B. RATIONING BY PRICE本文来自辣.文,论-文·网原文请找腾讯752018766
Rationing by price, the use of market systems to ration medical care, is endemic to the health sector and represents very poor health policy. Considerable data demonstrates that the lack of sufficient medical insurance yields reduced health care consumption, even where consumption is socially desirable and where non-consumption produces significantly poorer results.
Many commentators attempt to prove that the price rationing system prevalent in the United States is deficient by appealing to rather surprising statistics. These statistics prove little because simple statistical comparisons do not properly consider conflating factors. For example, a low life expectancy in the United States might be due more to a high homicide rate, poor nutrition, or a sedentary culture, than to ineffective health care.Rather, data from empirical experiments–carefully designed to demonstrate such deficiency, and structured to avoid the articulation of false positive results–is necessary to support the claim that forced or coerced reductions in consumption of health care produces undesirable results. The empirical literature on the subject is broad and cannot be briefly summarized. Instead, I provide below brief summaries of two empirical studies that I find particularly persuasive.
One interesting empirical study inquired whether the existence of a $1000 cap on prescription drug benefits for certain sixty-five-or-older Medicare beneficiaries was closely correlated with differential outcomes between those patients and similarly situated patients whose prescription drug benefits were complemented by their former employers (that is, the second class was subject to no limitation as a result of the $1000 cap). Researchers found that those subject to the cap suffered relative to the other group, including from an increased death rate of about seven per 1000 people each year. Importantly, the research suggested that the cap actually created a net cost, rather than a net savings.
Another study demonstrated that among patients who experience a dramatic change in their health status (due to severe trauma, for example), the uninsured patients performed significantly worse than those with insurance shortly after their dramatic change in health status.
Price rationing has a tendency to inspire perverse decision-making that is ultimately costly to the system. Consumers often do not know how to distinguish between non-emergent and emergent health conditions. Accordingly, they refrain from spending on both frivolous care and on genuinely useful care. The results can be tragic and very expensive. Consider the following anecdote: Dee Dee Dodd tried to independently manage her insulin-dependant diabetes as a means of reducing her medical costs, visiting her doctor only occasionally. Her efforts failed. Her health deteriorated and, during one eighteen-month period, she needed to be rushed to the emergency room nearly monthly; she ultimately needed to spend weeks in the intensive care unit. Dodd accumulated $191,000 in unpaid medical bills and was not employable due to her physical condition. Her story is particularly interesting in light of what happened next. The local hospital realized that it would incur fewer unrecoverable costs over time by voluntarily providing Dodd with charity care. It gave her a $3200 insulin pump, access to a specialist, and in-home counseling. In the following eighteen months, the hospital saved an estimated $86,580.
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