2 How Healthcare Is DifferentRead more at location 345
Note: Relazione lasca tra costi sanitari e salute. Relazione forte tra altri fattori (status, ambiente, clima...) e salute Edit
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COMPLEX SYSTEMS, by definition, are systems that are too complex for any single individualRead more at location 347
Note: NN BASTA UN INTELLIGENZA Edit
if we don't know anything about nuclear power plants, most of us wouldn't walk into one and start pushing buttons.Read more at location 350
Note: CENTRALE NUCLEARE Edit
The late Nobel laureate economist, Friedrich Hayek, called the hubris of people who want to tinker with systems they do not understand the “fatal conceit.”Read more at location 353
suppose you are choosing to live in one of two cities, and City A spends twice as much on medical care per citizen as City B. City A has more doctors, more medical equipment, more hospital beds; and doctors in that city do more things. Would your life expectancy be longer if you choose to live in City A rather than City B? Probably not.Read more at location 695
Note: SALUTE E SPESA Edit
large variations in healthcare spending apparently have little, if any impact on overall population mortality. George Mason University economist Robin Hanson summarizes the literature this way:31 [H]ealth policy experts know that we see at best only weak aggregate relations between health and medicine, in contrast to apparently strong aggregate relations between health and many other factors, such as exercise, diet, sleep, smoking, pollution, climate, and social status…. For example, [one study] found large and significant lifespan effects: a three year loss for smoking, a six year gain for rural living, a ten year loss for being underweight, and about fifteen year losses each for low income and low physical activityRead more at location 698
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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
Note: SANITÀ INCASINATA Edit
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
Note: INCENTIVI DEI DOTTORI Edit
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
Note: FORMULE E NN PREZZI Edit
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
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if patients have no out-of-pocket costs their economic incentive will be to overuse the system,Read more at location 192
Note: INCENTIVO: USA E SPRECA Edit
Also, if patients are not paying money for the services they receive, they're not likely to shop aroundRead more at location 193
Note: INCENTIVO: INDIFFERENZA X IL MIGLIORE Edit
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
Note: SORPRESA: TUTELARE POCHI RENDE TUTTO PIÙ COSTOSO Edit
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
Note: STESSO PREMIO X TUTTI: PREMIO MEDIO PIÙ ALTO Edit
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
Note: SPENDERE IL DOPPO X MORIRE PRIMA Edit
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
Note: COMPETIZIONE X LA QUALITÀ Edit
Perverse incentives are faced by everyone: patients, doctors, nurses, hospital administrators, employees, employers, and so on.Read more at location 232
Note: INCENTIVI PERVERSI Edit
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
Note: GLI INNOVATORI Edit
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
