I can tell you that in the 1980’s with DRG’ s and Medicare and Medicaid changes, hospitals changed from being run by doctors and nurses to being run by MBA execs. Then layers and layers of seafood. My observations as a 40 year was-just-about-to-retire nurse.
“Managed Care” in the 1980s caused me to leave nursing. The sense of being able to provide the level of care patients needed along with compassion was ruined by the “bean counters.” Patients were being booted out with raging infections. I worked orthopedics some patients needed extensive and intense care and therapy for the long haul. Not with managed care... out you go.
Layers of seafood? Lol. Sorry. I typed layers of deadwood, not seafood.
Very astute.
Once the policy change to.a fixed pool of money was made (from employers and taxpayers), the hospital industry realized that employing a tribe of accountants to make sure they got their share and then some would be a good strategy.
Of course, this has, over 30 years, made hospitals and hospital "systems" the kings, and the deciders of what gets done, when, where, and how.
Mix this with fixed, centrally administered prices that use 1968 as a benchmark, and all of a sudden you have no bread in Ukraine.
There are no pediatricians under 50, but we can't train people fast enough to do boob jobs.