THE RISE AND FALL OF HMOS: An American Health Care Revolution

Jan Coombs, Author . Univ. of Wisconsin $35 (412p) ISBN 978-0-299-20240-8

Alternating a broad historical overview of HMOs with a close analysis of one institution, the Marshfield Clinic in northern Wisconsin, medical historian Coombs (You Can Help: Living with the Disabled ) paints a sobering portrait of American health care. A rural multispecialty clinic long admired for its quality of care, Marshfield is, for Coombs, "emblematic" of the failure caused by federal legislation that began in the early 1970s and continued through the end of the century. Coombs marshals an array of statistics, anecdotes and extended narratives that point to the detrimental effects HMOs have had on both patients and the providers. With a gift for deciphering and articulating complex scenarios, Coombs provides readers with the necessary historical background to understand HMOs. For instance, her deft treatment of the history of health-care economics and the political motivations behind the 1973 Health Maintenance Organization Act allows the reader to better grasp how employer-based systems, in her assessment, have led to care that is inequitable, wasteful and financially woeful when the benefits are evaluated against the costs. Coombs also offers prescriptions. Health-care policy makers and administrators will appreciate Coombs's thoroughness, and while the lay reader may struggle with pages devoted to arcane health-care legislation, this book makes a critical contribution to medicine and its literature. (Mar.)

Reviewed on: 02/07/2005
Release date: 03/01/2005
Genre: Nonfiction
Discover what to read next