Health Economics and Financing

Thomas E. Getzen is Emeritus Professor of Risk, Insurance, and Health Management at Temple University and the founder and emeritus Executive Director of iHEA, the International Health Economics Association. After receiving an undergraduate degree in literature from Yale University, he worked for the U.S. Public Health Service Centers for Disease Control venereal disease program in New York and Los Angeles, and then obtained a Master of Health Administration degree in Medical Care Organization and a Ph.D. in Economics from the University of Washington. Dr. Getzen's main research contributions have been in the areas of contracting, price indexes, the history of health care spending, and forecasting future trends. His consulting work has included employee benefit negotiations, projections of health care cost trends and premiums, risk assessment, and capital financing for managed care. Dr. Getzen has been a visiting professor at the University of Toronto, the Center for Health and Wellbeing at Princeton University, the Wharton School at the University of Pennsylvania, and the University of York (UK). He has served on the boards of multiple health care organizations, was associate editor for the journal Health Economics, and editor-in-chief for the "HEN-Health Economics Network" in collaboration with SSRN. Professor Getzen periodically updates the forecasting model of "Long Run Medical Cost Trends" for the Society of Actuaries. Michael Kobernick is a lecturer at Jefferson College of Population Health, an Adjunct Assistant Professor at Madonna University, and a Senior Medical Director at Blue Cross of Michigan. Dr. Kobernick was raised in Detroit and completed his undergraduate, medical education, and Family Practice Residency at Michigan State University. His clinical career has included family practice and 30 years as an emergency physician, fields in which he is board certified as well. Dr. Kobernick has master's degrees in health care administration and population health. He has held numerous administrative positions including emergency department medical director, vice-president medical affairs, community health service medical director, and chief medical officer. At Blue Cross, he is a consultant to large employers, helping them to understand the opportunities to improve quality-outcome and optimize patient experience at the lowest possible cost through the application of population health principles.

Preface xix

Acknowledgments xxiii

About the Authors xxv

Foreword xxvii

1 Choices: Money, Medicine, and Health 1

2 Demand and Supply 20

3 Cost-Benefit and Cost-Effectiveness Analysis 40

4 Financing Medical Care: Health Insurance Contracts: Managed Care 63

5 Physicians 98

6 Medical Education, Organization, and Business Practices 116

7 Hospitals 136

8 Management and Regulation of Hospital Costs 151

9 Long-Term Care 170

10 Pharmaceuticals 188

11 Financing and Ownership of Health Care Providers 207

12 History, Demography, and the Growth of Modern Medicine 229

13 Macroeconomics of Medical Care 254

14 The Role of Government and Public Goods 279

15 International Comparisons of Health and Health Expenditures 308

16 Value for Money in the Future of Health Care 325

Glossary G-1

Index I-1