Healthy Markets?

The New Competition in Medical Care

Healthy Markets?

Book Pages: 448 Illustrations: Published: March 1999

Subjects
Medicine and Health > Public Health and Health Policy, Politics > Public Policy

When federal and state policy makers’ efforts to enact sweeping health care reform in the mid-1990s ended in stalemate, the private sector unleashed initiatives that have affected virtually every aspect of health care. With updated essays first published in issues of the Journal of Health Politics, Policy and Law, Healthy Markets? offers the most comprehensive and critical examination yet found in a single volume of the economic, political, and social implications of this recent market transformation of health care in the United States.
With original contributions from leading social science health policy analysts, this volume addresses the full context of health system change. Believing that the analysis of health care change is too important to be left to economists alone, Mark A. Peterson has collected a mulitdisciplinary group of experts who revisit the contentious debate over the market approaches to health care and consider the disparate effects of these approaches on cost, quality, and coverage of both managed care and Medicaid and Medicare. While market enthusiasts applaud the enhanced efficiency, reduced excess capacity, and abatement of the decades-long health care cost explosion, a backlash has emerged among many providers and the public against the perceived excesses of the market: diminished access to care, commercialization of the physician-patient relationship, and exacerbated inequality. Contributors assess these varied responses while examining the impact that market-based applications are likely to have for future health policy making, the significance of the U.S. experience for policy makers abroad, and the lessons that these changes might provide for thinking sensibly about the future of our health care system.
This volume will be useful for public policy analysts, economists, social scientists, health care providers and administrators, and others interested in the future—and in understanding the past—of American health care.

Contributors. Gary S. Belkin, Lawrence D. Brown, Robert G. Evans, Martin Gaynor, Paul B. Ginsburg, Marsha Gold, Theodore R. Marmor, Cathie Jo Martin, Jonathan B. Oberlander, Mark V. Pauly, Mark A. Peterson, Thomas Rice, Deborah A. Stone, William B. Vogt, Kenneth E. Thorpe

Praise

“[S]uccinct and convincing. . . . [I]t will prove most useful for U.S. citizens, and the agents and students of the U.S. system. There is, however, much discussion of analytic tools and many insights about how health care markets function for students of other health care systems.” — John L. Fiedler , Social Science & Medicine

Healthy Markets? does what we always want and rarely get in an edited volume: combine the different perspectives of many fine scholars into a whole that is greater than the parts. The essays are sometimes contentious, often brilliant, and always illuminating. They add up to a rich assessment both of health policy in the mid-1990s and of the forces that will determine what happens next.” — Joseph White, Tulane University Medical Center

“This timely and insightful volume presents an invaluable road-map to understanding the turbulent American health care market at the turn of the twenty-first century. It draws together leading academic observers of the health care arena to address both intellectual disputes and practical experience in a matchless set of contributions.” — Carolyn Hughes Tuohy, University of Toronto

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Author/Editor Bios Back to Top

Mark A. Peterson is Associate Professor of Public and International Affairs, Political Science, and Health Services Administration at the University of Pittsburgh. He is the editor of the Journal of Health Politics, Policy and Law and author of Legislating Together: The White House and Capitol Hill from Eisenhower to Reagan.

Table of Contents Back to Top
Introduction: Health Care into the Next Century / Mark A. Peterson 1

Part 1. The Market Model 25

Can Markets Give Us the Health System We Want? / Thomas Rice 27

Going for the Gold: The Redistributive Agenda behind Market-Based Health Care Reform / Robert G. Evans 66

Commentary. Who Was That Straw Man Anyway? A Comment on Evans and Rice / Mark V. Pauly 104

Commentary. What Does Economics Have to Say about Health Policy Anyway? A Comment and Correction on Evans and Rice / Martin Gaynor and William B. Vogt 110

Response. A Reply to Gaynor and Vogt, and Pauly / Thomas Rice 129

Response. Coarse Correction—And Way off Target / Robert G. Evans 134

A Technocratic Wish: Making Sense and Finding Power in the "Managed" Medical Marketplace / Gary S. Belkin 140

The Doctor as Businessman: The Changing Politics of a Cultural Icon / Deborah A. Stone 161

Part 2. The Market in Practice 183

The Dynamics of Market-Level Change / Paul B. Ginsberg 185

The Health System in Transition: Care, Cost, and Coverage / Kenneth E. Thorpe 203

Markets, Medicare, and Making Do: Business Strategies after National Health Care Reform / Cathie Jo Martin 223

Managed Care and Medicare Reform / Jonathan Oberlander 255

Markets and Medicaid: Insights from Oregon and Tennessee / Marsha Gold 284

Part 3. Reflections on the Road Ahead 317

The Limits of Social Learning: Translating Analysis into Action / Mark A. Peterson 319

Expectionalism as the Rule? U.S. Health Policy Innovation and Cross-National Learning / Lawrence D. Brown 353

Forecasting American Health Care: How We Got Here and Where We Might Be Going / Theodore R. Marmor 367

Bibliography 387

Contributors 425

Index 427
Sales/Territorial Rights: World

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Additional InformationBack to Top
Paper ISBN: 978-0-8223-2138-5 / Cloth ISBN: 978-0-8223-2236-8
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