Introduction
conflict between cost and care
insurers make the patients unhappy when sick (limit care) and unhappy when well (high premiums)
no ideal solution--everyone is unhappy with their system
Controling the Transfer of GNP to Providers
private or social good
eruope and canada--social
america--wandered between the two
Germany: not socialized medicine but socialized insurance
The Approaches Used in Canada and Europe
90% covered under government plans
supply side control by allocateing technology and facilities
price controls and/or expenditure caps to prevent abuse of the system
explicit payments negotiated through a few large pipes
do not look at the individual patient to control costs
since only 5% of the population accounts for nearly half of all health expenditures, it is reasonable to think of healthcare for the sick, not for everyone
lag time for new medical technology as its cost-effectiveness is evaluated
The Entrepeneurial American Approach
belife in demand control--by making consumers shop around for the best deal
shifting the cost onto the consumer--people are not as well insured as belived
managed care as the solution--limits patient choice and underserves patients
The Economic Footprints of these Approaches
America has few rivals elsewhere at both its best and its worst
The Cost of Health Care
massive surplus of beds in the US--provides incentives for unneeded care
growing at a disguisting rate
no care for the poor
The Uninsured
no where else is there so poor coverage for the poor
37 million unisured
profit pressures are forcing hosptials to reduce free critical care
Styles of Rationing
explicit rationing--by ability to pay (America)
implicit rationing--by judged medical need (elsewhere)
Summary of the Economic Footsteps
trade offs: freedom to organize production and price, degree of control over total expenditures, degree of equity in distribution
The Convergence of Health Care Systems
under older expenditure-driven financing of health care invention was the mother of neccesity--no attention to cost/benefit ratios
move towars "budged-driven deliver of health care"
others: constrain the physical capcity of the system, control prcies, impose global monetary budgets
Conclusion
cost caps and statistical care coverage--massive exchanges of information will allow incentive structures to encourage physicans to provide the best care at a fixed total cost