management of care is delegated to risk-bearing "health plans" or "budget holders." These agencies, which could be public or private, would integrate the insurance function with other aspects of risk pooling and risk management functions, across a broad spectrum of health services.
RICHARD B. SCOTTON
Arrow, Kenneth J., 1963. "The Welfare Economics of Medical Care". American Economic Review, vol. 53: 941-973.
Burner, S. T., D. R. Waldo, and D. R. McKusick, 1992. "National Health Expenditure Projection Through 2030". Health Care Financing Review, vol. 14: 1-30.
Employer Benefit Research Institute, 1994. "Effectiveness of Health Care Management Strategies: A Review of the Evidence". EBRI Issue Brief No. 154, Washington, DC.
-----, 1995. "Sources of Health Insurance and Characteristics of the Uninsured: Analysis of the March 1994 Current Population Survey". EBRI Special Report SR-28 and Issue Brief No. 158, Washington, DC.
Enthoven, A. C., 1993a. "The History and Principles of Managed Competition". Health Affairs, vol. 12, supplement: 24-48.
-----, 1993b. "Why Managed Care Has Failed to Contain Health Costs". Health Affairs, vol. 12, no. 3 (Fall): 27-43.
Frech, H. E., ed., Health Care in America: The Political Economy of Hospitals and Health Insurance. San Francisco: Pacific Research Institute for Public Policy.
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Newhouse, J. P., and the Insurance Experiment Group, 1994. Free for All? Lessons from the RAND Health Insurance Experiment. Cambridge, MA: Harvard University Press.
Organization for Economic Cooperation and Development, 1992. The Reform of Health Care: A Comparative Analysis of Seven OECD Countries. Paris: OECD.
Phelps, Charles E., 1992. Health Economics. New York: HarperCollins. (Especially chapters 3 and 10-13.)
Starr, Paul, 1982. The Social Transformation of American Medicine. New York: Basic Books.
White, J., 1995. Competing Solutions: American Health Care Proposals and International Experience. Washington, DC: Brookings Institution.
Up-to-date information and analysis of major issues is contained in the following journals, of which the content consist wholly or principally of commissioned articles written by expert authors:
Health Affairs, vol. 12, no. 2 ( 1993). Special section: state models. (Contains articles on reform programs in Florida, Hawaii, Maryland, Minnesota, New Jersey, Oregon, Vermont, and Washington.)
Health Affairs, vol. 12, Supplement ( 1993). "Managed Competition: Health Reform American Style?"
Health Affairs, vol. 13, no. 1 ( 1994). Special issue: "The Clinton Plan: Pro and Con".
Health Affairs, vol. 13, no. 2 ( 1994). Special issues: "Mandates: The Road to Reform?"
Health Care Financing Review, 1989 Annual Supplement. "International Comparison of Health Care Financing and Delivery: Data and Perspectives".
Health Care Financing Review, 1991 Annual Supplement. "CostContainment Issues, Methods, and Experiences".
Health Care Financing Review, 1992 Annual Supplement. "Medicare and Medicaid Statistical Supplement".
Social Science and Medicine, vol. 39, no. 10, ( 1994). "Forming and Reforming the Market for Third-Party Purchasing of Health Care".
HEALTH POLICY . In the United States, a patchwork of programs, financing, health benefits, and medical care offered by the federal government, private insurers, managed care providers, hospitals, outpatient clinics, and physicians. Health policy has been developed in a decentralized manner by both congressional legislation and market forces. The absence of many normal market constraints, however, has led to escalating health care expenditures.
During the post- World War II period, health care in the United States grew into a multibillion-dollar industry, consuming, by the early 1990s, 14 percent of the gross domestic product (GDP). These expenditures represent a mosaic of programs and funding streams. Yet, despite the large proportion of GDP spent in this policy area, considerable disgruntlement exists among reformers, leading them to charge that the system itself is unhealthy.
The health care system was and is bewilderingly complex, consisting of public and private programs and delivery mechanisms. Health policy appears to have been developed in a somewhat chaotic incremental approach in response to various crises and situations rather than in a rational, comprehensive manner. Health care costs rose dramatically toward the end of the twentieth century, rising from 4.4 percent of GDP in 1950 to double-digit levels by the 1990s, and many quality and access issues remained unresolved.
Several factors have contributed to the increase of United States health care costs. The first factor is the shift in the United States from a focus on sometimes quickly cured and prevented infectious diseases to more costly chronic diseases. About 40 percent of all deaths in 1900 were caused by eleven major infectious diseases (typhoid, smallpox, scarlet fever, measles, whooping cough, diphtheria, influenza, tuberculosis, pneumonia, disease of the digestive system, and poliomyelitis). Only 16 percent of deaths then were caused by three major chronic conditions (heart disease, cancer, and stroke); 4 percent were caused by accidents, leaving 37 percent for a mixture of other causes.
With the development and widespread distribution of antibiotics, as well as vaccines for specific diseases, the incidence of infectious diseases began to decline. By 1973,