Medical Governance

Values, Expertise, and Interests in Organ Transplantation

David L. Weimer

"Does an excellent job of researching and analyzing the delegation of medical decision making to private nonprofit organizations."
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Governments throughout the industrialized world make decisions that fundamentally affect the quality and accessibility of medical care. In the United States, despite the absence of universal health insurance, these decisions have great influence on the practice of medicine.

In Medical Governance, David Weimer explores an alternative regulatory approach to medical care based on the delegation of decisions about the allocation of scarce medical resources to private nonprofit organizations. He investigates the specific development of rules for the U.S. organ transplant system and details the conversion of a voluntary network of transplant centers to one private rulemaker: the Organ Procurement and Transplantation Network (OPTN).

As the case unfolds, Weimer demonstrates that the OPTN is more efficient, nimble, and better at making evidence-based decisions than a public agency; and the OPTN also protects accountability and the public interest more than private for-profit organizations. Weimer addresses similar governance arrangements as they could apply to other areas of medicine, including medical records and the control of Medicare expenditures, making this timely and useful case study a valuable resource for debates over restructuring the U.S. health care system.

Table of Contents

Abbreviations and Acronyms

1. Medical Governance: Important but Neglected

2. Balancing Values, Expertise, and Interests

3. The Organ Procurement and Transplantation Network

4. Expanding Organ Supply

5. Liver Allocation and the Final Rule

6. Incremental Response to Racial Disparity in Kidney Allocation

7. The Kidney Allocation Review: Can The OPTN Make Nonincremental Change?

8. How and How Well Does the OPTN Govern?

9. Is the OPTN a Viable and Desirable Model in Other Medical Contexts?




"In this blend of theory, practical understanding, and methodological sophistication, Weimer has produced and important set of ideas that can be applied to at least some of today’s health-care policy challenges and perhaps beyond."—Perspectives on Politics

"Does an excellent job of researching and analyzing the delegation of medical decision making to private nonprofit organizations."—Choice

"A tightly written, carefully researched volume that speaks to multiple audiences; it will be of interest to professionals and academics, yet remains accessible for use in advanced undergraduate courses in policy analysis and public administration. The question of whether privately administered rulemaking is an appropriate vehicle to allocate a scarce public good such as human organs will be of interest to political scientists, policy analysts, and students of health policy."—Robert B. Hackey, Providence College

"This book not only provides an excellent case study about an important health policy issue, it helps to fill a significant gap in the public administration literature. It identifies the right questions and generates a host of hypotheses that are likely to be explored by scholars in the field for years."—Michael K. Gusmano, Department of Health Policy and Management, State University of New York Health Sciences Center, Brooklyn

"In this important and penetrating book, David Weimer uses the fascinating case of organ transplantation in the United States to produce fresh insights into the role of values, professional authority, technical expertise, and political influence in the health care arena. . . . Weimer's thoughtful analysis of the strengths and weaknesses of alternative medical governance models could not be more timely. This significant book deserves to find a wide audience among policymakers, analysts, and concerned citizens."—Eric Patashnik, professor and associate dean, Batten School of Leadership and Public Policy, University of Virginia

"A fascinating exploration of private rulemaking where the stakes are life and death. Institutional policy analysis at its best."—William Gormley, interim dean, Georgetown Public Policy Institute, and professor of government and public policy, Georgetown University


Supplemental Materials


About the Author

David L. Weimer is professor of public affairs and political science at the University of Wisconsin-Madison and a former president of the Association for Public Policy Analysis and Management. He is the coauthor of Organizational Report Cards; Policy Analysis: Concepts and Practice; and Cost-Benefit Analysis: Concepts and Practice.

232 pp., 6 x 9
2 figures, 17 tables
Feb 2010

232 pp., 6 x 9
2 figures, 17 tables
ISBN: 978-1-58901-631-6
Feb 2010

232 pp.
2 figures, 17 tables
ISBN: 978-1-58901-682-8
Feb 2010

American Governance and Public Policy series
Gerard W. Boychuk, Karen Mossberger, and Mark C. Rom, Series Editors

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