Competitive approaches to health care reform:
Gespeichert in:
| Format: | Buch |
|---|---|
| Sprache: | English |
| Veröffentlicht: |
Washington, D.C.
Urban Inst. Press
1993
|
| Schlagworte: | |
| Online-Zugang: | Inhaltsverzeichnis |
| Beschreibung: | XVII, 361 S. graph. Darst. |
| ISBN: | 0877666040 |
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| 245 | 1 | 0 | |a Competitive approaches to health care reform |c Richard J. Arnould ... eds. |
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Datensatz im Suchindex
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| adam_text | CONTENTS
Foreword xix
Preface xxi
PART ONE Context and Framework 1
1 Competitive Reforms: Context and Scope Richard
/. Arnouid, Robert F. Rich, and WiJJiam D. While 3
Costs and Access 4
Eroding Foundations of U.S. Health Care System 5
Cost Containment and Public Policy 6
Scope of Competitive Reforms 9
Assessing Competitive Reforms 12
Volume Overview 13
2 Controlling Costs of the U.S. Health Care System:
Trends and Prospects Kathryn M. Langweli and
Terri Menke 19
Trends in Spending for Health Care 19
Impact on Consumers 20
Impact on Providers 20
Impact on Federal Budget 25
Evidence on Cost Control Policies 28
Competitive Strategies 31
Regulation of the Market for Health Services 37
Potential to Control Rising Health Care Costs
in the United States 44
3 Outcomes Assessment: Market Incentives or
Regulatory Fiat? Deborah A. Freund 49
Outcomes Research and Precursors 50
PORTs and Medical Practice Guidelines 53
x Contents
Outcomes Research: Competitive and Regulatory
Contexts 55
Outcomes of Outcome Research: Impact on
Consumer, Physicians, and the Delivery
System 57
Health Care Markets 61
PART TWO Competitive Strategies and Managed Care 65
4 The Case for Competitive Reform in Health
Care David Dranove 67
What Is Competition? 69
Competition between Medical Providers: From
Patient Driven to Payer Driven 71
Empirical Evidence on Competition between
Providers 72
What about Monopoly Providers? 74
Future Prospects for Competition between
Providers 75
Competition between Insurers 75
Restatement of the Problem 79
What about Technology? 79
5 The Role of Managed Care in Competitive Policy
Reforms Richard /. ArnouJd, Robert F. Rich,
William D. White, and Craig Copeland 83
Competitive Reforms and Managed Care Systems 83
Managed Care Systems and Other Competitive
Reforms 85
Effects of Competitive Reforms and Managed Care
Systems 96
Direct Effects of Managed Care 97
Managed Care—Spillover Effects 102
Conclusions 104
6 Effects of Competition on the Hospital Industry:
Evidence from California Jack Zwanziger and
Glenn A. MeJnick 111
Conceptual Framework 112
Hospitals in Traditional Competition 113
Introduction of Selective Contracting 113
Contents xi
The Research Results 117
How Competitive Is the Industry? 117
Is Competition Constraining Revenue? 119
Does Competition Lead to Lower Prices? 120
Are Costs Being Controlled? 122
Did Hospitals Cut Costs in Selected Areas or
Across the Board? 123
Is Hospitals Service Mix Becoming More
Specialized? 125
Do Cost Controls Reduce the Quality of Care? 127
Access to Care 128
Conclusions 129
Aggregate Expense Data 130
Policy Implications 132
Appendix 6.A: Aggregation of Cost Centers 134
7 Variations in Medical Practice Use: Causes
and Consequences Charles E. PheJps and
CathJeen Mooney 139
The Phenomenon of Variations 140
Explanations for Variations 141
Economic Factors—Demand Side 142
Economic Factors—Supply Side 143
Intrinsic Differences in Illness Patterns 145
Random Noise 146
Physician Differences 147
Substitution in Production 148
Summary 153
Toward a Model of Physician Learning about
Treatment Efficacy 154
Patient Beliefs 157
Why Do Teaching Centers Differ in Beliefs? 158
Testing the Model 160
Welfare Losses from Variations 162
Welfare Loss with Current Average Use Too
Large or Too Small 164
Estimates of Welfare Losses Due to Variations in
Hospital Admissions 166
Within Hospital Procedure Variability 167
How Big Is Big ? 169
Conclusions 170
xii Contents
Appendix 7.A: Relationship between the Coefficient
of Variation in an Explanatory Variable and the
Coefficient of Variation in a Dependent
Variable 173
8 An Empirical Test of Competition in the
Medicare HMO Market Roger Feldman, Catherine
L. Wisner, Bryan Dowd, and Jon B. Christianson 179
Theoretical Model 181
Background 181
Formal Statement of ACR Constraint 182
Formal Model for a Monopoly HMO 184
Formal Model for Competitive HMO 187
Methods 188
Data 189
Results 193
Implications of the Findings 198
Summary 201
PART THREE The Case against Competition 205
9 The Ironic Flaw in Health Care Competition: The
Politics of Markets James A. Morone 207
Health Care Markets: An Evolving Idea 209
Health Care Markets in the Real World 211
Markets and Regulators 215
Ironic Flaw in Health Care Competition 217
The Health Policy Lesson of the Eighties 219
10 Competition and the New Accountability: Do
Market Incentives and Medical Outcomes Conflict or
Cohere? Lawrence D. Brown 223
Market Competition and Accountability 224
Medical Culture and Accountability 227
Practice Guidelines as Public Policy 230
And What Became of Competition? 233
Managed Competition and Global Budgets: Raising
the Ante on Accountability 236
Accountability, Lower and Higher 238
11 The Political Considerations of Procompetitive
Reform Theodore R. Marmor and David A. Boyum 245
Problems of Implementation 247
Contents xiii
Historical Evidence 247
The Need for Regulation 248
Robustness 250
Issues of Values 251
Choice 251
Access and Distribution 252
Professional Ideals 252
Conclusion 253
PART FOUR Changing the Assumptions 257
12 Does the Market Choose the Correct Incentives to
Get to the Desired Outcomes? Market Failure
Reexamined Frank A. Sloan 259
Distinguishing Characteristics of Health Care and
Market Failures 259
Asymmetric Information 259
Externalities in Consumption 260
Uncertainty 262
Public Goods 266
Role of Incentives in Health Care Markets 266
Effects of Price on Behavior of Individuals and
Organizations in Health Care Markets 267
Can Markets Be Expected to Provide Appropriate
Incentives? 268
Appropriate Roles for Government in a Market
System 271
Conclusion 274
13 Is Canada Really Different? A Comparison of
Health Care Spending in Selected U.S. States and
Canadian Provinces Kenneth E. Thorpe 281
International Comparisons: United States, Canada,
Germany, and United Kingdom 283
How Do State Payment Experiments in the United
States Compare with Those in Canada? 287
Conclusion and Observations 291
14 The Political Economy of Health Care Reform in
the United Kingdom John Posnett 293
Background of Reform 293
Underfunding in the NHS 293
xiv Contents
The Reform Proposals 296
Operation of the NHS Internal Market 300
Contracts 301
Competition 302
Regulation 303
Operation of the Market in the Long Run 305
Reflections on the First Year 306
15 Policies for the 1990s: Rationing Health
Care Mary Ann Baily 313
Rationing Defined 313
Reasons for Limiting Beneficial Health Care 315
Rationing in American Health Policy 316
Competitive Strategies and the Rationing Issue 319
Information about Rationing Strategies 320
Social Insurance Objective in Health Policy 322
Role of Physicians 324
Role of Employers 327
Role of Government 330
Rationing in the Future 331
Conclusion 332
PART FIVE Competitive Reform and the Future 341
16 Competitive Reform and the Future Richard J.
Arnodd, Robert F. Rich, and William D. White 343
Three Lessons from Competitive Reforms 343
Future of Competitive Strategies 345
Rationing 345
Voucher/Tax Credit Schemes 347
Mandated Benefits 348
Universal National Health Insurance 348
Implementation Issues 349
Feasibility of Reform 350
Origins/Implications of the Policy Crisis 351
About the Editors 355
About the Contributors 357
Contents xv
Tables
2.1 Federal Spending on Health, Fiscal Years
1965 96 27
4.1 Price Indices: 1983 88 73
4.2 Annualized Inflation Rates 74
6.1 Proportion of California Population in Areas
with Given HHI Ranges 118
6.2 Net Revenue to Gross Revenue in California
Hospitals 119
6.3 Average Distance Traveled to Hospital from ZIP
Code Areas of Differing Competitiveness in
California 129
6.4 Average Annual Growth Rate in Hospital
Expenses per Capita: California versus the
United States 130
6.5 Average Annual Growth Rate in Hospital
Expenses per Adjusted Day: California versus
the United States 130
6.6 Average Annual Growth Rate in Hospital
Expenses per Adjusted Discharge: California
versus the United States 131
6.7 Hospital Expenses per Capita as Percentage of
per Capita Income: California versus the
United States 131
7.1 Correlation of Substitutable Procedures/
Admission Rates 151
7.2 Substitution of Inpatient and Outpatient Care? 153
7.3 Correlations between Procedures/Admissions
Rates Performed by Specialists 161
7.4 Critical Values for Determining Significant
Variability in Regional Rates of Hospital
Admissions 167
7.5 Calculation of Welfare Losses for Procedures
Related to Heart Attack 168
8.1 Number of Medicare HMOs by U.S. County 180
8.2 Hirschman Herfindahl Indexes for Medicare
HMOs by U.S. County and MSA 191
8.3 Hirschman Herfindahl Indexes for all HMOs by
MSA 191
8.4 HMO Based Hirschman Herfindahl Index 192
xvi Contents
8.5 Means and Standard Deviations of Variables (95
Observations) 194
8.6 Reduced Form Equations for Premium and
Coverage 197
8.7 Structural Demand Equation (Dependant
Variable = ENROLL) 198
13.1 Average Annual Rate of Real per Capita Health
Care Growth, Canada and United States,
1970 87 285
13.2 Average Annual Real per Capita Growth in
Health Spending, by Type of Payer, United
States, 1970 87 286
13.3 Average Annual Rate of Real per Capita Growth
in Health Care Spending, Selected U.S. States
and Canadian Provinces 289
13.4 Average Annual Percentage Increase in Real per
Capita Hospital and Physician Spending,
Selected U.S. States and Canadian Provinces,
1876 82 290
14.1 Total Health Expenditure of OECD Countries,
1987 295
14.2 Age Standardized Death Rates per 100,000
(Total Population) 297
Figures
2.1 Health Expenditures as Percentage of Gross
Domestic Product: United States and Selected
Countries, 1970 89 21
2.2 Distribution of Personal Health Care
Expenditures in the United States by Source
of Payment, 1965 89 22
2.3 Direct Out of Pocket Spending for Health in the
United States as Percentage of After Tax
Income 23
2.4 U.S. Hospital Margins Based on Total Revenues,
1965 90 24
2.5 Ratio of Average Income of Physicians to
Average Compensation of all Employees:
United States and Selected Countries,
1965 87 26
Contents xvii
2.6 Average Annual Growth Rates of Real National
and Medicare Expenditures for Health in the
United States, Total and per Capita, 1970 89 29
2.7 Average Annual Growth Rates of Real National
and Medicare Expenditures for Hospital and
Physician Services in the United States, Total
and per Capita, 1970 89 30
5.1 Physical Behavior with Alternative
Compensation Schemes 91
6.1 Division of California Hospitals into Five Groups
According to Market Competitiveness and
Degree of Financial Pressure from Medicare s
Prospective Payment System (PPS) 124
7.1 Substitute versus Complement Treatments for
the Same Illness 149
7.2 Blending of Training Style with Community
Practice 156
7.3 Welfare Loss from Variations when Average Rate
is Correct 163
7.4 Welfare Loss from Variations when Average Rate
is Biased 165
8.1 Monopoly HMO with Binding Premium
Constraint 186
13.1 Health Spending as Percentage of GNP, Canada
and United States, 1970 87 282
13.2 Real per Capita Growth in Health Care, 1970 87 284
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| spelling | Competitive approaches to health care reform Richard J. Arnould ... eds. Washington, D.C. Urban Inst. Press 1993 XVII, 361 S. graph. Darst. txt rdacontent n rdamedia nc rdacarrier Gezondheidszorg gtt Gesundheitswesen Politik Competition United States Delivery of Health Care economics Canada Delivery of Health Care economics United States Economic Competition Canada Economic Competition United States Health Policy Canada Health Policy United States Health Services Administration Canada Health Services Administration United States Health care reform United States Health insurance Finance Government policy United States Medical care United States Cost control Medical policy United States Gesundheitswesen (DE-588)4020775-4 gnd rswk-swf Marktwirtschaft (DE-588)4037653-9 gnd rswk-swf Kanada USA USA (DE-588)4078704-7 gnd rswk-swf USA (DE-588)4078704-7 g Gesundheitswesen (DE-588)4020775-4 s Marktwirtschaft (DE-588)4037653-9 s DE-604 Arnould, Richard J. Sonstige oth HBZ Datenaustausch application/pdf http://bvbr.bib-bvb.de:8991/F?func=service&doc_library=BVB01&local_base=BVB01&doc_number=006315290&sequence=000002&line_number=0001&func_code=DB_RECORDS&service_type=MEDIA Inhaltsverzeichnis |
| spellingShingle | Competitive approaches to health care reform Gezondheidszorg gtt Gesundheitswesen Politik Competition United States Delivery of Health Care economics Canada Delivery of Health Care economics United States Economic Competition Canada Economic Competition United States Health Policy Canada Health Policy United States Health Services Administration Canada Health Services Administration United States Health care reform United States Health insurance Finance Government policy United States Medical care United States Cost control Medical policy United States Gesundheitswesen (DE-588)4020775-4 gnd Marktwirtschaft (DE-588)4037653-9 gnd |
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| title | Competitive approaches to health care reform |
| title_auth | Competitive approaches to health care reform |
| title_exact_search | Competitive approaches to health care reform |
| title_full | Competitive approaches to health care reform Richard J. Arnould ... eds. |
| title_fullStr | Competitive approaches to health care reform Richard J. Arnould ... eds. |
| title_full_unstemmed | Competitive approaches to health care reform Richard J. Arnould ... eds. |
| title_short | Competitive approaches to health care reform |
| title_sort | competitive approaches to health care reform |
| topic | Gezondheidszorg gtt Gesundheitswesen Politik Competition United States Delivery of Health Care economics Canada Delivery of Health Care economics United States Economic Competition Canada Economic Competition United States Health Policy Canada Health Policy United States Health Services Administration Canada Health Services Administration United States Health care reform United States Health insurance Finance Government policy United States Medical care United States Cost control Medical policy United States Gesundheitswesen (DE-588)4020775-4 gnd Marktwirtschaft (DE-588)4037653-9 gnd |
| topic_facet | Gezondheidszorg Gesundheitswesen Politik Competition United States Delivery of Health Care economics Canada Delivery of Health Care economics United States Economic Competition Canada Economic Competition United States Health Policy Canada Health Policy United States Health Services Administration Canada Health Services Administration United States Health care reform United States Health insurance Finance Government policy United States Medical care United States Cost control Medical policy United States Marktwirtschaft Kanada USA |
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