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Toward a 21st Century Health System: The Contributions and Promise of Prepaid Group Practice

Alain C. Enthoven (Editor), Laura A. Tollen (Editor), William L. Roper (Foreword by)
ISBN: 978-0-7879-7404-6
300 pages
March 2004, Jossey-Bass
Toward a 21st Century Health System: The Contributions and Promise of Prepaid Group Practice (0787974048) cover image


Toward a 21st Century Health System is a collection of thoughtful analyses that explore a key element of the health care delivery system¾physician group practices. Edited by policy experts Alain Enthoven and Laura Tollen, and written by a blue ribbon panel of health policy scholars and leaders including Stephen Shortell, Hal Luft, Donald Berwick, James Robinson, and Helen Darling, this resource addresses a variety of topics, including 
  • Organized delivery systems
  • Quality of care in prepaid group practice versus other types of managed care
  • The role of physician leadership and culture in group practice
  • Prepaid group practice and the formation of national health policy

This comprehensive resource also covers such topics as pharmacy benefit management, technology assessment, health services research, and employer purchasing of benefits– all as they relate to prepaid group practice.


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Table of Contents

Tables and Exhibits ix

Acknowledgments xi

The Contributors xiii

Foreword xxiii
William L. Roper

Preface xxvii
Alain C. Enthoven, Laura A. Tollen

1 Prepaid Groups and Organized Delivery Systems: Promise, Performance, and Potential 1
Stephen M. Shortell and Julie Schmittdiel

2 Systems and Results: The Basis for Quality Care in Prepaid Group Practice 22
Donald M. Berwick and Sachin H. Jain

3 The Clinical and Economic Performance of Prepaid Group Practice 45
Kenneth H. Chuang, Harold S. Luft, and R. Adams Dudley

4 Prepaid Group Practice and Health Care Policy 61
Jon B. Christianson and George Avery

5 Technology Assessment, Deployment, and Implementation in Prepaid Group Practice 85
David M. Eddy

6 Managing the Pharmacy Benefit in Prepaid Group Practice 108
William H. Campbell, Richard E. Johnson, and Sharon L. Levine

7 Prepaid Group Practice and Medical Workforce Policy 128
Jonathan P. Weiner

8 Prepaid Group Practice and Health Care Research 156
Raymond Fink and Merwyn R. Greenlick

9 Physician Leadership: “Group Responsibility” as Key to Accountability in Medicine 179
Francis J. Crosson, Allan J. Weiland, and Robert A. Berenson

10 The Limits of Prepaid Group Practice 199
James C. Robinson

11 The Relationship Between Prepaid Group Practice and the Employer Community 213
Helen Darling

12 Open the Markets and Level the Playing Field 227
Alain C. Enthoven

Editors’ Introduction to the Epilogue 247

Epilogue: Prepaid Group Practice and Computerized Caregiver

Support Tools 249
George C. Halvorson

Appendix: The Origins of Prepaid Group Practice in the United States 265
Jon A. Stewart

Index 275

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Author Information

Alain C. Enthoven is Marriner S. Eccles Professor of Public and Private Management (Emeritus), Graduate School of Business, and Senior Fellow, , Center for Health Policy, Stanford University. He was an architect of the managed competition model of health reform, subsequently adopted by President Clinton in the Health Security Act of 1996.

Laura A. Tollen is senior policy consultant for the Kaiser Permanente Institute for Health Policy.  She works on issues related to insurance market structure and functioning. 

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"Several of the chapters are excellent analyses of how the PGP model is responsive to current policy and delivery concerns." (JAMA; 11/24/2004)

"This book should be required reading for every physician in the United States." (Health Affairs, Vol 23, No 4; July/August 2004)

“A brief review cannot do justice to the range of issues explored in this volume… Toward a 21st Century Health System repays careful study.” (Health Service Journal, April 2004)

"After three decades of trying to reform?health care...by looking for a 'silver bullet,' I found?the ?future? has been here for more than a century. Policymakers tired of banging heads and gavels on stone walls need look no further than this well-designed?analysis of prepaid group practice for the incentives necessary to enhance health system quality, safety and performance, expand access and equity, and vastly improve the professional-patient relationship."
—Hon. David Durenberger, U. S. Senator (1978-1995), Senior Health Policy Fellow, University of St. Thomas

"If you wonder why the American health system...is judged by distinguished experts as ?the poster boy of underachievement,? read this collection of fine essays by longtime students of that system.... The book is a particularly valuable read for students of medicine, health administration and health policy. Here they will learn...how much better value might be wrung out of the health system for the truly ample resources Americans grant it."
—Uwe Reinhardt, James Madison professor of Political Economy, Princeton University

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