(NOTE: Each chapter ends with Endnotes.)
1. Is It NICE to Ration?
Putting a Price on Your Life. The Pressure to Ration. Cutting to the Chase. Rationing Drugs Down Under. The National Institute for Clinical Excellence (NICE). The Beta-Interferon Controversy. Medicine versus Economics.
2. Defending Rationing in Principle.
Rationing and Toy Shopping. Are We Wasting Money on Health Care? Moral Hazard. The RAND Study. Demand Inducement. Bad Buys in Health Care. The Wennberg Variations. Defending Rationing.
3. Rationing Around the World.
Rationing in Germany. Controlling Drug Costs in Germany. If It Looks Like Rationing. Rationing in Canada. The Consequences of Waiting Lists. The Future of Rationing in Canada. Rationing in England. Rationing Elsewhere in the World.
4. Rationing in the U.S. Health Care Marketplace.
Rationing Through the Market Mechanism: The Uninsured in the United States. Attempts to Provide Universal Coverage. Rationing Among Insured Americans. Government-Sponsored Rationing in the United States. A Brief History of Managed Care. MCO Strategies for Containing Costs. Whither Rationing in America? Enough Is Enough.
5. Doing Cost-Effectiveness and Cost-Benefit Research.
Some Background on CEA. Is It Valid to Use CEA for Health Care? Doing CEA/CBA. Measuring Costs. Discounting. Is CEA/CBA Research Valid? CBA/CEA in Practice.
6. Measuring the Quality of Life.
Using Rating Scales to Measure Health States. Working with QALYs. Putting QALYs into Practice. All QALYs Are Equal. Measuring QALYs. How Do Your QALY Scores Measure Up? The Quality of Well-Being (QWB) Scale. Concerns about QALYs. Discrimination and QALYs. Limitations of QALY Surveys. Summing Up CEA/CBA Methods. What about the PSA Test?
7. The Oregon Plan.
Rationing in Oregon. The Story of Coby Howard. Toward a Rational Rationing Plan. The Creation of the Oregon Health Plan. The Oregon Plan and HMOs. Creating the List. The New List. More Protests. The Performance of the Rationing Plan. Oregon Ten Years Later. Where Do We Draw the Line?
8. What Is Your Life Worth?
Willingness to Pay, Human Capital, and Intrinsic Value. Pricing Life in the Real World. The Cost-of-Illness (COI) Approach. Using Surveys to Put a Price. on Good Health. Some WTP Measures. Willingness to Pay for Life. How Useful Are WTP Measures? Statistical versus Identified Lives. The Economic Approach to Valuing Statistical Lives. Other Evidence on the Value of Life. What Is Your Life Worth? Value of a QALY. Responding to Mr. Mortimer. The Bottom Line.
9. Rising Costs and Rational Rationing.
The Health Care Budget "Crisis". The Drain on the U.S. Economy. Targeting Technology. The Fallacy of Cost Containment. The Steady Drumbeat of Rational Rationing. Can Patients Be Rational? Who Should Ration? Rational Rationing in the Public Sector. Rational Rationing and Managed Care. The Real Obstacles. Rational Rationing in the 21st Century.
Healthcare rationing is coming, with a vengeance. If you value your health, you'd better understand it--and be ready. In this book, one of the world's leading healthcare economists offers a hard-nosed analysis of today's soaring healthcare costs--and shows how it will feel to be at the mercy of a system that might choose not to cure you. Dranove previews the transition from today's ad hoc rationing to an era of "rational rationing," in which economic analysis of the value of human lives and specific treatments is both explicit and routine. He assesses the mixed results of rational rationing in Great Britain and Australia, where government decision-makers struggle with balancing science and politics, in the face of budgets that place a shockingly low value on life. You'll discover healthcare economists have learned to numerically score different diseases to determine which are most worth curing; even how to calculate the value of your own life in tomorrow's healthcare system. Finally, Dranove compares the track record of government-sponsored and market-based rationing, concluding that if rationing must come, it's best left to the market, where individuals can decide for themselves what their lives are worth.
David Dranove is one of the world's most respectedhealth care economists. He is the Walter McNerneyDistinguished Professor of Health Industry Managementat Northwestern University's Kellogg Graduate School ofManagement, as well as Director of the Center for HealthIndustry Market Economics there.His research and teaching focus on problems in industrialorganization and business strategy with an emphasison the health care industry. He has published over 70research papers, monographs, and book chapters on healtheconomics and pharmacoeconomics, and is co-author ofthe popular textbook The Economics of Strategy and the tradebooks How Hospitals Survived and The Economic Evolution ofAmerican Health Care: From Marcus Welby to Managed Care.His many awards have included the Association ofUniversity Programs in Health Administration'sJohn D. Thompson Prize in Health Services Research andnumerous "research article of the year" prizes. ProfessorDranove holds a Ph.D. in Business Economics from Stanford University.