Health economics and financing:
Gespeichert in:
| 1. Verfasser: | |
|---|---|
| Format: | Buch |
| Sprache: | English |
| Veröffentlicht: |
Hoboken, NJ
Wiley
2007
|
| Ausgabe: | 3. ed. |
| Schlagworte: | |
| Online-Zugang: | Inhaltsverzeichnis |
| Beschreibung: | 2. Aufl. u.d.T.: Health economics |
| Beschreibung: | XXVIII, 458 S. graph. Darst. |
| ISBN: | 0471772593 9780471772590 |
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| 100 | 1 | |a Getzen, Thomas E. |e Verfasser |4 aut | |
| 245 | 1 | 0 | |a Health economics and financing |c Thomas E. Getzen |
| 250 | |a 3. ed. | ||
| 264 | 1 | |a Hoboken, NJ |b Wiley |c 2007 | |
| 300 | |a XXVIII, 458 S. |b graph. Darst. | ||
| 336 | |b txt |2 rdacontent | ||
| 337 | |b n |2 rdamedia | ||
| 338 | |b nc |2 rdacarrier | ||
| 500 | |a 2. Aufl. u.d.T.: Health economics | ||
| 650 | 4 | |a Economics, Medical |z United States | |
| 650 | 4 | |a Flow of funds | |
| 650 | 4 | |a Health Care Costs |z United States | |
| 650 | 4 | |a Medical care, Cost of | |
| 650 | 4 | |a Medical economics | |
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| 651 | 4 | |a USA | |
| 655 | 7 | |0 (DE-588)4123623-3 |a Lehrbuch |2 gnd-content | |
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Datensatz im Suchindex
| _version_ | 1804136484690722816 |
|---|---|
| adam_text | CONTENTS
Preface
xxiii
Acknowledgments
xxvi
About the Author
xxvii
Foreword
xxviii
1
Terms of Trade: The Flow of Funds Through the Health
Care System
ι
1.1
WHAT IS ECONOMICS?
2
Terms of Trade
3
Can We Pay Somebody to Care?
4
Financing Health Care
5
Value
6
1.2
THE FLOW OF FUNDS
6
Health Care Spending in the United States
7
Sources of Financing
8
Health Care Providers: The Uses of Funds
10
1.3
QUALITY
12
1.4
PUBLIC OR PRIVATE CHOICES
12
1.5
RESEARCH
13
1.6
TIME
14
1.7
ECONOMIC PRINCIPLES AS CONCEPTUAL TOOLS
15
Trade
15
Choice: Are Benefits Greater Than Costs?
15
Opportunity Cost
16
Scarcity (Budget Constraints)
16
Maximization/Marginalism
16
Money Flows in a Circle
16
Financial Contracts and Risk
16
Organizations Adapt and Evolve
17
1.8
HEALTH PRINCIPLES
17
Health Is Priceless
17
X
CONTENTS
Having More Does Not Reduce the Value of Health
18
Quality, Not Quantity, Matters
18
Differences in Quality over Time, or Regions, Are Greater than
Most Quality Differences That Patients Actually Choose From
18
Health Risks Are More Public Than Private
18
Individual Choices: Lifestyle Matters More Than Medicine
18
Even When No Money Changes Hands, Econ Principles Apply
19
And Yet, Money Still Determines Health
19
1.9
HEALTH AND THE ECONOMY
19
Suggestions for Further Reading
20
Summary
20
Problems
21
Endnotes 22
2
Demand and Supply
24
2.1
NEED VERSUS DEMAND
24
2.2
THE DEMAND CURVE
25
The Diamonds-Water Paradox: An Example of
Marginal Analysis
26
Ceteris
Paribus 28
Individual, Firm, and Market Demand Curves
28
2.3
MARGINAL REVENUE
29
Price Sensitivity
29
Price Elasticity and Marginal Revenue
31
Price Discrimination
32
2.4
IS MONEY THE ONLY PRICE?
33
The Labor-Leisure Choice
34
2.5
SUPPLY: INPUTS AND PRODUCTION FUNCTIONS
34
Marginal Productivity
35
Production Functions
35
2.6
MARKETS
35
2.7
THE PRODUCTION OF HEALTH
36
How Much is a Doctor Visit Worth?
37
The Demand for Medical Care is Derived Demand
37
2.8
EFFICIENCY
38
Suggestions for Further Reading
40
Summary
40
Problems
41
Endnotes 43
CONTENTS Xl
3
Cost-Benefit and Cost-Effectiveness Analysis
44
3.1
COST-BENEFIT ANALYSIS IS ABOUT MAKING CHOICES
45
An Everyday Example: Knee Injury
45
Stepwise Choices: Yes or No? How Much?
48
Calculating Marginal and Average Costs
49
Defining Marginal: What is the Decision?
50
Opportunity Cost: Looking at Alternatives
53
Expected Value
54
3.2
MAXIMIZATION: FINDING THE OPTIMUM
55
Declining Marginal Benefits
55
Optimization: Maximum Net Benefits
56
Why Marginals are the Max, and Averages are Misleading
57
3.3
MEASURING BENEFITS
58
Health
58
Productivity
59
Reductions in Future Medical Costs
59
3.4
MEASURING COSTS
59
Medical Care and Administration: Charges Versus Costs
59
Follow-Up and Treatment
60
Time and Pain of Patient and Family
60
Provider Time and Inconvenience
60
3.5
EVIDENCE-BASED MEDICINE
61
3.6
THE VALUE OF LIFE
62
3.7
QUALITY-ADJUSTED LIFE YEARS (QALYs)
64
Discounting Over Time
64
QALY League Tables
65
3.8
PERSPECTIVES: PATIENT, PAYER, GOVERNMENT,
PROVIDER, SOCIETY
66
Distribution: Whose Costs and Whose Benefits?
67
CBA Is a Limited Perspective
67
CBA and Public Policy Decision Making
67
Suggestions for Further Reading
68
Summary
68
Problems
70
Endnotes 72
4
Health Insurance: Financing Medical Care
74
4.1
METHODS FOR COVERING RISKS
75
Savings
75
XU CONTENTS
Family and Friends
75
Charity
75
Private Market Insurance Contracts
76
Social Insurance
77
Strengths and Weaknesses of Different Forms of
Risk Spreading
77
4.2
INSURANCE: THIRD-PARTY PAYMENT
78
Why Third-Party Payment?
79
Variability
80
Third-Party Transactions
81
Who Pays? How Much?
82
How Are Benefits Determined?
83
4.3
RISK AVERSION
83
4.4
ADVERSE SELECTION
85
4.5
MORAL HAZARD
87
Welfare Losses Due to Moral Hazard
89
4.6
TAX BENEFITS
90
4.7
EFFECTS OF HEALTH INSURANCE ON LABOR MARKETS
91
4.8
HISTORY OF HEALTH INSURANCE
92
4.9
FINANCING HEALTH CARE: INSURANCE AS A
FUNDING MECHANISM
94
Entitlements: Open or Closed Financing?
95
Suggestions for Further Reading
96
Summary
96
Problems
98
Endnotes 100
5
Insurance Contracts and Managed Care
102
5.1
TYPES OF INSURANCE PLANS
102
Employer-Based Group Health Insurance
102
Self-Paid Private Insurance
104
Medicare
104
Medicaid
104
Other Government Programs and Charity
106
The Uninsured
106
State Children s Health Insurance Program
107
5.2
HSA s, MEDICAL SAVINGS ACCOUNTS AND CONSUMER-DRIVEN
HEALTH PLANS
107
Defined Contribution Health Plans
108
High-Deductible Insurance
109
CONTENTS
ХІІІ
Reforming the Medical Market
109
Are HSAs the Solution to Rising Costs?
109
5.3
A RANGE OF RISK BEARING: FIXED PREMIUMS, ADMINISTERED
SERVICES ONLY, AND SELF-INSURANCE
110
The Underwriting Cycle 111
ERISA, Taxes, and Mandated Benefits
112
5.4
MANAGED CARE PLANS
114
Why Managed Care?
114
Management: The Distinctive Feature of Managed Care
114
Contractual Reforms to Reduce Costs
115
A Fourth Way: Reforming the Organization to Reduce Cost
117
Medical Loss Ratios
118
5.5
THE RANGE OF MANAGED CARE PLANS
118
Provider Networks
119
Gatekeeping
120
Capitation
120
Withholds
120
Utilization Review
122
5.6
IS MANAGED CARE THE SOLUTION TO RISING COSTS?
122
Evidence on Cost Reductions
122
Risk Selection
123
Quality of Care
123
Cost Reductions in
IPA
HMOs, PPOs, and
POS
Plans
124
Administrative Costs and Profits
124
One-Time Savings?
124
Backlash: Are There Losers As Well As Winners?
125
5.7
MANAGED COMPETITION: THE ENTHOVEN PLAN
125
5.8
INCENTIVES—TO PATIENTS, TO PAYERS, AND
TO PROVIDERS
126
Suggestions for Further Reading
127
Summary
127
Problems
129
Endnotes 130
6
Physicians
134
6.1
FINANCING PHYSICIAN SERVICES: REVENUES
134
Co-Pays, Assignment, and Balance Billing
138
Physician Payment in Managed Care Plans
139
Incentives: Why Differences in the Type of Payment Matter
140
A Progression: From Prices to Reimbursement Mechanisms
140
XIV CONTENTS
6.2
PHYSICIAN INCOMES
141
6.3
PHYSICIAN FINANCING: EXPENSES
142
Physician Practice Expenses
142
The Labor-Leisure Choice
144
The Doctor s Workshop and Unpaid Hospital Inputs
144
Malpractice
145
6.4
THE TRANSACTION BETWEEN DOCTOR AND PATIENT
146
Asymmetric Information
146
6.5
UNCERTAINTY
146
6.6
LICENSURE: QUALITY OR PROFITS?
147
How Does Licensure Increase Physician Profits?
148
Supply and Demand Response in Licensed Versus
Unlicensed Professions
149
How Does Licensure Improve Quality?
150
A Test of the Quality Hypothesis: Strong Versus
Weak Licensure
151
Suggestions for Further Reading
152
Summary
152
Problems
153
Endnotes 154
7
Medical Education, Organization, and Business
Practices
156
7.1
MEDICAL EDUCATION
156
7.2
THE ORIGINS OF LICENSURE AND LINKAGE TO MEDICAL
EDUCATION
157
AMA
Controls Over Physician Supply,
1930-1965 158
Breaking the Contract: The Great Medical Student Expansion
of
1970-1980 160
Building Pressure: Fixed Domestic Graduation Rates
1980-2007 160
7.3
ADJUSTING PHYSICIAN SUPPLY
161
The Flow of New Entrants and the Stock of Physicians
161
Immigration of International Medical Graduates
162
Growth in Non-MD Physicians
162
Balancing Supply and Incomes: Tracing the Past and Projecting
the Future
163
7.4
GROUP PRACTICE: HOW ORGANIZATION AND TECHNOLOGY
AFFECT TRANSACTIONS
164
7.5
KICKBACKS, SELF-DEALING, AND SIDE PAYMENTS
166
7.6
PRICE DISCRIMINATION
168
CONTENTS
XV
7.7
PRACTICE
VARIATIONS
170
7.8
INSURANCE,
PRICE
COMPETITION, AND THE STRUCTURE
OF
MEDICAL
MARKETS
173
Suggestions
for Further Reading 1
75
Summary
175
Problems
177
Endnotes 180
8
Hospitals
182
8.1
FROM CHARITABLE INSTITUTIONS TO CORPORATE CHAINS:
DEVELOPMENT OF THE MODERN HOSPITAL
182
8.2
HOSPITAL FINANCING: REVENUES
184
Sources of Revenues
184
8.3
HOSPITAL FINANCING: EXPENSES
190
8.4
FINANCIAL MANAGEMENT AND COST SHIFTING
191
8.5
HOW DO HOSPITALS COMPETE?
194
Competing for Patients
194
Competing for Physicians
195
Competing for Contracts
195
Measuring Competitive Success
196
Measuring the Competitiveness of Markets
197
8.6
ORGANIZATION: WHO CONTROLS THE HOSPITAL AND FOR
WHAT ENDS?
197
Suggestions for Further Reading
199
Summary
199
Problems
201
Endnotes 202
9
Management and Regulation of Hospital Costs
204
9.1
WHY DO SOME HOSPITALS COST MORE THAN OTHERS?
204
9.2
HOW MANAGEMENT CONTROLS COSTS
205
Short-Run Versus Long-Run Cost Functions
205
Uncertainty and Budgeting
207
9.3
CONFLICT BETWEEN ECONOMIC THEORY AND ACCOUNTING
MEASURES OF PER UNIT COST
209
Timing
209
Whose Costs?
211
9.4
ECONOMIES OF SCALE
212
The Hospital is a Multiproduct Firm
213
Contracting Out
213
XVI
CONTENTS
9.5
QUALITY AND COST
213
Technology: Cutting Costs or Enhancing Quality?
213
Improved Efficiency May Raise Total Spending
214
9.6
CONTROLLING HOSPITAL COSTS THROUGH REGULATION
216
Suggestions for Further Reading
218
Summary
218
Problems
219
Endnotes 221
10
Long-Term
Care
222
10.1
DEVELOPMENT OF THE LONG-TERM CARE MARKET
223
10.2
DEFINING LTC: TYPES OF CARE
225
10.3
MEDICAID: NURSING HOMES AS A TWO-PART MARKET
226
10.4
CERTIFICATE OF NEED: WHOSE NEEDS?
229
Money and Quality
229
Competing for Certificates of Need, Not for Patients
230
Evidence on the Effects of CON
231
10.5
CASE-MIX REIMBURSEMENT
231
10.6
SUBSTITUTION
233
10.7
FINANCIAL REIMBURSEMENT CYCLES
234
10.8
CONTINUING CARE RETIREMENT COMMUNITIES AND THE
WEALTHY ELDERLY
236
Medicare Catastrophic Coverage Act of
1988
and the Taxpayer
Revolt
238
10.9
THE EFFECTS OF AGING ON COST AND UTILIZATION
238
Defining Boundaries: Is Long-Term Care Medical ?
238
LTC Insurance
239
The Effects of Aging
240
Suggestions for Further Reading
241
Summary
242
Problems
243
Endnotes 244
11
Pharmaceuticals
246
11.1
PHARMACEUTICAL REVENUES: SOURCES OF FINANCING
247
Inpatient Pharmaceuticals
249
11.2
USES OF FUNDS
249
Retail Pharmacies
250
Wholesalers
251
Insurance Companies and PBMs
251
CONTENTS
XVII
Pharmaceutical Firms
251
Cost Structure
253
11.3
HISTORY AND REGULATION OF PHARMACEUTICALS
253
11.4
RESEARCH AND DEVELOPMENT
257
11.5
PHARMACOECONOMICS AND OUTCOMES RESEARCH
259
11.6
INDUSTRY STRUCTURE AND COMPETITION
260
Market Segmentation: Types of Buyers
261
Contractual Responses to Pharmacy Benefits Management
261
Value and Cost
262
The Role of Middlemen: Distribution Versus Marketing
263
Research Productivity
265
11.7
TRENDS: FORM FOLLOWS FUNCTION (AND MONEY)
266
Suggestions for Further Heading
267
Summary
267
Problems
268
Endnotes 269
12
Capital Financing And Ownership of Health Care
Providers
271
12.1
WHAT IS CAPITAL FINANCING?
271
12.2
VALUE AND RATE OF RETURN
272
The Time Value of Money
272
Interest Rates and Present Value
273
IRR:
The Internal Rate of Return
274
Human Capital: Medical Education as an Investment
276
Risk
277
Valuing Assets
278
12.3
UNCORRELATED (INDEPENDENT) AND CORRELATED
(SYSTEM) RISKS
280
Which is Riskier: Nursing Homes or Drug Companies?
281
Assessing Business Risk
282
12.4
OWNERSHIP AND AGENCY
283
Equity and Debt
283
Who Owns the Business? Who Owns the Patient? Agency
Issues
284
The Role of Financial Intermediaries
286
12.5
CAPITAL FINANCING: HOSPITALS
286
12.6
WORKING CAPITAL AND THE CASH FLOW CYCLE
289
The Cash Cycle
290
Health Insurers as Financial Intermediaries
291
XVÜi CONTENTS
Growth and Working Capital
291
Business Risks for an HMO
291
Kaiser Health Plan: The Evolution of an HMO
292
12.7
HMO OWNERSHIP AND CAPITAL MARKETS: SIGNS
OF FAILURE
294
GHA: A Consumer Co-Op Gets Bought Out by a Franchise
Chain
295
Corporate Advantage
295
U.S. Healthcare: A Profitable Growth Company
296
Suggestions for Further Reading
298
Summary
299
Problems
300
Endnotes 301
13
Macroeconomics of Medical Care
304
13.1
WHAT IS MACRO?
304
Micro and Macro Perspectives on Spending
305
13.2
THE CONSUMPTION FUNCTION
306
The Permanent Income Hypothesis
308
Shared Income
309
Public and Private Decisions
310
Borders that Matter
311
13.3
ADJUSTING TO CHANGE: DYNAMICS
311
Permanent Income and Adjustment of Health Spending
to GDP
313
Adjustment to Inflation
314
Adjustment to GDP: Rates of Change and Time Series
Analysis
316
13.4
FORECASTING FUTURE HEALTH EXPENDITURES
318
13.5
COST CONTROLS: SPENDING GAPS AND THE PUSH
TO REGULATE
319
Capacity Constraints and Budget Constraints
321
13.6
WORKFORCE DYNAMICS: SPENDING IS MOSTLY LABOR
321
Employment
322
Wages
322
Suggestions for Further Reading
327
Summary
327
Problems
327
Endnotes 329
CONTENTS
ХІХ
14
The Role of
Government
331
14.1
GOVERNMENT HEALTH
FINANCING
331
14.2
THE ROLES
OF
GOVERNMENT
333
Government
is Necessary, Even for Private Exchange
333
Efficiency of Markets Under Conditions of Perfect
Competition
334
Government in a Mixed Economy
335
14.3
LAW AND ORDER
335
14.4
PUBLIC GOODS AND EXTERNALITIES
336
Externalities
337
The
Coase
Theorem: Transaction Costs and Property Rights
337
Politicians: Entrepreneurs Who Try to Get Votes
338
14.5
MARKET FAILURE
339
Monopoly
339
Paternalism
340
14.6
INCOME REDISTRIBUTION AND CARE OF THE POOR
341
Medicaid and Medicare: Dependency or Rights?
341
14.7
HOW GOVERNMENT WORKS
342
The Voluntary Sector
343
Government as the Citizen s Agent
344
Winners and Losers
346
14.8
PROS AND CONS OF REGULATION AND COMPETITION
346
Suggestions for Further Reading
348
Summary
348
Problems
349
Endnotes 350
15
Public Goods and Public Health
352
15.1
CHARACTERISTICS OF PUBLIC GOODS
352
Privatizing Public Goods
353
Social Costs Depend on the Number of People
354
Insurance Makes Any Good More Public
354
15.2
INFORMATION
355
Rational Consumer Ignorance
356
Milk or Bread: Which is More Public?
356
15.3
THE THEORY OF PURE PUBLIC GOODS
357
Public Goods Make Most People Better Off, But Few Happy
359
XX
CONTENTS
15.4
INFECTIOUS DISEASE EXTERNALITIES
361
Epidemics
361
HIV/AIDS
362
The Sanitary Revolution: A Moral Campaign for Public
Health
363
Formation of the U.S. Public Health Service
364
15.5
SEX, DRUGS, AND WAR: PUBLIC HEALTH IN ACTION
364
Who Counts as a Citizen? Abortion and Other Dilemmas
365
Addiction
366
War and Public Health
367
Suggestions for Further Reading
368
Summary
368
Problems
369
Endnotes 369
l6 History, Demography, and the Growth of Modern
Medicine
371
16.1
ECONOMIC GROWTH HAS DETERMINED THE SHAPE OF
HEALTHCARE
371
16.2
BIRTH RATES, DEATH RATES, AND POPULATION GROWTH
372
16.3
THE STONE AGE
372
16.4
THE AGRICULTURAL AGE
373
Investment and Trade
374
Civilization, War, and Government
374
The Decline of Civilizations Leads to Population Declines
375
The Plague
376
Food Supply Determines Population
376
The Rise of Economics
376
The Malthusian Hypothesis
377
16.5
THE INDUSTRIAL AGE
378
Why
Malthus
Was Wrong
378
Demographic Transition
379
Demographic Change, Income Distribution, and the Rise of the
Middle Classes
380
16.6
THE INFORMATION AGE
382
16.7
INCOME AND HEALTH
383
Income and the Effects of Medical Care
385
16.8
REDUCING UNCERTAINTY: THE VALUE OF LIFE AND
ECONOMIC SECURITY
385
The Value of Risk Reduction
386
CONTENTS XXI
Social Security and Health Insurance
386
Preconditions for Changing Medical Organization
387
16.9
THE RISE OF MEDICAL TECHNOLOGY
387
Suggestions for Further Reading
390
Summary
390
Problems
391
Endnotes 393
17
International Comparisons of Health and Health
Expenditures
396
17.1
WIDE DIFFERENCES AMONG NATIONS
396
Size of the Market
398
17.2
MICRO VERSUS MACRO ALLOCATION: HEALTH AS A NATIONAL
LUXURY GOOD
399
17.3
CAUSALITY: DOES MORE SPENDING IMPROVE HEALTH?
401
17.4
LOW-INCOME COUNTRIES
402
Sudan
403
Health Care in Kenya
405
17.5
MIDDLE-INCOME COUNTRIES
406
The HealthCare System of Mexico
407
Poland
408
17.6
HIGH-INCOME COUNTRIES
410
Costs and Cost Control
410
Japan
412
The German Health System
415
17.7
INTERNATIONAL TRADE IN HEALTH CARE
418
Pharmaceuticals
418
Equipment
419
Services
419
People and Ideas
419
Suggestions for Further Reading
420
Summary
420
Problems
421
Endnotes 422
18
Value for Money in the Future of Health Care
424
18.1
FORCING THE QUESTION: WHO GETS HEALTHY AND WHO
GETS PAID?
424
18.2
SPENDING MONEY OR PRODUCING HEALTH?
425
XXII CONTENTS
18.3
ALLOCATION, ALLOCATION, ALLOCATION
427
18.4 DYNAMIC
EFFICIENCY
428
18.5
THE FUTURE
429
Suggestions
for Further Reading
430
Summary
431
Problems
431
Endnotes 432
Glossary
433
Index
443
|
| adam_txt |
CONTENTS
Preface
xxiii
Acknowledgments
xxvi
About the Author
xxvii
Foreword
xxviii
1
Terms of Trade: The Flow of Funds Through the Health
Care System
ι
1.1
WHAT IS ECONOMICS?
2
Terms of Trade
3
Can We Pay Somebody to Care?
4
Financing Health Care
5
Value
6
1.2
THE FLOW OF FUNDS
6
Health Care Spending in the United States
7
Sources of Financing
8
Health Care Providers: The Uses of Funds
10
1.3
QUALITY
12
1.4
PUBLIC OR PRIVATE CHOICES
12
1.5
RESEARCH
13
1.6
TIME
14
1.7
ECONOMIC PRINCIPLES AS CONCEPTUAL TOOLS
15
Trade
15
Choice: Are Benefits Greater Than Costs?
15
Opportunity Cost
16
Scarcity (Budget Constraints)
16
Maximization/Marginalism
16
Money Flows in a Circle
16
Financial Contracts and Risk
16
Organizations Adapt and Evolve
17
1.8
HEALTH PRINCIPLES
17
Health Is Priceless
17
X
CONTENTS
Having More Does Not Reduce the Value of Health
18
Quality, Not Quantity, Matters
18
Differences in Quality over Time, or Regions, Are Greater than
Most Quality Differences That Patients Actually Choose From
18
Health Risks Are More Public Than Private
18
Individual Choices: Lifestyle Matters More Than Medicine
18
Even When No Money Changes Hands, Econ Principles Apply
19
And Yet, Money Still Determines Health
19
1.9
HEALTH AND THE ECONOMY
19
Suggestions for Further Reading
20
Summary
20
Problems
21
Endnotes 22
2
Demand and Supply
24
2.1
NEED VERSUS DEMAND
24
2.2
THE DEMAND CURVE
25
The Diamonds-Water Paradox: An Example of
Marginal Analysis
26
Ceteris
Paribus 28
Individual, Firm, and Market Demand Curves
28
2.3
MARGINAL REVENUE
29
Price Sensitivity
29
Price Elasticity and Marginal Revenue
31
Price Discrimination
32
2.4
IS MONEY THE ONLY PRICE?
33
The Labor-Leisure Choice
34
2.5
SUPPLY: INPUTS AND PRODUCTION FUNCTIONS
34
Marginal Productivity
35
Production Functions
35
2.6
MARKETS
35
2.7
THE PRODUCTION OF HEALTH
36
How Much is a Doctor Visit Worth?
37
The Demand for Medical Care is Derived Demand
37
2.8
EFFICIENCY
38
Suggestions for Further Reading
40
Summary
40
Problems
41
Endnotes 43
CONTENTS Xl
3
Cost-Benefit and Cost-Effectiveness Analysis
44
3.1
COST-BENEFIT ANALYSIS IS ABOUT MAKING CHOICES
45
An Everyday Example: Knee Injury
45
Stepwise Choices: Yes or No? How Much?
48
Calculating Marginal and Average Costs
49
Defining Marginal: What is the Decision?
50
Opportunity Cost: Looking at Alternatives
53
Expected Value
54
3.2
MAXIMIZATION: FINDING THE OPTIMUM
55
Declining Marginal Benefits
55
Optimization: Maximum Net Benefits
56
Why Marginals are "the Max," and Averages are Misleading
57
3.3
MEASURING BENEFITS
58
Health
58
Productivity
59
Reductions in Future Medical Costs
59
3.4
MEASURING COSTS
59
Medical Care and Administration: Charges Versus Costs
59
Follow-Up and Treatment
60
Time and Pain of Patient and Family
60
Provider Time and Inconvenience
60
3.5
EVIDENCE-BASED MEDICINE
61
3.6
THE VALUE OF LIFE
62
3.7
QUALITY-ADJUSTED LIFE YEARS (QALYs)
64
Discounting Over Time
64
QALY League Tables
65
3.8
PERSPECTIVES: PATIENT, PAYER, GOVERNMENT,
PROVIDER, SOCIETY
66
Distribution: Whose Costs and Whose Benefits?
67
CBA Is a Limited Perspective
67
CBA and Public Policy Decision Making
67
Suggestions for Further Reading
68
Summary
68
Problems
70
Endnotes 72
4
Health Insurance: Financing Medical Care
74
4.1
METHODS FOR COVERING RISKS
75
Savings
75
XU CONTENTS
Family and Friends
75
Charity
75
Private Market Insurance Contracts
76
Social Insurance
77
Strengths and Weaknesses of Different Forms of
Risk Spreading
77
4.2
INSURANCE: THIRD-PARTY PAYMENT
78
Why Third-Party Payment?
79
Variability
80
Third-Party Transactions
81
Who Pays? How Much?
82
How Are Benefits Determined?
83
4.3
RISK AVERSION
83
4.4
ADVERSE SELECTION
85
4.5
MORAL HAZARD
87
Welfare Losses Due to Moral Hazard
89
4.6
TAX BENEFITS
90
4.7
EFFECTS OF HEALTH INSURANCE ON LABOR MARKETS
91
4.8
HISTORY OF HEALTH INSURANCE
92
4.9
FINANCING HEALTH CARE: INSURANCE AS A
FUNDING MECHANISM
94
Entitlements: Open or Closed Financing?
95
Suggestions for Further Reading
96
Summary
96
Problems
98
Endnotes 100
5
Insurance Contracts and Managed Care
102
5.1
TYPES OF INSURANCE PLANS
102
Employer-Based Group Health Insurance
102
Self-Paid Private Insurance
104
Medicare
104
Medicaid
104
Other Government Programs and Charity
106
The Uninsured
106
State Children's Health Insurance Program
107
5.2
HSA's, MEDICAL SAVINGS ACCOUNTS AND "CONSUMER-DRIVEN
HEALTH PLANS"
107
Defined Contribution Health Plans
108
High-Deductible Insurance
109
CONTENTS
ХІІІ
Reforming the Medical Market
109
Are HSAs the Solution to Rising Costs?
109
5.3
A RANGE OF RISK BEARING: FIXED PREMIUMS, ADMINISTERED
SERVICES ONLY, AND SELF-INSURANCE
110
The Underwriting Cycle 111
ERISA, Taxes, and Mandated Benefits
112
5.4
MANAGED CARE PLANS
114
Why Managed Care?
114
Management: The Distinctive Feature of Managed Care
114
Contractual Reforms to Reduce Costs
115
A Fourth Way: Reforming the Organization to Reduce Cost
117
Medical Loss Ratios
118
5.5
THE RANGE OF MANAGED CARE PLANS
118
Provider Networks
119
Gatekeeping
120
Capitation
120
Withholds
120
Utilization Review
122
5.6
IS MANAGED CARE THE SOLUTION TO RISING COSTS?
122
Evidence on Cost Reductions
122
Risk Selection
123
Quality of Care
123
Cost Reductions in
IPA
HMOs, PPOs, and
POS
Plans
124
Administrative Costs and Profits
124
One-Time Savings?
124
Backlash: Are There Losers As Well As Winners?
125
5.7
MANAGED COMPETITION: THE ENTHOVEN PLAN
125
5.8
INCENTIVES—TO PATIENTS, TO PAYERS, AND
TO PROVIDERS
126
Suggestions for Further Reading
127
Summary
127
Problems
129
Endnotes 130
6
Physicians
134
6.1
FINANCING PHYSICIAN SERVICES: REVENUES
134
Co-Pays, Assignment, and Balance Billing
138
Physician Payment in Managed Care Plans
139
Incentives: Why Differences in the Type of Payment Matter
140
A Progression: From Prices to Reimbursement Mechanisms
140
XIV CONTENTS
6.2
PHYSICIAN INCOMES
141
6.3
PHYSICIAN FINANCING: EXPENSES
142
Physician Practice Expenses
142
The Labor-Leisure Choice
144
The Doctor's Workshop and Unpaid Hospital Inputs
144
Malpractice
145
6.4
THE TRANSACTION BETWEEN DOCTOR AND PATIENT
146
Asymmetric Information
146
6.5
UNCERTAINTY
146
6.6
LICENSURE: QUALITY OR PROFITS?
147
How Does Licensure Increase Physician Profits?
148
Supply and Demand Response in Licensed Versus
Unlicensed Professions
149
How Does Licensure Improve Quality?
150
A Test of the Quality Hypothesis: Strong Versus
Weak Licensure
151
Suggestions for Further Reading
152
Summary
152
Problems
153
Endnotes 154
7
Medical Education, Organization, and Business
Practices
156
7.1
MEDICAL EDUCATION
156
7.2
THE ORIGINS OF LICENSURE AND LINKAGE TO MEDICAL
EDUCATION
157
AMA
Controls Over Physician Supply,
1930-1965 158
Breaking the Contract: The Great Medical Student Expansion
of
1970-1980 160
Building Pressure: Fixed Domestic Graduation Rates
1980-2007 160
7.3
ADJUSTING PHYSICIAN SUPPLY
161
The Flow of New Entrants and the Stock of Physicians
161
Immigration of International Medical Graduates
162
Growth in Non-MD Physicians
162
Balancing Supply and Incomes: Tracing the Past and Projecting
the Future
163
7.4
GROUP PRACTICE: HOW ORGANIZATION AND TECHNOLOGY
AFFECT TRANSACTIONS
164
7.5
KICKBACKS, SELF-DEALING, AND SIDE PAYMENTS
166
7.6
PRICE DISCRIMINATION
168
CONTENTS
XV
7.7
PRACTICE
VARIATIONS
170
7.8
INSURANCE,
PRICE
COMPETITION, AND THE STRUCTURE
OF
MEDICAL
MARKETS
173
Suggestions
for Further Reading 1
75
Summary
175
Problems
177
Endnotes 180
8
Hospitals
182
8.1
FROM CHARITABLE INSTITUTIONS TO CORPORATE CHAINS:
DEVELOPMENT OF THE MODERN HOSPITAL
182
8.2
HOSPITAL FINANCING: REVENUES
184
Sources of Revenues
184
8.3
HOSPITAL FINANCING: EXPENSES
190
8.4
FINANCIAL MANAGEMENT AND COST SHIFTING
191
8.5
HOW DO HOSPITALS COMPETE?
194
Competing for Patients
194
Competing for Physicians
195
Competing for Contracts
195
Measuring Competitive Success
196
Measuring the Competitiveness of Markets
197
8.6
ORGANIZATION: WHO CONTROLS THE HOSPITAL AND FOR
WHAT ENDS?
197
Suggestions for Further Reading
199
Summary
199
Problems
201
Endnotes 202
9
Management and Regulation of Hospital Costs
204
9.1
WHY DO SOME HOSPITALS COST MORE THAN OTHERS?
204
9.2
HOW MANAGEMENT CONTROLS COSTS
205
Short-Run Versus Long-Run Cost Functions
205
Uncertainty and Budgeting
207
9.3
CONFLICT BETWEEN ECONOMIC THEORY AND ACCOUNTING
MEASURES OF PER UNIT COST
209
Timing
209
Whose Costs?
211
9.4
ECONOMIES OF SCALE
212
The Hospital is a Multiproduct Firm
213
Contracting Out
213
XVI
CONTENTS
9.5
QUALITY AND COST
213
Technology: Cutting Costs or Enhancing Quality?
213
Improved Efficiency May Raise Total Spending
214
9.6
CONTROLLING HOSPITAL COSTS THROUGH REGULATION
216
Suggestions for Further Reading
218
Summary
218
Problems
219
Endnotes 221
10
Long-Term
Care
222
10.1
DEVELOPMENT OF THE LONG-TERM CARE MARKET
223
10.2
DEFINING LTC: TYPES OF CARE
225
10.3
MEDICAID: NURSING HOMES AS A TWO-PART MARKET
226
10.4
CERTIFICATE OF NEED: WHOSE NEEDS?
229
Money and Quality
229
Competing for Certificates of Need, Not for Patients
230
Evidence on the Effects of CON
231
10.5
CASE-MIX REIMBURSEMENT
231
10.6
SUBSTITUTION
233
10.7
FINANCIAL REIMBURSEMENT CYCLES
234
10.8
CONTINUING CARE RETIREMENT COMMUNITIES AND THE
WEALTHY ELDERLY
236
Medicare Catastrophic Coverage Act of
1988
and the Taxpayer
Revolt
238
10.9
THE EFFECTS OF AGING ON COST AND UTILIZATION
238
Defining Boundaries: Is Long-Term Care "Medical"?
238
LTC Insurance
239
The Effects of Aging
240
Suggestions for Further Reading
241
Summary
242
Problems
243
Endnotes 244
11
Pharmaceuticals
246
11.1
PHARMACEUTICAL REVENUES: SOURCES OF FINANCING
247
Inpatient Pharmaceuticals
249
11.2
USES OF FUNDS
249
Retail Pharmacies
250
Wholesalers
251
Insurance Companies and PBMs
251
CONTENTS
XVII
Pharmaceutical Firms
251
Cost Structure
253
11.3
HISTORY AND REGULATION OF PHARMACEUTICALS
253
11.4
RESEARCH AND DEVELOPMENT
257
11.5
PHARMACOECONOMICS AND OUTCOMES RESEARCH
259
11.6
INDUSTRY STRUCTURE AND COMPETITION
260
Market Segmentation: Types of Buyers
261
Contractual Responses to Pharmacy Benefits Management
261
Value and Cost
262
The Role of Middlemen: Distribution Versus Marketing
263
Research Productivity
265
11.7
TRENDS: FORM FOLLOWS FUNCTION (AND MONEY)
266
Suggestions for Further Heading
267
Summary
267
Problems
268
Endnotes 269
12
Capital Financing And Ownership of Health Care
Providers
271
12.1
WHAT IS CAPITAL FINANCING?
271
12.2
VALUE AND RATE OF RETURN
272
The Time Value of Money
272
Interest Rates and Present Value
273
IRR:
The Internal Rate of Return
274
Human Capital: Medical Education as an Investment
276
Risk
277
Valuing Assets
278
12.3
UNCORRELATED (INDEPENDENT) AND CORRELATED
(SYSTEM) RISKS
280
Which is Riskier: Nursing Homes or Drug Companies?
281
Assessing Business Risk
282
12.4
OWNERSHIP AND AGENCY
283
Equity and Debt
283
Who Owns the Business? Who Owns the Patient? Agency
Issues
284
The Role of Financial Intermediaries
286
12.5
CAPITAL FINANCING: HOSPITALS
286
12.6
WORKING CAPITAL AND THE CASH FLOW CYCLE
289
The Cash Cycle
290
Health Insurers as Financial Intermediaries
291
XVÜi CONTENTS
Growth and Working Capital
291
Business Risks for an HMO
291
Kaiser Health Plan: The Evolution of an HMO
292
12.7
HMO OWNERSHIP AND CAPITAL MARKETS: SIGNS
OF FAILURE
294
GHA: A Consumer Co-Op Gets Bought Out by a Franchise
Chain
295
Corporate Advantage
295
U.S. Healthcare: A Profitable Growth Company
296
Suggestions for Further Reading
298
Summary
299
Problems
300
Endnotes 301
13
Macroeconomics of Medical Care
304
13.1
WHAT IS MACRO?
304
Micro and Macro Perspectives on Spending
305
13.2
THE CONSUMPTION FUNCTION
306
The Permanent Income Hypothesis
308
Shared Income
309
Public and Private Decisions
310
Borders that Matter
311
13.3
ADJUSTING TO CHANGE: DYNAMICS
311
Permanent Income and Adjustment of Health Spending
to GDP
313
Adjustment to Inflation
314
Adjustment to GDP: Rates of Change and Time Series
Analysis
316
13.4
FORECASTING FUTURE HEALTH EXPENDITURES
318
13.5
COST CONTROLS: SPENDING GAPS AND THE PUSH
TO REGULATE
319
Capacity Constraints and Budget Constraints
321
13.6
WORKFORCE DYNAMICS: "SPENDING" IS MOSTLY LABOR
321
Employment
322
Wages
322
Suggestions for Further Reading
327
Summary
327
Problems
327
Endnotes 329
CONTENTS
ХІХ
14
The Role of
Government
331
14.1
GOVERNMENT HEALTH
FINANCING
331
14.2
THE ROLES
OF
GOVERNMENT
333
Government
is Necessary, Even for Private Exchange
333
Efficiency of Markets Under Conditions of Perfect
Competition
334
Government in a Mixed Economy
335
14.3
LAW AND ORDER
335
14.4
PUBLIC GOODS AND EXTERNALITIES
336
Externalities
337
The
Coase
Theorem: Transaction Costs and Property Rights
337
Politicians: Entrepreneurs Who Try to Get Votes
338
14.5
MARKET FAILURE
339
Monopoly
339
Paternalism
340
14.6
INCOME REDISTRIBUTION AND CARE OF THE POOR
341
Medicaid and Medicare: Dependency or Rights?
341
14.7
HOW GOVERNMENT WORKS
342
The Voluntary Sector
343
Government as the Citizen's Agent
344
Winners and Losers
346
14.8
PROS AND CONS OF REGULATION AND COMPETITION
346
Suggestions for Further Reading
348
Summary
348
Problems
349
Endnotes 350
15
Public Goods and Public Health
352
15.1
CHARACTERISTICS OF PUBLIC GOODS
352
Privatizing Public Goods
353
Social Costs Depend on the Number of People
354
Insurance Makes Any Good More Public
354
15.2
INFORMATION
355
Rational Consumer Ignorance
356
Milk or Bread: Which is More Public?
356
15.3
THE THEORY OF PURE PUBLIC GOODS
357
Public Goods Make Most People Better Off, But Few Happy
359
XX
CONTENTS
15.4
INFECTIOUS DISEASE EXTERNALITIES
361
Epidemics
361
HIV/AIDS
362
The Sanitary Revolution: A Moral Campaign for Public
Health
363
Formation of the U.S. Public Health Service
364
15.5
SEX, DRUGS, AND WAR: PUBLIC HEALTH IN ACTION
364
Who Counts as a Citizen? Abortion and Other Dilemmas
365
Addiction
366
War and Public Health
367
Suggestions for Further Reading
368
Summary
368
Problems
369
Endnotes 369
l6 History, Demography, and the Growth of Modern
Medicine
371
16.1
ECONOMIC GROWTH HAS DETERMINED THE SHAPE OF
HEALTHCARE
371
16.2
BIRTH RATES, DEATH RATES, AND POPULATION GROWTH
372
16.3
THE STONE AGE
372
16.4
THE AGRICULTURAL AGE
373
Investment and Trade
374
Civilization, War, and Government
374
The Decline of Civilizations Leads to Population Declines
375
The Plague
376
Food Supply Determines Population
376
The Rise of Economics
376
The Malthusian Hypothesis
377
16.5
THE INDUSTRIAL AGE
378
Why
Malthus
Was Wrong
378
Demographic Transition
379
Demographic Change, Income Distribution, and the Rise of the
Middle Classes
380
16.6
THE INFORMATION AGE
382
16.7
INCOME AND HEALTH
383
Income and the Effects of Medical Care
385
16.8
REDUCING UNCERTAINTY: THE VALUE OF LIFE AND
ECONOMIC SECURITY
385
The Value of Risk Reduction
386
CONTENTS XXI
Social Security and Health Insurance
386
Preconditions for Changing Medical Organization
387
16.9
THE RISE OF MEDICAL TECHNOLOGY
387
Suggestions for Further Reading
390
Summary
390
Problems
391
Endnotes 393
17
International Comparisons of Health and Health
Expenditures
396
17.1
WIDE DIFFERENCES AMONG NATIONS
396
Size of the Market
398
17.2
MICRO VERSUS MACRO ALLOCATION: HEALTH AS A NATIONAL
LUXURY GOOD
399
17.3
CAUSALITY: DOES MORE SPENDING IMPROVE HEALTH?
401
17.4
LOW-INCOME COUNTRIES
402
Sudan
403
Health Care in Kenya
405
17.5
MIDDLE-INCOME COUNTRIES
406
The HealthCare System of Mexico
407
Poland
408
17.6
HIGH-INCOME COUNTRIES
410
Costs and Cost Control
410
Japan
412
The German Health System
415
17.7
INTERNATIONAL TRADE IN HEALTH CARE
418
Pharmaceuticals
418
Equipment
419
Services
419
People and Ideas
419
Suggestions for Further Reading
420
Summary
420
Problems
421
Endnotes 422
18
Value for Money in the Future of Health Care
424
18.1
FORCING THE QUESTION: WHO GETS HEALTHY AND WHO
GETS PAID?
424
18.2
SPENDING MONEY OR PRODUCING HEALTH?
425
XXII CONTENTS
18.3
ALLOCATION, ALLOCATION, ALLOCATION
427
18.4 DYNAMIC
EFFICIENCY
428
18.5
THE FUTURE
429
Suggestions
for Further Reading
430
Summary
431
Problems
431
Endnotes 432
Glossary
433
Index
443 |
| any_adam_object | 1 |
| any_adam_object_boolean | 1 |
| author | Getzen, Thomas E. |
| author_facet | Getzen, Thomas E. |
| author_role | aut |
| author_sort | Getzen, Thomas E. |
| author_variant | t e g te teg |
| building | Verbundindex |
| bvnumber | BV022417114 |
| callnumber-first | R - Medicine |
| callnumber-label | RA410 |
| callnumber-raw | RA410 |
| callnumber-search | RA410 |
| callnumber-sort | RA 3410 |
| callnumber-subject | RA - Public Medicine |
| classification_rvk | QX 700 XC 5400 |
| ctrlnum | (OCoLC)843265308 (DE-599)BVBBV022417114 |
| dewey-full | 338.4/33621 |
| dewey-hundreds | 300 - Social sciences |
| dewey-ones | 338 - Production |
| dewey-raw | 338.4/33621 |
| dewey-search | 338.4/33621 |
| dewey-sort | 3338.4 533621 |
| dewey-tens | 330 - Economics |
| discipline | Wirtschaftswissenschaften Medizin |
| discipline_str_mv | Wirtschaftswissenschaften Medizin |
| edition | 3. ed. |
| format | Book |
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| genre | (DE-588)4123623-3 Lehrbuch gnd-content |
| genre_facet | Lehrbuch |
| geographic | USA |
| geographic_facet | USA |
| id | DE-604.BV022417114 |
| illustrated | Illustrated |
| index_date | 2024-07-02T17:24:22Z |
| indexdate | 2024-07-09T20:57:08Z |
| institution | BVB |
| isbn | 0471772593 9780471772590 |
| language | English |
| oai_aleph_id | oai:aleph.bib-bvb.de:BVB01-015625490 |
| oclc_num | 843265308 |
| open_access_boolean | |
| owner | DE-703 DE-355 DE-BY-UBR DE-83 DE-1050 |
| owner_facet | DE-703 DE-355 DE-BY-UBR DE-83 DE-1050 |
| physical | XXVIII, 458 S. graph. Darst. |
| publishDate | 2007 |
| publishDateSearch | 2007 |
| publishDateSort | 2007 |
| publisher | Wiley |
| record_format | marc |
| spelling | Getzen, Thomas E. Verfasser aut Health economics and financing Thomas E. Getzen 3. ed. Hoboken, NJ Wiley 2007 XXVIII, 458 S. graph. Darst. txt rdacontent n rdamedia nc rdacarrier 2. Aufl. u.d.T.: Health economics Economics, Medical United States Flow of funds Health Care Costs United States Medical care, Cost of Medical economics Gesundheitsökonomie (DE-588)4130935-2 gnd rswk-swf USA (DE-588)4123623-3 Lehrbuch gnd-content Gesundheitsökonomie (DE-588)4130935-2 s DE-604 Digitalisierung UB Regensburg application/pdf http://bvbr.bib-bvb.de:8991/F?func=service&doc_library=BVB01&local_base=BVB01&doc_number=015625490&sequence=000002&line_number=0001&func_code=DB_RECORDS&service_type=MEDIA Inhaltsverzeichnis |
| spellingShingle | Getzen, Thomas E. Health economics and financing Economics, Medical United States Flow of funds Health Care Costs United States Medical care, Cost of Medical economics Gesundheitsökonomie (DE-588)4130935-2 gnd |
| subject_GND | (DE-588)4130935-2 (DE-588)4123623-3 |
| title | Health economics and financing |
| title_auth | Health economics and financing |
| title_exact_search | Health economics and financing |
| title_exact_search_txtP | Health economics and financing |
| title_full | Health economics and financing Thomas E. Getzen |
| title_fullStr | Health economics and financing Thomas E. Getzen |
| title_full_unstemmed | Health economics and financing Thomas E. Getzen |
| title_short | Health economics and financing |
| title_sort | health economics and financing |
| topic | Economics, Medical United States Flow of funds Health Care Costs United States Medical care, Cost of Medical economics Gesundheitsökonomie (DE-588)4130935-2 gnd |
| topic_facet | Economics, Medical United States Flow of funds Health Care Costs United States Medical care, Cost of Medical economics Gesundheitsökonomie USA Lehrbuch |
| url | http://bvbr.bib-bvb.de:8991/F?func=service&doc_library=BVB01&local_base=BVB01&doc_number=015625490&sequence=000002&line_number=0001&func_code=DB_RECORDS&service_type=MEDIA |
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