Korn D
J Investig Med. 1995 Apr;43(2):108-15.
When David Korn, MD, was named dean of the Stanford University School of Medicine on October 9, 1984, he assumed leadership of a world class research institution. Stanford was at the forefront of medicine in the areas of transplantation and oncology, and the steady influx of privately insured patients had generated a net operating surplus of $17 million in that year alone. However, in the same issue of the Stanford University Hospital newsletter which announced the selection of Korn as Dean, a small article appeared on a new prospective payment system based on diagnosis-related groups (DRGs). The article stated that the new system had begun smoothly, though some payments for cost outliers had been delayed. Other cost containment measures soon followed, most notably the implementation of managed care, and by 1990, Stanford was $14 million in the red. Buffeted by changes in medical reimbursement, competition with less costly hospitals, and a nasty squabble with Congress over indirect research costs, Stanford has been on the frontlines of a struggle now confronting many academic medical centers. After successfully consolidating the university's clinical services into a unified Stanford Health System, Korn announced that he would be stepping down as Dean on April 1. Interviewed in his office in Palo Alto, Korn reflected on the difficulties of dealing with managed care, the current financial state of the institution, and what Stanford's experience may predict for other academic medical centers.
1984年10月9日，医学博士大卫·科恩被任命为斯坦福大学医学院院长时，他接手领导了一家世界级的研究机构。斯坦福在移植和肿瘤学领域处于医学前沿，仅在那一年，大量私人参保患者的涌入就带来了1700万美元的运营净利润。然而，在宣布科恩当选院长的同一期斯坦福大学医院通讯中，一篇关于基于诊断相关分组（DRGs）的新型前瞻性支付系统的小文章出现了。文章称新系统顺利启动，不过一些高额费用的支付有所延迟。其他成本控制措施很快接踵而至，最显著的是实施了管理式医疗，到1990年，斯坦福出现了1400万美元的赤字。受医疗报销变化、与成本较低医院的竞争以及与国会就间接研究成本发生的激烈争吵的冲击，斯坦福一直处于许多学术医疗中心目前所面临斗争的前沿。在成功将大学的临床服务整合为一个统一的斯坦福医疗系统后，科恩宣布他将于4月1日卸任院长一职。在他位于帕洛阿尔托的办公室接受采访时，科恩反思了应对管理式医疗的困难、该机构目前的财务状况，以及斯坦福的经历可能对其他学术医疗中心有何预示。
