Abstract Voluntary testing and counseling (VTC) is a popular method for fighting the HIV/AIDS epidemic. The purpose of VTC is to reduce the incidence of the virus in a two-fold manner. First, testing provides access to health care and antiretroviral therapies that diminish the transmission rate of the virus. Second, counseling encourages safer behavior for not only individuals who test HIV-negative and wish to avoid HIV/AIDS infection but also altruistic individuals who test HIV-positive and wish to protect their partners from becoming infected by HIV. Surprisingly, DHS surveys that were conducted in sub-Saharan Africa provide empirical evidence that testing services are underutilized. Moreover, it is rare for both partners in a couple to be tested for HIV. This paper proposes a theoretical model that indicates how misperceptions about the HIV/AIDS virus may explain these puzzles. More specifically, this study demonstrates that individuals who are at risk of HIV infection may act strategically to avoid the cost of testing if they overestimate the risk of HIV transmission or believe that health care is not required if HIV is asymptomatic. The correction of false beliefs and the promotion of self-testing are expected to increase HIV testing rates.
{"title":"Why are Testing Rates so Low in Sub-Saharan Africa? Misconceptions and Strategic Behaviors","authors":"O. Sterck","doi":"10.1515/fhep-2012-0033","DOIUrl":"https://doi.org/10.1515/fhep-2012-0033","url":null,"abstract":"Abstract Voluntary testing and counseling (VTC) is a popular method for fighting the HIV/AIDS epidemic. The purpose of VTC is to reduce the incidence of the virus in a two-fold manner. First, testing provides access to health care and antiretroviral therapies that diminish the transmission rate of the virus. Second, counseling encourages safer behavior for not only individuals who test HIV-negative and wish to avoid HIV/AIDS infection but also altruistic individuals who test HIV-positive and wish to protect their partners from becoming infected by HIV. Surprisingly, DHS surveys that were conducted in sub-Saharan Africa provide empirical evidence that testing services are underutilized. Moreover, it is rare for both partners in a couple to be tested for HIV. This paper proposes a theoretical model that indicates how misperceptions about the HIV/AIDS virus may explain these puzzles. More specifically, this study demonstrates that individuals who are at risk of HIV infection may act strategically to avoid the cost of testing if they overestimate the risk of HIV transmission or believe that health care is not required if HIV is asymptomatic. The correction of false beliefs and the promotion of self-testing are expected to increase HIV testing rates.","PeriodicalId":38039,"journal":{"name":"Forum for Health Economics and Policy","volume":"1 1","pages":"219 - 257"},"PeriodicalIF":0.0,"publicationDate":"2013-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89723204","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Abstract Informal care provided to the elderly by their children is proposed as a less expensive alternative to institutional long-term care. This paper explores how the elderly's consumption of medical care changes in response to changes in the informal care they receive from their children. Many earlier studies have ignored both the endogeneity of informal care and the complicated nature of health care utilization data. This paper develops a two-part model with informal care treated as an endogenous regressor and imposes exclusion restrictions on the selection process. The model is fitted using the Bayesian Markov Chain Monte Carlo (MCMC) methods, in particular the Gibbs sampler and the Metropolis-Hasting algorithm. The average treatment effects and the distributions of the treatment effects are obtained via posterior simulation. The results indicate that informal care provides a substitute for nursing home care and hospital inpatient care, but it does not affect paid home health care on average. The treatment effects are heterogeneous. The largest substitution effects occur for nursing home and hospital inpatient care at the intensive margin. The policy analysis suggests that informal care policies targeting the group that incurs the largest substitution effect may help to reduce government spending on Medicaid and Medicare.
{"title":"Formal and Informal Care: An Empirical Bayesian Analysis Using the Two-part Model","authors":"Juan Du","doi":"10.1515/1558-9544.1253","DOIUrl":"https://doi.org/10.1515/1558-9544.1253","url":null,"abstract":"Abstract Informal care provided to the elderly by their children is proposed as a less expensive alternative to institutional long-term care. This paper explores how the elderly's consumption of medical care changes in response to changes in the informal care they receive from their children. Many earlier studies have ignored both the endogeneity of informal care and the complicated nature of health care utilization data. This paper develops a two-part model with informal care treated as an endogenous regressor and imposes exclusion restrictions on the selection process. The model is fitted using the Bayesian Markov Chain Monte Carlo (MCMC) methods, in particular the Gibbs sampler and the Metropolis-Hasting algorithm. The average treatment effects and the distributions of the treatment effects are obtained via posterior simulation. The results indicate that informal care provides a substitute for nursing home care and hospital inpatient care, but it does not affect paid home health care on average. The treatment effects are heterogeneous. The largest substitution effects occur for nursing home and hospital inpatient care at the intensive margin. The policy analysis suggests that informal care policies targeting the group that incurs the largest substitution effect may help to reduce government spending on Medicaid and Medicare.","PeriodicalId":38039,"journal":{"name":"Forum for Health Economics and Policy","volume":"34 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2012-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76400462","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Abstract Flexible spending accounts (FSAs) are a widely used arrangement that allow employees to pay for qualified out-of-pocket health expenses with pre-tax dollars. The tax preference given to FSAs has been controversial and recent health care law (Patient Protection and Affordable Care Act and Health Care and Education Reconciliation Act) limits the tax exclusion to an inflation-adjusted value of $2,500 (2013 $s). The limit is estimated to increase federal payroll and income tax receipts by $13 billion between 2013 and 2019. But the welfare implications of this change are unclear.This paper uses a unique panel dataset to explore the demographic profile of households likely to be affected by the tax increase. We use a sample of 19,322 households observed over the period 1998–2008. The data include FSA expenditures, insurance claim information for covered medical and dental expenditures, and household demographic information. We explore patterns of FSA usage by income and health status.We find that households likely to be affected by the tax increase disproportionately tend to be households experiencing one or more chronic health conditions. The existence of chronic illness is associated with relatively high and persistent medical expenses and also with relatively older and wealthier households. We estimate an average tax increase of $101 in 2013 for 13.9 million households with an FSA.
{"title":"The Distributional Effects of Health Reform Limits on Flexible Spending Accounts","authors":"J. Cardon, J. Moore, M. Showalter","doi":"10.1515/1558-9544.1310","DOIUrl":"https://doi.org/10.1515/1558-9544.1310","url":null,"abstract":"Abstract Flexible spending accounts (FSAs) are a widely used arrangement that allow employees to pay for qualified out-of-pocket health expenses with pre-tax dollars. The tax preference given to FSAs has been controversial and recent health care law (Patient Protection and Affordable Care Act and Health Care and Education Reconciliation Act) limits the tax exclusion to an inflation-adjusted value of $2,500 (2013 $s). The limit is estimated to increase federal payroll and income tax receipts by $13 billion between 2013 and 2019. But the welfare implications of this change are unclear.This paper uses a unique panel dataset to explore the demographic profile of households likely to be affected by the tax increase. We use a sample of 19,322 households observed over the period 1998–2008. The data include FSA expenditures, insurance claim information for covered medical and dental expenditures, and household demographic information. We explore patterns of FSA usage by income and health status.We find that households likely to be affected by the tax increase disproportionately tend to be households experiencing one or more chronic health conditions. The existence of chronic illness is associated with relatively high and persistent medical expenses and also with relatively older and wealthier households. We estimate an average tax increase of $101 in 2013 for 13.9 million households with an FSA.","PeriodicalId":38039,"journal":{"name":"Forum for Health Economics and Policy","volume":"52 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2012-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74771661","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
M. R. McKellar, Matthew B. Frank, H. Huskamp, M. Chernew
Abstract Despite bringing breakthrough medications to market, pharmaceutical companies incurred criticism during the 1990s and early 2000s because of high prices of many drugs. We argue that the benefits of pharmaceuticals should be evaluated in a dynamic context that extends beyond the patent expiration date. Now that numerous patents have expired, generic medications exist in many important drug classes. Thus, consumers reap the benefits of past innovation for years to come. We estimate that across 19 molecules whose patents expired from 2005-2009, $193-436 billion will transfer to consumers over 10 to 20 years due to patent expiration. This suggests that, while prices were high during the patent period, creating an incentive for innovation, the transfers to consumers after patent expiration are significant, which is how the patent system is designed to function.
{"title":"The Value of Patent Expiration","authors":"M. R. McKellar, Matthew B. Frank, H. Huskamp, M. Chernew","doi":"10.1515/1558-9544.1311","DOIUrl":"https://doi.org/10.1515/1558-9544.1311","url":null,"abstract":"Abstract Despite bringing breakthrough medications to market, pharmaceutical companies incurred criticism during the 1990s and early 2000s because of high prices of many drugs. We argue that the benefits of pharmaceuticals should be evaluated in a dynamic context that extends beyond the patent expiration date. Now that numerous patents have expired, generic medications exist in many important drug classes. Thus, consumers reap the benefits of past innovation for years to come. We estimate that across 19 molecules whose patents expired from 2005-2009, $193-436 billion will transfer to consumers over 10 to 20 years due to patent expiration. This suggests that, while prices were high during the patent period, creating an incentive for innovation, the transfers to consumers after patent expiration are significant, which is how the patent system is designed to function.","PeriodicalId":38039,"journal":{"name":"Forum for Health Economics and Policy","volume":"124 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2012-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87937121","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Abstract Recent evidence suggests that the economic value of increased health has been enormous, with most of these gains being driven by medical R&D. The R&D process for pharmaceuticals is particularly expensive and time consuming, with well-known studies from the Tufts Center for the Study of Drug Development suggesting that developing a single successful drug costs around $1 billion and takes roughly 12 years. We argue that these estimates are incomplete because they do not incorporate the social costs imposed by the regulatory process, namely the costs to producers in terms of forgone profits and the costs to consumers in terms of delayed access to drugs. In this article, we develop a framework to estimate the social costs imposed by the regulatory process. Under this framework, delays in drug development are socially costly because of reduced consumer surplus (due to delayed access to beneficial therapies), reduced producer variable profits, and increased R&D expenditures. We apply this framework to the case of therapies aimed at treating AIDS, non-Hodgkin’s lymphoma, and breast cancer. In each case, we find that the effects of drug delays on consumer surplus and variable producer profits are far larger than the effects on R&D costs. These findings suggest that patients, not firms, would be the primary beneficiaries from any improvements in streamlining the drug development process.
最近的证据表明，健康水平的提高带来了巨大的经济价值，其中大部分收益是由医疗研发推动的。药物的研发过程尤其昂贵和耗时，塔夫茨药物开发研究中心(Tufts Center for The Study of Drug Development)的著名研究表明，开发一种成功的药物需要大约10亿美元，大约需要12年的时间。我们认为，这些估计是不完整的，因为它们没有纳入监管过程所造成的社会成本，即生产者在放弃利润方面的成本和消费者在延迟获得药物方面的成本。在本文中，我们开发了一个框架来估计监管过程所施加的社会成本。在这一框架下，由于消费者剩余减少(由于获得有益疗法的延迟)、生产者可变利润减少和研发支出增加，药物开发的延迟在社会上代价高昂。我们将这一框架应用于治疗艾滋病、非霍奇金淋巴瘤和乳腺癌的病例。在每种情况下，我们都发现药品延迟对消费者剩余和可变生产者利润的影响远大于对研发成本的影响。这些发现表明，患者，而不是公司，将是药物开发过程中任何改进的主要受益者。
{"title":"A Reexamination of the Costs of Medical R&D Regulation","authors":"T. Philipson, E. Sun, D. Goldman, A. Jena","doi":"10.1515/FHEP-2012-0020","DOIUrl":"https://doi.org/10.1515/FHEP-2012-0020","url":null,"abstract":"Abstract Recent evidence suggests that the economic value of increased health has been enormous, with most of these gains being driven by medical R&D. The R&D process for pharmaceuticals is particularly expensive and time consuming, with well-known studies from the Tufts Center for the Study of Drug Development suggesting that developing a single successful drug costs around $1 billion and takes roughly 12 years. We argue that these estimates are incomplete because they do not incorporate the social costs imposed by the regulatory process, namely the costs to producers in terms of forgone profits and the costs to consumers in terms of delayed access to drugs. In this article, we develop a framework to estimate the social costs imposed by the regulatory process. Under this framework, delays in drug development are socially costly because of reduced consumer surplus (due to delayed access to beneficial therapies), reduced producer variable profits, and increased R&D expenditures. We apply this framework to the case of therapies aimed at treating AIDS, non-Hodgkin’s lymphoma, and breast cancer. In each case, we find that the effects of drug delays on consumer surplus and variable producer profits are far larger than the effects on R&D costs. These findings suggest that patients, not firms, would be the primary beneficiaries from any improvements in streamlining the drug development process.","PeriodicalId":38039,"journal":{"name":"Forum for Health Economics and Policy","volume":"43 1","pages":"1 - 28"},"PeriodicalIF":0.0,"publicationDate":"2012-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88067293","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Abstract The empirical association between high hospital procedure volume and lower mortality rates has led to recommendations for the centralization of complex surgical procedures. Yet redirecting patients to a select number of high-volume hospitals creates potential negative consequences for market competition. We use patient-level data to estimate the association between hospital procedure volume and patient mortality and costs. We also estimate the association between hospital market concentration and mortality, cost, and prices. We use our estimates to simulate the change in social welfare resulting from redirecting patients at low-volume hospitals to high-volume facilities. We find that a higher procedure volume leads to significant reductions in mortality for patients undergoing surgery for pancreatic cancer, but not colon cancer. Procedure volume also influences costs for both surgeries, but in a nonlinear fashion. Increased market concentration is associated with higher costs and prices for colon cancer, but not pancreatic cancer patients. Simulations indicated that centralizing pancreatic cancer surgery is unambiguously welfare enhancing. In contrast, there is less evidence to suggest that centralizing colon cancer surgery would be welfare improving.
{"title":"Can Centralization of Cancer Surgery Improve Social Welfare?","authors":"V. Ho, Marah Short, Meei-Hsiang Ku-Goto","doi":"10.1515/FHEP-2012-0016","DOIUrl":"https://doi.org/10.1515/FHEP-2012-0016","url":null,"abstract":"Abstract The empirical association between high hospital procedure volume and lower mortality rates has led to recommendations for the centralization of complex surgical procedures. Yet redirecting patients to a select number of high-volume hospitals creates potential negative consequences for market competition. We use patient-level data to estimate the association between hospital procedure volume and patient mortality and costs. We also estimate the association between hospital market concentration and mortality, cost, and prices. We use our estimates to simulate the change in social welfare resulting from redirecting patients at low-volume hospitals to high-volume facilities. We find that a higher procedure volume leads to significant reductions in mortality for patients undergoing surgery for pancreatic cancer, but not colon cancer. Procedure volume also influences costs for both surgeries, but in a nonlinear fashion. Increased market concentration is associated with higher costs and prices for colon cancer, but not pancreatic cancer patients. Simulations indicated that centralizing pancreatic cancer surgery is unambiguously welfare enhancing. In contrast, there is less evidence to suggest that centralizing colon cancer surgery would be welfare improving.","PeriodicalId":38039,"journal":{"name":"Forum for Health Economics and Policy","volume":"34 1","pages":"1 - 25"},"PeriodicalIF":0.0,"publicationDate":"2012-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80282086","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
George L Wehby, Ann Marie McCarthy, Eduardo E Castilla, Jeffrey C Murray
Abstract This paper assesses the effects of household investments through child educating activities on child neurodevelopment between the ages of 3 and 24 months, and evaluates whether investments explain racial and socioeconomic developmental gaps in South America. Quantile regression is used to evaluate the heterogeneity in investment effects by unobserved developmental endowments. The study finds large positive investment effects on early child neurodevelopment, with generally larger effects among children with low developmental endowments (children at the left margin of the development distribution). Investments explain part of the observed racial gaps and the whole socioeconomic developmental gap. Investments may compensate for low endowments and policy interventions to increase investments may reduce early development gaps and result in high social and economic returns.
{"title":"The Impact of Household Investments on Early Child Neurodevelopment and on Racial and Socioeconomic Developmental Gaps - Evidence from South America.","authors":"George L Wehby, Ann Marie McCarthy, Eduardo E Castilla, Jeffrey C Murray","doi":"10.2202/1558-9544.1237","DOIUrl":"https://doi.org/10.2202/1558-9544.1237","url":null,"abstract":"Abstract This paper assesses the effects of household investments through child educating activities on child neurodevelopment between the ages of 3 and 24 months, and evaluates whether investments explain racial and socioeconomic developmental gaps in South America. Quantile regression is used to evaluate the heterogeneity in investment effects by unobserved developmental endowments. The study finds large positive investment effects on early child neurodevelopment, with generally larger effects among children with low developmental endowments (children at the left margin of the development distribution). Investments explain part of the observed racial gaps and the whole socioeconomic developmental gap. Investments may compensate for low endowments and policy interventions to increase investments may reduce early development gaps and result in high social and economic returns.","PeriodicalId":38039,"journal":{"name":"Forum for Health Economics and Policy","volume":"14 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2012-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.2202/1558-9544.1237","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"30649100","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Abstract The ultimate aim of health care policy is good care at good prices. Managed care failed to achieve this goal through influencing providers, so health policy has turned to the only market-based option left: treating patients like consumers. Health insurance and tax policy now pressure patients to spend their own money when they select health plans, providers, and treatments. Expecting patients to choose what they need at the price they want, consumerists believe that market competition will constrain costs while optimizing quality. This classic form of consumerism is today’s health policy watchword. This article evaluates consumerism and the regulatory mechanism of which it is essentially an example – legally mandated disclosure of information. We do so by assessing the crucial assumptions about human nature on which consumerism and mandated disclosure depend. Consumerism operates in a variety of contexts in a variety of ways with a variety of aims. To assess so protean a thing, we ask what a patient’s life would really be like in a consumerist world. The literature abounds in theories about how medical consumers should behave. We look for empirical evidence about how real people actually buy health plans, choose providers, and select treatments. We conclude that consumerism is unlikely to accomplish its goals. Consumerism’s prerequisites are too many and too demanding. First, consumers must have choices that include the coverage, care-takers, and care they want. Second, reliable information about those choices must be available. Third, information must be put before consumers in helpful ways, especially by doctors. Fourth, the information must be complete and comprehensible enough for consumers to use it. Fifth, consumers must understand what they are told. Sixth, consumers must actually analyze the information and do so well enough to make good choices. Our review of the empirical evidence concludes that these prerequisites cannot be met reliably most of the time. At every stage people encounter daunting hurdles. Like so many other dreams of controlling costs and giving patients control, consumerism is doomed to disappoint. This does not mean that consumerist tools should never be used. If all that consumerism accomplished is to raise general cost-consciousness among patients, still, it could make a substantial contribution to the larger cost-control efforts by insurers and the government. Once patients bear responsibility for much day-to-day spending on their health needs, they should be increasingly sensitized to the difficult trade-offs that abound in medical care and might even begin to understand that public and private health insurers have a legitimate interest in controlling medical spending.
{"title":"Can Consumers Control Health-Care Costs?","authors":"M. Hall, C. Schneider","doi":"10.1515/FHEP-2012-0008","DOIUrl":"https://doi.org/10.1515/FHEP-2012-0008","url":null,"abstract":"Abstract The ultimate aim of health care policy is good care at good prices. Managed care failed to achieve this goal through influencing providers, so health policy has turned to the only market-based option left: treating patients like consumers. Health insurance and tax policy now pressure patients to spend their own money when they select health plans, providers, and treatments. Expecting patients to choose what they need at the price they want, consumerists believe that market competition will constrain costs while optimizing quality. This classic form of consumerism is today’s health policy watchword. This article evaluates consumerism and the regulatory mechanism of which it is essentially an example – legally mandated disclosure of information. We do so by assessing the crucial assumptions about human nature on which consumerism and mandated disclosure depend. Consumerism operates in a variety of contexts in a variety of ways with a variety of aims. To assess so protean a thing, we ask what a patient’s life would really be like in a consumerist world. The literature abounds in theories about how medical consumers should behave. We look for empirical evidence about how real people actually buy health plans, choose providers, and select treatments. We conclude that consumerism is unlikely to accomplish its goals. Consumerism’s prerequisites are too many and too demanding. First, consumers must have choices that include the coverage, care-takers, and care they want. Second, reliable information about those choices must be available. Third, information must be put before consumers in helpful ways, especially by doctors. Fourth, the information must be complete and comprehensible enough for consumers to use it. Fifth, consumers must understand what they are told. Sixth, consumers must actually analyze the information and do so well enough to make good choices. Our review of the empirical evidence concludes that these prerequisites cannot be met reliably most of the time. At every stage people encounter daunting hurdles. Like so many other dreams of controlling costs and giving patients control, consumerism is doomed to disappoint. This does not mean that consumerist tools should never be used. If all that consumerism accomplished is to raise general cost-consciousness among patients, still, it could make a substantial contribution to the larger cost-control efforts by insurers and the government. Once patients bear responsibility for much day-to-day spending on their health needs, they should be increasingly sensitized to the difficult trade-offs that abound in medical care and might even begin to understand that public and private health insurers have a legitimate interest in controlling medical spending.","PeriodicalId":38039,"journal":{"name":"Forum for Health Economics and Policy","volume":"128 1","pages":"23 - 52"},"PeriodicalIF":0.0,"publicationDate":"2012-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88089268","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Abstract We compare health care spending in the USA to other industrialized countries and find that payment rates for hospitals, physicians, and drugs are generally much higher in the USA than they are in other industrialized countries while the quantity of services – as measured by the number of physician visits, hospital days and prescriptions filled per capita – is relatively similar across countries. We then explore policy initiatives designed to control payment rates and volume of services and review the success and failures of these initiatives. Within the USA, the private sector pays significantly higher rates for hospital and physician services and drugs than the public sector. Thus, if the USA is going to reduce health care spending, it may be necessary to begin by reducing payment rates in the private sector. Options to achieve this goal are presented.
{"title":"High US Health-Care Spending and the Importance of Provider Payment Rates","authors":"G. Anderson, K. Chalkidou, B. Herring","doi":"10.1515/FHEP-2012-0007","DOIUrl":"https://doi.org/10.1515/FHEP-2012-0007","url":null,"abstract":"Abstract We compare health care spending in the USA to other industrialized countries and find that payment rates for hospitals, physicians, and drugs are generally much higher in the USA than they are in other industrialized countries while the quantity of services – as measured by the number of physician visits, hospital days and prescriptions filled per capita – is relatively similar across countries. We then explore policy initiatives designed to control payment rates and volume of services and review the success and failures of these initiatives. Within the USA, the private sector pays significantly higher rates for hospital and physician services and drugs than the public sector. Thus, if the USA is going to reduce health care spending, it may be necessary to begin by reducing payment rates in the private sector. Options to achieve this goal are presented.","PeriodicalId":38039,"journal":{"name":"Forum for Health Economics and Policy","volume":"51 1","pages":"1 - 22"},"PeriodicalIF":0.0,"publicationDate":"2012-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83770198","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Abstract This chapter traces the history of attempts at cost control in the United States from the origins of our modern health care financing system in the 1930s and 1940s, through health care cost regulation in the 1970s, and the deregulatory 1980s and 1990s, to the Affordable Care Act.
{"title":"Eight Decades of Discouragement: The History of Health Care Cost Containment in the USA","authors":"T. Jost","doi":"10.1515/FHEP-2012-0009","DOIUrl":"https://doi.org/10.1515/FHEP-2012-0009","url":null,"abstract":"Abstract This chapter traces the history of attempts at cost control in the United States from the origins of our modern health care financing system in the 1930s and 1940s, through health care cost regulation in the 1970s, and the deregulatory 1980s and 1990s, to the Affordable Care Act.","PeriodicalId":38039,"journal":{"name":"Forum for Health Economics and Policy","volume":"28 1","pages":"53 - 82"},"PeriodicalIF":0.0,"publicationDate":"2012-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84863742","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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