American Health Economy Illustrated , livre ebook

AEI Press - Christopher J. Conover

Découvre YouScribe en t'inscrivant gratuitement

Je m'inscris

Obtenez un accès à la bibliothèque pour le consulter en ligne
En savoir plus

220 pages

English

Vous pourrez modifier la taille du texte de cet ouvrage

Obtenez un accès à la bibliothèque pour le consulter en ligne
En savoir plus

A propos
Informations
Extrait

Description

How much does the average American spend on health care? Are costs and quality of health care equal across US states? Do Americans get good value for money spent on health services compared with citizens of other developed nations? Are current health spending trends sustainable through the 21st century? All too often, policymakers and the public alike form judgments about health care based on myths and misconceptions. A common refrain is that US health care is too expensive — both in costs to the taxpayer and costs to the consumer. But few realize that despite its lack of national health insurance, the United States leads nearly all other industrialized nations in the share of health spending paid by third parties, whether public or private. Americans, therefore, are less sensitive to health care prices than citizens of other nations. American Health Economy Illustrated sifts through nearly a century of data to examine — and debunk — the most common myths about the US health care system. With an unbiased, just-the-facts approach and hundreds of color illustrations, Christopher J. Conover assesses the strengths and weaknesses of the current system and evaluates whether current health cost trends are sustainable. Wide-ranging, accessible, and provocative, this book is a must-read for anyone concerned with the future of American health care.

Sujets

Health Care Issues

General officer

Health

General

Fitness

Informations

Publié par	AEI Press
Date de parution	16 février 2012
Nombre de lectures	0
EAN13	9780844772035
Langue	English
Poids de l'ouvrage	3 Mo

Informations légales : prix de location à la page 0,0950€. Cette information est donnée uniquement à titre indicatif conformément à la législation en vigueur.

Extrait

AMERICAN HEALTH ECONOMY ILLUSTRATED
AMERICAN HEALTH ECONOMY ILLUSTRATED

Christopher J. Conover

AEI PRESS Publisher for the American Enterprise Institute Washington, D.C.
Distributed to the Trade by National Book Network, 15200 NBN Way, Blue Ridge Summit, PA 17214. To order call toll free 1-800-462-6420 or 1-717-794-3800. For all other inquiries please contact the AEI Press, 1150 Seventeenth Street, N.W., Washington, D.C. 20036 or call 1-800-862-5801.
Library of Congress Cataloging-in-Publication Data
Conover, Christopher J.
American Health Economy Illustrated / Christopher J. Conover.
p. ; cm.
Includes bibliographical references.
ISBN-13: 978-0-8447-7201-1 (cloth)
ISBN-10: 0-8447-7201-1 (cloth)
ISBN-13: 978-0-8447-7202-8 (pbk.)
ISBN-10: 0-8447-7202-X (pbk.)
[etc.]
1. Medical care, Cost of—United States. 2. Health insurance—Economic aspects—United States. I. Title. [DNLM: 1. Delivery of Health Care—economics—United States. 2. Health Services—economics—United States. 3. Insurance, Health—economics—United States. W 74 AA1]
RA410.53.C6526 2011
362.1068'1—dc23
© 2012 by the American Enterprise Institute for Public Policy Research, Washington, D.C. All rights reserved. No part of this publication may be used or reproduced in any manner whatsoever without permission in writing from the American Enterprise Institute except in the case of brief quotations embodied in news articles, critical articles, or reviews. The views expressed in the publications of the American Enterprise Institute are those of the authors and do not necessarily reflect the views of the staff, advisory panels, officers, or trustees of AEI.
Printed in China
Acknowledgments
I am indebted to Herbert Stein and Murray Foss, whose book, The Illustrated Guide to the American Economy , served as an inspiration and template for this book. Likewise, I am deeply grateful for the myriad ways in which David Gerson assisted in bringing this book into fruition. His patient persistence helped see this project through completion.
I could not have undertaken the research and writing for this compilation without generous support for my time and travel from the American Enterprise Institute’s National Research Initiative. My thanks go to Henry Olsen for taking a gamble on this somewhat unconventional style of scholarship.
I benefited from excellent research assistance from two Duke University undergraduates, Erica Jain and Jesse Tang. Lisa Copeland, in the Center for Health Policy, skillfully assembled the various U.S. maps used throughout the book. Kristy Marynak, a public policy graduate student, provided extraordinary research support, keeping track of many moving parts even as she completed her MPP, graduated and moved to Atlanta, all without dropping a ball in the process. I also am grateful to the Sanford School of Public Policy for their loan of office space at a critical juncture during the writing process.
I very much appreciate the valuable input of AEI scholars in health care policy who reviewed chapters of the book as I completed them, through a series of meetings that lasted many months. These include Joe Antos, Jack Calfee (who died earlier this year), Bob Helms, and Tom Miller. Thanks also go to Jim Blumstein, who sat in on one of these sessions. Tom Miller and Rohit Parulkar were especially helpful in arranging logistics for these various gatherings. Although I never got to see him face-to-face even once during the long process of assembling this book, AEI adjunct scholar Ted Frech provided extraordinarily helpful fine-grained comments on each chapter. I also benefited from some useful discussions with Mark Pauly regarding cross-national comparisons and feel deeply honored by his willingness to contribute the book’s foreword. I also welcomed many productive discussions with AEI visiting scholar Mark Perry, whose keen eye for graphics helped sharpen the quality of many of the book’s figures.
I also thank David Cutler, Craig Eyermann, John Graham, Laurence Kotlikoff, Thomas Selden, and Douglas Sherlock for their generosity in sharing data for use in the book, as well as various organizations, including the Dartmouth Atlas of Health Care, the New England Journal of Medicine, the Organisation for Economic Co-operation and Development, and the World Health Organization for their copyright permissions.
The final draft was improved immensely by editing suggestions from Judy Fox Eddy that were as thorough as any author could wish. Her conscientiousness and efficiency were a marvel to behold and it was most gratifying to see the much tighter and more eloquent draft that emerged from her capable hands. Likewise, Laura Harbold at AEI Press was most patient with both of us as we labored to make this the best it could be over a six-month stretch.
None of the people listed should be held responsible for any residual errors the book might contain.
Christopher J. Conover July 1, 2011
Foreword
Mark V. Pauly
Compared to other industries, medical care is awash in data. Both common industry practice and regulation require the collection and storage of large volumes of quantitative information. We have much more information on transactions, inputs, prices, and even outcomes for health care than we do for industries such as beer brewing, ladies’ ready-to-wear, or cosmetology. Every encounter is tabulated and recorded by the provider, by the insurer, and sometimes by the consumer. And yet, this plentitude of data is often insufficient to satisfy managers, policy analysts, or external critics.
Perhaps part of the frustration has to do with high expectations. We complain that often we do not have enough data to determine whether health care produces health, but we do not seek data on whether beauty shops produce beauty, or whether beer really does make us happier. But health care is often (though not always) more consequential for human well being than any other consumer resource. This importance leads to a demand to assemble health care data in ways that suggest alternative policies that would produce better outcomes, supply them more efficiently, and distribute them more fairly. The abundance of data makes it hard for the numbers to speak for themselves, and easy for people to comb selectively for statistics that support a predetermined point of view.
This book by Chris Conover is an attempt to cut through the clutter and confusion and assemble and explain the data that bear on the most important health policy issues in the United States. It differs from other sources for health data in two ways. First, it is organized around key health policy questions, rather than being purely descriptive, as are many government data compendia. Second, it is intended to confront complex and controversial issues by trying as much as possible to show “both sides” where there is competing evidence. The book also confronts imprecision and ambiguity head on—whether in data definition, measurement, or our ability to determine causation. Paradoxically, the data shown here are often more eloquent about what we don’t know than what we do know.
Why don’t the numbers speak for themselves? Let’s consider one of the most commonly cited numbers in health economics: medical spending relative to gross domestic product (GDP). This ratio of two numbers is usually used in international comparisons to judge the relative efficiency of medical care systems. The data show that the United States spends more on health care but gets worse outcomes than other developed countries. This is unequivocally true, but what does it mean? To be useful, numbers must point to some judgments about possibilities for improvements.
An economist would think of such data as providing information about a “production function”: the process that links inputs into medical care (measured by spending) with the outcomes (health) generated. On this score, the evidence seems to support the view that the United States does not have a very efficient production function, in the sense that it gets less health out of its spending than other developed countries do. Maybe the production processes, the management, or the motivational skills of health workers are better in these other countries—maybe not. Even if we think our health outcomes are as good as those in other countries (after we adjust for differences in measurement and prior risk), it still looks like we spend too much.
But Conover’s data show why this interpretation is misleading. Differences in spending must be considered alongside variations in the prices of health services. After all, if you buy the same resources but pay twice as high a price, your spending will be twice as high—but the level of resources will be the same. The data shown here tell us that prices do vary; as everyone surely knows, the bad news is that prices for health care are higher in the United States than in other countries. But the good news is that, after we adjust spending levels for international price differences, much of the apparent inefficiencies in the U.S. system go away. We do not produce medical care more inefficiently than other countries—rather, we compensate health workers more generously than other countries. That may not make you happy, but it should definitely give you a new direction for your worries or your outrage. Not all of this relative overpayment goes to doctors and drug company stockholders; most goes to other health workers, and it should be up to the reader to decide what to think about that.
Here are some additional examples of where I found Conover’s data both fresh and illuminating. Let’s go back to those high physician incomes, higher than in other developed countries. For an economist, the right measurement for income is not the average annual net gain, but rather the return on investment. Given medical tuition costs (which are higher in the United States than anywhere else in the world) and, even more important, given the lost