Healthcare economics is a topic of increasing importance due to the substantial changes that are expected to radically alter the way Americans obtain and finance healthcare. Understanding Healthcare Economics: Managing Your Career in an Evolving Healthcare System provides an evidence-based framework to help practitioners comprehend the changes already underway in our nation's healthcare system. It presents important economic facts and explains the economic concepts needed to understand the implications of these facts. It also summarizes the results of recent empirical studies on access, cost, and quality problems in today's healthcare system. Explaining what the term healthcare crisis means, the book evaluates key reforms designed to ameliorate the crisis. It examines emerging trends in the healthcare delivery system to provide a clear understanding of the implications of recently implemented policy solutions. It also illustrates how public- and private-sector initiatives are working to reduce cost increases by fundamentally altering the systems for delivery of care through managed care organizations, accountable care organizations, and patient-centered medical homes. The text identifies the pressures for change and examines six emerging strategies that can help boost efficiencies in the healthcare system. It addresses the macro-economic problems, such as the impact of changing demographics, as well as the micro-economic problems, such as lifestyle choices on healthcare costs. Demystifying the terminology, facts, and types of changes that are currently underway, the book provides you with the understanding of healthcare economics you will need to identify viable strategies for adapting to the changes on the horizon.

• PRESSURES FOR CHANGE Access Introduction Background: Information Available to Lawmakers during the PPACA Debate Proposed Strategies for Increasing Access: Impacts on the Incidence of Uninsurance (Pre-PPACA Estimates) Public and Private Insurance Trends Who Was Uninsured Prior to PPACA? Insurance Markets: Three Critical Access Issues How Do Insurance Markets Work? Basic Insurance Concepts Three Critical Issues Issue 1: Some Employers Do Not Offer Health Insurance Issue 2: Some Individuals Are Uninsured, Even Though They Are Eligible for Public Insurance or ESI Because They Do Not Take Up the Insurance Offer Issue 3: Restrictive Insurance Company Practices Make It Impossible for Some Individuals to Purchase Insurance Solution Options: What Do We Learn from Examining the Three Critical Issues? Conclusion: Equitable Access to Healthcare Is an Important Social Goal, but Health Insurance Is Just a Tool to Achieve a Larger Goal-Health Endnotes Cost Introduction Background Information: What Does It Mean to Say, "The System Is Not Sustainable"? Diagnosing the Problem: What Is Fueling the Cost Increases? Technology Since Technological Advancement Is the Root Cause of the Unsustainable Cost Increases, Maybe We Should Reduce Our Investment in Research Do the New Treatments Produce Good Value for the Dollar? Can We Assess Whether 1ドル.9 Million Is Too Much (or Too Little) to Spend in Order to Save a Life? Solution Options: How Can We Make the System More Sustainable? Option 1: We Could Continue to Spend More on Healthcare Every Year, and Accommodate This by Spending Less on Other Goods Option 2: We Could Restrain the Quantities of Healthcare Services That Are Utilized Annually in the United States We Could Ration by Price We Could Ration by Wait Time We Could Ration by Setting Priorities Option 3: We Could Make Our Healthcare System More Efficient Conclusion: Given the Challenges Posed by Strategies to Ration or Prioritize, We Should Pay Serious Attention to Strategies for Increasing the Efficiency of Our Healthcare System Two of the Numerous Suggestions That Sound Good, but Have Limited Potential for Solving the Problem Modify Tax or Patent Policies to Reduce Pharmaceutical Profits Facilitate Importation of Prescription Drugs from Lower-Price Non-U.S. Sources General Conclusions Quality Introduction Background Information: Three Types of Evidence Indicate That Quality Is Not Consistently High International Comparisons Indicate That Other Countries Are Doing More with Less What Can We Conclude about This Evidence? Diagnosing the Root Cause of the Quality Problem Evidence Documents the Occurrence of Preventable Medical Errors Evidence Documents Variations in Regional Treatment Patterns What Is Influencing Physician Decisions? Does Higher Utilization Reduce Mortality? Are the Regional Differences Large Enough to Be Important? Solution Options: How Can We Make Our Healthcare System More Systematic? Applying Total Quality Management Principles to Healthcare Brief History Implement Systematic Protocols: Clinical Pathways and Guidelines Clinical Pathways Clinical Guidelines Implications of Not Enough Science Conclusion: Some Strategies for Strengthening Quality Are Clear
• However, the Concept of Healthcare Quality Is Multidimensional Conclusion to Section I Endnote STRATEGIES TO INCREASE EFFICIENCY Introduction Do Healthcare Markets Operate Efficiently? Two Key Market Failures in Healthcare The Principal-Agent Problem: Healthcare Providers and Auto Mechanics Insurance Reduces the Incentive for Patients to Shop Wisely How Should Government Address These Market Failures? Align Incentives via Payment System Design Introduction Strategies to Control Cost: Rate Design Replaced Certificate of Need Programs What Is the "Right" Price? Rate Design: Setting the Level of Payments Rate Design: Designing the Structure of Payments Efficiency Incentives: Diagnostic-Related Groups (DRGs) Current Issues: Two Facets of Medicare Payment Policy Bundled Payment: Eliminate Silos Selective Contracting Measuring Quality: Pay-for-Performance and Consumer Information Conclusion Managed Care Organizations, Accountable Care Organizations, and Patient-Centered Medical Homes Introduction Background: Managed Care Organizations Managed Care: Historical Trends Managed Care: The Backlash Current Issues: Lessons Learned Lesson 1. Defining Consumer Protection Is Complex Lesson 2. Shifting to Managed Care or ACOs Focuses On A Definition of Quality That Is New for Many Patients Lesson 3. Growth of Managed Care Organizations Raised Two Types of Market Power Issues Lesson 4. Managed Care Organizations Also Raised Questions About Physician Risk Taking and Solvency Regulation Lesson 5. Mental Health Parity Mandate May Constitute A Special Case Lesson 6. Physician Rating Systems Raise Concerns Conclusion: Experiences with Managed Care Organizations Provide Significant Lessons Learned, as Providers Begin Forming ACOs and PCMHs Endnotes Wellness, Prevention, Disease Management Introduction Background: PPACA Focuses Increased Attention on Prevention and Wellness Current Issues After We Identify Individuals Who Are Most Likely to Benefit from Prevention Programs, Can We Design Programs to Successfully Induce Them to Participate? Conclusion New Types of Providers Introduction Background Current Issues New Types of Providers Retail Clinics Single Specialty Hospitals New Roles for Patients HIT = EMR + HIE Introduction Background: Simultaneous Public- and Private-Sector Initiatives Federal Initiatives Private Sector Initiatives Concerns Provider Privacy Patient Privacy Conclusion Conclusion to Section II References Index