Abstract: The Rise of the Medical Monopoly? The Consequences of Three Decades of System Building in American Academic Medicine
Since the 1980s, many Americans have expressed concern about role that profit has seemed to play in fueling the growth of the health care system in United States. While initial critiques focused on the role of proprietary actors, some of the most rapid and sustained growth has come from the not-for-profit sector. Using the example of the University of Pittsburgh Medical Center (UPMC) this paper explores how a regional medical center grew to become an integrated health system and the largest non-governmental employer in Pennsylvania. Key areas that this paper will address include an examination of the changing public and private health care market in the United States from the 1970s to the 1990s; the role of attempted health care reform under the Clinton Administration in promoting the integrated delivery system as an idealized organizational model; and the evolution of providers becoming payers and payers becoming providers. When all of these areas are taken together, this paper will show that the growth of large academic health systems in the 1990s and beyond are not simply the product of chance or luck, but result from the consequences of deliberate and well-planned actions.