Gene therapy and the 14th century Karelians.
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The market for gastroenterology (GI) fellows adopted a centralized Match in 1986, and abandoned it in the late 1990s. We discuss why the Match initially was adopted, how and why it broke down, what differences this has made in the market for fellows, and what would be needed to restart the Match successfully. We assess the effects of the Match by comparing the GI fellows market now with when the Match was operating, and with the fellowship markets for internal medicine subspecialties that continue to use a Match. The breakdown of a well-functioning Match is rare, but may be caused by unusual shifts in market conditions, such as those experienced by gastroenterology in the late 1990s. The problems the gastroenterology Match originally was designed to solve re-emerged with the demise of the Match. The market has become more local and less national, than when there was a Match in place, and program recruitment of fellows occurs earlier and is more dispersed in time than internal medicine subspecialties that continue to use a Match. There is no evidence that the demise of the Match has had any effect on wages. The evidence strongly suggests that the Match could be reintroduced successfully, which would increase the mobility of potential GI fellows, allow potential fellows to compete for the widest range of programs, and allow programs to compete for the widest range of fellows.
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After the health networks tied to HMOs are organized into oligopolies, and eventually fail to provide adequate access, social equity, and cost containment, public pressures will demand that state health services commissions be established to regulate market share, the scope of health services, reimbursement rates, and allowable profits. The German health system is multipayer, multitier, decentralized, self-governing, and allows providers and insurers to negotiate reimbursement rates without direct government involvement. Such a model would offer more competition among providers and less government regulation.
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