Health economics : fundamentals and flow of funds

Başlık:

Yazar:

Getzen, Thomas E.

ISBN:

9780471586487

Ek Yazar:

Getzen, Thomas E.

Yayım Bilgisi:

Fiziksel Tanım:

xii, 467 pages : illustrations ; 26 cm

Contents:

Terms of Trade: The Flow of Funds Through the Health Care System -- What is Economics? -- Terms of Trade -- Value -- The Flow of Funds -- Health Care Spending in the United States -- Sources of Funds -- Health Care Providers: The Uses of Funds -- Quality -- Public or Private Choices -- Research -- Time -- The Structure of the Economy: Contracts -- Economic Principles as Conceptual Tools -- Trade -- Choice: Are Benefits Greater Than Costs? -- Opportunity Cost -- Scarcity (Budget Constraints) -- Maximization/Marginalism -- Money Flows in a Circle -- Contracts and Organization -- Health Principles -- Health Is Priceless -- And Yet, Money Still Determines Health -- Health Risks Are More Public Than Private -- Individual Choices: Lifestyle Is More Than Medicine -- Measurable Differences in Quality Over Time, or Regions, Are Greater Than Most Differences in Choices Faced by Patients -- Health and the Economy -- Demand -- Need Versus Demand -- The Demand Curve -- The Diamonds-Water Paradox: An Example of Marginal Analysis -- Ceteris Paribus -- Derived Demand -- Individual, Firm, and Market Demand Curves -- Marginal Revenue -- Price Sensitivity -- Price Elasticity and Marginal Revenue -- Price Discrimination -- Is Price the Only Thing That Matters? -- Profit-Maximizing Firms, Supply, and Markets -- Efficiency -- Cost-Benefit and Cost-Effectiveness Analysis -- Cost-Benefit Analysis is About Making Choices -- An Everyday Example: Knee Injury -- Opportunity Cost: Looking at Alternatives -- Expected Value.

Konu Terimleri:

Medical economics.

Tıp ekonomisi.

Electronic Access:

Table of contents http://catdir.loc.gov/catdir/toc/onix03/96021162.html
Contributor biographical information http://catdir.loc.gov/catdir/enhancements/fy0607/96021162-b.html
Publisher description http://catdir.loc.gov/catdir/description/wiley033/96021162.html

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Library	Materyal Türü	Barkod	Yer Numarası	Durum
Searching... Pamukkale Merkez Kütüphanesi	Kitap	0103922	W74 G48 1997	Searching... Unknown

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This examination of the economic analysis of medical markets and the production of health traces the economic rationale and development of the medical care organization. It examines transactions between patients and health care providers to see how profits are made, costs covered, contracts written and regulations formed. It also uses a macroeconomic perspective to explore the dynamics of change within the health care system and to consider determinants of national health spending and the role of governments in public and private health.

Author Notes

Thomas E. Getzen Temple University

Preface	p. xviii
Acknowledgements	p. xxi
About the Author	p. xxii
Foreword	p. xxiii
1 Terms of Trade: The Flow of Funds Through the Health Care System	p. 1
1.1 What is Economics?	p. 2
Terms of Trade	p. 3
Value	p. 4
1.2 The Flow of Funds	p. 4
Health Care Spending in the United States	p. 5
Sources of Funds	p. 6
Health Care Providers: The Uses of Funds	p. 8
1.3 Quality	p. 10
1.4 Public or Private Choices	p. 10
1.5 Research	p. 11
1.6 Time	p. 12
1.7 The Structure of the Economy: Contracts	p. 13
1.8 Economic Principles as Conceptual Tools	p. 14
Trade	p. 14
Choice: Are Benefits Greater Than Costs?	p. 14
Opportunity Cost	p. 14
Scarcity (Budget Constraints)	p. 14
Maximization/Marginalism	p. 15
Money Flows in a Circle	p. 15
Contracts and Organization	p. 15
1.9 Health Principles	p. 15
Health Is Priceless	p. 16
And Yet, Money Still Determines Health	p. 16
Health Risks Are More Public Than Private	p. 16
Individual Choices: Lifestyle Is More Than Medicine	p. 16
Measurable Differences in Quality Over Time, or Regions, Are Greater Than Most Differences in Choices Faced by Patients	p. 17
1.10 Health and the Economy	p. 17
Suggestions for Further Reading	p. 18
Summary	p. 18
Problems	p. 19
Endnotes	p. 20
2 Demand	p. 21
2.1 Need Versus Demand	p. 21
2.2 The Demand Curve	p. 22
The Diamonds-Water Paradox: An Example of Marginal Analysis	p. 23
Ceteris Paribus	p. 25
Derived Demand	p. 25
Individual, Firm, and Market Demand Curves	p. 26
2.3 Marginal Revenue	p. 26
Price Sensitivity	p. 27
Price Elasticity and Marginal Revenue	p. 28
Price Discrimination	p. 30
2.4 Is Price the Only Thing That Matters?	p. 31
2.5 Profit-Maximizing Firms, Supply, and Markets	p. 32
2.6 Efficiency	p. 33
Suggestions for Further Reading	p. 34
Summary	p. 34
Problems	p. 36
Endnotes	p. 38
3 Cost-Benefit and Cost-Effectiveness Analysis	p. 39
3.1 Cost-Benefit Analysis is About Making Choices	p. 40
An Everyday Example: Knee Injury	p. 40
Opportunity Cost: Looking at Alternatives	p. 43
Expected Value	p. 44
Maximization: Finding the Optimum	p. 44
Average, Total, and Marginal Costs	p. 47
3.2 An Example of Marginal Analysis: Costs and Benefits of a Sixth Stool Guaiac	p. 48
3.3 Measuring Benefits	p. 52
Health	p. 52
Productivity	p. 53
Reductions in Future Medical Costs	p. 53
3.4 Measuring Costs	p. 53
Medical Care and Administration: Charges Versus Costs	p. 54
Follow-up and Treatment	p. 54
Time and Pain of Patient and Family	p. 54
Provider Time and Inconvenience	p. 55
3.5 The Value of Life	p. 55
3.6 Quality-Adjusted Life Years (QALYs)	p. 57
Discounting Over Time	p. 57
QALY League Tables	p. 58
3.7 Perspectives: Patient, Payer, Government, Provider, Society	p. 59
Distribution: Whose Costs and Whose Benefits?	p. 60
CBA Is a Limited Perspective	p. 60
CBA and Public Policy Decision Making	p. 61
Suggestions for Further Reading	p. 61
Summary	p. 62
Problems	p. 63
Endnotes	p. 65
4 Insurance	p. 67
4.1 Methods for Covering Risks	p. 67
Savings	p. 68
Family and Friends	p. 68
Charity	p. 68
Private Market Insurance Contracts	p. 69
Social Insurance	p. 70
Strengths and Weaknesses of Different Forms of Risk Spreading	p. 70
4.2 Why Third-Party Payment?	p. 71
Variability	p. 72
4.3 Risk Aversion	p. 74
4.4 Adverse Selection	p. 75
4.5 Moral Hazard	p. 77
Welfare Losses Due to Moral Hazard	p. 78
4.6 Open or Closed Funding?	p. 80
Suggestions for Further Reading	p. 81
Summary	p. 81
Problems	p. 82
Endnotes	p. 84
5 Insurance Contracts and Managed Care	p. 86
5.1 Third-Party Transactions	p. 86
Tax Benefits	p. 87
Who Pays? How Much?	p. 88
5.2 Managed Care Plans	p. 89
5.3 How are Benefits Determined?	p. 90
5.4 Types of Insurance Plans	p. 90
Employer-Based Group Health Insurance	p. 90
Self-Paid Private Insurance	p. 92
Medicare	p. 92
Medicaid	p. 92
Other Government Programs and Charity	p. 92
The Uninsured	p. 94
State Children's Health Insurance Program	p. 95
Medical Savings Accounts (MSAs) and Defined Contribution "Voucher" Plans	p. 95
5.5 A Range of Risk Bearing: Fixed Premiums, Administered Services Only, and Self-Insurance	p. 96
The Underwriting Cycle	p. 97
5.6 Erisa, Taxes, and Mandated Benefits	p. 97
5.7 History of Health Insurance	p. 99
5.8 Incentives--To Patients, to Payers, and to Providers	p. 102
Suggestions for Further Reading	p. 103
Summary	p. 103
Problems	p. 104
Endnotes	p. 104
6 Physicians	p. 106
6.1 Physician Payment: How Funds Flow in	p. 106
Co-pays, Assignment, and Balance Billing	p. 110
Physician Payment in Managed Care Plans	p. 111
Incentives: Why Differences in the Type of Payment Matter	p. 111
A Progression: From Prices to Reimbursement Mechanisms	p. 112
6.2 Physician Incomes	p. 112
6.3 Physician Costs: How Funds Flow Out	p. 113
Physician Practice Expenses	p. 113
The Labor-Leisure Choice	p. 115
The Doctor's Workshop and Unpaid Hospital Inputs	p. 116
Malpractice	p. 116
6.4 The Transaction Between Doctor and Patient	p. 117
Asymmetric Information	p. 117
6.5 Uncertainty	p. 118
6.6 Licensure: Quality or Profits?	p. 119
How Does Licensure Increase Physician Profits?	p. 119
Supply and Demand Response in Licensed Versus Unlicensed Professions	p. 120
How Does Licensure Improve Quality?	p. 121
A Test of the Quality Hypothesis: Strong Versus Weak Licensure	p. 122
Suggestions for Further Reading	p. 123
Summary	p. 123
Problems	p. 124
Endnotes	p. 125
7 Medical Education, Organization, and Business Practices	p. 127
7.1 Medical Education	p. 127
Human Capital: Medical Education as Investment	p. 128
7.2 The Origins of Licensure and Linkage to Medical Education	p. 129
AMA Controls Over Physician Supply, 1930-1965	p. 130
Breaking the Contract: The Great Medical Student Expansion of 1970-1980	p. 132
Building Pressure: Fixed Domestic Graduation Rates 1980-2002	p. 132
7.3 Adjusting Physician Supply	p. 133
The Flow of New Entrants and the Stock of Physicians	p. 133
Immigration of International Medical Graduates	p. 134
Growth in Non-M.D. Physicians	p. 134
Balancing Supply and Incomes: Tracing the Past and Projecting the Future	p. 135
7.4 Group Practice: How Organization and Technology Affect Transactions	p. 135
7.5 Kickbacks, Self-Dealing, and Side Payments	p. 138
7.6 Price Discrimination	p. 140
7.7 Practice Variations	p. 142
7.8 Insurance, Price Competition, and the Structure of Medical Markets	p. 145
Suggestions for Further Reading	p. 147
Summary	p. 147
Problems	p. 149
Endnotes	p. 152
8 Hospitals	p. 154
8.1 From Charitable Institutions to Corporate Chains: Development of the Modern Hospital	p. 154
8.2 Revenues: The Flow of Funds into the Hospital	p. 156
Sources of Revenues	p. 157
8.3 Costs: The Flow of Funds Out of the Hospital	p. 162
8.4 Financial Management and cost Shifting	p. 162
8.5 Capital Financing	p. 166
8.6 Organization: Who Controls the Hospital and for What Ends?	p. 169
Suggestions for Further Reading	p. 171
Summary	p. 171
Problems	p. 172
Endnotes	p. 173
9 Management and Regulation of Hospital Costs	p. 175
9.1 Why do Some Hospitals Cost More Than Others?	p. 175
9.2 How Management Controls Costs	p. 176
Short-Run Versus Long-Run Cost Functions	p. 176
Uncertainty and Budgeting	p. 178
9.3 Conflict Between Economic Theory and Accounting Measures of Per Unit Cost	p. 180
Timing	p. 180
Whose Costs?	p. 182
9.4 Economies of Scale	p. 183
The Hospital is a Multiproduct Firm	p. 184
Contracting Out	p. 184
9.5 Quality and Cost	p. 185
Technology: Cutting Costs or Enhancing Quality?	p. 185
Improved Efficiency May Raise Total Spending	p. 185
9.6 How do Hospitals Compete?	p. 186
Competing for Patients	p. 186
Competing for Physicians	p. 187
Competing for Contracts	p. 187
Measuring Competitive Success	p. 188
Measuring the Competitiveness of Markets	p. 189
9.7 Controlling Hospital Costs Through Regulation	p. 189
Suggestions for Further Reading	p. 193
Summary	p. 193
Problems	p. 194
Endnotes	p. 196
10 Managed Care	p. 197
10.1 Why Managed Care?	p. 197
Costs and Quality	p. 198
Management: The Distinctive Feature of Managed Care	p. 198
Contractual Reforms to Reduce Costs	p. 199
Reforming the Organization to Reduce Cost	p. 200
10.2 Sources and Uses of Funds	p. 201
10.3 The Range of Managed Care Plans	p. 202
Provider Networks	p. 202
Gatekeeping	p. 203
Capitation	p. 203
Withholds	p. 205
Utilization Review	p. 205
10.4 How Care is Managed: A Mental Health Example	p. 206
10.5 Individual and System Risks in Health Care	p. 208
10.6 Kaiser: The Evolution of an HMO	p. 210
10.7 Ownership and Capital Markets: Signs of Failure	p. 212
GHA: A Consumer Co-op Gets Bought Out by a Franchise Chain	p. 212
Corporate Advantage	p. 213
U.S. Healthcare: A Profitable Growth Company	p. 214
10.8 The Enthoven "Managed Competition" Plan	p. 216
10.9 Is Managed Care the Solution to Rising Costs?	p. 217
Evidence on Cost Reductions	p. 217
Risk Selection	p. 217
Quality of Care	p. 218
Costs Reductions in IPA HMOs, PPOs, and POS Plans	p. 218
Administrative Costs and Profits	p. 218
One-Time Savings?	p. 219
10.10 Backlash: Are There Losers as well as Winners?	p. 219
Suggestions for Further Reading	p. 220
Summary	p. 220
Problems	p. 222
Endnotes	p. 223
11 Long-Term Care	p. 227
11.1 Development of the Long-Term Care Market	p. 228
11.2 Defining Ltc: Types of Care	p. 230
11.3 Medicaid: Nursing Homes as a Two-Part Market	p. 231
11.4 Certificate of Need: Whose Needs?	p. 234
Money and Quality	p. 234
Competing for Certificates of Need, Not for Patients	p. 235
Evidence on the Effects of CON	p. 236
11.5 Case-Mix Reimbursement	p. 236
11.6 Substitution	p. 238
11.7 Financial Reimbursement Cycles	p. 239
11.8 Continuing Care Retirement Communities and the Wealthy Elderly	p. 241
Medicare Catastrophic Coverage Act of 1988 and the Taxpayer Revolt	p. 242
11.9 The Effects of Aging on Cost and Utilization	p. 243
Defining Boundaries: Is Long-Term Care "Medical"?	p. 243
LTC Insurance	p. 244
The Effects of Aging	p. 245
Suggestions for Further Reading	p. 246
Summary	p. 247
Problems	p. 248
Endnotes	p. 249
12 Pharmaceuticals	p. 251
12.1 How Funds Flow in	p. 252
Medicare and Medicaid	p. 253
Inpatient Pharmaceuticals	p. 254
12.2 Uses of Funds	p. 254
Retail Pharmacies	p. 255
Wholesalers	p. 256
Insurance Companies and PBMs	p. 256
Pharmaceutical Firms	p. 256
Cost Structure	p. 258
12.3 History and Regulation of Pharmaceuticals	p. 258
12.4 Research and Development	p. 262
12.5 Pharmacoeconomics and Outcomes Research	p. 265
12.6 Industry Structure and Competition	p. 265
Market Segmentation: Types of Buyers	p. 266
Contractual Responses to Pharmacy Benefits Management	p. 267
Value and Cost	p. 267
The Role of Middlemen: Distribution Versus Marketing	p. 269
Research Productivity	p. 270
12.7 Trends: Form Follows Function (and Money)	p. 271
Suggestions for Further Reading	p. 272
Summary	p. 273
Problems	p. 273
Endnotes	p. 275
13 Introduction to the Macroeconomics of Health	p. 277
13.1 What is Macro Health Economics?	p. 277
13.2 Properties of the Individual Versus Properties of the System	p. 278
13.3 Dynamics: Change Over Time	p. 279
13.4 Abstractions and Complications	p. 280
13.5 The Role of Government (Overview of Chapters 14-18)	p. 282
Suggestions for Further Reading	p. 282
Problems	p. 282
Endnotes	p. 283
14 The Role of Government	p. 284
14.1 The Flow of Government Health Funds	p. 284
14.2 The Roles of Government	p. 285
Government is Necessary, Even for Private Exchange	p. 285
Efficiency of Markets Under Conditions of Perfect Competition	p. 287
Government in a Mixed Economy	p. 287
14.3 Law and Order	p. 288
14.4 Public Goods and Externalities	p. 289
Externalities	p. 289
The Coase Theorem: Transaction Costs and Property Rights	p. 290
Politicians: Entrepreneurs Who Try to Get Votes	p. 291
14.5 Market Failure	p. 291
Monopoly	p. 291
Paternalism	p. 293
14.6 Income Redistribution and Care of the Poor	p. 294
Medicaid and Medicare: Dependency or Rights?	p. 294
14.7 How Government Works	p. 295
The Voluntary Sector	p. 296
Government as the Citizen's Agent	p. 296
Winners and Losers	p. 298
14.8 Pros and Cons of Regulation and Competition	p. 299
Suggestions for Further Reading	p. 301
Summary	p. 301
Problems	p. 302
Endnotes	p. 303
15 Public Goods and Public Health	p. 305
15.1 Characteristics of Public Goods	p. 305
Privatizing Public Goods	p. 306
Social Costs Depend on the Number of People	p. 307
Insurance Makes Any Good More Public	p. 307
15.2 Information	p. 308
Rational Consumer Ignorance	p. 309
Milk or Bread: Which is More Public?	p. 309
15.3 The Theory of Pure Public Goods	p. 310
Public Goods Make Most People Better Off, But Few Happy	p. 312
15.4 Infectious Disease Externalities	p. 313
Epidemics	p. 314
HIV/AIDS	p. 315
The Sanitary Revolution: A Moral Campaign for Public Health	p. 316
Formation of the U.S. Public Health Service	p. 316
15.5 Sex, Drugs, and War: Public Health in Action	p. 317
Who Counts as a Citizen? Abortion and Other Dilemmas	p. 318
Addiction	p. 319
War and Public Health	p. 319
Suggestions for Further Reading	p. 321
Summary	p. 321
Problems	p. 321
Endnotes	p. 322
16 Economic History, Population Growth, and Medical Care	p. 324
16.1 Economic Growth has Determined the Shape of Health Care	p. 324
16.2 Birth Rates, Death Rates, and Population Growth	p. 325
16.3 The Stone Age	p. 325
16.4 The Agricultural Age	p. 326
Investment and Trade	p. 327
Civilization, War, and Government	p. 327
The Decline of Civilizations Leads to Population Declines	p. 328
The Plague	p. 329
Food Supply Determines Population	p. 329
The Rise of Economics	p. 329
The Malthusian Hypothesis	p. 330
16.5 The Industrial Age	p. 331
Why Malthus Was Wrong	p. 331
Demographic Transition	p. 332
Demographic Change, Income Distribution, and the Rise of the Middle Classes	p. 334
16.6 The Information Age	p. 335
16.7 Income and Health	p. 336
Income and the Value of Medical Care	p. 338
16.8 Reducing Uncertainty: The Value of Life and Economic Security	p. 339
The Value of Risk Reduction	p. 339
Social Security and Health Insurance	p. 339
Preconditions for Changing Medical Organization	p. 340
16.9 The Rise of Medical Technology	p. 341
Suggestions for Further Reading	p. 343
Summary	p. 343
Problems	p. 345
Endnotes	p. 346
17 International Comparisons of Health and Health Expenditures	p. 349
17.1 Wide Differences Among Nations	p. 349
Size of the Market	p. 351
17.2 Micro Versus Macro Allocation: Health as a National Luxury Good	p. 352
17.3 Causality: Does More Spending Improve Health?	p. 354
17.4 Low-Income Countries	p. 356
Sudan	p. 357
Health Care in Kenya	p. 358
17.5 Middle-Income Countries	p. 359
The Health Care System of Mexico	p. 360
Poland	p. 361
17.6 High-Income Countries	p. 363
Costs and Cost Control	p. 363
Japan	p. 365
The German Health System	p. 368
17.7 International Trade in Health Care	p. 370
Pharmaceuticals	p. 371
Equipment	p. 371
Services	p. 371
People and Ideas	p. 372
Suggestions for Further Reading	p. 372
Summary	p. 373
Problems	p. 374
Endnotes	p. 374
18 Dynamics of National Health Spending	p. 376
18.1 Micro and Macro Perspectives on Spending	p. 376
18.2 The Consumption Function	p. 377
The Permanent Income Hypothesis	p. 378
Income Elasticity and Shared Income	p. 379
18.3 Dynamics	p. 380
Permanent Income and Adjustment of Health Spending to GDP	p. 382
Adjustment to Inflation	p. 383
A Dynamic Model of U.S. Health Expenditures	p. 385
18.4 Government Cost Controls: Spending Gaps and the Push to Regulate	p. 386
Price Controls: The "ESP" Program	p. 388
The Voluntary Effort	p. 389
Prospective Payment System with Diagnosis-Related Groups	p. 390
Why Do People Believe Cost Controls Work?	p. 391
18.5 "Spending" is Mostly Labor	p. 391
Employment	p. 392
Wages	p. 394
Suggestions for Further Reading	p. 396
Summary	p. 396
Problems	p. 397
Endnotes	p. 399
19 Value for Money in the Future of Health Care	p. 401
19.1 Forcing the Question: Who Gets Healthy and Who Gets Paid?	p. 401
19.2 Spending Money or Producing Health?	p. 402
19.3 Allocation, Allocation, Allocation	p. 404
19.4 Dynamic Efficiency	p. 405
19.5 The Future	p. 406
Suggestions for Further Reading	p. 407
Summary	p. 408
Problems	p. 408
Endnotes	p. 409
Glossary	p. 411
Index	p. 421

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