This book is a history of medicine and psychiatry over the last two centuries but with particular emphasis on economic changes in medicine in general and psychiatry in particular over the past 40 years. The Alexian Brothers health systems and its 700 year history is used as a point of focus and illustration for changes which have occurred in all hospitals, medical and psychiatric, in the age of Managed Care. It is a history of the scientific and economic issues driving these changes.
I wrote this book for laymen interested in a concise history of medicine and psychiatry as well as for healthcare professionals generally. My other motive is to raise the issue of “free market” incentives in medicine and stimulate concerns (I hope) about who has control when it comes to quality and cost. If the free market in medicine is best, why do Americans pay more for pharmaceuticals, for example, than any other nation on planet Earth? Isn’t the competition implied by a “free” market supposed to keep prices low? Why don’t we see price competition in prescription drugs?
And what is the primary purpose of any health system or plan anyway? One might reasonably assume that caring for the sick would be job one. If so, then why do health plans and politicians lobby ceaselessly to exclude sick people ( eg.,pre-existing conditions) from access to health insurance?
This book also examines psychiatry’s place as a medical specialty and the legitimacy of insurance coverage for psychiatric conditions. This is less of an issue today than it was 40 or 50 years ago. “Obamacare” laws have mandated parity in coverage for psychiatric illnesses and addictive conditions with “medical” illnesses. This seems fair enough, so why then do so many Americans seem to want these laws repealed?
As the subtitle implies, The Alexian Brothers Behavioral Health Hospital’s existence itself is just one of many controversies in psychiatry. Is what we do legitimate medical treatment? I believe so and have practiced psychiatry most of my life under that assumption. But there are controversial practices and I try to address several of these in a way that makes sense for the general reader who has an interest in the mental health field. The word “curious” in the title refers to the dramatic rise of this single location community psychiatric hospital to the nation’s 7th largest psychiatric corporation at a time when most not-for-profit, as well as for-profit, psychiatric hospitals were dramatically contracting or going out of business.
Although there is considerable overlap, the first six chapters are about medicine and psychiatry before the advent of health insurance. They trace the history of hospitals from their function as places where the poor went to die, to their evolution into repositories of high tech medical (and initially surgical) practice. Chapters seven through fifteen are primarily about medicine and psychiatry after the rather dramatic expansion of employer based health insurance during the 1930’s, and during and after World War ll. Chapter ten describes the major influence of psychoanalysis in American psychiatry and its effect in diminishing interest in brain function among American psychiatrists while increasing interest in the practice of psychotherapy by psychiatrists and other mental health professionals.
Chapters nine, eleven, and thirteen discuss why so much medical, surgical, and psychiatric care today is managed. Do doctors and hospitals have conflicts of interest? Do insurance companies have conflicts of interest? And what is all this talk about “Medicare For All?”
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About the Author
Anthony M. D’Agostino, MD, served as Chair, Dept of Psychiatry, Alexian Bros Medical Center, in Elk Grove Village, Illinois from 1979 to 1999 and CMO at the Alexian Brothers Behavioral Health Hospital in Hoffman Estates, Illinois from 1999 to 2011. He received his medical degree from the University of Illinois College of Medicine, Interned at the Los Angeles County General Hospital and completed residencies in General and Child Psychiatry at the University of Illinois, Chicago (UIC), the University of California, Los Angeles (UCLA), and The University of Wisconsin, Madison.
He served as an examiner for the Hospital Licensing Division of the Illinois Dept of Public Health from 1978-1986. He was President, Illinois Psychiatric Society in 1986-87 and served on the Health Insurance and Ethics committees for much of 2 decades. At the national level he was an Illinois delegate to the Assembly of the American Psychiatric Association from 1996 to 2002 where he also served as Vice Chair of its Managed Care Committee and is a Distinguished Fellow of the American Psychiatric Association. He has practiced Psychiatry at Alexian Brothers Hospitals for 40+ years. From 1969-71 on active duty US Navy (assigned to the Marines).