Dear Graham,

 My introductory Health Economics texbook, "A Health Economics Primer", Shirley-Johnson-Lans (Boston, Pearson/Addison Wesley, 2006) gives a straightforward account of the history and evoluation of private health insurance and social insurance (Medicare, Medicaid, SCHIP, VA programs, etc) up to the present time (with the exception of the new Massachusetts "universal" health care plan, and a couple of other recent state initiatives).   I would recommend it , particularly Chapter3-5 and Chapter 14 (which outlines the different options usually discussed for getting to universal health insurance coverage in the U.S. )  The book does not take a position on preferred alternatives.  But I think it will give you what you need in the way of understanding the institutional context of the fragmented U.S. system.  The book has been used for courses at Columbia (School of Public Health) and Yale, as well as many other schools and colleges.

 Sorry to put in a plug for my own work, but it is the shortest and most straightforward health econ. text I know.  I wrote it to fulfill my need as an instructor who wanted to assign a lot of other material but wanted something that would provide the basics for my students.

Best,
Shirley Johnson-Lans
Professor and Chair
Department of Economics
Vassar College
   
----- Original Message -----
From: Graham Martin <[log in to unmask]>
To: [log in to unmask]
Sent: Mon, 23 Feb 2009 04:46:46 -0500 (EST)
Subject: Re: FFS etc. - introductory textbook?

Dear all

This interesting and informative discussion has brought home to me how little I still know about the American health care system(s!).  I'm guessing I'm not the only one on this list who is still relatively uninformed, so I wonder if those who are familiar with American health care could recommend any introductory texts on its history / politics / economics / etc.?

Thanks in advance.

Graham Martin








___________________________________________________________

Graham
Martin, Senior Research Fellow



CLAHRC
NDL, Sir Colin Campbell Building, Triumph Road, Nottingham NG7 2TU

0115
823 1277 | 07917 220140 | http://www.nottingham.ac.uk/~lqzgpm








--- On Thu, 19/2/09, AAHPN automatic digest system <[log in to unmask]> wrote:

-----Original Message-----
From: Anglo-American Health Policy Network [mailto:[log in to unmask]] On
Behalf Of Adam Oliver
Sent: Wednesday, February 18, 2009 7:53 AM
To: [log in to unmask]
Subject: FFS

So, it seems as though FFS still dominates in the US, and some (including me)
might see FFS as particularly inflationary. But other systems also heavily use
FFS and, though health care expenditure growth may be problematic, it has not
been as problematic as it has been in the US.

The key might therefore be the keep the FFS system within a reasonable
 overall
budget constraint. It seems to me that a special feature of the US is that the
payers (employers, government) are more willing to pay the increasing fees
charged by providers without too much questioning, so to control total US health
care expenditure growth, there needs to be reform not necessarily of the way
physicians are paid, but of the control that the payers exert over total budget.
I guess this was tried with managed care, and then the backlash (which was
really a backlash against HMOs rather than managed care wasn't it? - the
number of PPOs exploded between the-mid 1990s and now - but let's not wind
Ted up any further about definitions of managed care).

Another reason why this type of reform (i.e. strenghening the role of the
payer) may be particularly difficult in the US is that there are so many
different sectors within the one country (this point came to me from speaking to
Larry Brown and
 Howard Berliner, so if my ideas here are useless, we can blame
them...). So if you take the Oregon experiment, a main reason why it seemed to
fail is because Medicaid patients and their advocates thought that it was unfair
that their care was being further constrained whilst that of those covered in
the private sector wasn't. In many other countries, these cross sector
comparisons within a country may not be quite so much of a problem (this might
feed into Michael and Anna's debate about whether different baskets of
services across states would be a problem in a Medicaid for all programme).

Anyway, I should do some work, and should refrain from writing what everyone
already knows. But greater payer control seems to be the key (?), but that might
call for a more unified system than previous reforms and plans to build upon the
existing system (Medicare/Medicaid, and last year's Obama proposals). But
that may be
 politically impossible. So perhaps we should study education
instead.

Best,
Adam



Please access the attached hyperlink for an important electronic communications
disclaimer: http://www.lse.ac.uk/collections/secretariat/legal/disclaimer.htm