University of South Carolina, Arnold School of Public Health,
Dept. of Health Services Policy and
India's health insurance --
will it follow China or Taiwan? Health insurance P.R. campaign against Michael Moore and Sicko described by industry whistleblower Wendell Potter. Wendell Potter and Michael Moore. Part 2.
No progress in reducing harm to patients in hospitals.
"Temporal Trends in Rates of Patient Harm Resulting from Medical Care," Christopher P. Landrigan, et al, N Engl J Med 2010; 363:2124-2134, November 25, 2010. 20% of patients were harmed. Half of those were judged to have been preventable. Obama realized that he fell for G.O.P. delay strategy.. Obama's people understood last year that delay was an attempt to kill health reform. What's new is realizing that the delay on health reform was a successful attempt to discredit all of Obama's efforts.
Nov. 10 slideshow:
health care reform will survive
New York Times:
High-risk pools aren't catching on. The insurance is pricey, and some states impose waiting periods and don't encourage eligible people to sign up (as with Medicaid).
Nov. 3 slideshows about
HMOs and the Kaiser Family Fund employer survey.
Oct. 27 slideshows about
administrative cost and malpractice.
Oct. 20 slideshows:
DRGs and RBRVS and the rest.
Oct. 13 slideshows:
Competition and Monopoly, Wennberg practice variation
RAND study and comments:
Oct. 6 slides
Forest and Trees
Sept. 29 slideshow
The U.S. spends far more than other countries on health care in relation to national income. The chart's caption says "wealth," but the axis label is GDP.
Are we spending so much because we're sicker? More bad habits?
Maybe for 1¼% of our health care spending.
Blogs I follow include
New York Times economix -- health care/, especially Uwe Reinhardt's posts, and Paul Krugman on macroeconomics.
a flow chart that shows how the health insurance reform was intended to work.
Not all that complex! Discussion of how the chart evolved is here.
The 2011 syllabus is at sambaker.com.
Department of Health Services Policy and Management
Arnold School of Public Health
University of South Carolina
800 Sumter St., Room 121
Columbia, SC 29208
712 in the
of course-related e-mail. Please see below for how to use Blackboard to submit course work.
What you'll need - What you'll do - Schedule
of Classes, Readings, and On-Line Materials - Interactive Tutorials
The class meets at
6:00 on pm-8:30 pm Wednesdays in
Swearingen 2A07. ( Map.)
Class meetings are available live over the internet to registered students. The class meetings are recorded as well. Students can view them at their convenience.
Office hours: Wednesdays, Noon
(We can have lunch!) to 5 pm,
or e-mail for an appointment.
HSPM J712 introduces the application of economics to decisions
regarding the amount, organization, and distribution of health care
services in the United States. The goals of the course are:
to provide an economics perspective for management
to provide theoretical groundwork for the study of finance,
accounting, marketing, and planning
to enable you as future health care managers to play positive
roles in the reform of health care
You will demonstrate on the course's written assignments and through
that you understand and can use basic economics concepts, such
as supply, demand, marginal analysis, the theory of capital, and
that you can analyze the economic institutions of the United
States health care system,
that you can discuss controversies surrounding the development
of health insurance and the government's role in providing, financing,
and regulating health services.
What you need to have to take
Prerequisite courses: None. No prior study of economics is
required for this course.
Required purchases: Sicko, a film by Michael Moore from 2007. If you don't have access to it already (see the November 3 class below), you can buy the DVD from Amazon.com for as little as $6.
If your Java version, :( If
you see this text, , is 1.4 or higher,
you should be able to do the tutorials. Otherwise, get the Java
for free at Java is not working at all.
Go to java.com to download and install it.
At some workplaces, you may have to request that
Java be enabled for your computer. http://java.com.
When you install or update Java, they will offer you extras, like OpenOffice or a browser toolbar or a trial of "Carbonite."
Take a moment to find and uncheck the boxes, unless you actually want the extras.
If you installed Java and you still don't
see the version number,
Required computer access: Students must have access to a
Computers meeting these requirements are available for student use in
the Department's BlueCross BlueShield and
Companion Technologies Computer Education Center, on the first floor of
the Arnold School of Public Health building.
a web browser with Java enabled (see box → )
Reader for pdf files. Get the free version. When you download and
install it, you can uncheck all
optional browser toolbars, etc.
Interactive instruction: A group of
interactive instructional tutorials is at http://hspm.sph.sc.edu/Courses/Econ/Tutorials.html.
The interactive tutorials introduce basic economics concepts, and assume no economics background. Your work with the
interactive tutorials is not monitored or graded. These
are integrated into the Class Schedule and Readings, as shown below.
of the interactive tutorials are available all semester, so you can use
or reuse them at any time.
How to submit written work:
In Blackboard, click the link for this course. Then click
. Click the link for the week you want. The library-based readings for that week will be there,
as will a link for submitting the assignment.
Click the link for the assignment. Attach your Word, WordPerfect, Rich-Text Format, or text file. (I can't
read Works files, unless you save them in rich text or plain text format.)
Click "Submit," not "Save." "Save" does not submit the assignment to me.
Please do not use Blackboard's digital drop box or messages. I do not
regularly check those.
By the act of submitting a paper or exam for this course, you certify that you are
complying with departmental and University academic integrity policies.
You agree that questions about adherence to the policies will be handled through the
formal procedures mandated by the department and the University.
Course Work for Credit
Each week when there is a class, starting with week 2, but excluding the week of the mid-term, submit a substantive, relevant, comment.
The comment should be equivalent to about one-half to one page of 12-point single-spaced
type. For prose, that's 250 to 500 words. For poetry, you can have fewer words.
Comments are due by the start of class. They can be about that
class's ideas, or about the preceding class's ideas.
All comments that are on time and use course concepts will get full "A" credit.
Doing all the comments on time will give you the equivalent of an A for one-third of your
Comments that are late or do not bring in course concepts will
get less than full credit.
Good comments can be about:
A personal or work experience that relates to an idea in the
readings or the lecture.
Your thoughts about an idea in the readings or lecture that seems
insightful, or pernicious.
A comparison of two readings' ideas.
You learn new concepts by using them. That is the purpose of the
Take-home exams are due on these dates:
Wed., Oct. 13
Wed., Dec. 8
Each exam counts for one-third of the grade.
The exams will be distributed via this web page or Blackboard.
Your course grade is one-third the comments, one-third the mid-term
exam, and one-third the final exam.
Class Schedule and Readings
Some readings may change, later in the semester.
Advice for the overwhelmed: If the reading for this course seems
like a lot, see
2 Read an Article.
August 25 Introduction to the Course -- no comment due
How the course will
operate, and the general shape of the US health care economic sector.
What is economics Go through for a general introduction to "the economic problem."
(Alternative talking version. Loads slower.)
and flows Dry, but helps with the next one.
The Gross Domestic Product
Go through for a general discussion of how this
important economic statistic is conceived. U.S. National Health Spending in 2008:
of the recent growth in health care spending has been for expanding
care for five conditions A quick look at this is
OK. Here is the summary table of the fastest-growing diseases. Fastest growing in terms of spending, that is.
A diagram, based on an
earlier version of this next article, of sources of U.S. health care
funding, 1995. Glance at this. Cathy A. Cowan and Micah B. Hartman, "
Health Care: Businesses, Households, and
Governments, 1987-2003," Health Care Financing Review, Web
Exclusive, July 2005, Volume 1, Number 2. Pages 1 and 2 explain their method. Page 4 has the table that shows how the my diagram's second column would have changed. This analysis has not been redone since, so far as I know.
Spending in the United States and the Rest of the Industrialized World,
by Gerard F. Anderson, Peter S. Hussey, Bianca K. Frogner, and Hugh R.
Waters, Health Affairs, 2005, Vol 24, Issue 4, 903-914. A USC campus computer may be required to
download this. Glance at this article. We'll talk about it near to the end of the course.
This article shows how much more the U.S. spends on health care than other
countries. The article debunks some myths that are dear to the anti-reform crowd, particularly (1) that people in other
countries wait longer and get less service than Americans do, and (2) that
big malpractice tort awards are why U.S. health care costs so much.
In class, I'll show these diagrams, that are based on the article's data:
spending and infant mortality, health spending
and nurses, health
spending and CT scanners. Meredith Minkler, Esme Fuller-Thomson, and Jack M. Guralnik, "
Disability across the Socioeconomic Spectrum in the United States,"
N Engl J Med,
355:7, Aug. 17, 2006. Alternative PDF link A little economics of health, rather than just the economics of health care. Paul Krugman,
Live Long and Prosper, August 13, 2010. The prosperous live longer, so the poor lose the most when the Social Security eligibility age is raised. A diagram. The CBO report.
Cost -- comment
Learning objectives: Basic cost concepts, the accounting of
future costs, methods and ethics of cost-benefit and cost-effectiveness
analysis applied to health care.
To find this, go to Blackboard, click this course's link, click on Assignments in the left menu, then click on the Readings folder.
Reinhardt, U.E., "Perspective: Spending More Through 'Cost
Control': Our Obsessive Quest to Gut the Hospital,"
1996, 15(2), pp. 145-154. A worthwhile
article. You see how a top-notch economist thinks. Relevant for this
week is how the author uses the "incremental cost" (marginal cost)
concept. External Cost and Public Goods
Future Cost and Income
Cost-Benefit, Cost-Effectiveness, and
Cost-Savings Analysis comment
Learning objectives: Methodology and ethics in cost-benefit
cost-effectiveness analysis, with application to evaluating the
cost-effectiveness of preventive care, the distinction between
cost-effective and cost-saving, and an attempt at policy based on
cost-effectiveness analysis. Then, the concepts of market, supply, and
Axnick, N.W., Shavell, S.M., Witte, J.J., "Benefits Due to
Immunization Against Measles,"
Public Health Reports, August
1969, 84(8), pp. 673-680. Read. See how the
authors use the idea of discounting future spending. See what they
include as the costs and benefits of measles immunizations, especially
how they value lives saved. Recent news:
Measles Inoculation Campaign in China Resisted
Neuhauser, D., Lewicki, A.M., "What Do We Gain from the Sixth
N Engl J Med, July 31, 1975, 293(5), pp.
226-228. Read pretty thoroughly. The notes (see
above) will help with this. Eddy, D.M., "Screening for Cervical Cancer,"
Internal Medicine, August 1, 1990, 113(3), pp. 214-226. More technical. Don't get bogged down in technical detail.
See the notes for help with this. Fries, J.F., Koop, E., et al, "Reducing Health Care Costs by
Reducing the Need and Demand for Medical Services,"
N Engl J Med,
July 29, 1993, 329(5), pp. 321-325. The
authors are renowned public health leaders. This is conventional
wisdom. But is it right? Russell, L.B., "The Role of Prevention in Health Care Reform,"
Engl J Med, July 29, 1993, 329(5), pp. 352-354. Worth
a fairly careful read. What is the basis of Russell's disagreement with
the conventional wisdom? Huntington, J., Connell, F.A., "For Every Dollar Spent -- The
Cost-Savings Argument for Prenatal Care,"
N Engl J Med, Nov.
10, 1994, 331(19), pp. 1303-1307. Also
questions conventional wisdom. Eddy, D.M., Oregon's Methods: Did Cost-effectiveness Analysis
JAMA, Oct. 16, 1991, 266(15), pp. 2135-2141. See the notes for background and explanation.
Beyond PAP tests: A study of the potential
of HPV vaccine. The study gives results with and without the discounting of
benefits that Eddy does in his PAP test study. Cost-effectiveness is
judged by dollars saved per quality-adjusted year of life saved. That
compares the vaccine with all efforts to save lives, rather than
comparing the vaccine specifically with other methods to control HPV
transmission or cervical cancer. Jane J. Kim, and Sue J. Goldie, "
Health and Economic Implications of HPV
Vaccination in the United States," New England J Med Aug 21 2008;359:821-32
on the Net Cost of Smoking in the Czech Republic, July 2001.
Large type version. In cost-effectiveness analysis, you have to be sure you know whose costs you are weighing.
Read quickly for main ideas.
Audio of discussion of the report's economics, politics, and ethics on NPR Planet Money, July 16, 2010. It starts at 3:52 in the recording.
pox immunizations save $100 million in annual hospital cost. Is
that enough to make immunizations a net saver of health care cost? Glance at this. A Washington Post story from 2007:
"For the Want of a Dentist" Prevention can save lives, and this one may save money, too: Finland reduced deaths from strokes and heart attacks by 75%, by working with the food industry to reduce salt. (The linked article I had was too much of a curve ball. Sorry!) If that also meant fewer strokes, angina, and infarctions requiring surgery,
health care spending would be less, too. The New England Journal of Medicine, Sept. 1. 2009, has
an article about hypertension in the U.S., where salt intake per person has increased 50% in the past 30 years. Donna Richter,
Prevention Key to Health Care Reform, The State, August 29, 2009. During 2009's health care reform battle, a version of the Fries-Koop argument. Arguments like that weren't just a distraction from the campaign to enact health insurance reform, they may have fed the paranoia about "death panels" that the opposition exploited. If you'd like a reminder of that craziness, here is Jon Stewart interviewing Betsy McCaughey (pronounced "McCoy") on the Daily Show August 20, 2009:
Part 1 as aired | Part 2 as aired.
The Right is pushing the fear for the 2010 election. On July 23, 2010, Rachel Maddow showed
U. S. Representative Louie Gohmert (R - TX) fretting that the government will be penalizing people with high cholesterol who buy bacon.
Health Care and the Free Market: The Demand for Health Care
-- comment due
Learning objectives: What economists mean by markets, supply and demand, elasticity, and risk and risk aversion. These are building block concepts towards assessing having a free market in health care.
Supply and Demand introduction
Health Care Demand and the Free Market model
Bodenheimer, T., Grumbach, K., "Paying for Health Care,"
August 24/31, 1994, 272(8), pp. 634-639.
Health Care Demand II: What's special about health care? comment due
Learning objectives: Information and uncertainty in health care
Arrow, K., "Uncertainty and the Welfare Economics of Medical
Care," American Economic Review, December 1963, 53(5),
pp. 941-973. Important. But difficult. The notes (see below) will help.
Health Care Demand III -- comment due.
These readings show that people do get less health care when
they have to pay more. Theory of demand
does apply. There is a demand curve for health care generally and there
are demand curves for specific types of health care. These demand
curves slope down from left to right. To use the jargon, the demand for
health care has some elasticity. The elasticity is pretty low,
especially for people seeking care for serious symptoms, but it's not 0.
The articles go on to investigate whether people who buy less care, because they have to pay more,
are worse off as a result. If the answer is No, then letting people get care without paying out of pocket
is wasteful. Or is it? Are all the costs being considered? How good are people at determining what care they can do without?
et al, "Does Free Care Improve Adults'
Health? Results from a Controlled Trial of Cost Sharing in Health
Insurance," N Engl J Med, December 8, 1983, 309, pp.
1426-1434. Worth a fairly careful read.
Shapiro, M.F., Ware, J.F., Sherbourne, C.D., "Effects of Cost
Sharing on Seeking Care for Serious and Minor Symptoms,"
Internal Medicine, February 1986, 104, pp. 246-251. Read quickly for the main ideas.
Rasell, M.E., "Cost Sharing in Health Insurance -- A
N Engl J Med, April 27, 1995, 332(17),
pp. 1164-1168. This article and the Gladwell pieces from the web argue against cost sharing as a cost control strategy.
Moral-Hazard Myth, by Malcolm Gladwell, The New Yorker,
August 29, 2005. Malcolm Gladwell, interviewed about "The Moral-Hazard Myth" on
the Al Franken Show, August 25, 2005:
A 19-minute mp3. Gladwell said that the reason we don't have universal health insurance is that our leaders think that we're better off without it. Listen carefully to
then-President Bush's "objective" for our health care system, from July 2007. It's in the first 20 seconds of the clip. Mark Pauly, "
The Truth about
Moral Hazard and Adverse Selection," Maxwell School of Syracuse
University Policy Brief No. 36/2007. Mr. Moral Hazard replies.
Wennberg, J.E., McPherson, K., Caper, P., "Will Payment Based on
Diagnosis-Related Groups Control Hospital Costs?"
N Engl J Med,
August 2, 1984, 311, pp. 295-300. People
living in different areas get very different care. This article created
a whole area of health services research.
October 13 First Exam Due
Theory of the Supply Side of Markets
Learning objectives: Competition and monopoly theory,
how markets in theory set price and quantity.
A light (lite?) lecture because the exam is due tonight.
October 20 The Supply Side of Health Care Markets: Pricing. Comment due.
Learning objectives: How prices are set in health care markets. How that compares with economic theory. How DRG- and RBRV-based payment work.
Roe, B.B., "The UCR Boondoggle: A Death Knell for Private
N Engl J Med, July 2, 1981, 305(1), pp.
41-45. Pricing in health care didn't follow the competitive market model ...
... so the government stepped in:
DRG's -- A tool for controlling hospital prices
Simborg, D.W., "DRG Creep: A New Hospital-Acquired Disease,"
Engl J Med, June 25, 1981, 304(26), pp. 1602-1604. Baker, S.L., Kronenfeld, J.J., "Medicaid Prospective Payment:
Health Care Financing Review, Fall 1990, 12(1),
pp. 63-70. RBRVS -- A tool for controlling physician fees
Hsiao, W.C., Braun, P., Dunn, D., Becker, E.R., DeNicola, M.,
Ketcham, T.R., "Results and Policy Implications of the Resource-Based
N Engl J Med, September 29, 1988, 319(13),
pp. 881-888. Hsiao, W.C., Braun, P., Yntema, D., Becker, E.R., "Estimating
Physicians' Work for a Resource-Based Relative Value Scale,"
J Med, September 29, 1988, 319(13), pp. 835-841. How pricing has worked
Reinhardt, U.E., "Resource Allocation in Health Care: The
Allocation of Lifestyles to Providers,"
The Milbank Quarterly,
1987, 65(2), pp. 153-176. Brown, M.L., Kessler, L.G., Reuter, F.G., "Is the Supply of
Mammography Machines Outstripping Need and Demand?"
Internal Medicine, October, 1, 1990, 113(7), pp. 547-552. Also contrary to the competitive market model, excess
capacity does not lead to price competition. Hillman, B.J., Joseph, C.A., Mabry, M.R., Sunshine, J.H.,
Kennedy, S.D., Noether, M., "Frequency and Costs of Diagnostic Imaging
in Office Practice -- A Comparison of Self-Referring and
N Engl J Med, Dec. 6, 1990, 323(23), pp.
1604-1608. Pattison, R.V., and Katz, H.M., "Investor-Owned and
Not-for-Profit Hospitals: A Comparison Based on California Data,"
Engl J Med, August 11, 1983, 309, pp. 347-353. More differences with the competitive model: Some
providers (for-profit hospitals, in this case) can charge more than
other providers for the same services. Woolhandler, S., Himmelstein, D.U., "Costs of Care and
Administration at For-Profit and Other Hospitals in the United States,"
N Engl J Med, March 13, 1997, 336(11), pp. 769-74. Reinhardt, Uwe E., "The
Pricing Of U.S. Hospital Services: Chaos Behind A Veil
January/February 2006; 25(1): 57-69.
Market outcomes: Transactions (administrative) cost; quality and the malpractice tort system. Comment
due Administrative Cost
Himmelstein, D.U., Woolhandler, S., "Cost Without Benefit:
Administrative Waste in U.S. Health Care,"
N Engl J Med,
February 13, 1986, 314, pp. 441-445. Letters and authors'
rejoinder, N Engl J Med, October 16, 1986, 315, pp.
1033-1035. Grumet, G.W., "Health Care Rationing Through Inconvenience: The
Third Party's Secret Weapon,"
N Engl J Med, August 31, 1989, 321(9),
pp. 607-611. Woolhandler, S., Himmelstein, D.U., "The Deteriorating
Administrative Efficiency of the U.S. Health Care System,"
N Engl J
Med, May 2,
1991, 324(18), pp. 1253-1258.
Canada slideshow and It's the Prices, Stupid, moved ahead two weeks.
Needleman, J., Buerhaus, P., Mattke, S., Stewart, M., Zelevinsky,
K., "Nurse-Staffing Levels and the Quality of Care in Hospitals,"
Engl J Med, May 30, 2002, 346(22), pp. 1715-1722. An example of quality variation that the market does not
solve. Read for the main ideas.
Brennan, T.A., Sox, C.M., Burstin, H.R., "Relation Between
Negligent Adverse Events and the Outcomes of Medical-Malpractice
N Engl J Med, December 26, 1996, 335(26), pp. 1963-1967. The skinny: There is not much relationship. Studdert, D.M., Mello, M.M., Gawande, A.A., Gandhi, T.K.,
Kachalia, A., Yoon, C., Puopolo, A.L., Brennan, T.A., "Claims, Errors,
and Compensation payments in Medical Malpractice Litigation,"
Engl J Med, May 11, 2006, Vol. 354, No. 18, pp. 2024-2033. Annas, G.J., "The Patient's Right to Safety -- Improving the
Quality of Care through Litigation against Hospitals,"
N Engl J Med,
May 11, 2006, Vol. 354, No. 19, pp. 2063-2066. In a
market system, the consumer's power over the seller is the power to
refuse to buy. That may be enough to guarantee quality of soap, for
example. Do we need more than that for health care quality?
Links to good studies about several aspects of malpractice economics, including:
Economics of politics
November 3 Health Insurance and Managed Care comment due
Learning objectives: The history and results of health insurance and managed care.
Sicko for this week's class.
Mayer, T.R., and Mayer, G.G., "HMOs: Origins and Development"
Engl J Med, February 28, 1985, 312, pp. 590-594. Siu, A.L., Leibowitz, L., Brook, R.H., Goldman, N.S., Lurie, N.,
Newhouse, J.P., "Use of the Hospital in a Randomized Trial of Prepaid
JAMA, March 4, 1988, 259, pp. 1343-1346. Bodenheimer, T.S., and Grumbach, K., "Capitation or
JAMA, October 2, 1996, 276(13), pp.
1025-1031. Morgan, R.O., Virnig, B.A., DeVito, C.A., Persily, N.A., "The
Medicare-HMO Revolving Door -- The Healthy Go In and the Sick Go Out,"
Engl J Med, July 17, 1997, 337(3), pp. 169-175.
Sicko, a film by Michael Moore, 2007. The DVD is available for $10 or less at Amazon.com. A low-resolution multi-part version is on YouTube. A link to part 1.. Tu, H. T.,
Health Costs, Medical Debt and Chronic Conditions Center for
Studying Health System Change, Issue Brief No. 88,
DU, Warren E, Thorne D, Woolhandler S., "Illness and Injury as
Contributors to Bankruptcy," Health Affairs,
2005 Jan-Jun, 2005, Supplement Web Exclusives, pp. W5-73. A Wal-Mart executive's
proposing that they "dissuade unhealthy people from coming to work at
Wal-Mart" by increasing health insurance copayments and making all jobs
physically demanding, Nov. 2005.
A woman's being beaten by her husband is a pre-existing condition in some states and D.C.
A Caesarian section delivery is a pre-existing condition.
Cheney Loses His Health Insurance, The Onion, September
7, 2005, 41•36. The Onion is satire. A July 2002
report on underinsurance. The
Kaiser Family Foundation report on employer health benefits. A distinction between
care and "real HMOs"? People pay for health insurance, then Blue Cross (of California) revokes it when they get
sick. This illustrates, in an extreme way, the lack of consumer
sovereignty in the health insurance market, which compounds the problem
of lack of consumer sovereignty in health care markets.
Here's the story, from the L.A. Times.
How Much Money Do Health Insurance Companies Make? Uwe Reinhardt, Sept. 25, 2009
What Portion of Premiums Should Insurers Pay Out in Benefits? Uwe Reinhardt Oct. 2, 2009 The following report is now available only to ACP members:
Health Insurance? It's Enough to Make You Sick, American College of
Physicians-American Society of Internal Medicine, 2000. The Report and
the References are
separate files. Instead, go to
the summary page for the Institute of Medicine's 2009 report, America's Uninsured Crisis: Consequences for Health and Health Care. Read the Testimony to Congress or the Report Brief.
http://www.kff.org/uninsured/upload/7806-03.pdf is a source for similar ideas.
Census Web Page with link for Income,
Poverty, and Health Insurance Coverage in the United States,
Census Bureau statistics on the number of insured and uninsured.
measures of the number of uninsured
Learning objectives: Pharmaceutical prices, research, and sales
promotion. The dilemma of how to finance and promote
"The Truth About the Drug Companies," New York Review of Books,
Volume 51, Number 12, July 15, 2004 Read for the
"Your Dangerous Drugstore," New York Review of Books, Volume
53, Number 10, June 8, 2006 Read for the main
ideas. What is Dr. Angell's complaint? Price? Quality? Lack of
innovation? More than one of the above?
Marcia Angell, "Drug Companies and Doctors: A Story of Corruption," New York Review of Books, January 15, 2009. Malcom Gladwell,
How to think about prescription drugs," The New
Yorker, October 25, 2004. Answers Angell. Does he blame consumers for high drug spending? National Institute for Health Care Management Research and
Prescription Drugs and Intellectual
Property Protection Finding the Right Balance Between Access and
Innovation, July 24, 2000. Available at: http://www.nihcm.org/pdf/prescription.pdf
Read quickly for the main idea, which is
illustrated in Figure 1. NPR report on
allegedly promoted Neurontin for uses not approved by the FDA, from
June 2002. Follow-up reports: Oct.
2004: Pfizer (which had acquired Parke-Davis) pled guilty and
agreed to pay fines totalling $430 million.
The report includes details of the marketing effort by a participating
doctor. Worth a listen. NPR All Things Considered report on
of interest in pharmaceutical benefits management, August 22, 2003.
Worth a listen.
political contributions Before you glance at
this, guess which party gets the most from the drug industry. You can
also get the contributions breakdown for others industries and groups.
Check out nurses' contributions.
The Rollercoaster: The Ups And Downs In Out-Of-Pocket Spending Under
The Standard Medicare Drug Benefit,
by Bruce Stuart, Becky A. Briesacher, Dennis G. Shea, Barbara Cooper,
Fatima S. Baysac and M. Rhona Limcangco, in Health Affairs,
2005, Vol 24, Issue 4, 1022-1031.
argues that countries
(like Britain) that negotiate lower drug prices are not free riders
benefitting from U.S.-consumer-financed industry research without
paying for it. British Medical Journal article
November 17 Obamacare
due The Health Reform Law
Learning objective: Understand and evaluate the claim that
universal health insurance covers gives more value at less expense.
comparison slide show (671Kb)
The Prices, Stupid: Why
The United States Is So
Different From Other Countries
by Gerard F. Anderson, Uwe E. Reinhardt, Peter S. Hussey, and
Varduhi Petrosyan . Higher health spending but lower use of health
much higher prices in the United States than in any other OECD
country. David Blumenthal and William Hsiao,
and Its Discontents — The Evolving Chinese Health Care System, New
Engl J Med, Sept. 15, 2005.
Bill Hsiao interviewed about the Taiwan health insurance system, which he helped design. In Canada,
lower income people access primary care doctors just as much as higher income people. Education is positively related to utilization of specialists. There is no relationship between income and use of specialists in Canada, separate from education.
"T.R. Reid: Looking Overseas For 'Healing Of America'". The page has a link to his Washington Post article. Reid's book, The Healing of America: A Global Quest for Better, Cheaper, and Fairer Health Care gives even more insight into health care system alternatives around the world, and is fun to read. Paul Krugman gives the 700-word version in
"The Swiss Menace," by Paul Krugman, New York Times, August 16, 2009.
Socialized Medicine! In America!
Arnst, C., "The
Best Medical Care In The U.S., How Veterans Affairs transformed itself
-- and what it means for the rest of us,"
July 17, 2006. To find this article, go to www.businessweek.com and
type "The Best Medical Care In The U.S." in the search box. Then look down the list for this July 2006 article. For a more academic
treatment, see Jonathan B. Perlin, Robert M. Kolodner, and Robert H.
Roswell, " The
Veterans Health Administration: Quality, Value, Accountability, and
Information as Transforming Strategies for Patient-Centered Care," The
American Journal of Managed Care, November 2004, pp. 828-836. A
magazine article about the V.A. Lately, the
December 1 Health Reform II
Newhouse, Joseph P., "Assessing Health Reform's Impact
on Four Key Groups of Americans,
Health Affairs 29:9, September 2010, pp. 1714-1725. Williams, David R., Mark B. McClellan, and Alice M. Rivlin,
"Beyond The Affordable Care Act:
Achieving Real Improvements
In Americans' Health,"
Health Affairs 29:8, August 2010, pp. 1481-1488. Primary Care Reform
Howell, Joel D., "Reflections on the Past
and Future of Primary Care"
Health Affairs 29:5, May 2010, pp. 760-765. Friedberg, Mark W., Peter S. Hussey, and Eric C. Schneider "Primary Care: A Critical Review
of the Evidence on Quality
and Costs of Health Care"
Health Affairs 29:5, May 2010, pp. 766-772. David Margolius and Thomas Bodenheimer, "Transforming Primary Care:
From Past Practice to the Practice of the Future"
Health Affairs 29:5, May 2010, pp. 779-784. Bryan T. Vaughn, Steven R. DeVrieze, Shelby D. Reed, and Kevin A. Schulman "Can We Close The Income And
Wealth Gap Between Specialists
And Primary Care Physicians?"
Health Affairs 29:5, May 2010, pp. 933-940. Jack M. Colwill "A Case of 'Medical
Health Affairs 29:5, May 2010, pp. 1067-1070.
Please see the News at the top of this syllabus for two items about the politics of health reform.
Nurses -- especially Advanced Practice Registered Nurses -- will be key to enabling the "world's best health care" system to actually care for the population.
More medical practices are owned by hospitals than by doctors,
according to one survey.
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