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October 1996, Vol 53, No. 10 >
Article | October 1996

A Funny Thing Happened on the Way to Reform

Gary L. Tischler, MD; Boris M. Astrachan, MD
Arch Gen Psychiatry. 1996;53(10):959-963. doi:10.1001/archpsyc.1996.01830100109014
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Out at Free Enterprise, where the Needies fight The Greedies for the great Grail of the World And always lose, we can help balance up The scales of earthly good; not much, but some; And for a wonder, though it hurt at first, It will feel good because our kindness did it.

Howard Nemerov, Trying Conclusions: New and Selected Poems, 1961-1991. Chicago, Ill: The University of Chicago Press; 1991.

TWO YEARS ago, we were eagerly awaiting major changes in the financing, organization, and delivery of health care. But a funny thing happened on the way to reform. America's corporate class discovered that it had the will, the ways, and the means to reshape the health care establishment. They seized the moment and effected a far more dramatic "takeover" than the consolidations and mergers we read about in the business sections of our daily newspapers. The values of the marketplace and

REFERENCES

1 +
Uchitelle L, Kleinfield NR.  On the battlefield of business: millions of casualties . The New York Times . (March 3) , 1996;;145(50335):1, 14-17.
2 +
Kleinfield NR.  The company as family: no more . The New York Times . (March 4) , 1996;;145(50356): 1, A8-A10.
3 +
Bragg R.  Big holes where the dignity used to be . The New York Times . (March 5) , 1996;;145 (50357):1, A8-A10.
4 +
Rimer S.  A hometown feels less like home . The New York Times . (March 6) , 1996;;145(50358):1, A8-A10.
5 +
Johnson K.  In the class of 70: wounded winners . The New York Times . (March 7) , 1996;;145 (50359):1, A12-A14.
6 +
Kolbert E. Clymer A.  The politics of layoffs: in search of a message . The New York Times . (March 8) , 1996;;145(50360):1, A12-A13.
7 +
Saeger DE, Lorh S.  A search of answers to avoid the layoffs . The New York Times . (March 9) , 1996;;145(50361):1, 10-11.
8 +
Head S.  The new ruthless economy . The New York Review of Books . (February 29) , 1996;;43:47-52.
9 +
Olfson M, Broadhead WE, Weissman, MM, Leon AC, Farber L, Hoven C, Kathol R.  Subthreshold psychiatric symptoms in a primary care group practice . Arch Gen Psychiatry . 1996;;53:880-886.
10 +
Sherbourne CD, Wells KB, Meredith LS, Jackson CA, Camp P.  Comorbid anxiety disorder and the functioning and well-being of chronically ill patients of general medical providers . Arch Gen Psychiatry . 1996;;53:889-895.
11 +
Henk HJ, Katzelnick DJ, Kobak KA, Greist JH, Jefferson JW.  Medical costs attributed to depression among patients with a history of high medical expenses in a health maintenance organization . Arch Gen Psychiatry . 1996;;53:899-904.
12 +
Meredith LS, Wells KB, Kaplan SH, Mazel RM.  Counseling typically provided for depression: role of clinician specialty and payment system . Arch Gen Psychiatry . 1996;;53:905-912.
13 +
Schulberg HC, Block MR, Madonia MJ. Scott CP, Rodriguez E, Imber SD, Pere IJ, Lave J. Houck PR, Coulehan JL.  Treating major depression in primary care practice: eight-month clinical outcomes . Arch Gen Psychiatry . 1996;;53:913-919.
14 +
Katon W, Robinson P, Von Korff M, Lin E, Bush T, Ludman E, Simon G, Walker E.  A multifaceted intervention to improve treatment of depression in primary care . Arch Gen Psychiatry . 1996;;53:924-932.
15 +
Frank RG. Huskamp HA, McGuire TG, Newhouse JP.  Some economics of mental health 'carve-outs.' Arch Gen Psychiatry . 1996;;53:933-937.
16 +
McFarland BH, Johnson RE, Hornbrook MC.  Enrollment duration, service use, and costs of care for severely mentally ill members of a health maintenance organization . Arch Gen Psychiatry . 1996;;53:938-944.
17 +
Dickey B, Normand S-LT, Norton EC, Azeni H, Fisher M, Altaffer F.  Managing the care of schizophrenia: lessons from a 4-year Massachusetts Medicaid study . Arch Gen Psychiatry . 1996;;53:945-952.
18 +
Unutzer J, Tischler GL.  The many faces of managed care . In: Moscarelli M, Rupp A, Sartorius N, eds. Handbook of Mental Health Economics and Health Policy . London, England: John Wiley &Sons Inc; 1996;;1:42:493-502.
19 +
Sledge WH, Astrachan B, Thompson K, Rakfeldt J, Leaf P.  Case management in psychiatry: an analysis of tasks . Am J Psychiatry . 1995;;152: (9) :1259-1265.
20 +
Zhang M, Owen RR, Pope SK, Smith GR.  Costeffectiveness of clozapine monitoring after the first 6 months . Arch Gen Psychiatry . 1996;;53:954-958.
21 +
Tischler GL.  Utilization management and the quality of care . Hosp Community Psychiatry . 1990;;41: (10) :1099-1102.
22 +
Docherty JP.  Myths and mystification of managed care . J Ment Health Administration . 1990;;17:138-144.
23 +
Tischler GL.  Utilization management of mental health services by private third parties . Am J Psychiatry . 1990;;147: (8) :967-973.
24 +
Reinhardt UE.  Turning our gaze from bread and circus games . Health Aff . 1994;;14:1:33-36.
25 +
Tenery RM.  Socialized care wrong? 'corporatized' not much better . American Medical News . April 1, 1996;;39( (13) ):17.
26 +
Starr P. The Social Transformation of American Medicine . New York, NY: Basic Books Inc Publishers; 1982;.
27 +
Stevens R. In Sickness and In Wealth: American Hospitals in the Twentieth Century . New York, NY: Basic Books Inc Publishers; 1989;.
28 +
Freidson E. Profession of Medicine: A Study of the Sociology of Applied Knowledge . New York, NY: Dodd Mead & Co; 1970;.
29 +
Ginsberg E.  High-tech medicine and rising health care costs . JAMA . 1990;;263:1820-1822.

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Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal

1 +
Uchitelle L, Kleinfield NR.  On the battlefield of business: millions of casualties . The New York Times . (March 3) , 1996;;145(50335):1, 14-17.
2 +
Kleinfield NR.  The company as family: no more . The New York Times . (March 4) , 1996;;145(50356): 1, A8-A10.
3 +
Bragg R.  Big holes where the dignity used to be . The New York Times . (March 5) , 1996;;145 (50357):1, A8-A10.
4 +
Rimer S.  A hometown feels less like home . The New York Times . (March 6) , 1996;;145(50358):1, A8-A10.
5 +
Johnson K.  In the class of 70: wounded winners . The New York Times . (March 7) , 1996;;145 (50359):1, A12-A14.
6 +
Kolbert E. Clymer A.  The politics of layoffs: in search of a message . The New York Times . (March 8) , 1996;;145(50360):1, A12-A13.
7 +
Saeger DE, Lorh S.  A search of answers to avoid the layoffs . The New York Times . (March 9) , 1996;;145(50361):1, 10-11.
8 +
Head S.  The new ruthless economy . The New York Review of Books . (February 29) , 1996;;43:47-52.
9 +
Olfson M, Broadhead WE, Weissman, MM, Leon AC, Farber L, Hoven C, Kathol R.  Subthreshold psychiatric symptoms in a primary care group practice . Arch Gen Psychiatry . 1996;;53:880-886.
10 +
Sherbourne CD, Wells KB, Meredith LS, Jackson CA, Camp P.  Comorbid anxiety disorder and the functioning and well-being of chronically ill patients of general medical providers . Arch Gen Psychiatry . 1996;;53:889-895.
11 +
Henk HJ, Katzelnick DJ, Kobak KA, Greist JH, Jefferson JW.  Medical costs attributed to depression among patients with a history of high medical expenses in a health maintenance organization . Arch Gen Psychiatry . 1996;;53:899-904.
12 +
Meredith LS, Wells KB, Kaplan SH, Mazel RM.  Counseling typically provided for depression: role of clinician specialty and payment system . Arch Gen Psychiatry . 1996;;53:905-912.
13 +
Schulberg HC, Block MR, Madonia MJ. Scott CP, Rodriguez E, Imber SD, Pere IJ, Lave J. Houck PR, Coulehan JL.  Treating major depression in primary care practice: eight-month clinical outcomes . Arch Gen Psychiatry . 1996;;53:913-919.
14 +
Katon W, Robinson P, Von Korff M, Lin E, Bush T, Ludman E, Simon G, Walker E.  A multifaceted intervention to improve treatment of depression in primary care . Arch Gen Psychiatry . 1996;;53:924-932.
15 +
Frank RG. Huskamp HA, McGuire TG, Newhouse JP.  Some economics of mental health 'carve-outs.' Arch Gen Psychiatry . 1996;;53:933-937.
16 +
McFarland BH, Johnson RE, Hornbrook MC.  Enrollment duration, service use, and costs of care for severely mentally ill members of a health maintenance organization . Arch Gen Psychiatry . 1996;;53:938-944.
17 +
Dickey B, Normand S-LT, Norton EC, Azeni H, Fisher M, Altaffer F.  Managing the care of schizophrenia: lessons from a 4-year Massachusetts Medicaid study . Arch Gen Psychiatry . 1996;;53:945-952.
18 +
Unutzer J, Tischler GL.  The many faces of managed care . In: Moscarelli M, Rupp A, Sartorius N, eds. Handbook of Mental Health Economics and Health Policy . London, England: John Wiley &Sons Inc; 1996;;1:42:493-502.
19 +
Sledge WH, Astrachan B, Thompson K, Rakfeldt J, Leaf P.  Case management in psychiatry: an analysis of tasks . Am J Psychiatry . 1995;;152: (9) :1259-1265.
20 +
Zhang M, Owen RR, Pope SK, Smith GR.  Costeffectiveness of clozapine monitoring after the first 6 months . Arch Gen Psychiatry . 1996;;53:954-958.
21 +
Tischler GL.  Utilization management and the quality of care . Hosp Community Psychiatry . 1990;;41: (10) :1099-1102.
22 +
Docherty JP.  Myths and mystification of managed care . J Ment Health Administration . 1990;;17:138-144.
23 +
Tischler GL.  Utilization management of mental health services by private third parties . Am J Psychiatry . 1990;;147: (8) :967-973.
24 +
Reinhardt UE.  Turning our gaze from bread and circus games . Health Aff . 1994;;14:1:33-36.
25 +
Tenery RM.  Socialized care wrong? 'corporatized' not much better . American Medical News . April 1, 1996;;39( (13) ):17.
26 +
Starr P. The Social Transformation of American Medicine . New York, NY: Basic Books Inc Publishers; 1982;.
27 +
Stevens R. In Sickness and In Wealth: American Hospitals in the Twentieth Century . New York, NY: Basic Books Inc Publishers; 1989;.
28 +
Freidson E. Profession of Medicine: A Study of the Sociology of Applied Knowledge . New York, NY: Dodd Mead & Co; 1970;.
29 +
Ginsberg E.  High-tech medicine and rising health care costs . JAMA . 1990;;263:1820-1822.

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