IntroductionRead more at location 167
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Other markets in our economy are also examples of complex systems, but healthcare is many times more complex than a normal market. The reason: in addition to garden-variety economic forces, the medical marketplace is institutionalized, bureaucratized, and extensively regulated.Read more at location 173
Doctors are heavily influenced by medical ethics and traditional ways of doing things. Almost everything they do is affected by third-party payer bureaucraciesRead more at location 175
To make matters even more complicated, we have completely suppressed normal market processes in healthcare—in this country and all over the developed world. As a result, in healthcare few people ever see a real price for anything.Read more at location 178
On the supply side, doctors and hospitals are rarely paid real prices for the services they render. Instead, they are paid on the basis of reimbursement formulas.Read more at location 182
An interesting characteristic of complex systems is that when you perturb them (by passing a law, for example), there are always unintended consequences.Read more at location 187
if patients have no out-of-pocket costs their economic incentive will be to overuse the system,Read more at location 192
Also, if patients are not paying money for the services they receive, they're not likely to shop aroundRead more at location 193
Well-intentioned public policies designed to make healthcare affordable for individuals, therefore, have had the surprising effect of causing healthcare spending to become unaffordable for the nation as a whole.Read more at location 196
Another well-intentioned public policy initiative—adopted by some states—is to try to make health insurance affordable for people with pre-existing conditions by requiring insurers to charge the same premium to all buyers, regardless of health status. Yet, this legislation has the unintended consequence of encouraging people to remain uninsured until they get sick.Read more at location 201
Yet MIT professor Amy Finkelstein has discovered that the passage of Medicare had no effect on the health of the elderly—at least as measured by mortality—but the additional spending set off a bout of healthcare inflation for all patients—one that never subsided.Read more at location 210
In other markets, producers don't compete only on price. They compete on quality as well. In healthcare, however, it appears that when providers don't compete on price, they often don't compete on quality either.Read more at location 222
Perverse incentives are faced by everyone: patients, doctors, nurses, hospital administrators, employees, employers, and so on.Read more at location 232
The conventional view is that we have too much freedom, not too little.Read more at location 238
Where is healthcare's equivalent of a Bill Gates or a Steve Jobs? The answer: There are literally thousands of entrepreneurs in healthcare.Read more at location 256
insurance companies, employers, and government. These are the three entities that pay most of the healthcare bills. They are the third-party payers.Read more at location 260
With respect to healthcare, they tend to be bureaucratic, wedded to tradition, and resistant to change.Read more at location 261
Getting Out of the Trap: Overcoming Unwise PoliciesRead more at location 302
