discussions of OHSU’s entry into the bond market, the challenges it faced expanding beyond Portland into outlying rural areas via the construction of a tram, and the resistance its mutation faced from its own faculty are all important parts of OHSU’s history but are also unlikely to grip readers without a professional interest in the subject. Nonetheless, this is an astute peek not just into Oregon’s grappling with the question of how to best provide affordable high-quality health care to its citizens, but also the nation’s encounter with the same issue at large. Despite the accessible language, this is more an academic than popular treatment of the subject and should serve as a valuable resource for those working in the medical field.

A comprehensive and insightful look at the intersection of health care and government.