Specialty Care in the Era of Managed Care: Cleveland Clinic versus University Hospitals of Cleveland

John A. Kastor. Specialty Care in the Era of Managed Care: Cleveland Clinic versus University Hospitals of Cleveland. Baltimore: Johns Hopkins University Press, 2005. x + 275 pp. Ill. $50.00 (0-8018-8174-9).

Reducing the cost of health care by limiting the use of expensive specialists was supposed to have been one of the central benefits of managed care. This book is a meticulously researched and documented case study of one of the most important actual outcomes of managed care: intense rivalry and competition among specialty-care institutions struggling to maintain the flow of patients into their services.

Like leading specialty-care institutions around the country, the Cleveland Clinic and University Hospitals of Cleveland (UH) began aggressively buying up community hospitals and bringing primary-care physicians into their organizations. In Cleveland as elsewhere, the consolidation was dramatic: In 1980, thirty-six hospitals served the Cleveland area, most of them independent entities; by 2004, there were only twenty-three, most of them absorbed into the systems created by one...