DECONSTRUCTING THE COLUMBIA HCA INVESTIGATION

Every issue raised by the current investigation into the business prac tices of Columbia/HCA serves as a sign post for the progress and probl ems inherent in market-driven health care reform. Actions against Colu mbia/HCA by regulators reveal deeply rooted resistance to the profit-m otivated reforms embodied in the company's philosophy: the public's re luctance to accept necessary reductions in excess hospital capacity; t he legal and cultural obstacles to the overdue alignment of physician and hospital economic interests; and the myriad reimbursement and acco unting problems involved in the vertical integration of health care de livery. The investigation also underscores the antiquation of the reim bursement mechanisms and control systems in place for financing the de livery of care to Medicare beneficiaries.