June 18, 2010
Why is our health care system so fragmented in the care it gives patients? Why is there little coordination amongst the many doctors who treat individual patients, who often even lack access to a common set of medical records?
A recently published book on health care in the United States, “The Fragmentation of U.S. Health Care: Causes and Solutions” (Oxford University Press, 2010), seeks to answer some of those questions. The book, edited and contributed to by HLS Professor Einer Elhauge ’86, examines the challenges arising from the absence of coordinated decision-making within the U.S. health care system, from the patient level to the administrative level.
The highly interdisciplinary volume offers evidence that fragmentation within the U.S. health care system leads to increased medical errors, higher costs, less preventive care and misallocation of health care resources. Its contributors—including leading scholars in the fields of law, medicine, business, economics and political science—identify possible causes, such as laws that mandate separate payments for each provider, creating a disincentive for coordinating care. They also explore regulatory issues and business and economic motivations they believe are responsible for fragmentation, and propose reforms to make the system more efficient and effective.
The book was born out of a June 2008 conference on fragmentation held at the Petrie-Flom Center for Law Policy, Biotechnology, and Bioethics at Harvard Law School. Elhauge, the Center's founding director, assembled an interdisciplinary group of scholars to look at the inefficiencies in health care delivery. Many of the papers presented at the conference are included in this edited volume, which includes, in the book’s first chapter, Elhauge’s article “Why We Should Care About Healthcare Fragmentation and How to Fix It.”
In a recent Q&A, Elhauge discusses fragmentation of healthcare with Allison Hoffman, a fellow at the Petrie-Flom Center.
An expert in antitrust, contracts, and health care law, Elhauge served as chairman of the Antitrust Advisory Committee for the Obama campaign and is the author of several books, including “Statutory Default Rules” and “United States Antitrust Law & Economics,” and “Global Competition Law and Economics.” Currently he is writing books about Contract Theory, Health Law Policy, and Re-engineering Human Biology, and editing books on Antitrust Economics and Health Law Economics.
Hoffman, who will be joining the faculty at UCLA law school, was an academic fellow and lecturer on law at HLS from 2008 to 2010. She focuses her research on exploring the role of regulation and the welfare state in promoting health and well being. Her scholarship examines how different models of regulation can create both intended and unintended consequences at the intersection of individual health, financial security, and equity concerns. She explores, in particular, how different models of regulation can shape the way we organize what is individual versus collective risk and responsibility, drawing on political science, sociology, psychology, and economics methodologies.
A 2004 graduate of the Yale Law School, Hoffman practiced health law at Ropes & Gray, where she counseled academic medical centers, insurers, pharmaceutical and biotechnology companies, and private equity firms on health care regulatory issues. She has also worked as a management consultant at The Boston Consulting Group and The Bridgespan Group, where she provided strategic advice to health care companies and to nonprofit organizations and foundations.