You’ll recall that the second group, health care providers, includes both the hospital and the professional and nonprofessional employees in the health care system. In some ways, the goals of the health care provider run counter to those of the first group, the purchasers of health care. The hospitals want to keep their beds full, and the doctors and other providers want to have a full appointment book, while the insurance companies will tell them they can, but only if the visits are absolutely necessary—and they’ll ask for proof. In many cases, in fact, the insurance companies will have the final say. Then again, the development of high-tech surgical procedures that can be performed on an outpatient basis, noninvasive testing, and potent new antibiotics that are given by mouth, not intravenously, has drastically reduced the length of the average hospital stay. The insurance companies have also begun to reward hospitals for encouraging shorter hospital stays by making the longer stays less profitable for them than shorter ones are. The hospitals have also begun to attract their own loyal market by forming their own HMOs—either an on-site staff group or a group of primary care physicians and specialists in private practice who refer their patients to a specific hospital when necessary. Hospital networks will also begin to develop: one hospital in the network will specialize in high-risk pediatric care, for instance, while another hospital will focus on state-of-the-art cancer therapies. This benefits patients who join the hospital-based HMOs, since they can easily be moved to the network hospital that specializes in their particular problem.

But while hospitals will quickly snap into action, many of the physicians in this country will have a dilemma: there are too many specialists in this country, and in the age of health care reform it’s the primary care physicians who will be in demand. As a result, many specialists will either have to incorporate primary care into their practices or else eliminate their specialty altogether. In addition, U.S. medical schools will need to make primary care an attractive option for medical students.


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