Regardless of the contours of the final Clinton plan, health-care reform is moving inexorably forward as hospitals attempt to pre-empt governmental meddling. “We wanted to exert some leadership on the way this turns out,” says Dr. J. Robert Buchanan, outgoing director of Mass General. “We should allow competition to show what it can do.”
In recent years competition hasn’t been kind to the hospital industry. Since 1980 more than a thousand hospitals have merged or closed–most small community hospitals. Neither the Brigham nor Mass General was strapped for cash. The two nonprofit hospitals, both affiliated with Harvard Medical School, are among the world’s most illustrious teaching institutions. Together they claim credit for pioneering such innovations as anesthesia and organ transplants. Yet even they worried about their ability to thrive in a more cost-conscious era. “Nobody is so big, so powerful, so esteemed that they’re not affected,” says James Bentley, senior vice president for policy at the American Hospital Association.
The training and research that makes hospitals like these so valuable also makes them notoriously expensive and inefficient. “We can’t survive without their constant input of cutting-edge information,” says Dr. Arnold Relman, editor in chief emeritus of The New England Journal of Medicine. “But if they go on the way they are now, they can’t survive,” Indeed, both Mass General and the Brigham acknowledge that they were feeling the squeeze from thrifty HMOs and insurers. Within several years, they say, they will be able to chop 20 percent from their combined $1.2 billion operating budget, an annual savings of $240 million.
The hospitals claim that patients won’t really notice the difference. Much of the savings will come from uniting administrative functions, like purchasing and billing. Each hospital will keep its own buildings. And for all the talk of eliminating excess services, neither has plans to close any clinical departments. Mass General insists that it will proceed with its new maternity unit even though the Brigham specializes in obstetrics.
Still, the new megahospital should be well placed to compete in the 21st century. Eventually it hopes to provide medical care in virtually every setting, from health clinics and doctors’ offices to surgical suites and nursing homes, perhaps even offering its own insurance. “It could be a model,” says Dr. Samuel Thier, the president of Brandeis University, who will head Mass General. Perhaps, but before everyone becomes too sanguine about medicine’s future, it’s telling that the two hospitals haven’t yet been able to agree on a single new name.
