Health Care Economics
İÇİNDEKİLERContents 1 AN INTRODUCTION TO THE ECONOMICS OF MEDICAL CARE 1 Trends in Medical Expenditures 1 Basic Choices That Must Be Made with Regard to Medical Services 4 The Applicability of Economics to the Study of Medical Care 10 The Trade-off Between Quantity and Quality in the Provision of Medical Services 12 2 THE PRODUCTION OF HEALTH: THE IMPACT OF MEDICAL SERVICES ON HEALTH 15 Medical Care as an Output of the Medical Services Industry and as an Input to Health 15 Determining the Allocation of Resources to Medical Care Using a Health Production Function 16 Empirical Studies of a Health Production Function 22 Applications of a Health Production Function 27 3 AN OVERVIEW OF THE MEDICAL CARE SECTOR 32 Description of the Medical Care Markets 32 Applications of a Model of the Medical Care Sector 39 Concluding Comments 42 4 MEASURING CHANGES IN THE PRICE OF MEDICAL CARE 45 The Uses of a Definition of the Product of the Medical Care Industry 45 The Consumer Price Index 47 The Medical Care Component of the CPI (MCPI) 54 An Alternative Medical Care Price Index: The Costs of Treatment of a Representative Group of Illnesses 64 APPENDIX: Health Insurance Premiums as a Measure of the Price of Medical Care 73 5 THE DEMAND FOR MEDICAL CARE 77 The Purpose of Demand Analysis 77 Demand Versus Need as Basis for Policy and Planning 77 A Model of the Demand for Medical Care 81 Applications of Demand Analysis 99 The Demand for Medical Care Faced by the Firm 104 APPENDIX: The Effect of Coinsurance on the Demand for Medical Care 105 6 THE DEMAND FOR HEALTH INSURANCE 110 Health Insurance Terminology 111 The Theory of Demand for Health Insurance 114 An Application of the Theory of the Demand for Health Insurance 123 The Demand for Health Insurance Under Conditions of Moral Hazard 125 Additional Factors Affecting the Demand for Health Insurance 129 Summary and Concluding Comments 130 APPENDIX 1. The Allocative Inefficiency of Blue Cross's Service Benefit Policy 134 APPENDIX 2. The Effect on the Insurance Premium of Extending Coverage to Include Additional Benefits 137 7 THE SUPPLY OF MEDICAL CARE: AN OVERVIEW 143 Determinants of Supply 143 Evaluation of Economic Efficiency in Production 147 8 THE MARKET FOR HEALTH INSURANCE: ITS PERFORMANCE AND STRUCTURE 151 The Demand Side of the Health Insurance Market 152 The Supply Side of the Health Insurance Market 159 Concluding Comments 165 9 THE PHYSICIAN SERVICES MARKET 169 Introduction and Overview 169 Observed Performance in the Physician Services Market 172 Determination of Physician Prices 181 Proposed Changes in the Physician Services Market 188 Concluding Comments 194 10 THE MARKET FOR HOSPITAL SERVICES 198 Background 198 The Extent of Economies of Scale in Hospitals 205 Theories of Hospital Behavior 213 Indicators of Hospital Performance: Hospital Cost Inflation 224 11 RELYING ON REGULATION TO IMPROVE HOSPITAL PERFORMANCE 248 Introduction 248 The Economics of Health Facility Planning 249 The Theory and Practice of Regulation 260 Concluding Comments on Hospital Regulation 307 The Economic Outlook for Hospitals 311 12 THE BENEFITS OF COMPETITION IN MEDICAL CARE 326 An Approach to Increased Competition in Medical Care 326 The Effect of Advertising on the Market for Medical Services 330 The Effect of Competition on Quality of Medical Care 335 Evidence on the Performance of HMOs 339 Barriers to the Development of Prepaid Health Plans 343 Empirical Evidence on the Impact of HMO Competition 347 Moving Toward a Competitive Market in Medical Care 349 13 HEALTH MANPOWER SHORTAGES: DEFINITIONS, MEASUREMENT, AND POLICIES 358 Definitions of a Health Manpower Shortage 359 The Measurement of Health Manpower Shortages 36614 THE MARKET FOR PHYSICIAN MANPOWER 380 Barriers to Entry in Medicine 381 The Physician as a Price-Discriminating Monopolist 386 Proposed Changes in the Physician Manpower Market 393 15 THE MARKET FOR MEDICAL EDUCATION: EQUITY AND EFFICIENCY 396 The Economic Efficiency of the Medical Education Sector 396 Equity in the Current System of Financing Medical Education 409 16 THE MARKET FOR REGISTERED NURSES 417 Measuring the Performance of the Market for Registered Nurses 418 Federal Support for Nurse Training 430 Concluding Comments 438 APPENDIX: The Effects on Wages and Employment of Registered Nurses of Unionization in a Monopsony Market 440 17 THE PHARMACEUTICAL INDUSTRY 444 Introduction 444 The Economic Performance of the Pharmaceutical Industry 446 Federal Regulation of Drugs 462 Public Policy Toward the Pharmaceutical Industry 470 18 THE POLITICAL ECONOMY OF HEALTH CARE 480 Introduction 480 The Demand for Legislation by Health Associations 483 Demand-Increasing Legislation 487 Securing the Method of Highest Reimbursement 489 Legislation to Reduce the Price and/or Increase the Quantity of Complements 491 Legislation to Decrease the Availability and/or Increase the Price of Substitutes 494 Legislation to Limit Increases in Supply 498 Concluding Comments 501 19 THE ROLE OF GOVERNMENT IN HEALTH AND MEDICAL CARE 506 Market Imperfections 507 Market Failure 511 Redistribution Using In-Kind Subsidies 516 20 NATIONAL HEALTH INSURANCE: AN APPROACH TO THE REDISTRIBUTION OF MEDICAL CARE 525 Achieving Efficiency for Different Values Underlying National Health Insurance 525 Specific Criteria for Evaluating National Health Insurance Plans 535 21 CONCLUDING COMMENTS ON THE ECONOMICS OF MEDICAL CARE 554 INDEX 559  |
