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Thomas E. Getzen is the author of Health Economics and Financing, 5th Edition, published by Wiley.
Preface
Acknowledgments
About the Author
Foreword
CHAPTER 1 CHOICES: MONEY, MEDICINE AND HEALTH
Questions
1.1 What Is Economics?
Terms of Trade
Value
Can We Pay Somebody to Care?
Financing Health Care
Full Cost: Paying For Medical Care
1.2 The Flow of Funds
Health Care Spending in the United States
Sources of Financing
Health Care Providers: The Uses of Funds
1.3 Economic Principles As Conceptual Tools
Scarcity (Budget Constraints)
Opportunity Cost
Willingness to Pay
Trade
Money Flows in a Circle
The Margin: What Matters?
Maximization: Marginal Costs and Marginal Benefits
Choice: Are Benefits Greater Than Costs?
Investment
Contracts: Complex Exchanges to Deal with Timing and Risk
Organizations Adapt and Evolve
Distribution: Who Gets What
1.4 Health Disparities
1.5 Whose Choices: Personal, Group or Public?
1.6 Social Science and Rational Choice Theory
Suggestions for Further Reading
Summary
Problems
Endnotes
CHAPTER 2 DEMAND AND SUPPLY
Questions
2.1 The Demand Curve
The Diamonds?Water Paradox: An Example of Marginal Analysis
Consumer Surplus: Marginal versus Average Value of Medicine
Ceteris Paribus
Individual, Firm, and Market Demand Curves
2.2 The Supply Curve
Marginal Revenue
2.3 Price Sensitivity
Price Elasticity and Marginal Revenue
Price Discrimination
2.4 Is Money the Only Price?
2.5 Inputs and Production Functions
Production Functions
Marginal Productivity
2.6 Markets: The Intersection of Demand and Supply
2.7 Need versus Demand
How Much is a Doctor Visit Worth?
The Demand for Medical Care is Derived Demand
The Demand for Health: What Makes Medical Care Different
2.8 The Determinants of Health
2.9 Efficiency
Suggestions for Further Reading
Summary
Problems
Endnotes
CHAPTER 3 COST?BENEFIT AND COST-EFFECTIVENESS ANALYSIS
Questions
3.1 Cost?Benefit Analysis is About Making Choices
An Everyday Example: Knee Injury
Stepwise Choices: Yes or No? How Much?
Calculating Marginal and Average Costs
Defining Marginal: What is the Decision?
3.2 Maximization: Finding the Optimum
Declining Marginal Benefits
Optimization: Maximum Net Benefits Expected Value
3.3 The Value of Life
3.4 Quality-Adjusted Life Years
Discounting Over Time
QALY League Tables
3.5 Perspectives: Patient, Payer, Government, Provider, Society
Distribution: Whose Costs and Whose Benefits?
CBA Is a Limited Perspective
CBA and Public Policy Decision Making
CBA Is a Limited Perspective/
Suggestions for Further Reading
Summary
Problems
Endnotes
CHAPTER 4 HEALTH INSURANCE: FINANCING MEDICAL CARE
Questions
4.1 Methods for Covering Risks
Savings
Family and Friends
Charity
Private Market Insurance Contracts
Social Insurance
Strengths and Weaknesses of Different Forms of Risk Spreading
4.2 Insurance: Third-Party Payment
Why Third-Party Payment?
Variability
Third-Party Transactions
Who Pays? How Much?
How Are Benefits Determined?
4.3 Risk Aversion
4.4 Adverse Selection
4.5 Moral Hazard
Welfare Losses Due to Moral Hazard
Ex Ante Moral Hazard
4.6 Tax Benefits
4.7 Effects of Health Insurance on Labor Markets
4.8 History of Health Insurance
Suggestions for Further Reading
Summary
Problems
Endnotes
CHAPTER 5 INSURANCE CONTRACTS AND MANAGED CARE
Questions
5.1 Sources of Insurance
Employer-Based Group Health Insurance
Medicare
Medicaid
State Children?s Health Insurance Program
Other Government Programs and Charity
The Uninsured
5.2 Contracting and Payments
Risk Bearing: From Fixed Premiums to Self-Insurance
Purchasing Medical Care for Groups
Medical Loss Ratios
Claim Processing
The Underwriting Cycle
ERISA, Taxes, and Mandated Benefits
Other People?s Money: Rising Costs and Mediocre Benefits
5.3 Consumer-Driven Health Plans: High Deductibles and Health Savings Accounts
Defined Contribution Health Plans
5.4 Managed Care
Closed-Panel Group Practice HMOs
IPA-HMOs and Open Contracts
Managed Care Contract Provisions
The Range of Managed Care Contracts: POS, PPO, HMO
Provider Networks and Legal Structure
Management: The Distinctive Feature of Managed Care
Contractual Reforms to Control Costs
5.5Unresolved Issues: Split Incentives, Divided Loyalties
Suggestions for Further Reading
Summary
Problems
Endnotes
CHAPTER 6 PHYSICIANS
Questions
6.1 Financing Physician Services: Revenues
Copayments, Assignment, and Balance Billing
Physician Payment in Managed Care Plans
Incentives: Why Differences in the Type of Payment Matter
A Progression: From Prices to Reimbursement Mechanisms
6.2 Physician Incomes
6.3 Physician Financing: Expenses
Physician Practice Expenses
The Labor versus Leisure Choice
The Doctor's Workshop and Unpaid Hospital Inputs
Malpractice
6.4 The Medical Transaction
Asymmetric Information
Agency: Whose Choices?
6.5 Uncertainty
6.6 Licensure: Quality or Profits?
How Does Licensure Increase Physician Profits?
Supply and Demand Response in Licensed versus Unlicensed Professions
How Does Licensure Improve Quality?
A Test of the Quality Hypothesis: Strong Versus Weak Licensure
Suggestions for Further Reading
Summary
Problems
Endnotes
CHAPTER 7 MEDICAL EDUCATION, ORGANIZATION, AND BUSINESS PRACTICES
Questions
7.1 Medical Education
7.2 The Origins of Licensure and Linkage to Medical Education
AMA Controls Over Physician Supply, 1930?1965
Breaking the Contract: The Great Medical Student Expansion of 1970 to 1980
Building Pressure: Fixed Domestic Graduation Rates 1980 to 2010
7.3 Adjusting Physician Supply
The Flow of New Entrants and the Stock of Physicians
Immigration of International Medical Graduates
Growth in Non-MD Physicians
Balancing Supply and Incomes: Tracing the Past and Projecting the Future
7.4 Group Practice: How Organization and Technology Affect Transactions
7.5 Kickbacks, Self-Dealing, and Side Payments
7.6 Price Discrimination
7.7 Practice Variations
7.8 Insurance, Price Competition, and the Structure of Medical Markets
7.9 Choices by and for Physicians
Suggestions for Further Reading
Summary
Problems
Endnotes
CHAPTER 8 HOSPITALS
Questions
8.1 From Charitable Institutions to Corporate Chains: Development of the Modern Hospital
8.2 Hospital Financing: Revenues
Sources of Revenues
8.3 Hospital Financing: Expenses
8.4 Financial Management and Cost Shifting
8.5 How Do Hospitals Compete?
Competing for Patients
Competing for Physicians
Competing for Contracts
Measuring Competitive Success
Measuring the Competitiveness of Markets
8.6 Organization: Who Controls the Hospital and for What Ends?
Suggestions for Further Reading
Summary
Problems
Endnotes
CHAPTER 9 MANAGEMENT AND REGULATION OF HOSPITAL COSTS
Questions
9.1 Why Do Some Hospitals Cost More than Others?
9.2 How Management Controls Costs
Short-Run versus Long-Run Cost Functions
Uncertainty and Budgeting
9.3 Conflict Between Economic Theory and Accounting Measures of Per Unit Cost
Timing
Whose Costs?
9.4 Economies of Scale
The Hospital is a Multiproduct Firm
Contracting Out
9.5 Quality and Cost
Technology: Cutting Costs or Enhancing Quality?
Improved Efficiency Can Raise Total Spending
9.6 Hospital Charges, Costs, and Prices: Confusion and Chaos
Chargemaster and Negotiated Fees
Cost Finding: Gross Revenues and the RCCAC
Medicare as a Standard for Pricing
9.7 Controlling Hospital Costs through Regulation
Suggestions for Further Reading
Summary
Problems
Endnotes
CHAPTER 10 LONG-TERM CARE
Questions
10.1 Development of the Long-Term Care Market
10.2 Age and Health Care Spending
10.3 Defining LTC: Types of Care
10.4 Medicaid: Nursing Homes as a Two-Part Market
10.5 Certificate of Need: Whose Needs?
Money and Quality
Competing for Certificates of Need, Not for Patients
Evidence on the Effects of Certificates of Need
10.6 Cost Control by Substitution
10.7 Case-Mix Reimbursement
10.8 Long-term Care Insurance
Is Long-Term Care ?Medical??
10.9 Retirement, Assisted Living, and the Wealthy Elderly
10.10 Financial Reimbursement Cycles
Suggestions for Further Reading
Summary
Problems
Endnotes
CHAPTER 11 PHARMACEUTICALS
Questions
11.1Pharmaceutical Revenues: Sources of Financing
Inpatient Pharmaceuticals
11.2 Uses of Funds
Retail Pharmacies
Wholesalers
Insurance Companies and PBMs
Pharmaceutical Firms
Cost Structure
11.3 History and Regulation of Pharmaceuticals
11.4 Research and Development
11.5 Pharmacoeconomics and Technology Assessment
11.6 Industry Structure and Competition
Value, Cost, and Marketing
The Role of Middlemen: Distribution Versus Marketing
Research Productivity
Suggestions for Further Reading
Summary
Problems
Endnotes
CHAPTER 12 FINANCING AND OWNERSHIP OF HEALTH CARE PROVIDERS
Questions
12.1 What is Financing?
12.2 Value and Rate of Return
The Time Value of Money.
Interest Rates and Present Value
The Internal Rate of Return
Human Capital: Medical Education as an Investment
Risk
Valuing Assets
12.3 Uncorrelated (Independent) and Correlated (System) Risks
Which is Riskier: Nursing Homes or Drug Companies?
Assessing Business Risk
12.4 Ownership and Agency
Equity and Debt
Who Owns the Business? Who Owns the Patient? Agency Issues
The Role of Financial Intermediaries
Health Insurers as Financial Intermediaries
12.5 Capital Financing: Hospitals
12.6 HMO Ownership and Capital Markets: Success and Failure
Business Risks for an HMO
Kaiser Health Plan: The Evolution of an HMO
Group Health Association: A Consumer Co-op Gets Bought Out by a Franchise Chain
12.7 Entrepreneurship and Profits
U.S. Healthcare: A Profitable Growth Company
12.8 Health Care for Profit, or Not
Differences between For-Profit and Nonprofit Behavior
Charity Care: For Real or for Show?
For-Profit or Not-for-Profit: Which Is Better?
Medical Care is Difficult: Risk, Information Asymmetry, Social Justice
Suggestions for Further Reading
Summary
Problems
Endnotes
CHAPTER 13 MACROECONOMICS OF MEDICAL CARE
Questions
13.1 What is Macro?
Micro and Macro Perspectives on Spending
13.2 The Consumption Function
The Permanent Income Hypothesis
Shared Income
Public and Private Decisions
Budget Constraints: Borders that Matter
13.3 Adjusting to Change: Dynamics
Permanent Income and Adjustment of Health Spending to GDP
Adjustment to Inflation
Adjustment to GDP: Rates of Change and Time Series Analysis
13.4 Forecasting Future Health Expenditures
13.5 Cost Controls: Spending Gaps and the Push to Regulate
Capacity Constraints and Budget Constraints
13.6 Workforce Dynamics: "Spending" is Mostly Labor
Employment
Wages
Suggestions for Further Reading
Summary
Problems
Endnotes
CHAPTER 14 THE ROLE OF GOVERNMENT AND PUBLIC GOODS
Questions
14.1 The Roles of Government
Markets Are Perfectly Efficient, but Only with Perfect Competition
Government in a Mixed Economy
How Government Works
The Voluntary Sector
Government is Necessary, and Costly
Markets are Costly, Limited, and Always Regulated
14.2 Government Health Financing
14.3 Law and Order
14.4 Public Goods and Externalities
Privatizing Public Goods
Insurance Makes Any Good More Public
Externalities
The Coase Theorem: Transaction Costs and Property Rights
14.5 Monopoly and Market Failure
14.6 Information
Rational Consumer Ignorance
Social Costs Depend on the Number of People
Milk or Bread: Which is More Public?
Infectious Disease Externalities
Epidemics
The Sanitary Revolution: A Moral Campaign for Public Health
Formation of the U.S. Public Health Service
14.7Drugs, Sex, and War: Public Health in Action
Addiction
Sexual Behavior
Who Counts as a Citizen? Abortion and Other Dilemmas
War and Public Health
14.8 Politics, Regulation, and Competition
Politicians: Entrepreneurs Who Try to Get Votes
Government as the Citizen?s Agent
Public Goods Make almost Everybody Better Off but Nobody Happy
Winners and Losers
14.9 Trust, Care, and Distribution
Suggestions for Further Reading
Summary
Problems
Endnotes
CHAPTER 15 HISTORY, DEMOGRAPHY, AND THE GROWTH OF MODERN MEDICINE
Questions
15.1 Economic Growth has Determined the Shape of Health Care
15.2 Birth Rates, Death Rates, and Population Growth
15.3 The Stone Age
15.4 The Agricultural Age
Investment and Trade
Civilization, War, and Government
The Decline of Civilizations Leads to Population Declines
The Plague
Food Supply Determines Population
The Rise of Economics
The Malthusian Hypothesis
15.5 The Industrial Age
Why Malthus Was Wrong
Demographic Transition
Demographic Change, Income Distribution, and the Rise of the Middle Classes
15.6 The Information Age
15.7 Income and Health
15.8 Reducing Uncertainty: The Value of Life and Economic Security
The Value of Risk Reduction
Social Security and Health Insurance
15.9The Rise of Modern Medicine
Preconditions for Change
The Growth of Medical Science and Technology
Did Better Medical Care Increase Life Expectancy?
Suggestions for Further Reading
Summary
Problems
Endnotes
CHAPTER 16 INTERNATIONAL COMPARISONS OF HEALTH AND HEALTH EXPENDITURES
Questions
16.1 Wide Differences Among Nations
Size of the Market
16.2 Micro Versus Macro Allocation: Health as a National Luxury Good
16.3 Causality: Does More Spending Improve Health?
16.4 Low-Income Countries
Health Care in Ghana
Sudan
16.5 Middle-Income Countries
China
The Health Care System of Mexico
Poland
16.6 High-Income Countries
Health Care in Japan
The Health System in Germany
The Expensive Exception: The United States
16.7 International Trade in Health Care
People and Ideas
Services
Equipment
Pharmaceuticals
Suggestions for Further Reading
Summary
Problems
Endnotes
CHAPTER 17 ECONOMIC EVALUATION OF HEALTH POLICY: THE PATIENT PROTECTION AND AFFORDABLE CARE ACT OF 2010
Questions
17.1ACA 2010: Description of Main Elements
Coverage Rules
State Health Insurance Exchanges
Individuals
Employers: Positive and Negative Incentives to Provide Benefits
Medicare: ACOs, IPAB, Bundled Payments, and the Donut Hole
Medicaid: Major Expansions with Federal Funding
Prevention and Other Provisions of PPACA
Still Uninsured: The Undocumented and Some Other Outsiders
17.2 Statement of the Problem: Affordability
Rising Costs Slowly Create a Crisis
The Middle Class Gets Stretched: A Leveraged Gap in Coverage
Macro Affordability: The Growth Gap
17.3 Using Existing Plans as Models
States
The Federal Employees Health Benefits Plan
17.4 Unresolved Issues
Equity
Defining Essential Benefits
The OPM Legacy: Third-Party Payment and Cost Shifting
Price Transparency: A Conspiracy of Silence
The Uninsured: Still There, Still Have to be Paid For
Unfunded Health and Retirement Benefits
Defined Benefits, Defined Services, or Defined Contribution
Who Bears the Risk?
Suggestions for Further Reading
Summary
Problems
Endnotes
CHAPTER 18 VALUE FOR MONEY IN THE FUTURE OF HEALTH CARE
Questions
18.1 Forcing the Question: Who Gets Healthy and Who Gets Paid?
18.2 Spending Money or Producing Health?
18.3 Dynamic Efficiency
18.4 Distribution, Distribution, Distribution
18.5 Path-Dependence and the Possibilities for Reform
How Did We Get Here?
What Did Medicine Miss?
What Went Wrong? Notable Failures and Unresolved Dilemmas
18.6 The Path Forward: Step by Step
18.7 The Shape of Health Care Spending to Come
18.8 The Long Run: 2050 and Beyond
Suggestions for Further Reading
Summary
Problems
Endnotes
Glossary
Index
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