Which way for competition? None of the above: Advocates of consumer-directed care do not speak the language of the public, no matter how often they invoke "consumer sovereignty."

Health Affairs

Volumn 24, Issue 6, 2005, Pages 1536-1542

  Berenson, Robert A ^a  

^a URBAN INSTITUTE   (United States)

Author keywords

[No Author keywords available]

Indexed keywords

ARTICLE; CONSUMER; COST CONTROL; ECONOMIC ASPECT; ECONOMICS; HEALTH INSURANCE; HUMAN; UNITED STATES;

CONSUMER PARTICIPATION; COST CONTROL; ECONOMIC COMPETITION; HEALTH BENEFIT PLANS, EMPLOYEE; HUMANS; UNITED STATES;

EID: 28444482759     PISSN: 02782715     EISSN: 02782715     Source Type: Journal    
DOI: 10.1377/hlthaff.24.6.1536     Document Type: Review

References (41)

1. L.M. Nichols et al., "Are Market Forces Strong Enough to Deliver Efficient Health Care Systems? Confidence Is Waning," Health Affairs 23, no. 2 (2004): 8-21.
2. V.R. Fuchs, "The 'Competition Revolution' in Health Care," Health Affairs 7, no. 3 (1988): 5-24.
3. V.R. Fuchs, " The 'Competition Revolution' in Health Care," Health Affairs 7, no. 3 ( 1988): 5-24. Ibid.
4. Nichols et al, "Are Market Forces Strong Enough?";
5. and M. Gaynor and W.B. Vogt, "Anti-trust and Competition in Health Care Markets," chap. 27 in Handbook of Health Economics, ed. A.J. Culyer and J.P. Newhouse (North-Holland, New York, and Oxford: Elsevier Science, 2000.)
6. Fuchs, "The 'Competition Revolution.'"
7. J.C. Robinson, "Managed Consumerism in Health Care," Health Affairs 24, no. 6 (2005): 1478-1489;
8. and M.A. Hall and C.C. Havighurst, "Reviving Managed Care with Health Savings Accounts," Health Affairs 24, no. 6 (2005): 1490-1500.
9. M.V. Pauly, "Competition and New Technology," Health Affairs 24, no. 6 (2005): 1523-1535.
10. The author encountered the views of Greg Scandlen at a meeting, "Health Care Market Competition: How Well Can It Work?" Lansdowne, Virginia, 29 April 2005. At the meeting, the main papers in this section were presented; the Perspectives (including one from Scandlen) were drawn from discussions that took place in this context.
11. J.E. Wennberg, E.S. Fisher, and J.S. Skinner, "Geography and the Debate over Medicare Reform," Health Affairs, 13 February 2002, content.healthaffairs.org/cgi/content/abstract/hlthaff.w2.96 (27 July 2005).
12. Asserting an essential role for insurers acting on behalf of patients in obtaining needed health care does not imply support for a competitive market structure. Medicare could also have smarter cost sharing, although such efforts would currently be confounded by the near-ubiquity of supplemental insurance. The problem would be reduced if Medicare were permitted to offer a reasonably comprehensive benefit package, obviating the need for supplemental insurance.
13. E.S. Fisher et al, "The Implications of Regional Variations in Medicare Spending," Parts 1 and 2, Annals of Internal Medicine 138, no. 4 (2003): 273-298;
14. and Wennberg et al., "Geography and the Debate over Medicare Reform."
15. K.J. Arrow "Uncertainty and the Welfare Economics of Medical Care," American Economic Review 53, no. 5 (1963): 941-973.
16. For a contemporary dismissal of Arrow, see H.L. Jenkins, "O Health-Care Leader, Where Art Thou?" Wall Street Journal, 1 June 2005.
17. M.V. Pauly, "Is Medical Care Different?" in Competition in the Health Care Sector: Past, Present, and Future: Proceedings of a Conference Sponsored by the Bureau of Economics, Federal Trade Commission, ed. W. Greenberg (Germantown, Md.: Aspen Systems, March 1978),
18. as cited in F.A. Sloan, "Arrow's Concept of the Health Care Consumer: A Forty-Year Retrospective," in Uncertain Times: Kenneth Arrow and the Changing Economics of Health Care, ed. P.J. Hammer et al. (Durham and London: Duke University Press, 2003), 49-59.
19. R.A. Berenson, "Getting Serious about Excessive Medicare Spending: A Purchasing Model," Health Affairs, 10 December 2003, content. healthaffairs.org/cgi/content/abstract/hlthaffw3.586 (27 July 2005).
20. E.A. McGlynn et al., "The Quality of Health Care Delivered to Adults in the United States," New England Journal of Medicine 348, no. 26 (2003): 2635-2645.
21. There are also provider-oriented strategies available that can be applied to high-volume, small-ticket items, such as performance profiling with variable payment - "pay for performance."
22. R.A. Berenson and D.M. Harris, "Using Managed Care Tools in Traditional Medicare - Should We? Could We?" Law and Contemporary Problems 65, no. 4 (2002): 139-168.
23. Fuchs, "The 'Competition Revolution.'"
24. M.E. Porter and E.O. Teisberg, "Redefining Competition in Health Care," Harvard Business Review 82, no. 6 (2004): 65-76.
25. D. Shactman, "Specialty Hospitals, Ambulatory Surgery Centers, and General Hospitals: Charting a Wise Public Policy Course," Health Affairs 24, no. 3 (2005): 868-873.
26. Fuchs, "The 'Competition Revolution.'"
27. For 2001, Columbia-Presbyterian Center, the hospital to which President Bill Clinton was referred, had a 3.93 percent mortality rate for CABG surgery, compared with the state's average of 2.18 percent. But in 2000 Columbia-Presbyterian was at the state average. L.K. Altman, "Clinton Surgery Puts Attention on Death Rate," New York Times, 6 September 2004.
28. David Lansky, director of Markle Foundation Health Program, personal communication, 3 June 2005.
29. J.M. Drazen, "COX-2 Inhibitors - A Lesson in Unexpected Problems" (Editorial), New England Journal of Medicine 352, no. 11 (2005): 1131-1132.
30. B. Meier, "Medicine Fueled by Marketing Intensified Trouble for Pain Pills," New York Times, 19 December 2004;
31. and B. Meier, "Doctors, Too, Ask: Is This Drug Right?" New York Times, 30 December 2004.
32. M.F. Hollon, "Direct-to-Consumer Advertising - A Haphazard Approach to Health Promotion," Journal of the American Medical Association 293, no. 16 (2005): 2030-2033.
33. V. Fuhrman, "Health Insurers' New Target," Wall Street Journal, 31 May 2005.
34. A.C. Enthoven, "Consumer-Choice Health Plan, 1. Inflation and Inequity in Health-Care Today - Alternative for Cost Control and an Analysis of Proposals for National Health Insurance," New England Journal of Medicine 298, no. 12 (1978): 650-658;
35. A.E. Enthoven, "Consumer-Choice Health Plan, 2. A National Health Insurance Proposal Based on Regulated Competition in the Private Sector," New England Journal of Medicine 298, no. 13 (1978): 709-720;
36. and U.E. Reinhardt, "Can Efficiency in Health Care Be Left to the Market?" in Uncertain Times, 111-133.
37. M.A. Hall, "Arrow on Trust," in Uncertain Times, 259-271;
38. and M.A. Hall and R.A. Berenson, "Ethical Practice in Managed Care: A Dose of Realism," Annals of Internal Medicine 128, no. 5 (1998): 395-402.
39. Nichols et al., "Are Market Forces Strong Enough?";
40. and A.C. Enthoven, "Market Forces and Efficient Health Care Systems," Health Affairs 23, no. 2 (2004): 25-27
41. J.C. Robinson, "The End of Asymmetric Information," in Uncertain Times, 181-188.