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January 6th, 2009Part II, explanatory economics, represents the bulk of the book. The economics of demand, price elasticity, risk aversion, and the effect of insurance on the demand for medical services are explained clearly and well. Behavior of suppliers in the medical care market is reviewed, with attention given to differences in for-profit and not-for-profit organizations. A solid explanation of competitive markets allows discussion of timely issues such as the limits of applicability of the competitive model to the medical care market, price and nonprice competition, and market power of providers, purchasers, and patients. Outside readings on current managed competition proposals would augment the textbook discussion well.A short section on the economic effects of information asymmetries in the medical care and health insurance market introduces the concepts of supplier induced demand and adverse selection. Both discussions are short, but the portion on adverse selection especially needs expansion. More rigor, explanatory graphs, and a more extensive bibliography would make the adverse selection concept more useful. This topic is critical to a sound understanding of the functioning of medical expense insurance.The final section deals with value judgments and evaluative economics. The nontechnical explanation of efficiency versus fairness criteria for evaluating medical care policy is somewhat cursory. More technical material is needed to improve the precision of this discussion. However, even without any additions, the text provides a general background on issues of access to medical care, affordability, and quality of care. The difficulty of making allocation decisions given scarce resources is clearly laid out and opens the way for a discussion of policy alternatives.
“There are [more than] 30 million Americans who have no health insurance and another 20 million who have inadequate health insurance,” says Rep. Louis Stokes (D0Ohio), chairman of the Congressional Black Caucus Health Brain Trust. “It is mandatory that we begin to try and give Americans–particularly minorities–adequate health care as a right.” The Bush plan would give people not covered by Medicaid tax credits, and families making less than $80,000 a year tax deductions to pay for medical costs. He would also pass laws to ensure that even chronically ill patients could receive health insurance. The plan has received a cool reception on Capitol Hill, and alternate proposals, including a full-scale, government-paid national health insurance plan, are under development. But what does America really want for its health care system? The views are many.
Before reading this chapter, please see “How to Get the Most Out of this Book” on page 1. It will clarify questions you may have concerning data collection procedures, forecasting methodology, sources and references, and the Standard Industrial Classification (SIC) system. For other topics related to this chapter, see chapters 44 (Drugs), and 45 (Medical and Dental Instruments and Supplies).