Since the 1970s health care costs in the United States have doubled, insurance premiums have far outpaced inflation, and the numbers of the uninsured and underinsured are increasing at an alarming rate. At the same time the public expects better health care and access to the latest treatment technologies. Governments, desperate to contain ballooning costs, often see a market-based approach to health care as the solution; critics of market systems argue that government regulation is necessary to secure accessible care for all.
The Catholic Church generally questions the market's ability to satisfy the many human needs intrinsic to any care delivery system yet, although the Church views health care as a basic human right, it has yet to offer strategies for how such a right can be guaranteed. Mary J. McDonough, a former Legal Aid lawyer for medical cases, understands the advantages and disadvantages of market-based care and offers insight and solutions in Can a Health Care Market Be Moral?
Drawing on Catholic social teachings from St. Augustine to Pope John Paul II, McDonough reviews health system successes and failures from around the world and assesses market approaches to health care as proposed by leading economists such as Milton Friedman, Regina Herzlinger, Mark Pauly, and Alain Enthoven. Balancing aspects of these proposals with Daniel Callahan's value-dimension approach, McDonough offers a Catholic vision of health care in the United States that allows for some market mechanisms while promoting justice and concern for the least advantaged.
“Competition. Deregulation. Free market forces. The debate over competition in health care that raged in the 1970s brought with it a new economic jargon, a vocabulary of concepts and issues unheard of in hospitals a decade earlier. “Competition in health care has developed to a greater degree than most economists predicted ten years ago. That is the conclusion of Warren Greenberg in his introduction to Competition in the Health Care Sector: Ten Years Later, a retrospective of a 1977 Federal Trade Commission conference, which produced the landmark treatise Competition in the Health Care Sector: Past, Present, and Future. Seven of the ten original papers are reexamined; a chapter on the nursing home industry has been added. “As with the original volume, Greenberg predicts that the retrospective will become a critical element in the health care economic literature.”—Hospitals
All advanced health care systems face severe difficulties in financing the delivery of today’s sophisticated medical care. In this study David Wilsford compares the health systems in France and the United States to demonstrate that some political systems are considerably more effective at controlling the cost of care than others. He argues that two variables—the autonomy of the state and the strength and cohesiveness of organized medicine—explain this variance. In France, Wilsford shows, the state is strong in the health policy domain, while organized medicine is weak and divided. Consequently, physicians exercise little influence over health care policymaking. By contrast, in the United States the state is weak, the employers and insurers who pay for health care are fragmented, and organized medicine is strong and well financed. As a result, medical professionals are able to exert a greater influence on policymaking, thus making cost control more difficult. Wilsford extends his comparison to health care systems in the United Kingdom, West Germany, Italy, Canada, and Japan. Whether the private or public sector finances health care, he discovers, there is now an important trend in all of the advanced industrial countries toward controlling escalating costs by curbing both the medical profession’s clinical autonomy and physicians’ incomes.
Doctors are obviously influential in determining the costs of their services. But even more important, many believe, is the influence physicians have over the use and cost of nonphysician health-care resources and services. Doctors and Their Workshops is the first comprehensive attempt to use economic analysis to understand some of the physician effects on nonphysician aspects of health care.
Economic Aspects of Health
Edited by Victor R. Fuchs University of Chicago Press, 1982 Library of Congress RA410.A2E23 1982 | Dewey Decimal 362.1042
Unlike earlier work in medical economics, which has focused on medical care, these ten papers stress the production and consequences of health itself. They reveal a serious concern with real-world health problems in their investigation of such subjects as infant mortality, life expectancy, morbidity, and disability. These papers are unusual, as well, in bringing to bear on these problems new and powerful theoretical and statistical tools. They draw on, and in some cases are, original sources for new bodies of data. As such, Economic Aspects of Health comprises a useful blend of relevance and rigor.
Fixing Medical Prices
Miriam J. Laugesen Harvard University Press, 2016 Library of Congress RA410.53.L385 2016 | Dewey Decimal 338.473621
Miriam Laugesen goes to the heart of U.S. medical pricing: to a largely unknown committee of organizations affiliated with the American Medical Association. Medicare’s ready acceptance of this committee’s advisory recommendations sets off a chain reaction across the American health care system, leading to high—and disproportionate—rate setting.
The twentieth century saw significant increases in both life expectancy and retirement rates-changes that have had dramatic impacts on nearly every aspect of society and the economy. Forecasting future trends in health and retirement rates, as we must do now, requires investigation of such long-term trends and their causes.
To that end, this book draws on new data-an extensive longitudinal survey of Union Army veterans born between 1820 and 1850-to examine the factors that affected health and labor force participation in nineteenth-century America. Contributors consider the impacts of a variety of conditions-including social class, wealth, occupation, family, and community-on the morbidity and mortality of the group. The papers investigate and address a number of special topics, including the influence of previous exposure to infectious disease, migration, and community factors such as lead in water mains. They also analyze the roles of income, health, and social class in retirement decisions, paying particular attention to the social context of disability.
Economists and historians who specialize in demography or labor, as well as those who study public health, will welcome the unique contributions offered by this book, which offers a clearer view than ever before of the workings and complexities of life, death, and labor during the nineteenth century.
For over a decade, the National Bureau of Economic Research has sponsored the Economics of Aging Program, under the direction of David A. Wise. The program addresses issues that affect the well-being of individuals as they age and a society that is composed increasingly of older people.
Within the next twenty years, an unprecedented proportion of Americans will be over sixty-five. New research in the economics of aging is an essential element of understanding what the future holds for this aging population. Inquiries in the Economics of Aging presents both empirical papers that consider questions that are fundamental to public policy and more theoretical contributions that lay new groundwork for future research in the economics of aging.
Inquiries in the Economics of Aging provides a timely overview of some of the most important questions facing researchers on aging and outlines new techniques and models that may help to answer these questions. This important volume will be of great interest to specialists and policy makers as it paves the way for future analysis.
As millions of Americans are aware, health care costs continue to increase rapidly. Much of this increase in health care costs is due to the development of new life-sustaining drugs and procedures, but part of it is due to the increased monopoly power of physicians, insurance companies, and hospitals, as the health care sector undergoes reorganization and consolidation. There are two tools to limit the growth of monopoly power: government regulation and antitrust policy. In this timely book, Deborah Haas-Wilson argues that enforcement of the antitrust laws is the tool of choice in most cases. Focusing on the economic concepts necessary to the enforcement of the antitrust laws in health care markets, Haas-Wilson provides a useful roadmap for guiding the future of these markets.
Americans at the end of the twentieth century worried that managed care had fundamentally transformed the character of medicine. In The Medical Delivery Business, Barbara Bridgman Perkins uses examples drawn from maternal and infant care to argue that the business approach in medicine is not a new development. Health care reformers throughout the century looked to industrial, corporate, and commercial enterprises as models for the institutions, specialties, and technological strategies that defined modern medicine.
In the case of perinatal care, the business model emphasized specialized over primary care, encouraged the use of surgical and technological procedures, and unnecessarily turned childbirth into an intensive care situation. Active management techniques, for example, encouraged obstetricians to accelerate labor with oxytocin to augment their productivity. Despite the achievements of the childbirth and women’s health movement in the 1970s, aggressive medical intervention has remained the birth experience for millions of American women (and their babies) every year.
The Medical Delivery Business challenges the conventional view that a dose of the market is good for medicine. While Perkins is sympathetic to the goals of progressive and feminist reformers, she questions whether their strategies will succeed in making medicine more equitable and effective. She argues that the medical care system itself needs to be fundamentally "re-formed," and the reforms must be based on democracy, caring, and social justice as well as economics.
This book examines the major phases in the history of health services in Africa and treats health as an integral aspect of the deepening crisis in Africa’s underdevelopment. One important thesis is that Western delivery systems have made health care less accessible for most people. Contributors direct attention to problems engendered by food shortages, acute cases of infection, the market in fake drugs as well as the inequality of access to facilities, the violation of human rights, and the recent danger of the dumping of toxic wastes in several African countries.
One major implication of this volume is that there can be no solution to the health crisis in Africa until the linkage between health and poverty is recognized. The authors consider questions that add to the contemporary discussion of the place that traditional African medicine and philosophy should take alongside modern Western medicine in Africa today.
Since Pinochet's regime assumed power in 1973, the Chilean public medical system has been incrementally disassembled in favor of private enterprise, modeled after U.S. HMOs. Scarpaci assembles data ranging from interviews with patients to income statements and balance sheets from the National Health Service System, National Health Fund, and National Statistics Institute to view the financial and cultural impediments imposed by the Pinochet system that have compromised and effectively limited health care accessibility for Chile's adult population.
Examining the health care market in a historical framework, Drake analyzes the forces and events that have shaped American health care in the twentieth century and sheds new light on why and how our health care system has dampened competitive market forces and failed to provide sound value for much of our health care expenditures. He examines the roles that physicians, hospitals, insurance companies, businesses, individual consumers, and government legislation have played in creating a provider-dominated market in which the cost of care has been concealed from consumers. Comparing U.S. health care expenditures with those of other developed countries, he concludes that a significant part of our health care problem is the style of medicine practiced in the United States, which is much more specialized and high tech than in other developed nations.
Drake develops proposals for health care financing reform that consider the political and economic difficulties involved. He first examines the Clinton health care reform plan and makes specific recommendations for revisions that would improve its likelihood of controlling costs. He then offers an alternative proposal that would both maintain the principle of universal, noncancelable coverage and eliminate the flaws in the market for health care services by giving consumers a financial stake in cost containment.
This timely argument, combining economic and historical analysis with thoughtful consideration of the motivating humanitarian and political concerns, will be of interest to everyone seeking to understand and to reform our ailing health care system.
This volume revisits the Nobel Prize-winning economist Kenneth Arrow’s classic 1963 essay “Uncertainty and the Welfare Economics of Medical Care” in light of the many changes in American health care since its publication. Arrow’s groundbreaking piece, reprinted in full here, argued that while medicine was subject to the same models of competition and profit maximization as other industries, concepts of trust and morals also played key roles in understanding medicine as an economic institution and in balancing the asymmetrical relationship between medical providers and their patients. His conclusions about the medical profession’s failures to “insure against uncertainties” helped initiate the reevaluation of insurance as a public and private good.
Coming from diverse backgrounds—economics, law, political science, and the health care industry itself—the contributors use Arrow’s article to address a range of present-day health-policy questions. They examine everything from health insurance and technological innovation to the roles of charity, nonprofit institutions, and self-regulation in addressing medical needs. The collection concludes with a new essay by Arrow, in which he reflects on the health care markets of the new millennium. At a time when medical costs continue to rise, the ranks of the uninsured grow, and uncertainty reigns even among those with health insurance, this volume looks back at a seminal work of scholarship to provide critical guidance for the years ahead.
Contributors Linda H. Aiken Kenneth J. Arrow Gloria J. Bazzoli M. Gregg Bloche Lawrence Casalino Michael Chernew Richard A. Cooper Victor R. Fuchs Annetine C. Gelijns Sherry A. Glied Deborah Haas-Wilson Mark A. Hall Peter J. Hammer Clark C. Havighurst Peter D. Jacobson Richard Kronick Michael L. Millenson Jack Needleman Richard R. Nelson Mark V. Pauly Mark A. Peterson Uwe E. Reinhardt James C. Robinson William M. Sage J. B. Silvers Frank A. Sloan Joshua Graff Zivin
How much should citizens invest in promoting health, and how should resources be allocated to cover the costs? A major contribution to economic approaches to the value of health, this volume brings together classic and up-to-date research by economists and public health experts on theories and measurements of health values, providing useful information for shaping public policy.
In the wake of structural adjustment programs in the 1980s and health reforms in the 1990s, the majority of sub-Saharan African governments spend less than ten dollars per capita on health annually, and many Africans have limited access to basic medical care. Using a community-level approach, anthropologist Ellen E. Foley analyzes the implementation of global health policies and how they become intertwined with existing social and political inequalities in Senegal. Your Pocket Is What Cures You examines qualitative shifts in health and healing spurred by these reforms, and analyzes the dilemmas they create for health professionals and patients alike. It also explores how cultural frameworks, particularly those stemming from Islam and Wolof ethnomedicine, are central to understanding how people manage vulnerability to ill health.
While offering a critique of neoliberal health policies, Your Pocket Is What Cures You remains grounded in ethnography to highlight the struggles of men and women who are precariously balanced on twin precipices of crumbling health systems and economic decline. Their stories demonstrate what happens when market-based health reforms collide with material, political, and social realities in African societies.