Governments throughout the industrialized world make decisions
that fundamentally affect the quality and accessibility of medical
care. In the United States, despite the absence of universal health
insurance, these decisions have great influence on the practice of
medicine.
In "Medical Governance," David Weimer explores an alternative
regulatory approach to medical care based on the delegation of
decisions about the allocation of scarce medical resources to
private nonprofit organizations. He investigates the specific
development of rules for the U.S. organ transplant system and
details the conversion of a voluntary network of transplant centers
to one private rulemaker: the Organ Procurement and Transplantation
Network (OPTN).
As the case unfolds, Weimer demonstrates that the OPTN is more
efficient, nimble, and better at making evidence-based decisions
than a public agency; and the OPTN also protects accountability and
the public interest more than private for-profit organizations.
Weimer addresses similar governance arrangements as they could
apply to other areas of medicine, including medical records and the
control of Medicare expenditures, making this timely and useful
case study a valuable resource for debates over restructuring the
U.S. health care system.
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