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In this book, Herzlinger comments that patient service is inactive since open market rivalry has been compromised and health care users, who should be involved in decision making regarding their fitness, are left out. The solution suggested by Herzlinger is basically a “user-focused medical system” that would meet patient needs at lower costs (Herzlinger, 2007, p. 23). Herzlinger provides an outline on how user-focused medical system would shift selection and buying supremacy to patients. Insurers and health care givers would be more receptive to patient needs; thus supply would be changed by demand. Implementing changes proposed in this work ensures information access to both insurers and health care givers, effective risk identifying mechanisms, and nursing practice that would meet specific patient needs.

Summary 1

Herzlinger presents two separate thoughts in her guest to address the dwindling health care. One camp believes in the influential authorities of extensive institutions like governments and big insurance organizations. The other team argues that “minute is decent”. This team believes that only users and health care organizations can change medical care. Herzlinger weighs between the influence of both political demands and economic models in health care. The “big is decent” team believes that the medical service field is not capable of the form of production benefits that define the entire economy. Further this team believes that consumers are not capable of the form of difficult decision-making that define medical care. Alternatively, the small is decent team have faith that users in collaboration with the entire health care would offer sufficient solution to health care menace (Herzlinger, 2007, p. 27).

Summary 2

Herzlinger logically presents the five killers of health care. First, is the insurance organizations that accumulate millions, remunerate their staff billions and erroneously claim bigger share in the current health system by increasing costs through either bureaucratic and stingy payouts or through monopolistic bottom-up incorporated union of nurses and health providers who accept low payouts. Other killers include: health institutions, which utilize their market position to suppress rivalry and discredit health care givers linked to isolated institutions or innovative speciality clinics; employers; the U.S. senate; and academics, whose innately inborn attitude regarding doctors and private clinics suppresses health care innovation (Herzlinger, 2007, p. 33).

Summary 3

Herzlinger successfully outlines the challenges presented by the current health care system. Overall medical specialists and consumers should in addition be held accountable for having killed health care. In democratic nations, consumers should optimize their voting capabilities so as to guard and promote critical sectors like health care. Although patient views are critical to patient-focused medical system, the author concentrates on the fact that medical services do not meet threshold stipulations essential for reliable consumer selection. Economic framework illustrates that user selection improves competence only if 1) an individual knows with sureness the degree of satisfaction he/she will get from health care, and 2) he/she has adequate details to make informed selections. Some amendments proposed by Herzlinger raise sombre queries. For example, he proposes that health enterprises be of a manageable level (Herzlinger, 2007, p. 42). What is the size of those manageable levels that will optimize capacity and economies of volume while aiming at the wishes of an individual user?


In spite of the various queries raised regarding the proposed “remedy” for the existing medical provision model, this is a captivating and significant book and anyone who is keen in advancements in effectiveness, results, and quality care in the United States medical provision field should read this book. At least, it should trigger sombre idea and essential discussion regarding the direction that the hospital executive board should take.


Herzlinger, R. (2007). Who Killed Health Care? America’s $2 Trillion Medical Problem-And the Consumer-Driven Cure. New York, NY: McGraw-Hill.

Mittell, D. A. (2008). Who killed health care?. The Providence Journal, Retrieved from http://www.projo.com/opinion/columnists/content/CL_mitt6_02-06-08_NO8QI9K_v19.38cb226.html