This book review inaugurates a new feature for the Bulletin-reviews of important books on the socioeconomics of medical practice and neurosurgery. Bleeding Edge is a good place to start.
If you’ve heard John Kusske, MD, speak in the past two years, you have heard something from this book. It provides an insightful look at how healthcare in the United States arrived at its present predicament and makes educated guesses about what will happen in the future.
Past, Present, Future
In Bleeding Edge, Kleinke applies various tools of traditional management theory-competitive strategic analysis, operations research, organizational design and the like-to a trillion dollar business. He proceeds on the principle that healthcare, despite its enormous share of the economy, is only now emerging as a full-fledged modern industry. He speculates on how management of the healthcare enterprise will make the transition from folk art to industrial science, from reactive stewardship to strategic execution.
Kleinke depends on Paul Starr’s The Social Transformation of American Medicine as a starting point in describing the history of healthcare. Healthcare in America costs too much. Because the producer of the medical product determines the need for that product and is paid more for producing more of it, the producer has no motive to reduce cost. Managed care has failed.
The Five Forces of Healthcare Transformation
The book explores the five forces of healthcare transformation. They are:
- Risk assumption, to correct fundamental problems in health care consumption and market economics.
- Consumerism, to neutralize distortions in the health system created by the self-interest and faulty paternalism of managed care and other insurers and to galvanize competition among providers.
- Consolidation, to scale the health care infrastructure properly, mobilize capital, spread risk across broader populations of patients and providers, and allocate healthcare resources more efficiently.
- Integration, to correct the fragmentation and other structural defects built into the medical deliver system.
- Industrialization, to rationalize the haphazard use of services, increase economic predictability, improve quality, and reduce cost.
The Emergence of the EHO
The interactions of all these forces will conclude with the development of a new business entity-the emerging healthcare organization (EHO). The EHO will produce a new cooperative effort between hospitals and physicians. Kleinke sees the rise of the EHO requiring an increase in the number of physicians and an increase in the need for specialists.
This book is cleverly divided into four sections:
- Diagnosis,
- Treatment,
- Prognosis, and
- Outcomes.
It is extremely physician friendly and few will disagree with the analysis of what ails health care in American today. Although Kleinke makes his conclusions seem logical, non-physician healthcare executives love to poke holes in his balloon. Kleinke seeks responses to his concepts and even posts his Web site to elicit response.
Worth the Read?
Should you spend $35 to purchase this book and take the time to read it? Well, Dr. Kusske tells us that if neurosurgeons want to understand the real world of healthcare, they need to start with this book. This book is an easy read that will keep you turning pages. It can be read in three to four hours and will enhance your appreciation for changes going on all around us.
Gary VanderArk, MD, is a member of the AANS Board of Directors, a senior partner of Rocky Mountain Neurosurgical Alliance, Englewood, Colo., and past president of the Colorado Medical Society.