Ebook Download (Ebook PDF) Health Economics: Theory, Insights, and Industry Studies 6th Edition All Chapter
Ebook Download (Ebook PDF) Health Economics: Theory, Insights, and Industry Studies 6th Edition All Chapter
Ebook Download (Ebook PDF) Health Economics: Theory, Insights, and Industry Studies 6th Edition All Chapter
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PREFACE
The health care sector, now representing more than one-sixth of the U.S. economy in
terms of economic activity, continues to change in unimaginable ways. Sweeping
transformations in the organizational arrangements of health care providers, newly
developed medical technologies, the creation of new health insurance products, and
the development and evaluation of various public policy initiatives all make the health
care sector a dynamic and exciting area for applying the lens and tools of economic
analysis. Indeed, not a day goes by without the unfolding of a medical event that
requires the insights of economics to unravel the depths of its implications.
Our textbook, now in its sixth edition, is written expressly to capture the excitement
generated by the health care field. As in the earlier editions, we take a fresh, contem-
porary approach to the study of health economics. We present the material in a lively
and inviting manner by providing numerous and timely real-world examples through-
out the text. At the same time, we resist the temptation of becoming overly encyclope-
dic and avoid purely technical issues that interest only academics and not students.
As a result of the approach taken, our book has wide appeal. Many business
schools; liberal arts colleges; medical schools; and schools of public health, pharmacy,
and health administration, at both the undergraduate and graduate levels, have chosen
to use our textbook. The mix of adopters attests to the relevance and practicality of the
material and the consistent and inviting manner in which various principles and con-
cepts of health economics are presented throughout the text.
Copyright 2012 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the eBook and/or eChapter(s). Editorial review has
deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it.
vi Preface
Copyright 2012 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the eBook and/or eChapter(s). Editorial review has
deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it.
Preface vii
nursing home industries are covered in great depth, and the analysis is kept as current
as possible. Various health care topics and issues are examined in these chapters.
Finally, Part IV, or Chapter 16, deals with health insurance reform. Some of the
more debated plans for reforming the U.S. health insurance system at the federal and
state levels are discussed and evaluated. The book ends with a glossary.
In most colleges and universities, a course in health economics is offered on a one-
semester basis. Within one semester, it is difficult to cover all of the material in this
text. The business curriculum at the University of Connecticut offers the typical health
economics course in two semesters at both the undergraduate and MBA/MPH levels.
(Not all students always take both courses, however.) The first-semester course is
titled Health Insurance. This first course covers Chapters 4 (Health Care Systems and
Institutions), 6 (The Demand for Medical Insurance), 10 (Government as Health
Insurer), 11 (The Private Health Insurance Industry), and 16 (Health Care Reform).
Parts of Chapter 2 (Health and Medical Care) are also covered before Chapter 6, and
Chapter 8 (Structure, Conduct, Performance, and Market Analysis) is briefly reviewed
before introducing Chapter 11 in this first semester Health Insurance course.
The second-semester course is titled Health Care Economics, which covers Chapters 1
(Introduction), 2 (Health and Medical Care), 3 (Cost and Benefit Analysis), 5 (The
Demand for Medical Services), 7 (Medical Care Production and Costs), 8 (Structure,
Conduct, Performance, and Market Analysis), 9 (Government, Health, and Medical
Care), and the four remaining industry chapters (12–15). Supplemental readings are
assigned in both courses, and typically student presentations or point/counterpoint
debates are assigned. Spreading the material over two courses means less rushing
from topic to topic and provides more time to explore individual issues in greater
detail. The students seem to appreciate the two-course approach and our book is
written in such a manner as to accommodate this approach.
Supplements
Economic Applications: Economic Applications includes South-Western’s dynamic
Web features: EconNews, EconDebate, and EconData Online. Organized by pertinent
economic topics and searchable by topic or feature, these features are easy to integrate
into the classroom. EconNews, EconDebate, and EconData all deepen students’ under-
standing of theoretical concepts through hands-on exploration and analysis of the latest
economic news stories, policy debates, and data. These features are updated on a reg-
ular basis. For more information, visit http://www.cengage.com/economics/infoapps
InfoTrac: With InfoTrac College Edition, students can receive anytime, anywhere
online access to a database of full-text articles from thousands of popular and scholarly
periodicals, such as Newsweek, Fortune, and Nation’s Business. InfoTrac is a great way
to expose students to online research techniques, with the security that the content is
academically based and reliable. For more information, visit http://www.cengage
.com/economics/infoapps
Web Site: The support site for Health Economics can be accessed at www.cengage
.com/economics/santerre and contains chapter-by-chapter web links, term paper tips,
instructor resources, and other teaching and learning resources.
If a 1pass access card came with this book, you can start using many of these
resources right away by following the directions on the card. One username and
password gives you multiple resources. Get started today at www.cengage.com/
economics/santerre/
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deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it.
viii Preface
PowerPoint™ Slides: PowerPoint slides are also located on the support site and are
available for use by instructors for enhancing lectures. Each chapter’s slides include a
lecture outline illustrated with key tables and graphs.
Instructor’s Resource CD-ROM: Get quick access to the Instructor’s Manual and
PowerPoint slides from your desktop via one CD-ROM.
Acknowledgments
Our goal is to create the best possible learning device for students and teaching tool for
professors. We are profoundly grateful to all of the reviewers of this textbook and the
talented and dedicated staff at Cengage Learning for helping us bring this goal closer to
fruition.
For reviewing the fifth edition and providing numerous comments and suggestions
for improving the sixth edition, we thank Doris Bennett, Jacksonville State University,
Karen Buhr (University of Maine), Jie Chen (College of Staten Island/CUNY), Joey
Crosby (Armstrong Atlantic State University), Atilla Cseh (Valdosta State University),
Diane Dewar (University at Albany), Debra Dwyer (Stony Brook University), Bianca
Frogner (George Washington University), Warren Greenberg (University of Maryland),
Vivian Ho (Rice University), Latoya Jackson (Albany State University), David Latif
(University of Charleston), Ricky Leung (University of Missouri-Columbia), Haiyong
Liu (East Carolina University), Christina Marsh (University of Georgia), Neil Meredith
(West Texas A&M University), Claudia Pereira (National School of Public Health),
John Perry (Centre College), Jessica Wolpaw Reyes (Amherst College), Patrick Richard
(George Washington University), Katie Showman (Florida State University), Christine
Spencer (University of Baltimore), Karen Travis (Pacific Lutheran University), Yavuz
Yasar (University of Denver), and Mustafa Younis (Jackson State University).
We also appreciate the reviewers of past editions and others who have provided us
with comments for improving the text over the years, including:
Mir Ali Partha Deb Vivian Ho
Steven Andes Derek DeLia Ashley Hodgson
Jay Bae Diane Dewar Robert Jantzen
Mary Ann Bailey Eric Doremus Juan Kelly
Mark Barabas Randall Ellis Donald Kenkel
Laurie Bates Alfredo Esposto Timothy Leslie
Richard Beil Maya Federman Dong Li
Sylvester Berki Andrew Foster Mindy Marks
Jay Bhattacharya A. Mark Freeman Amalia Miller
David Bishai Linda Ghent Frank Musgrave
Stacey Brook Stephan Gohmann John Nyman
Bruce Carpenter Glenn Graham Albert Oriol
Sewin Chan Darren Grant Gabriel Picone
Chris Coombs Dennis Heffley Irene Powell
Guy David Jim Hilliard Keith Rayburn
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Preface ix
Rex Santerre
rsanterre@business.uconn.edu
Stephen Neun
sneun@antioch.edu
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CONTENTS
C H A PT E R 1 Introduction 3
What Is Health Economics? 4
The Four Basic Questions 4
Production and Allocative Efficiency and the Production
Possibilities Curve 5
The Distribution Question 7
Implications of the Four Basic Questions 8
Taking the Pulse of the Health Economy 9
Medical Care Costs 9
Uses of Medical Funds 10
Sources of Medical Funds 11
Amount of Medical Care Spending 12
Medical Care Access 14
Medical Care Quality 15
A Note on the Relation between System Structure and Performance 16
A Brief Note on the Patient Protection and Affordable
Care Act of 2010 18
Summary 18
Review Questions and Problems 19
References 20
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xii Contents
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Contents xiii
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xiv Contents
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deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it.
Contents xv
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deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it.
xvi Contents
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deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it.
Contents xvii
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deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it.
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Basic Health Care
PART
Economic Tools
and Institutions
ONE
CHAPTER 1 Introduction
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deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it.
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CHAPTER 1
Introduction
Like millions of Americans at some point in their lives, Joe awoke one night feeling a
crushing weight on his chest. As the pain spread down his arm, he realized he was
experiencing his worst dread: a heart attack. His wife, Angela, called the paramedics. While
the ambulance rushed Joe to the hospital, she anguished over the kind of care he would
receive. Angela’s anxiety starkly illustrates the basic questions any health care system faces:
1. Who should receive medical goods and services? Would a person like Joe receive care
merely because he is a citizen, or would he receive care only if he worked for a large
company that provides health insurance for its employees?
2. What types of medical goods and services should be produced? Should the most
expensive tests (such as angiograms) be performed without regard to cost? What
treatments (such as balloon angioplasties) should be provided?
3. What inputs should be used to produce medical goods and services? Should the
hospital use high-tech medical equipment, a large nursing staff, or both?1
All health care systems face questions such as these, but sometimes choose to answer them
differently. When responding to health and health care questions, societies around the
world take into account important moral, cultural, legal, economic, and other considerations.
Addressing all of these concerns simultaneously and thoroughly is a daunting task, in part
because one concern often conflicts with another, but also because this task involves a sub-
stantial amount of time, effort, and knowledge. Indeed, the intellectual resource commitment
would be so great that no one book could adequately cover all of the pertinent issues.
This textbook focuses solely on the economic aspects of questions involving health and
health care. The general objective of this textbook is to develop a set of analytical and con-
ceptual tools that can be used to gain valuable insights into a host of health care issues and
problems from an economic perspective. This chapter takes the first step in accomplishing
this important objective. In particular, this chapter:
• introduces the discipline of health economics
• discusses resource constraints, trade-offs, efficiency, and equity
• highlights the state of the health economy in the United States and sets the stage
for the material in the remaining chapters.
1. We are indebted to Gary Wyckoff of Hamilton College for providing us with this example.
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Another random document with
no related content on Scribd:
"I'm sure that you are not more sorry than I am!" cried
Caroline. "I wish that silver knife had been at the bottom of
the sea—I heartily do—mistress is so displeased with me,
and I never thought that I was doing such mischief by
speaking a word."
On Miriam's replying that she had just done so, the lady
continued, in the same cold manner, "And what does he
think of the hasty step which you have taken in giving me
warning?"
A LIGHT
OR,
A CHRISTIAN IN INFLUENCE.
CHAPTER I.
The Young Stepmother.
"THIS is most vexatious, most perplexing; I am sure
that I scarcely know which way to turn," exclaimed Mrs.
Fairley, as she entered the room in which her firstborn babe
lay asleep in his cradle, trimmed with muslin, blue ribbon,
and lace.
"If I were but sure that he would have it, I should leave
with an easier mind," said the lady; "but I must take you to
look after baby, and I leave the two children with a girl
whom I never saw till a few days ago—a girl who has never
been in service before. It seems so strange—so unkind."
"I wish that I knew what to do," said the young mother,
with an anxious sigh, as she seated herself by the cradle.
Before her marriage, Lucy had never had to decide on any
matter more important than the colour of a dress, or the
choice of an amusement. Now she found herself in a
position of serious responsibility as mistress and mother,
with no experience, no strength of will, no knowledge of
character, to help her. Mrs. Fairley wished to do her duty
towards her husband's children; kind and gentle she always
had been to them both, but she dreaded scarlet fever much
for herself, and a great deal more for her baby, and dared
not remain at the risk of catching the disease from Jessy or
her brother.
"You are right, quite right, nurse," she said; "we must
leave this house at once; you had better see to the packing
directly. I will speak to Susan myself, and give her the
strictest orders, and tell her—And, oh! I must write at once
to put off the children's party that we were to have had on
Friday to keep Tommy's birthday. I must send notes to the
Hardys, the Lauries, the Wares. It will be a sad
disappointment to poor Tommy and Jessy not to have their
young friends, but I'll give them each a new five-shilling
piece to make up for their disappointment."
CHAPTER II.
Off to the Station.
* Matthew v. 9.
The boy jumped down from the chair, and flung himself
on his chest on the carpet, kicking with passion. He could
not bear to watch the carriage disappearing behind the
trees.
"Oh I never say that, Miss Jessy!" cried the mild voice of
Susan, who had just entered the room. She was a bright,
cheerful-looking girl of sixteen, very neatly dressed, with
hair smooth as satin beneath her simple little white cap.
"She cares for no one but the baby!" growled Tom. "It's
unfair, it's horridly unfair."
Susan was very young, and she felt that hers was an
anxious and responsible charge, left as the two children
were entirely under her care during the absence of their
parents. The burden upon the nursery-maid was all the
more heavy as the training of the young Fairleys had been
in some points neglected, and in others mismanaged; they
did not submit, they would not obey, nor had they learned
to look up with fear and love to a Father in heaven.
Susan saw all this, and it grieved her, but she felt that
she must have patience and ask for grace, that she might
be a humble means of leading to God the precious souls of
these two children. Very different from Jessy's careless
"saying prayers" was the young servant girl's earnest
pleading when she knelt down by her sleeping charges that
night. She entreated forgiveness for all her past sins, as
one who knows how hateful in the sight of God is all sin;
she asked for the grace of the Holy Spirit to make her heart
pure, and to guide all her thoughts, words, and actions.
Susan also prayed, and prayed heartily for her young
charges—asking God to enable her to do her duty towards
them, both in caring for their health and comfort, and in
watching over their souls.
* Eph. vi. 5, 6.
† Matt. v. 16.
CHAPTER III.
A Dinner-Party.
TOM FAIRLEY arose in the morning perfectly free from
fever, and the doctor, when he came in the forenoon, said
that the boy would soon be as well as ever, and that in one
or two days, should the weather continue warm, he and his
little sister might take a turn in the garden.
Susan waited till the noise of the spinning was over, and
then quietly observed, "I am afraid, Master Tom, that a long
time must pass before it will be right for you and your sister
to shop in the town."
Tom broke out abruptly with the question, "As you make
such a mighty fuss about infection, Susan, are you not
afraid of catching the fever yourself? I wonder that you
don't run away in a fright, like mamma with the baby."
Susan had a good deal to try her temper during the rest
of that day. The Fairleys, like most children when recovering
from illness, were very impatient and cross; they would not
bear contradiction, they quarrelled, they broke their toys,
they tore their books, they grumbled against the doctor who
kept them in-doors when they chose to go out. Susan came
in for a large share of their rudeness; but she was quiet and
patient, never returned a cross word, and did all that she
could to give pleasure to those who seemed resolved not to
be pleased.
Knife and fork were flung to the other end of the table,
Tom started to his feet in a violent fury, and Jessy burst into
tears.
Jessy dried her eyes, listened and smiled; the child was
accustomed to the pleasure of eating pastry, but the
pleasure of helping to make it was something entirely new.
Tom's passion subsided into sulky ill-humour, as he sat
balancing his crown-piece on his thumb, then throwing it up
and catching it again.
"Well, Master Tom," said Susan, gaily, "if you can't tell
what to do with your money, I know a famous way in which
you could spend it; and if you want guests, I know how you
can get as many as you please to invite."