There is no other source for many patients who come through the private system to receive follow-up care other than the public health system. Where there was once virtually very little coordination between private and public systems, today we see extensive coordination because it is necessary. The cuts in Medicaid, and the loss of group health benefits has necessitated a more coordinated effort. Is there a health care delivery preparedness plan for a public health event, such as an infectious epidemic or bioterrorist attack?

Private hospitals have plans, and go over and test those plans on a periodic basis as is required by oversight. However, after Hurricane Katrina it is difficult to imagine how those plans would unfold. Those hospitals that were forced to abandon patients and staff were required by law to have those kinds of plans, and, in my opinion, they failed. So we have plans, but let's hope we would never have to test them, because the day-to-day operations as dictated by the delivery of health care is really not conducive to carrying out those plans. Either of those events that you mentioned would really spell disaster for a hospital. The atmosphere in hospitals today, with specialists and without the staff that is actually employed by a hospital to make that loyalty connection, has turned the hospital environment into a kind of every man for himself environment.

Follow-Up

Researching the director's remarks, concurring remarks to his are found in the 1997 book authored by Arnold Birenbaum, Managed Care: Mad in America. Birenbaum makes very similar remarks about health care before, and after managed care (p. 1). The language, or rhetoric, used by professionals writing on the subject raises concerns about the direction of health care and the delivery of services consistent with maintaining and improving the quality of life.

The rhetoric has now changed to that of evidence-based practice (EBP), the influential philosophy introduced into medicine in the 1980s (Stoil, 2004) that suggests that best practice can be determined through a careful analysis of the extant...

This philosophy is now being introduced into other disciplines, including nursing and social work (Tsang, Bogo, & George, 2003; Tucker & Brust, 2000). Whereas previous movements to integrate scientific knowledge into social work practice were met with great resistance by clinicians and were at best only partially effective (Penka & Kirk, 1991; Welch, 1983), the EBP movement may be permanent and may have already influenced evolving practice standards for social workers (Franklin, 2001) (Bolen, Rebecca M., 2007, p. 463)."
What this rhetoric is saying to us is that managed care is a cost focused delivery of care, replacing what was once a preventative approach to care. If the diagnosis is one that leads to death, or permanent disability, then the intervention authorized by managed care for the physician to treat the patient will be minimal, consistent with the diagnosis that there is little quality of life to be achieved by treatment. This is inconsistent with the way most people feel about their loved ones.

Like our business office director, there is much bemoaning the delivery of care under the managed care system of delivery (Zelman, Walter and Berenson, Robert, 1998).