Healthy, Wealthy, or Wise? Issues in American Health Care Policy

By Charles T. Stewart Jr. | Go to book overview

a base rid of excessive compensation, excessive prices, overtreatment as a result of malpractice fears on the one hand and technological imperatives on the other, excess demand on the part of customers who are risk averse and well insured against the costs of treatment, and finally, bloated administrative costs. There are other concerns: health care resources are badly allocated and their productivity is low and could be greatly increased.


Notes
1.
Victor Fuchs, The Health Economy ( Cambridge: Harvard University Press, 1986), 281.
2.
Edgar Peden and Mei Lin Lee, "Output and Inflation Components of Medical Care and Other Spending Changes," Health Care Financing Review 134, no. 2 (Winter 1991): 75-81.
3.
Victor Fuchs, "The Health Care Sector's Share of the Gross National Product," Science 247 ( February 2, 1990): 534-38.
4.
Division of National Cost Estimates, Office of the Actuary, Health Costs Financing Administration, "National Health Expenditures, 1986-2000," Health Care Financing Review 8 (Summer 1987): 1-36.
5.
Estimates of the contribution of prices and quantities to increase in cost of medical care are based on the difference between the Commerce Department medical price indices and the index of consumer prices. These ratios are approximate. There are problems in estimating the medical price index over long time periods. The biggest is the result of new technology. New procedures are introduced, diagnostic as well as therapeutic, and new pharmaceuticals enter the market. Some employed in the early period disappear from the market or drop in significance. In some instances the prices for new drugs and equipment drop as their market expands, production costs decline, patents expire, substitutes are developed. The case mix also changes, with changing age distribution, in technology, access to insurance, but also as a result of improved prevention. For instance, there has been a drop in heart attacks and strokes. This complicates estimates of long-term trends in quantity of medical services.
6.
Stanley Wohl, The Medical Industrial Complex ( New York: Harmony Books, 1984), 45.
7.
National Center for Education Statistics, Digest of Education Statistics ( Washington, D.C.: Government Printing Office, 1964 and 1991), table 176.
8.
Gregory Pope and Terri Menke, "Hospital Labor Markets in the 1980s," Health Care Financing Review 9, no. 4 (Fall 1993): 127-37; see esp. 131.
9.
Steffie Woolhandler, David Himmelstein, and James Lewontin, "Administrative Costs in U.S. Hospitals," New England Journal of Medicine 329 ( August 5, 1993): 400-403. See also David Himmelstein and Steffie Woolhandler, "Cost without Benefit: Administrative Waste in U.S. Health Care," New England Journal of Medicine 314 ( February 13, 1986): 441-45.
10.
William Baumol, "Social Wants and Dismal Science: The Curious Case of the Climbing Costs of Health and Teaching," C.V. Starr Center for Applied Economics RR #93-20, New York University Department of Economics, May 1993.
11.
Stephen Long and Susan Marquis, "The Uninsured 'Access Gap' and the Cost of Universal Coverage," Health Affairs 13 (Spring 1994): 211-20. See also Brenda Spillman , "The Impact of Being Uninsured on Utilization of Basic Health Care Services," Inquiry 29 (Winter 1992): 457-66.

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Healthy, Wealthy, or Wise? Issues in American Health Care Policy
Table of contents

Table of contents

  • Title Page iii
  • Contents v
  • Preface vii
  • Notes viii
  • 1 - Determinants of Health 1
  • Notes 6
  • 2 - Why Are Costs Out of Control? 7
  • Notes 27
  • 3 - Must Living Standards Decline? 28
  • Notes 38
  • 4 - Health Insurance Raises Demand and Supply 40
  • Notes 49
  • 5 - The Excess of Physicians and Services 51
  • Notes 77
  • 6 - The Medicalization of Health 82
  • Notes 97
  • 7 - Mental Illness 99
  • Notes 119
  • 8 - The Excessive Demand for Medical Care 123
  • Notes 136
  • 9 - Research and Technology 138
  • Notes 161
  • 10 - The Physician as Agent 164
  • Notes 179
  • 11 - Prevention: Environmental and Behavioral Modification 181
  • Notes 210
  • 12 - The Demedicalization of Health Care 213
  • Notes 222
  • 13 - What to Do? 223
  • Notes 250
  • Index 253
  • About the Author 263
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