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Problems with efficiency: What is measurable output?. 1) Consumer satisfaction? 2) Consumer health? 3) Incidence of specific problems? 4) Morbidity and mortality rates?. Three Revolutions . 1) Technological 2) Professionalization 3) Third party payer. Technological Revolution.
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Problems with efficiency: What is measurable output? 1) Consumer satisfaction? 2) Consumer health? 3) Incidence of specific problems? 4) Morbidity and mortality rates?
Three Revolutions 1) Technological 2) Professionalization 3) Third party payer
Technological Revolution • The modern hospital • 1907—Medicine becomes worth it • Effective Antibiotics • Reasonable safety in abdominal surgery • ICUs and CCUs • Transplants and organ replacement • Expansion of therapy – Psychological disorders – Perfective procedures • Preventive Medicine
Professionalization Revolution • The Nineteenth Century: Real free market medicine – The chaos of medical education – Doc and the Longhorn Saloon • Harvard, Johns Hopkins and the German model of medical education • The Council of Medical Education (1904) – Promoted “scientific” medicine – Proposed pre-med and med school standards • The Flexner Report (1910) – Licensure laws – Locking up drugs • The ascendency of the AMA • The physician as Captain of the Ship