Myths and realities about the decentralization of health systems

✍ Scribed by Maggie Huff-Rousselle

• Publisher: John Wiley and Sons
• Year: 2001
• Tongue: English
• Weight: 37 KB
• Volume: 16
• Category: Article
• ISSN: 0749-6753
• DOI: 10.1002/hpm.624

✦ Synopsis

Academic health centres clearly run the risk of succumbing to the processes that would encourage them to be much more like other organizations in their communities than organizations with rather unique missions and visions. The great fear is that like many of their community counterparts they will not have the courage to either seek excellence, nor to make decisions that will sacri®ce the spoils of excessive attention to bottom line. Of course when there is no margin there is no opportunity to be true to one's mission. But if there is a regression by AHCs to the mean of clinical practice in the community, these organizations that served as the stimulus to make American medicine great may no longer be the driving force for greatness in the 21st century. What role these organizations may play for the urban poor is also not clear. As the pool of uninsured Americans grows and public hospitals are equally challenged, AHCs will be challenged to provide enhanced services to communities of need.

Ginzberg concludes his discussion by stating that Congressional passage of a comprehensive insurance statute soon would go far to provide access to mainline health care for the urban poor and in turn improve the AHC's revenue position. Per-hapsÐbut perhaps not. Non AHC providers would certainly compete for this same patient base (assuming that the reimbursement rates were as attractive as Medicare or better Medicaid rates nationally)Ðand there is no guarantee that in such bidding AHCs would be the natural winners. And it is also not clear that securing such patient revenue would guarantee the opportunity to refocus on teaching, research and rescuing jurisdictions long gone.