Synthesis Please click the link below to see the full description.
View Full Description and Attachment(s)
Personality inventories often report the distribution of personality types by gender. The chicken-and-egg question:
· To what degree is gender a component of personality, or personality a component of gender?
· Is there a better way to express the relationship between the two, and if so, what is it?
Please use course concepts and outside sources to support your answer to this forum.
INSTRUCTIONS:
Initial posts must be 250+ words, using correct grammar and spellcheck, posted. Part of the requirement for asubstantive post is to bring something new to the conversation. Read the forum prompt and fully answer it, demonstrate understanding of the lesson/content, include evidence from firsthand experience, reference to the course materials, and apply what you’re discussing to work, life, and reality.
U.S. Health Care Spending In
An International Context
Why is U.S. spending so high, and can we afford it?
by Uwe E. Reinhardt, Peter S. Hussey, and Gerard F. Anderson
ABSTRACT: Using the most recent data on health spending published by the Organization
for Economic Cooperation and Development (OECD), we explore reasons why U.S. health
spending towers over that of other countries with much older populations. Prominent
among the reasons are higher U.S. per capita gross domestic product (GDP) as well as a
highly complex and fragmented payment system that weakens the demand side of the
health sector and entails high administrative costs. We examine the economic burden that
health spending places on the U.S. economy. We comment on attempts by U.S. policy-
makers to increase the prices foreign health systems pay for U.S. prescription drugs.
F
or a brief moment in the early 1990s it seemed that the combina-
tion of “ managed care” embedded in “ managed competition” would allow
the United States to keep its annual growth of health care spending roughly
in step with the annual growth of gross domestic product (GDP). It was a short-
lived illusion. By the turn of the millennium the annual growth in U.S. health
spending once again began to exceed the annual growth in the rest of the GDP by
ever-larger margins.
In the United States the impact on health spending of managed care and man-
aged competition had been controversial from the start. Skeptics argued that
these tools might yield a one-time savings, spread over a few years, but that by
themselves they would be unlikely to slow the long-term growth in health spend-
ing thereafter.1 It now appears that these analysts were right. In retrospect, and
taking a longer-run view, the cost control of the early and mid-1990s merely repre-
sents an abnormal period in the history of U.S. health care.
Data for 2001, released by the Organization for Economic Cooperation and De-
velopment (OECD), show that over the period 1990–2001 the United States suc-
ceeded only in matching the median growth in inflat.
Acs0008 Health Care Economics The Broader Contextmedbookonline
1) US healthcare spending is very high at over $2 trillion annually, yet health outcomes are mixed compared to other developed nations.
2) There is debate around whether rising healthcare costs represent an economic risk, with some arguing costs crowd out other spending while others say spending is acceptable if the value of health is high.
3) A key factor driving higher US costs with no clear improvement in outcomes is the market-based healthcare system, which differs from other countries. Features of healthcare markets like supplier-induced demand and moral hazard may contribute to rising costs.
Chapter 2Where Are WeAmerican health care is in a state of flJinElias52
Chapter 2
Where Are We?
American health care is in a state of flux as new scientific knowledge and clinical experience continue to change our definitions of illness and wellness. As a society, we respond by changing the ways health care is delivered. Health services increasingly impact our society—from health status to employment to budgetary economics to recreation to professional concerns to our perceptions of our own well-being.
American health care is also in flux because now that it has grown to more than one-sixth of our economy it threatens to squeeze out public goods such as education and infrastructure maintenance. People have wanted to do something about cost and access to care problems for a long time. The 2010 Affordable Care Act (ACA) is doing much to address access issues, but opposition to certain provisions is strong. Employers are steadily shifting more risk to employees and their families, and there is a real tension between Washington and the state capitols over Medicaid expansion. Medicare trust funds are forecast to disappear over the next decade or so. Washington is unlikely to tolerate another major health reform battle, although major changes may come as a side effect of a “grand” government overhaul of spending and tax policies. The future is highly uncertain, and still we must plan and act as we go along.
This chapter reviews the current status of the U.S. health care system from several points of view:
• Current outcomes and costs
• Quality
• Leadership
• Complexity
• Industrializing structures for delivery
• Medicalization of our society
• Redistribution of wealth
2.1 Current Outcomes and Costs
Previous section
Next section
2.1 CURRENT OUTCOMES AND COSTS
Health care expenditures were projected to rise to close to 20% of the U.S. gross domestic product (GDP) by 2015 (Borger et al., 2006), but more recent estimates from the Centers for Medicare & Medicaid Services (CMS) project it to be 18.2% for 2015 and 19.5% by 2021 (CMS, 2012). Average annual family health insurance premiums were estimated for 2012 at $15,745, with $11,429 paid by employers. The 4% growth rate for 2012 was slow by historical standards but still more than twice the growth rate of wage income. The comparable total insurance cost for a single individual was $5,615. Large employers (98%) offered health care benefits to workers but were cutting back on retiree health benefits. Only 50% of firms with 3 to 9 workers and 73% with 10 to 24 workers offered health benefits. Many small companies do not provide health benefits. At the same time, control of health care by health professionals is being threatened by outsiders calling for more reliance on government programs, more consumer-centered care, or both.
High Comparative Costs and Low Comparative Outcomes
The United States spends far more on health care per capita and as a percentage of GDP than other developed countries, yet does not seem to be much better off for it. Table 2-1 illustrates this ...
COMPLETE GUIDE ON MAKING A PRESENTATION ABOUT HEALTH ECONOMICSLauren Bradshaw
The document provides guidance on creating an effective presentation about health economics, including introducing the topic, structuring the body with main points and evidence, and concluding by restating the central idea. It also gives examples of potential topics to cover such as the costs and policies of healthcare systems, and suggests thesis statements that take a position on issues in health economics like providing universal healthcare.
Essay on Definitions of Health
Healthcare in the United States Essay
Why Is Healthcare Important? Healthcare?
Essay On Healthcare System
Essay On Impact On Health Care
Essay On Home Health Care
Essay On Affordable Health Care
Health Care Persuasive Essay
Essay on Careers in Healthcare
Essay On Health Care
Persuasive Essay On Health Care
Essay On Healthcare In The United States
Inequality in Healthcare Essay examples
Health Care Trends Essay examples
Social Media And Health Care Essay
Essay on Quality Health Care
Essay on Health Care
The Health Of A Health Care System
Essay On Health Care
Persuasive Essay On Health Care
Running Head THE NEED FOR APPROACHES TO IMPROVE CAUSE ADMINISTRA.docxaryan532920
Running Head: THE NEED FOR APPROACHES TO IMPROVE CAUSE ADMINISTRATION AND REPAYMENT IN THE HEALTHCARE SYSTEM
1
THE NEED FOR APPROACHES TO IMPROVE CAUSE ADMINISTRATION AND REPAYMENT IN THE HEALTHCARE SYSTEM
10
Title: The Need for Approaches to Improve Case Administration and Repayment in the Healthcare System
Abstract
The medical care system of the United States of America for the past years has been considered to be the most expensive in the world. The government of the United States has to spend huge amounts of money for medical care in relation to the gross domestic product and these sums are systematically increasing. Now many scholars came to the conclusion that it is the government programs, which held the responsibility for the growth of uncontrolled spending on medical care, with which such growth is a threat to the financial stability of the United States. The issue is worth-discussing, thus, the given work is devoted to the overview of the structure and the main issues of the US healthcare system to find the effective solution.
Unlike other developed countries the medical care system in the United States of America demands more and more funds while its quality remains the same. 1/3 of the US citizens are still uninsured and there is no future hope for improving the situation. People suffer from rapidly growing prices of medical services and slow growth of salaries inclement. Furthermore, the department of insurance loses its integrity and honesty; since they use such an opportunity to fraud money as well as not paying the workers. The risk of becoming bankrupt is very high in medical care system because of unplanned budget. The insurance programs, financed by the state, are also becoming more expensive, and the government is forced to pay more and more money, which later brings about increase in state financial expenditure that immensely contribute to the poor economy. Employees do not have the free will to change their job due to the high cost of insurance and the monopolization (Stone, et al., 2008,p.2-57). This paper will provide evidences by giving the most effective solution to control this problem and also encouraging people make decisive market decisions by finding new approaches.
There are many ways of handling this subject issue of “The Need for Approaches to Improve Case Administration and Repayment in the Healthcare System,” but this research paper primarily will focus on the five articles that represent scholarly articles concerning the subject issue on this topic. The five scholarly articles are: Nolin, (2015) in his study about “Jail overcrowding a perennial issue for many counties; (Stone, P., Hughes, R., & Dailey, M. 2008)about “Creating a safe and high-quality health care environment: Agency for Healthcare Research and Quality (US); U.S. Department of Health & Human Services (2014). New HHS Data Shows Major Strides Made in Patient Safety, Leading to Improved Care and Savings; Unit ...
This document provides a research proposal examining whether the US government has contributed to rising healthcare costs. The proposal includes an introduction outlining rising premium costs and relevance of the research question. A literature review discusses various theories for increasing costs and analyses linking the Affordable Care Act to rising premiums, though noting limitations in scope. The proposed research will use a methodology to determine a correlation between government involvement through the ACA and increasing insurance costs nationally. Expected results are not stated to remain open-ended.
The document proposes replacing the US's fragmented health care system with a single-payer system to improve accessibility and control costs. It notes that the current system leaves 47 million uninsured, costs more per capita than other countries, and has poorer health outcomes. A single-payer system could reduce costs by eliminating private insurers and negotiating drug and treatment prices directly. This would improve accessibility through universal coverage and help achieve more sustainable cost control and better public health outcomes.
Acs0008 Health Care Economics The Broader Contextmedbookonline
1) US healthcare spending is very high at over $2 trillion annually, yet health outcomes are mixed compared to other developed nations.
2) There is debate around whether rising healthcare costs represent an economic risk, with some arguing costs crowd out other spending while others say spending is acceptable if the value of health is high.
3) A key factor driving higher US costs with no clear improvement in outcomes is the market-based healthcare system, which differs from other countries. Features of healthcare markets like supplier-induced demand and moral hazard may contribute to rising costs.
Chapter 2Where Are WeAmerican health care is in a state of flJinElias52
Chapter 2
Where Are We?
American health care is in a state of flux as new scientific knowledge and clinical experience continue to change our definitions of illness and wellness. As a society, we respond by changing the ways health care is delivered. Health services increasingly impact our society—from health status to employment to budgetary economics to recreation to professional concerns to our perceptions of our own well-being.
American health care is also in flux because now that it has grown to more than one-sixth of our economy it threatens to squeeze out public goods such as education and infrastructure maintenance. People have wanted to do something about cost and access to care problems for a long time. The 2010 Affordable Care Act (ACA) is doing much to address access issues, but opposition to certain provisions is strong. Employers are steadily shifting more risk to employees and their families, and there is a real tension between Washington and the state capitols over Medicaid expansion. Medicare trust funds are forecast to disappear over the next decade or so. Washington is unlikely to tolerate another major health reform battle, although major changes may come as a side effect of a “grand” government overhaul of spending and tax policies. The future is highly uncertain, and still we must plan and act as we go along.
This chapter reviews the current status of the U.S. health care system from several points of view:
• Current outcomes and costs
• Quality
• Leadership
• Complexity
• Industrializing structures for delivery
• Medicalization of our society
• Redistribution of wealth
2.1 Current Outcomes and Costs
Previous section
Next section
2.1 CURRENT OUTCOMES AND COSTS
Health care expenditures were projected to rise to close to 20% of the U.S. gross domestic product (GDP) by 2015 (Borger et al., 2006), but more recent estimates from the Centers for Medicare & Medicaid Services (CMS) project it to be 18.2% for 2015 and 19.5% by 2021 (CMS, 2012). Average annual family health insurance premiums were estimated for 2012 at $15,745, with $11,429 paid by employers. The 4% growth rate for 2012 was slow by historical standards but still more than twice the growth rate of wage income. The comparable total insurance cost for a single individual was $5,615. Large employers (98%) offered health care benefits to workers but were cutting back on retiree health benefits. Only 50% of firms with 3 to 9 workers and 73% with 10 to 24 workers offered health benefits. Many small companies do not provide health benefits. At the same time, control of health care by health professionals is being threatened by outsiders calling for more reliance on government programs, more consumer-centered care, or both.
High Comparative Costs and Low Comparative Outcomes
The United States spends far more on health care per capita and as a percentage of GDP than other developed countries, yet does not seem to be much better off for it. Table 2-1 illustrates this ...
COMPLETE GUIDE ON MAKING A PRESENTATION ABOUT HEALTH ECONOMICSLauren Bradshaw
The document provides guidance on creating an effective presentation about health economics, including introducing the topic, structuring the body with main points and evidence, and concluding by restating the central idea. It also gives examples of potential topics to cover such as the costs and policies of healthcare systems, and suggests thesis statements that take a position on issues in health economics like providing universal healthcare.
Essay on Definitions of Health
Healthcare in the United States Essay
Why Is Healthcare Important? Healthcare?
Essay On Healthcare System
Essay On Impact On Health Care
Essay On Home Health Care
Essay On Affordable Health Care
Health Care Persuasive Essay
Essay on Careers in Healthcare
Essay On Health Care
Persuasive Essay On Health Care
Essay On Healthcare In The United States
Inequality in Healthcare Essay examples
Health Care Trends Essay examples
Social Media And Health Care Essay
Essay on Quality Health Care
Essay on Health Care
The Health Of A Health Care System
Essay On Health Care
Persuasive Essay On Health Care
Running Head THE NEED FOR APPROACHES TO IMPROVE CAUSE ADMINISTRA.docxaryan532920
Running Head: THE NEED FOR APPROACHES TO IMPROVE CAUSE ADMINISTRATION AND REPAYMENT IN THE HEALTHCARE SYSTEM
1
THE NEED FOR APPROACHES TO IMPROVE CAUSE ADMINISTRATION AND REPAYMENT IN THE HEALTHCARE SYSTEM
10
Title: The Need for Approaches to Improve Case Administration and Repayment in the Healthcare System
Abstract
The medical care system of the United States of America for the past years has been considered to be the most expensive in the world. The government of the United States has to spend huge amounts of money for medical care in relation to the gross domestic product and these sums are systematically increasing. Now many scholars came to the conclusion that it is the government programs, which held the responsibility for the growth of uncontrolled spending on medical care, with which such growth is a threat to the financial stability of the United States. The issue is worth-discussing, thus, the given work is devoted to the overview of the structure and the main issues of the US healthcare system to find the effective solution.
Unlike other developed countries the medical care system in the United States of America demands more and more funds while its quality remains the same. 1/3 of the US citizens are still uninsured and there is no future hope for improving the situation. People suffer from rapidly growing prices of medical services and slow growth of salaries inclement. Furthermore, the department of insurance loses its integrity and honesty; since they use such an opportunity to fraud money as well as not paying the workers. The risk of becoming bankrupt is very high in medical care system because of unplanned budget. The insurance programs, financed by the state, are also becoming more expensive, and the government is forced to pay more and more money, which later brings about increase in state financial expenditure that immensely contribute to the poor economy. Employees do not have the free will to change their job due to the high cost of insurance and the monopolization (Stone, et al., 2008,p.2-57). This paper will provide evidences by giving the most effective solution to control this problem and also encouraging people make decisive market decisions by finding new approaches.
There are many ways of handling this subject issue of “The Need for Approaches to Improve Case Administration and Repayment in the Healthcare System,” but this research paper primarily will focus on the five articles that represent scholarly articles concerning the subject issue on this topic. The five scholarly articles are: Nolin, (2015) in his study about “Jail overcrowding a perennial issue for many counties; (Stone, P., Hughes, R., & Dailey, M. 2008)about “Creating a safe and high-quality health care environment: Agency for Healthcare Research and Quality (US); U.S. Department of Health & Human Services (2014). New HHS Data Shows Major Strides Made in Patient Safety, Leading to Improved Care and Savings; Unit ...
This document provides a research proposal examining whether the US government has contributed to rising healthcare costs. The proposal includes an introduction outlining rising premium costs and relevance of the research question. A literature review discusses various theories for increasing costs and analyses linking the Affordable Care Act to rising premiums, though noting limitations in scope. The proposed research will use a methodology to determine a correlation between government involvement through the ACA and increasing insurance costs nationally. Expected results are not stated to remain open-ended.
The document proposes replacing the US's fragmented health care system with a single-payer system to improve accessibility and control costs. It notes that the current system leaves 47 million uninsured, costs more per capita than other countries, and has poorer health outcomes. A single-payer system could reduce costs by eliminating private insurers and negotiating drug and treatment prices directly. This would improve accessibility through universal coverage and help achieve more sustainable cost control and better public health outcomes.
According to this idea that gender is socially constructed, answer.docxronak56
According to this idea that gender is socially constructed, answer the following questions:
1. What does it mean to be a man in the U.S.? What does it mean to be a woman?
2. From what institutions do we learn these gender roles?
3. How do these clips demonstrate the ways in which gender is socially constructed in the U.S.? Do the concepts discussed in the clips resonate with you? Why or why not?
In Persepolis, the main character Marji struggles to define her identity as an Iranian woman in a changing society.
· What roles are depicted for women in Iranian society in the film? How do they change over time?
· How does Persepolis demonstrate the ways in which gender and identity are influenced in many ways, by different processes across cultures? How are gender roles in Iran similar, or different to gender in the U.S.?
· What are some of the stereotypes that exist about Muslim women and how does Abu-Lughod in “Do Muslim Women Need Saving” and Persepolis complicate these stereotypes?
Answer the following questions 2 full pages
Running head: MAJOR HEALTH CARE PROBLEMS IN THE U.S. 1
Major Health Care Problems in the U.S.
Jane Doe
ID: 1212121
MAJOR HEALTH CARE PROBLEMS IN THE U.S. 2
Major Health Care Problems in the US
Problem statement: High and continuously rising cost of health care has been and still is one of
the biggest challenges affecting the Health Care system in United States.
Methods of Examining the Problem
Both qualitative and quantitative research methods should be used to fully understand the
issue of high cost of care in the US. Quantitative methods like surveys and experimentations will
aid in estimating the prevalence, magnitude and frequency of the problem in different regions.
On the other hand, qualitative methods like case studies and observation will help describe the
extent and complexity of the issue. The two approaches need to work in complementation to
obtain a clear understanding of this menace.
Surveys, as a quantitative research method, is one of the most effective in the social
research and present a more viable method of examining the cost of health in the country. They
involve asking of questions in the form of questionnaires and interviews. Questionnaires are
written questions to which the response can be open ended or multiple-choice format. This
would be used to gain information about cost within determinants that are of
disagree/neutral/agree nature. An example is if patients are contented with the cost of services
they get or they deem the cost of cover worthy. Interviews, the researcher discussing issues with
the respondents, are to be used to gain more details on already known aspects of the system. This
may include gathering information to inform policies, administration and use of technology to
minimize the cost of care.
Since health cost in the US is not a new challenge and there have been studies about it,
qualitative methods like .
Essay On Health Care
Essay On Home Health Care
Healthcare in the United States Essay
Essay about U.S. Health Care system
The Cost Of Health Care Essay
Essay on Definitions of Health
Health Care Persuasive Essay
Essay On Healthcare System
Home Health Journal Essay examples
Essay about Funding Healthcare Services
Discussion Of Health Care System Essay Paper.docx4934bk
The document discusses factors that impact the US healthcare system. It argues that while healthcare is considered a basic human right, it operates as a privilege in the US due to many people remaining uninsured. Social determinants of health and health disparities also impact the system by influencing health outcomes, particularly for vulnerable groups, and how healthcare is provided through integrating social services. The seven key drivers identified by Appleby that influence rising healthcare costs are discussed, including fee-for-service reimbursement, an aging population, demand for new technologies, tax breaks for insurance, lack of information, industry consolidation, and supply/demand issues.
Assessing U.S. and International Experience with Health Reform and Implications for the Future by W. David Helms, Ph.D, President and CEO, Academy Health
MMS State of the State Conference: Susan Dentzer - Rationalizing Health Spend...Frank Fortin
The document discusses challenges facing Massachusetts and the US in controlling rising healthcare costs. It notes that current spending growth rates threaten Massachusetts' reforms and the nation's fiscal health. Several key drivers of higher spending are identified, including new medical technologies, chronic diseases like obesity, and low productivity growth in the healthcare sector. Solutions proposed include reducing unnecessary variations in supply-sensitive care, payment reforms like bundled payments that incentivize quality over quantity, and policies to improve prevention and management of chronic conditions.
Running head IMPACT OF SMOKING ON HEALTHCARE COSTS1IMPACT OF.docxcowinhelen
Running head: IMPACT OF SMOKING ON HEALTHCARE COSTS 1
IMPACT OF SMOKING ON HEALTHCARE COSTS 6
Impact of smoking on healthcare costs
Cherod Jones
American Military University
Impact of smoking on healthcare costs
Introduction
In the world today, smoking is one of the things that trigger a significant number of ailments on people. This is the case because tobacco affects almost all internal body organs gradually compromising their functioning (Stewart, & Wild, 2017). The research claims that continued smoking makes a person susceptible to contract more than one ailment, which becomes hard to treat. Many people who smoke have recurring diseases that are hard to get rid of. Smoking negatively affects the cost of healthcare not only because of triggering ailments but in many other aspects. The purpose of this research paper shall focus on the various ways that smoking impacts healthcare cost.
Body of paper
An overview of the issue
Smoking is a complex health challenge that negatively affects the cost of healthcare in different countries around the world, but mainly the U.S. Smoking-related ailments include; stroke, coronary heart disease, cardiovascular disease, damaged and blocked blood vessels, respiratory infections like emphysema, chronic bronchitis, and asthma. Smoking also plays a vital role in the formation and development of all types of cancer. For instance: bladder, blood (acute myeloid leukemia), cervix, esophagus, colon, and rectum (colorectal), kidney and ureter (Lloyd-Jones et al., 2010). According to some researchers, other cancers caused by smoking are; “larynx, liver, oropharynx (includes parts of the throat, tongue, soft palate, and the tonsils), pancreas, stomach, trachea, bronchus, and lung” (Stewart & Wild, 2017). Meaning, that a majority of healthcare issues addressed in different healthcare facilities emanates from smoking. The challenge is that these ailments are complicated and they need high-quality skills, quality medical equipment, and resources to maintain services. Patients will have to incur the high cost of treatment. Therefore smoking causes an escalation in healthcare cost.
Why is this issue a concern from a health care economics perspective?
Ailments emanating from smoking are complex and requires a significant concern for the healthcare economics. The idea is that high skilled medical professionals need to be paid in a manner that is equivalent to the services they are offering. The tools required to diagnose and test are expensive, making healthcare services providing smoking-related ailments treatment costly. Moreover, the medication for such diseases is too strong and goes through a long and tedious process, which makes it hard to cut on the cost of production. In other cases, some of the diseases require surgeries which are complex and sensitive putting a demand on the number of medical surgeons.
Who are the major parties involved in this issue
· Government as they set laws and en ...
Health Care and Medicare Corporate Culture and the Three-Legged StoolLillian Rosenthal
This document discusses the history and current state of Medicare spending in the United States. It notes that while Medicare was originally intended to provide healthcare access for seniors, costs have risen significantly due to an aging population living longer and advancing medical technology. The document analyzes newly released data on payments made to individual physicians by the Centers for Medicare and Medicaid Services to determine if and how healthcare providers may respond to financial incentives.
The document discusses several issues with the U.S. healthcare system including a large uninsured population, rising costs of healthcare leading to increased bankruptcies, huge profits for healthcare corporations, and a growing national debt. It notes the U.S. ranks last in quality of healthcare compared to other industrialized nations while spending the most per capita. Key issues include a lack of access to primary care, high mortality rates from preventable conditions, and disparities in healthcare that disproportionately impact those in lower social and economic classes. Comprehensive healthcare reform is needed to address rising costs, ensure access and coverage for all Americans, and improve overall quality and outcomes of the healthcare system.
The United States spends more on healthcare than any other country but has poor health outcomes. Money influences the healthcare system in several ways. The system is fragmented with different providers and payers not sharing information, leading to duplicate tests and costs. A fee-for-service payment model incentivizes providers to see more patients and perform more procedures to increase payments. Lobbying by the pharmaceutical and insurance industries shapes healthcare policies and regulations in ways that prioritize profits over public health. Transforming how care is delivered, such as emphasizing prevention and plant-based diets, could reduce costs and improve health.
The document discusses Medicare spending in the United States. It reports that Medicare spending was reduced to 0.2% in 2013 compared to 1.8% between 2009-2012. This decrease may have resulted from the recession limiting spending, delivery system reforms to improve quality while reducing local costs, or a focus on patient-centered care. Statistical data from Medicare budget reports is cited to support the claims around reduced spending.
Healthcare oligopoly is Affecting u.s. economy convertedRoyJMeidinger
The document provides an overview of rising healthcare costs and declining outcomes in the United States compared to other developed nations. It notes that while the US spends much more per capita on healthcare, it has lower life expectancy and rates of preventable deaths than peers. The high costs are driven by administrative waste, high prices, and lack of cost control. The document argues that healthcare costs are a major burden on the US economy and individuals, and that reforms are needed to reduce costs while improving access and outcomes for all Americans.
Online Journal of Health EthicsVolume 1 Issue 1 Article .docxcherishwinsland
Online Journal of Health Ethics
Volume 1 | Issue 1 Article 5
Universal Healthcare in America
Sandra Carr Hayes
University of Mississippi Medical Center
Follow this and additional works at: http://aquila.usm.edu/ojhe
This Article is brought to you for free and open access by The Aquila Digital Community. It has been accepted for inclusion in Online Journal of Health
Ethics by an authorized administrator of The Aquila Digital Community. For more information, please contact [email protected]
Recommended Citation
Hayes, S. C. (2004). Universal Healthcare in America. Online Journal of Health Ethics, 1(1).
http://dx.doi.org/10.18785/ojhe.0101.05
http://aquila.usm.edu/ojhe?utm_source=aquila.usm.edu%2Fojhe%2Fvol1%2Fiss1%2F5&utm_medium=PDF&utm_campaign=PDFCoverPages
http://aquila.usm.edu/ojhe/vol1?utm_source=aquila.usm.edu%2Fojhe%2Fvol1%2Fiss1%2F5&utm_medium=PDF&utm_campaign=PDFCoverPages
http://aquila.usm.edu/ojhe/vol1/iss1?utm_source=aquila.usm.edu%2Fojhe%2Fvol1%2Fiss1%2F5&utm_medium=PDF&utm_campaign=PDFCoverPages
http://aquila.usm.edu/ojhe/vol1/iss1/5?utm_source=aquila.usm.edu%2Fojhe%2Fvol1%2Fiss1%2F5&utm_medium=PDF&utm_campaign=PDFCoverPages
http://aquila.usm.edu/ojhe?utm_source=aquila.usm.edu%2Fojhe%2Fvol1%2Fiss1%2F5&utm_medium=PDF&utm_campaign=PDFCoverPages
http://dx.doi.org/10.18785/ojhe.0101.05
mailto:[email protected]
Universal Healthcare
1
Universal Healthcare in America
Sandra Carr Hayes
University of Mississippi Medical Center
Keywords:
Health care; Universal Healthcare; Healthcare Access; National Health; Health Costs
Abstract
Lack of health care insurance, once thought to be a problem of the poor, and has
now begun to affect a new population- the middle class. The major factors
contributing to this are increased deductibles and co-payments, cost shifting and
the introduction of managed care networks. The idea of a universal health plan has
been introduced several times over the last few decades. With the introduction of
Medicare and Medicaid came the promise of a more inclusive health care plan for
all Americans. However, Medicare and Medicaid remain largely unchanged from
what they were when they were first introduced in 1965. The U. S. was built on the
foundation of ‘unalienable rights’. Why then is the number of uninsured and
uninsured rising and projected to continue rising? This article seeks to explore
these questions.
Universal Healthcare
2
Universal Healthcare in America
Introduction
One in six Americans doesn’t have health insurance. Studies have shown that health
insurance and poverty are the strongest determinants of access to health services
(Guendelman, et. al, 1986). The uninsured are less likely to obtain medical attention
when they have a perceived "need for care". This is best illustrated in the case of
George and Tina. George and Tina were siblings who had been diagnosed with
diabetes in childhood. However, their disease went un.
11 minutes agoJessica Dunne RE Discussion - Week 3COLLAPS.docxdrennanmicah
11 minutes ago
Jessica Dunne
RE: Discussion - Week 3
COLLAPSE
Top of Form
NURS 6050C: Policy and Advocacy for Improving Population Health
INITIAL POST
Economic Challenges of Healthcare Policy
The economics of the healthcare system in the United States is complex and fragmented. Costs associated with care and the prices healthcare consumers pay are determined by a wide variety of factors making it extremely difficult to find a one size fits all solution. Knickman and Kovner (2015) argue that healthcare is neither a commodity or a service, because of the high variabilities in need, cost, and consumption. The United States spends 80% of all healthcare revenue on just 20% of the population. Health insurance can be provided by the government, the private sector, or an employer. Some citizens do not have any form of healthcare coverage. Regardless of type, insurance coverage generally only pays a portion of the total healthcare cost leaving the consumer to pay the remaining balance. Moreover, reimbursement standards differ for facilities and providers. The government reimburses healthcare facilities, such as hospitals a fixed amount per patient, which creates a higher incentive to work efficiently. Healthcare providers, on the other hand, are reimbursed based on a fee for service model, meaning the more services they provide, the more money they are reimbursed (Knickman & Kovner, 2015).
Reindart (2010) maintains the passage of the Affordable Care Act (ACA) created more strain on the system by adding approximately 30 million uninsured Americans to the market. The projected cost to provide such coverage is around 8 billion to 1 trillion dollars over the next decade. However, the estimated expense of healthcare with no legislative intervention is 35 trillion dollars over the next decade (Reindart, 2010). Laureate Education (2012) contends that the human resources required to provide healthcare to an additional 30 million people is another consideration the ACA does not address. The United States is already experiencing staff shortages for key healthcare jobs like nurses and physicians. Additionally, with baby boomers retiring from the workforce and simultaneously needing more healthcare resources as they age will inevitably exacerbate the shortage of providers (Laureate Education, 2012).
Ethical Considerations
It is important to recognize that the private sector often follows the public sector when deciding what services will be covered (Knickman & Kovner, 2015). Therefore, the implications of Medicare deciding not to pay for a drug or service will likely affect the entire population. Stein (2010) asserts that cost should not be a consideration in determining if medications or services will be paid for by Medicare. Nonetheless, that is what happened with Provenge, a vaccine indicated for late stage prostate cancer patients. The drug prolonged the lifespan of patients by about four months. Provenge costs around 93,000 dollars per p.
This document discusses socioeconomic issues in medicine. It summarizes that:
1) While only 10% of premature deaths are due to inadequate medical care, 40% are due to unhealthy behaviors like smoking, excessive drinking, obesity, and imprudent sexual behaviors.
2) Lower socioeconomic status is associated with poorer health and higher mortality, due to factors like higher rates of unhealthy behaviors, stress, and lack of control over life circumstances among those of lower socioeconomic status.
3) The United States spends much more on health care than other countries, at over 17% of GDP currently, due to both supply factors, like expensive technologies and specialist care, and demand factors, like consumer appetite for new medical advances
SW 619Infancy and Early Childhood Development of Drug Addicted.docxmabelf3
SW 619
Infancy and Early Childhood Development of Drug Addicted Children
While in the womb fetus is in the it feeds off the food intake and nourishment through the
placenta, which also means that any substances such as drugs, alcohol or tobacco that enters the
mothers system flows through the placenta and is delivered to the fetus as well. From birth to three
years old is the most critical period in a child’s development process. Children of mothers that use
drugs while they are pregnant increase the likelihood that the child will suffer from some form of
birth defect and oftentimes born prematurely. The lasting effects of prenatal cocaine affect the
growth of the fetus physically. The results of the increase of premature birth, and generalized growth
retardation including decreased birth weight, shorter body length, and smaller head circumference
(Bigsby et al, 2011; Covington et al, 2002; Gouin et al, 2011; Mayes et al, 2003).
These toxic chemicals can sometimes have irreversible damage that affect the child’s normal
development process with regards to proper development of organs and brain function.
From the ages of 0-2 months old a child are expected to have develop motor skills that would
include the ability to recognize different colors and shapes, kicking waving, have the ability to
recognize familiar voices and their sleeping patterns would change, meaning that as they grow older
children should be sleeping a little longer than a new born baby. Children from the ages of 2
months old should be able to extend their arm and reach and pick up toys and other objects,
hand coordination by shifting objects from one hand to another. The child should be able to pick up
finger food and bring it to their mouths. Identifying a problem with a child is when they are not able
to perform these age appropriate task.
A toddler ages 3 to 5 years old should be able to perform task such as holding crayons drawing horizontal lines, circles and have the ability to fold and snip paper with scissors. Children that have been exposed to substance may struggle with completing these tasks or will develop these cognitive skills at a slower rate. One study using play behavior (Rodning, Beckwith, & Howard, 1989a) found that preterm toddlers exposed to cocaine
and other drugs to show poorly developed play behaviors, and a lack of interest and motivation in
unstructured situations, in comparison to a group of high risk preterm children. Using play behavior,
one study found preterm toddlers exposed to cocaine and other drugs to show poorly. However, by
3 years of age, there were no changes associated with fine motor performance or behavior observed
with the child externalizing behavioral problems at age 5 years old. Stress and psychological
symptoms of caregivers were found to be in direct correlation with increased child behavioral issues;
indicating that the effected children may have m.
SWK311 Assessment 2 Final EssayWhat is t.docxmabelf3
SWK311 Assessment 2
Final Essay
What is the policy and its impact on vulnerable groups?
Why should/could you influence change?
How can you influence social policy change?
Developing your own practice framework for influencing policy change
What, Why and How
Critical analysis of social policy
Application of theory to practice
Adherence to academic conventions of writing (eg referencing; writing style)
At least 8 references
Assessment Criteria
a) Critically examine the policy or policies that you consider impact upon a client group
Suggest ways that policy could be changed to improve the life outcomes for those with whom you are working.
Part 1
What is this?
Not just describing
Critical analysis – a reminder
Critically examine
What is the political and ideological underpinning of the social policy?
What is the intended outcome of the policy? Is it achieving this gaol?
How the policy impacts your client group – both positive and negative impacts
How is the policy implemented – for example income support as delivered through Centrelink
Is it the policy or the service delivery that is the problem
Prompt questions
Consider vulnerable populations/clients you work with or those that interest you.
There are likely to be many policies that impact the group you choose. It is important to acknowledge the ways that economic and social policies intersect.
You can select one main policy or several policies for the purpose of the assignment.
e.g. women – are impacted by economic policy, income support, parenting payments and family tax benefits, child care support and many more.
recap
As you have worked through this unit, there are likely to have been topics or issues that have resonated with your , or really grated you.
For example, do you feel angry that people on income support payments appear to be allowed to just sit around and do nothing? Do you think the government supports them to just do nothing?
What would happen if there was a continued tightening of conditions for receiving income support?
Would anyone suffer? Would this matter? Would this impact society?
Why influence change?
Do you consider the government approach to income support is punitive?
Does the approach of welfare conditionality under a neoliberal government leave vulnerable people at risk?
What would drive your approach to intervene in this area of macro policy compared to the approach you would take if you fully supported government’s tightening of access to income support?
Alternatively
It is important to know your current world view and values as you enter any field of human services practice.
This will ensure that your tactics and strategies for influencing policy are transparent and appropriate.
Do your own values and philosophy align with those of your professional association?
Articulate your own theoretical perspective
Develop a framework that you would adopt for influencing policy change th.
Surname 1
Student's Name
Professor's Name
Course
Date
Kanopy Films Option 6: Arab Invasion of Andalusia
The film, Arab Invasion of Andalusia (AIA), narrates the story that ignited a period of 800 years of what would be the Muslim reign in the region of the Iberian Peninsula. Information regarding the said events has been hard to come by with the available sources lacking the much-needed reliability. However, armed with minimal sources of information, the creators of the documentary set to answer tricky questions on a topic where most people have failed. While AIA presents a fascinating experience for history scholars and other interested parties alike, the film still lacks in terms of the accuracy of the submitted data, making it unreliable to some extent.
The documentary is primarily based on the accounts detailed in a document whose author did not live the said ordeals. A first-hand account experience of events usually is accurate since the narrator can give more details, which are valid and reliable. However, in the mentioned film, the creators rely on data contained in a document known as “The chronicle of 754”. According to Gearon, the author of the material was a native Christian who lived in Iberia, whose real identity was unknown (Gearon, 45). Gearon further highlights that the said author lived in a location far from the center of all the action. Among the unproven details mentioned in The Chronicle of 754 is the inaccurate number of combat participants present in different battles. Other accounts such as that of Abd al-Hakem equally fall short in detail since the author was over 3,000 miles away from the invasion. Therefore, AIA fails in providing accurate data to some of the pressing questions that the audience may have.
The documentary fails to convince the audience if the events qualified to be termed as an ordinary raid or a full-blown invasion. As Gearon points out, Tariq's team that comprised of Berbers had set out on a grabbing spree since they knew the riches that the Iberian Penisula possessed (Gearon 47). Their knowledge was informed by the previous trade engagements they had with the locals. Several accounts on Andalusia, modern-day Spain, confirm that the region was vastly abundant in diverse ways ranging from natural resources to other essentials that were prominent for prosperity (Shamice 129). The area also enjoyed a rich culture championed by its residents. Therefore, personal gain, which topped the agenda of Tariq's troops, most likely quenched their thirst for a proper invasion. Invasions, unlike raids, are meant to achieve a complete takeover of the targeted region.
Two explanations further put to doubt the idea of invasion, as presented in the film. The first one centers on the composition of the invaders and those invaded. For it to qualify to be an Arab invasion of Andalusia (Spain), the invaders had to comprise of individuals solely from an Arab background. If not, a majority of them had to have links t.
SWK 527 -Signature Assignment Social Work Theory and Practice Ass.docxmabelf3
SWK 527 -Signature Assignment: Social Work Theory and Practice Assignment
EPAS 2015 - Competency 8: Intervene with Individuals, Families, Groups, Organizations, and Communities Social workers understand that intervention is an ongoing component of the dynamic and interactive process of social work practice with, and on behalf of, diverse individuals, families, groups, organizations, and communities. Social workers are knowledgeable about evidence-informed interventions to achieve the goals of clients and constituencies, including individuals, families, groups, organizations, and communities. Social workers understand theories of human behavior and the social environment, and critically evaluate and apply this knowledge to effectively intervene with clients and constituencies. Social workers understand methods of identifying, analyzing and implementing evidence-informed interventions to achieve client and constituency goals. Social workers value the importance of inter-professional teamwork and communication in interventions, recognizing that beneficial outcomes may require interdisciplinary, inter-professional, and inter-organizational collaboration.
Social workers:
· Critically choose and implement interventions to achieve practice goals and enhance capacities of clients and constituencies;
· Apply knowledge of human behavior and the social environment, person-in-environment, and other multidisciplinary theoretical frameworks in interventions with clients and constituencies;
· Use inter-professional collaboration as appropriate to achieve beneficial practice outcomes;
· Negotiate, mediate, and advocate with and on behalf of diverse clients and constituencies; and
· Facilitate effective transitions and endings that advance mutually agreed-on goals.
The Signature Assignment: (200 Points)
Signature Assignments are those assignments chosen by the WNMU School of Social Work faculty to evaluate a student’s ability to demonstrate the CSWE-mandated core competencies and related practice behaviors. In addition to measuring student competency, the assignments are used as indicators of program efficacy. Signature assignments are clearly identified in all School of Social Work syllabi. Students must demonstrate competency in order to pass each course. Students must complete all signature assignments throughout their program of study.
This Signature Assignment is an opportunity for you to apply critical thinking to explore topics of your professional interest related to social work theories, areas of social work practice and interventions that help our clients. The goal of the assignment for you to identify 2 theoretical perspectives that interests you and plan to use in your social work practice. Your chosen theories should be presented in relation to related area of practice, client system/population and supporting interventions. In order to optimize your learning, you encouraged to choose new areas of learning, rather than areas in which you hav.
The document discusses a persuasive speech on social justice warriors. It begins by introducing the topic and providing an overview of the key points to be covered: 1) types of social justice warriors, 2) benefits of their actions, and 3) real-world applications. The body then discusses Christopher Columbus's cruel treatment of indigenous people as evidence of the need for social justice advocacy. It argues that Indigenous Peoples' Day should replace Columbus Day in order to properly recognize Native American history and figures. The conclusion reiterates that society should not celebrate Columbus and instead pay respect to Native Americans who suffered at his hands.
Surname 2
Student’s Name
Professor’s Name
Course Code
Date
Turning Point
When growing up, children grow up wishing to be doctors, lawyers, surgeons, engineers or pilots mostly because these careers are regarded as high prestige in the society. However, very few of them desire to be teachers due to the perception that it is tiresome, low paying and requires a lot of work input. However, teaching is one of the most exciting jobs since it gives on a chance to help mold future career paths of different specialists such that in one class, it can consist of over fifty careers. Alternatively, good teachers act as role models due to their constant advice, sharing’s on life experiences and challenging students not to limit themselves to small achievements. As such, even as students go about their daily activities or after school, they always remember the teachings of a particular teacher and relate the activities thus being able to make better choices. Alternatively, the joy of teaching emanates from seeing other people make it in life or achieve their dreams and associating with their success.
The person who led me to consider a turning point was Peter Banks, my high school English teacher. He was inspiring in his lessons which he taught through life experiences and although he lacked technical expertise, when he talked, everyone played attention since he would communicate emotionally and make the whole process exiting using facial expressions, voice variations and using rhetorical questions which led us to think critically. Before he came along, English lessons were boring since we would lead literature books throughout the lessons, a process that had become tiring and monotonous which resulted to fall in grades. By good luck, the board of education showed concern on the issue and terminated the previous teacher. Peter would come to class, ask everyone to close their books and ask us to write what was on our thoughts even though it was ridiculous which would then discuss as a class. One of his major lessons was learning to write based on feelings as a way of being truthful to oneself and aiding the reader to form a connection.
Most teachers want to come to class, give assignments and wait for the time to lapse especially at the beginning of an academic year. However, this was not the case for Peter who would use any available chance to counsel us on what to expect in college and how to cope. He would share stories of his college life and in one particular case, he told us about the first time he was late for an exam because he overslept but he lied to the professor that he had fainted on the way to class and had to be rushed to the campus clinic. As such, Banks taught us on the importance of honest and ways of avoiding misconducts in future which could result in huge implications. For those of us who loved writing, he encouraged us to read most of the books in the library and analyze them amongst ourselves. Peter also supported talented individuals.
More Related Content
Similar to Synthesis Please click the link below to see the full description..docx
According to this idea that gender is socially constructed, answer.docxronak56
According to this idea that gender is socially constructed, answer the following questions:
1. What does it mean to be a man in the U.S.? What does it mean to be a woman?
2. From what institutions do we learn these gender roles?
3. How do these clips demonstrate the ways in which gender is socially constructed in the U.S.? Do the concepts discussed in the clips resonate with you? Why or why not?
In Persepolis, the main character Marji struggles to define her identity as an Iranian woman in a changing society.
· What roles are depicted for women in Iranian society in the film? How do they change over time?
· How does Persepolis demonstrate the ways in which gender and identity are influenced in many ways, by different processes across cultures? How are gender roles in Iran similar, or different to gender in the U.S.?
· What are some of the stereotypes that exist about Muslim women and how does Abu-Lughod in “Do Muslim Women Need Saving” and Persepolis complicate these stereotypes?
Answer the following questions 2 full pages
Running head: MAJOR HEALTH CARE PROBLEMS IN THE U.S. 1
Major Health Care Problems in the U.S.
Jane Doe
ID: 1212121
MAJOR HEALTH CARE PROBLEMS IN THE U.S. 2
Major Health Care Problems in the US
Problem statement: High and continuously rising cost of health care has been and still is one of
the biggest challenges affecting the Health Care system in United States.
Methods of Examining the Problem
Both qualitative and quantitative research methods should be used to fully understand the
issue of high cost of care in the US. Quantitative methods like surveys and experimentations will
aid in estimating the prevalence, magnitude and frequency of the problem in different regions.
On the other hand, qualitative methods like case studies and observation will help describe the
extent and complexity of the issue. The two approaches need to work in complementation to
obtain a clear understanding of this menace.
Surveys, as a quantitative research method, is one of the most effective in the social
research and present a more viable method of examining the cost of health in the country. They
involve asking of questions in the form of questionnaires and interviews. Questionnaires are
written questions to which the response can be open ended or multiple-choice format. This
would be used to gain information about cost within determinants that are of
disagree/neutral/agree nature. An example is if patients are contented with the cost of services
they get or they deem the cost of cover worthy. Interviews, the researcher discussing issues with
the respondents, are to be used to gain more details on already known aspects of the system. This
may include gathering information to inform policies, administration and use of technology to
minimize the cost of care.
Since health cost in the US is not a new challenge and there have been studies about it,
qualitative methods like .
Essay On Health Care
Essay On Home Health Care
Healthcare in the United States Essay
Essay about U.S. Health Care system
The Cost Of Health Care Essay
Essay on Definitions of Health
Health Care Persuasive Essay
Essay On Healthcare System
Home Health Journal Essay examples
Essay about Funding Healthcare Services
Discussion Of Health Care System Essay Paper.docx4934bk
The document discusses factors that impact the US healthcare system. It argues that while healthcare is considered a basic human right, it operates as a privilege in the US due to many people remaining uninsured. Social determinants of health and health disparities also impact the system by influencing health outcomes, particularly for vulnerable groups, and how healthcare is provided through integrating social services. The seven key drivers identified by Appleby that influence rising healthcare costs are discussed, including fee-for-service reimbursement, an aging population, demand for new technologies, tax breaks for insurance, lack of information, industry consolidation, and supply/demand issues.
Assessing U.S. and International Experience with Health Reform and Implications for the Future by W. David Helms, Ph.D, President and CEO, Academy Health
MMS State of the State Conference: Susan Dentzer - Rationalizing Health Spend...Frank Fortin
The document discusses challenges facing Massachusetts and the US in controlling rising healthcare costs. It notes that current spending growth rates threaten Massachusetts' reforms and the nation's fiscal health. Several key drivers of higher spending are identified, including new medical technologies, chronic diseases like obesity, and low productivity growth in the healthcare sector. Solutions proposed include reducing unnecessary variations in supply-sensitive care, payment reforms like bundled payments that incentivize quality over quantity, and policies to improve prevention and management of chronic conditions.
Running head IMPACT OF SMOKING ON HEALTHCARE COSTS1IMPACT OF.docxcowinhelen
Running head: IMPACT OF SMOKING ON HEALTHCARE COSTS 1
IMPACT OF SMOKING ON HEALTHCARE COSTS 6
Impact of smoking on healthcare costs
Cherod Jones
American Military University
Impact of smoking on healthcare costs
Introduction
In the world today, smoking is one of the things that trigger a significant number of ailments on people. This is the case because tobacco affects almost all internal body organs gradually compromising their functioning (Stewart, & Wild, 2017). The research claims that continued smoking makes a person susceptible to contract more than one ailment, which becomes hard to treat. Many people who smoke have recurring diseases that are hard to get rid of. Smoking negatively affects the cost of healthcare not only because of triggering ailments but in many other aspects. The purpose of this research paper shall focus on the various ways that smoking impacts healthcare cost.
Body of paper
An overview of the issue
Smoking is a complex health challenge that negatively affects the cost of healthcare in different countries around the world, but mainly the U.S. Smoking-related ailments include; stroke, coronary heart disease, cardiovascular disease, damaged and blocked blood vessels, respiratory infections like emphysema, chronic bronchitis, and asthma. Smoking also plays a vital role in the formation and development of all types of cancer. For instance: bladder, blood (acute myeloid leukemia), cervix, esophagus, colon, and rectum (colorectal), kidney and ureter (Lloyd-Jones et al., 2010). According to some researchers, other cancers caused by smoking are; “larynx, liver, oropharynx (includes parts of the throat, tongue, soft palate, and the tonsils), pancreas, stomach, trachea, bronchus, and lung” (Stewart & Wild, 2017). Meaning, that a majority of healthcare issues addressed in different healthcare facilities emanates from smoking. The challenge is that these ailments are complicated and they need high-quality skills, quality medical equipment, and resources to maintain services. Patients will have to incur the high cost of treatment. Therefore smoking causes an escalation in healthcare cost.
Why is this issue a concern from a health care economics perspective?
Ailments emanating from smoking are complex and requires a significant concern for the healthcare economics. The idea is that high skilled medical professionals need to be paid in a manner that is equivalent to the services they are offering. The tools required to diagnose and test are expensive, making healthcare services providing smoking-related ailments treatment costly. Moreover, the medication for such diseases is too strong and goes through a long and tedious process, which makes it hard to cut on the cost of production. In other cases, some of the diseases require surgeries which are complex and sensitive putting a demand on the number of medical surgeons.
Who are the major parties involved in this issue
· Government as they set laws and en ...
Health Care and Medicare Corporate Culture and the Three-Legged StoolLillian Rosenthal
This document discusses the history and current state of Medicare spending in the United States. It notes that while Medicare was originally intended to provide healthcare access for seniors, costs have risen significantly due to an aging population living longer and advancing medical technology. The document analyzes newly released data on payments made to individual physicians by the Centers for Medicare and Medicaid Services to determine if and how healthcare providers may respond to financial incentives.
The document discusses several issues with the U.S. healthcare system including a large uninsured population, rising costs of healthcare leading to increased bankruptcies, huge profits for healthcare corporations, and a growing national debt. It notes the U.S. ranks last in quality of healthcare compared to other industrialized nations while spending the most per capita. Key issues include a lack of access to primary care, high mortality rates from preventable conditions, and disparities in healthcare that disproportionately impact those in lower social and economic classes. Comprehensive healthcare reform is needed to address rising costs, ensure access and coverage for all Americans, and improve overall quality and outcomes of the healthcare system.
The United States spends more on healthcare than any other country but has poor health outcomes. Money influences the healthcare system in several ways. The system is fragmented with different providers and payers not sharing information, leading to duplicate tests and costs. A fee-for-service payment model incentivizes providers to see more patients and perform more procedures to increase payments. Lobbying by the pharmaceutical and insurance industries shapes healthcare policies and regulations in ways that prioritize profits over public health. Transforming how care is delivered, such as emphasizing prevention and plant-based diets, could reduce costs and improve health.
The document discusses Medicare spending in the United States. It reports that Medicare spending was reduced to 0.2% in 2013 compared to 1.8% between 2009-2012. This decrease may have resulted from the recession limiting spending, delivery system reforms to improve quality while reducing local costs, or a focus on patient-centered care. Statistical data from Medicare budget reports is cited to support the claims around reduced spending.
Healthcare oligopoly is Affecting u.s. economy convertedRoyJMeidinger
The document provides an overview of rising healthcare costs and declining outcomes in the United States compared to other developed nations. It notes that while the US spends much more per capita on healthcare, it has lower life expectancy and rates of preventable deaths than peers. The high costs are driven by administrative waste, high prices, and lack of cost control. The document argues that healthcare costs are a major burden on the US economy and individuals, and that reforms are needed to reduce costs while improving access and outcomes for all Americans.
Online Journal of Health EthicsVolume 1 Issue 1 Article .docxcherishwinsland
Online Journal of Health Ethics
Volume 1 | Issue 1 Article 5
Universal Healthcare in America
Sandra Carr Hayes
University of Mississippi Medical Center
Follow this and additional works at: http://aquila.usm.edu/ojhe
This Article is brought to you for free and open access by The Aquila Digital Community. It has been accepted for inclusion in Online Journal of Health
Ethics by an authorized administrator of The Aquila Digital Community. For more information, please contact [email protected]
Recommended Citation
Hayes, S. C. (2004). Universal Healthcare in America. Online Journal of Health Ethics, 1(1).
http://dx.doi.org/10.18785/ojhe.0101.05
http://aquila.usm.edu/ojhe?utm_source=aquila.usm.edu%2Fojhe%2Fvol1%2Fiss1%2F5&utm_medium=PDF&utm_campaign=PDFCoverPages
http://aquila.usm.edu/ojhe/vol1?utm_source=aquila.usm.edu%2Fojhe%2Fvol1%2Fiss1%2F5&utm_medium=PDF&utm_campaign=PDFCoverPages
http://aquila.usm.edu/ojhe/vol1/iss1?utm_source=aquila.usm.edu%2Fojhe%2Fvol1%2Fiss1%2F5&utm_medium=PDF&utm_campaign=PDFCoverPages
http://aquila.usm.edu/ojhe/vol1/iss1/5?utm_source=aquila.usm.edu%2Fojhe%2Fvol1%2Fiss1%2F5&utm_medium=PDF&utm_campaign=PDFCoverPages
http://aquila.usm.edu/ojhe?utm_source=aquila.usm.edu%2Fojhe%2Fvol1%2Fiss1%2F5&utm_medium=PDF&utm_campaign=PDFCoverPages
http://dx.doi.org/10.18785/ojhe.0101.05
mailto:[email protected]
Universal Healthcare
1
Universal Healthcare in America
Sandra Carr Hayes
University of Mississippi Medical Center
Keywords:
Health care; Universal Healthcare; Healthcare Access; National Health; Health Costs
Abstract
Lack of health care insurance, once thought to be a problem of the poor, and has
now begun to affect a new population- the middle class. The major factors
contributing to this are increased deductibles and co-payments, cost shifting and
the introduction of managed care networks. The idea of a universal health plan has
been introduced several times over the last few decades. With the introduction of
Medicare and Medicaid came the promise of a more inclusive health care plan for
all Americans. However, Medicare and Medicaid remain largely unchanged from
what they were when they were first introduced in 1965. The U. S. was built on the
foundation of ‘unalienable rights’. Why then is the number of uninsured and
uninsured rising and projected to continue rising? This article seeks to explore
these questions.
Universal Healthcare
2
Universal Healthcare in America
Introduction
One in six Americans doesn’t have health insurance. Studies have shown that health
insurance and poverty are the strongest determinants of access to health services
(Guendelman, et. al, 1986). The uninsured are less likely to obtain medical attention
when they have a perceived "need for care". This is best illustrated in the case of
George and Tina. George and Tina were siblings who had been diagnosed with
diabetes in childhood. However, their disease went un.
11 minutes agoJessica Dunne RE Discussion - Week 3COLLAPS.docxdrennanmicah
11 minutes ago
Jessica Dunne
RE: Discussion - Week 3
COLLAPSE
Top of Form
NURS 6050C: Policy and Advocacy for Improving Population Health
INITIAL POST
Economic Challenges of Healthcare Policy
The economics of the healthcare system in the United States is complex and fragmented. Costs associated with care and the prices healthcare consumers pay are determined by a wide variety of factors making it extremely difficult to find a one size fits all solution. Knickman and Kovner (2015) argue that healthcare is neither a commodity or a service, because of the high variabilities in need, cost, and consumption. The United States spends 80% of all healthcare revenue on just 20% of the population. Health insurance can be provided by the government, the private sector, or an employer. Some citizens do not have any form of healthcare coverage. Regardless of type, insurance coverage generally only pays a portion of the total healthcare cost leaving the consumer to pay the remaining balance. Moreover, reimbursement standards differ for facilities and providers. The government reimburses healthcare facilities, such as hospitals a fixed amount per patient, which creates a higher incentive to work efficiently. Healthcare providers, on the other hand, are reimbursed based on a fee for service model, meaning the more services they provide, the more money they are reimbursed (Knickman & Kovner, 2015).
Reindart (2010) maintains the passage of the Affordable Care Act (ACA) created more strain on the system by adding approximately 30 million uninsured Americans to the market. The projected cost to provide such coverage is around 8 billion to 1 trillion dollars over the next decade. However, the estimated expense of healthcare with no legislative intervention is 35 trillion dollars over the next decade (Reindart, 2010). Laureate Education (2012) contends that the human resources required to provide healthcare to an additional 30 million people is another consideration the ACA does not address. The United States is already experiencing staff shortages for key healthcare jobs like nurses and physicians. Additionally, with baby boomers retiring from the workforce and simultaneously needing more healthcare resources as they age will inevitably exacerbate the shortage of providers (Laureate Education, 2012).
Ethical Considerations
It is important to recognize that the private sector often follows the public sector when deciding what services will be covered (Knickman & Kovner, 2015). Therefore, the implications of Medicare deciding not to pay for a drug or service will likely affect the entire population. Stein (2010) asserts that cost should not be a consideration in determining if medications or services will be paid for by Medicare. Nonetheless, that is what happened with Provenge, a vaccine indicated for late stage prostate cancer patients. The drug prolonged the lifespan of patients by about four months. Provenge costs around 93,000 dollars per p.
This document discusses socioeconomic issues in medicine. It summarizes that:
1) While only 10% of premature deaths are due to inadequate medical care, 40% are due to unhealthy behaviors like smoking, excessive drinking, obesity, and imprudent sexual behaviors.
2) Lower socioeconomic status is associated with poorer health and higher mortality, due to factors like higher rates of unhealthy behaviors, stress, and lack of control over life circumstances among those of lower socioeconomic status.
3) The United States spends much more on health care than other countries, at over 17% of GDP currently, due to both supply factors, like expensive technologies and specialist care, and demand factors, like consumer appetite for new medical advances
Similar to Synthesis Please click the link below to see the full description..docx (16)
SW 619Infancy and Early Childhood Development of Drug Addicted.docxmabelf3
SW 619
Infancy and Early Childhood Development of Drug Addicted Children
While in the womb fetus is in the it feeds off the food intake and nourishment through the
placenta, which also means that any substances such as drugs, alcohol or tobacco that enters the
mothers system flows through the placenta and is delivered to the fetus as well. From birth to three
years old is the most critical period in a child’s development process. Children of mothers that use
drugs while they are pregnant increase the likelihood that the child will suffer from some form of
birth defect and oftentimes born prematurely. The lasting effects of prenatal cocaine affect the
growth of the fetus physically. The results of the increase of premature birth, and generalized growth
retardation including decreased birth weight, shorter body length, and smaller head circumference
(Bigsby et al, 2011; Covington et al, 2002; Gouin et al, 2011; Mayes et al, 2003).
These toxic chemicals can sometimes have irreversible damage that affect the child’s normal
development process with regards to proper development of organs and brain function.
From the ages of 0-2 months old a child are expected to have develop motor skills that would
include the ability to recognize different colors and shapes, kicking waving, have the ability to
recognize familiar voices and their sleeping patterns would change, meaning that as they grow older
children should be sleeping a little longer than a new born baby. Children from the ages of 2
months old should be able to extend their arm and reach and pick up toys and other objects,
hand coordination by shifting objects from one hand to another. The child should be able to pick up
finger food and bring it to their mouths. Identifying a problem with a child is when they are not able
to perform these age appropriate task.
A toddler ages 3 to 5 years old should be able to perform task such as holding crayons drawing horizontal lines, circles and have the ability to fold and snip paper with scissors. Children that have been exposed to substance may struggle with completing these tasks or will develop these cognitive skills at a slower rate. One study using play behavior (Rodning, Beckwith, & Howard, 1989a) found that preterm toddlers exposed to cocaine
and other drugs to show poorly developed play behaviors, and a lack of interest and motivation in
unstructured situations, in comparison to a group of high risk preterm children. Using play behavior,
one study found preterm toddlers exposed to cocaine and other drugs to show poorly. However, by
3 years of age, there were no changes associated with fine motor performance or behavior observed
with the child externalizing behavioral problems at age 5 years old. Stress and psychological
symptoms of caregivers were found to be in direct correlation with increased child behavioral issues;
indicating that the effected children may have m.
SWK311 Assessment 2 Final EssayWhat is t.docxmabelf3
SWK311 Assessment 2
Final Essay
What is the policy and its impact on vulnerable groups?
Why should/could you influence change?
How can you influence social policy change?
Developing your own practice framework for influencing policy change
What, Why and How
Critical analysis of social policy
Application of theory to practice
Adherence to academic conventions of writing (eg referencing; writing style)
At least 8 references
Assessment Criteria
a) Critically examine the policy or policies that you consider impact upon a client group
Suggest ways that policy could be changed to improve the life outcomes for those with whom you are working.
Part 1
What is this?
Not just describing
Critical analysis – a reminder
Critically examine
What is the political and ideological underpinning of the social policy?
What is the intended outcome of the policy? Is it achieving this gaol?
How the policy impacts your client group – both positive and negative impacts
How is the policy implemented – for example income support as delivered through Centrelink
Is it the policy or the service delivery that is the problem
Prompt questions
Consider vulnerable populations/clients you work with or those that interest you.
There are likely to be many policies that impact the group you choose. It is important to acknowledge the ways that economic and social policies intersect.
You can select one main policy or several policies for the purpose of the assignment.
e.g. women – are impacted by economic policy, income support, parenting payments and family tax benefits, child care support and many more.
recap
As you have worked through this unit, there are likely to have been topics or issues that have resonated with your , or really grated you.
For example, do you feel angry that people on income support payments appear to be allowed to just sit around and do nothing? Do you think the government supports them to just do nothing?
What would happen if there was a continued tightening of conditions for receiving income support?
Would anyone suffer? Would this matter? Would this impact society?
Why influence change?
Do you consider the government approach to income support is punitive?
Does the approach of welfare conditionality under a neoliberal government leave vulnerable people at risk?
What would drive your approach to intervene in this area of macro policy compared to the approach you would take if you fully supported government’s tightening of access to income support?
Alternatively
It is important to know your current world view and values as you enter any field of human services practice.
This will ensure that your tactics and strategies for influencing policy are transparent and appropriate.
Do your own values and philosophy align with those of your professional association?
Articulate your own theoretical perspective
Develop a framework that you would adopt for influencing policy change th.
Surname 1
Student's Name
Professor's Name
Course
Date
Kanopy Films Option 6: Arab Invasion of Andalusia
The film, Arab Invasion of Andalusia (AIA), narrates the story that ignited a period of 800 years of what would be the Muslim reign in the region of the Iberian Peninsula. Information regarding the said events has been hard to come by with the available sources lacking the much-needed reliability. However, armed with minimal sources of information, the creators of the documentary set to answer tricky questions on a topic where most people have failed. While AIA presents a fascinating experience for history scholars and other interested parties alike, the film still lacks in terms of the accuracy of the submitted data, making it unreliable to some extent.
The documentary is primarily based on the accounts detailed in a document whose author did not live the said ordeals. A first-hand account experience of events usually is accurate since the narrator can give more details, which are valid and reliable. However, in the mentioned film, the creators rely on data contained in a document known as “The chronicle of 754”. According to Gearon, the author of the material was a native Christian who lived in Iberia, whose real identity was unknown (Gearon, 45). Gearon further highlights that the said author lived in a location far from the center of all the action. Among the unproven details mentioned in The Chronicle of 754 is the inaccurate number of combat participants present in different battles. Other accounts such as that of Abd al-Hakem equally fall short in detail since the author was over 3,000 miles away from the invasion. Therefore, AIA fails in providing accurate data to some of the pressing questions that the audience may have.
The documentary fails to convince the audience if the events qualified to be termed as an ordinary raid or a full-blown invasion. As Gearon points out, Tariq's team that comprised of Berbers had set out on a grabbing spree since they knew the riches that the Iberian Penisula possessed (Gearon 47). Their knowledge was informed by the previous trade engagements they had with the locals. Several accounts on Andalusia, modern-day Spain, confirm that the region was vastly abundant in diverse ways ranging from natural resources to other essentials that were prominent for prosperity (Shamice 129). The area also enjoyed a rich culture championed by its residents. Therefore, personal gain, which topped the agenda of Tariq's troops, most likely quenched their thirst for a proper invasion. Invasions, unlike raids, are meant to achieve a complete takeover of the targeted region.
Two explanations further put to doubt the idea of invasion, as presented in the film. The first one centers on the composition of the invaders and those invaded. For it to qualify to be an Arab invasion of Andalusia (Spain), the invaders had to comprise of individuals solely from an Arab background. If not, a majority of them had to have links t.
SWK 527 -Signature Assignment Social Work Theory and Practice Ass.docxmabelf3
SWK 527 -Signature Assignment: Social Work Theory and Practice Assignment
EPAS 2015 - Competency 8: Intervene with Individuals, Families, Groups, Organizations, and Communities Social workers understand that intervention is an ongoing component of the dynamic and interactive process of social work practice with, and on behalf of, diverse individuals, families, groups, organizations, and communities. Social workers are knowledgeable about evidence-informed interventions to achieve the goals of clients and constituencies, including individuals, families, groups, organizations, and communities. Social workers understand theories of human behavior and the social environment, and critically evaluate and apply this knowledge to effectively intervene with clients and constituencies. Social workers understand methods of identifying, analyzing and implementing evidence-informed interventions to achieve client and constituency goals. Social workers value the importance of inter-professional teamwork and communication in interventions, recognizing that beneficial outcomes may require interdisciplinary, inter-professional, and inter-organizational collaboration.
Social workers:
· Critically choose and implement interventions to achieve practice goals and enhance capacities of clients and constituencies;
· Apply knowledge of human behavior and the social environment, person-in-environment, and other multidisciplinary theoretical frameworks in interventions with clients and constituencies;
· Use inter-professional collaboration as appropriate to achieve beneficial practice outcomes;
· Negotiate, mediate, and advocate with and on behalf of diverse clients and constituencies; and
· Facilitate effective transitions and endings that advance mutually agreed-on goals.
The Signature Assignment: (200 Points)
Signature Assignments are those assignments chosen by the WNMU School of Social Work faculty to evaluate a student’s ability to demonstrate the CSWE-mandated core competencies and related practice behaviors. In addition to measuring student competency, the assignments are used as indicators of program efficacy. Signature assignments are clearly identified in all School of Social Work syllabi. Students must demonstrate competency in order to pass each course. Students must complete all signature assignments throughout their program of study.
This Signature Assignment is an opportunity for you to apply critical thinking to explore topics of your professional interest related to social work theories, areas of social work practice and interventions that help our clients. The goal of the assignment for you to identify 2 theoretical perspectives that interests you and plan to use in your social work practice. Your chosen theories should be presented in relation to related area of practice, client system/population and supporting interventions. In order to optimize your learning, you encouraged to choose new areas of learning, rather than areas in which you hav.
The document discusses a persuasive speech on social justice warriors. It begins by introducing the topic and providing an overview of the key points to be covered: 1) types of social justice warriors, 2) benefits of their actions, and 3) real-world applications. The body then discusses Christopher Columbus's cruel treatment of indigenous people as evidence of the need for social justice advocacy. It argues that Indigenous Peoples' Day should replace Columbus Day in order to properly recognize Native American history and figures. The conclusion reiterates that society should not celebrate Columbus and instead pay respect to Native Americans who suffered at his hands.
Surname 2
Student’s Name
Professor’s Name
Course Code
Date
Turning Point
When growing up, children grow up wishing to be doctors, lawyers, surgeons, engineers or pilots mostly because these careers are regarded as high prestige in the society. However, very few of them desire to be teachers due to the perception that it is tiresome, low paying and requires a lot of work input. However, teaching is one of the most exciting jobs since it gives on a chance to help mold future career paths of different specialists such that in one class, it can consist of over fifty careers. Alternatively, good teachers act as role models due to their constant advice, sharing’s on life experiences and challenging students not to limit themselves to small achievements. As such, even as students go about their daily activities or after school, they always remember the teachings of a particular teacher and relate the activities thus being able to make better choices. Alternatively, the joy of teaching emanates from seeing other people make it in life or achieve their dreams and associating with their success.
The person who led me to consider a turning point was Peter Banks, my high school English teacher. He was inspiring in his lessons which he taught through life experiences and although he lacked technical expertise, when he talked, everyone played attention since he would communicate emotionally and make the whole process exiting using facial expressions, voice variations and using rhetorical questions which led us to think critically. Before he came along, English lessons were boring since we would lead literature books throughout the lessons, a process that had become tiring and monotonous which resulted to fall in grades. By good luck, the board of education showed concern on the issue and terminated the previous teacher. Peter would come to class, ask everyone to close their books and ask us to write what was on our thoughts even though it was ridiculous which would then discuss as a class. One of his major lessons was learning to write based on feelings as a way of being truthful to oneself and aiding the reader to form a connection.
Most teachers want to come to class, give assignments and wait for the time to lapse especially at the beginning of an academic year. However, this was not the case for Peter who would use any available chance to counsel us on what to expect in college and how to cope. He would share stories of his college life and in one particular case, he told us about the first time he was late for an exam because he overslept but he lied to the professor that he had fainted on the way to class and had to be rushed to the campus clinic. As such, Banks taught us on the importance of honest and ways of avoiding misconducts in future which could result in huge implications. For those of us who loved writing, he encouraged us to read most of the books in the library and analyze them amongst ourselves. Peter also supported talented individuals.
Switching costs ____________________________.
Question 1 options:
a)
that are high provide good opportunities for new partners or suppliers to enter this market (picture).
b)
in consumer markets can be high due to investments that partners make in matching buying and ordering.
c)
can be kept lower by utilizing a sole supplier.
d)
are more important for businesses, than for consumer buyers, due to the close buyer-seller relationships that develop.
e)
that are kept high are a good long-term tactic to keep buyers locked into poor quality service.
Question 2
(3 points)
Which of the following applies to Intellectual Property law?
Question 2 options:
a)
copyrights provide protection for trade secrets.
b)
copyrights provide protection for the original works of authors, musicians, and photographers.
c)
confidentiality agreements are only required for customers.
d)
requires a substantiality test to gain property protection.
e)
tends to reduce competition and decrease innovation.
Question 3
(3 points)
Business buyers
are similar
to final consumers in that:
Question 3 options:
a)
They purchase products and services that support the production of other products.
b)
Ensuring that revenues exceed costs always the primaryconsideration when evaluating a product for purchase.
c)
They purchase products to add to and make their own final product
d)
Customer satisfaction is determined by the customer when the product or service is consumed.
e)
Products purchased are often incorporated into the buying organization's offering to its own customers.
Question 4
(3 points)
Based on the Endries Fastener Company video, the goal of the President of Endries Supply Company was to __________________________.
Question 4 options:
a)
save their customers at least 4% of the cost of their fasteners.
b)
not get involved in Endries' customers' buying decisions until the Deliver
Solution
Stage
c)
be the sole supplier of all the fastener needs of Endries' customers by getting involved all the way through their manufacturing processes.
d)
be the number two fastener provider for the U. S. Department of Defense.
e)
be the number one fastener provider for the women's fashion industry.
Question 5
(3 points)
A good example of Natural Law is ______________?
Question 5 options:
a)
behaving naturally and not getting too excited when a crisis occurs in your company.
b)
the belief that some people are just naturally bad and the more of these bad people that we lock up the better.
c)
when executives just naturally look out for themselves and take company funds for their personal use.
d)
a belief that taking anyone's life is wrong, even for the government when terrible mass murders are committed, like those by the young man in Charleston at a church prayer meeting.
e)
protecting the natural environment by restricting access to wilderness areas
Question 6
(3 points)
Which of the following takes place.
swer the following questionsWhy would it be important for you.docxmabelf3
swer the following questions:
Why would it be important for you, an investor and a manager, to be able to read and analyze financial statements?
Do you think it would be important for a nonprofit entity to provide statements. Why?
Do you think statements are relevant given the estimates, assumptions, and biases involved?
.
Swifts A Modest Proposal is one of the most famous examples of sa.docxmabelf3
Swift's "A Modest Proposal" is one of the most famous examples of satire in the English language. Why would he argue for the very behavior that he would want readers to shun?
Make sure you understand what the satire is and who is being criticized. Think about what Swift would want to see changed. Entry should be 350 - 400 words
A Modest Proposal
For preventing the children of poor people in Ireland,
from being a burden on their parents or country,
and for making them beneficial to the publick.
by Dr. Jonathan Swift
1729
It is a melancholy object to those, who walk through this great town, or travel in the country, when they see the streets, the roads, and cabbin-doors crowded with beggars of the female sex, followed by three, four, or six children, all in rags, and importuning every passenger for an alms. These mothers, instead of being able to work for their honest livelihood, are forced to employ all their time in stroling to beg sustenance for their helpless infants who, as they grow up, either turn thieves for want of work, or leave their dear native country, to fight for the Pretender in Spain, or sell themselves to the Barbadoes.
I think it is agreed by all parties, that this prodigious number of children in the arms, or on the backs, or at the heels of their mothers, and frequently of their fathers, is in the present deplorable state of the kingdom, a very great additional grievance; and therefore whoever could find out a fair, cheap and easy method of making these children sound and useful members of the commonwealth, would deserve so well of the publick, as to have his statue of him set up for a preserver of the nation.
But my intention is very far from being confined to provide only for the children of professed beggars: it is of a much greater extent, and shall take in the whole number of infants at a certain age, who are born of parents in effect as little able to support them, as those who demand our charity in the streets.
As to my own part, having turned my thoughts for many years upon this important subject, and maturely weighed the several schemes of our projectors, I have always found them grossly mistaken in their computation. It is true, a child just dropt from its dam, may be supported by her milk, for a solar year, with little other nourishment: at most not above the value of two shillings, which the mother may certainly get, or the value in scraps, by her lawful occupation of begging; and it is exactly at one year old that I propose to provide for them in such a manner, as, instead of being a charge upon their parents, or the parish, or wanting food and raiment for the rest of their lives, they shall, on the contrary, contribute to the feeding, and partly to the clothing of many thousands.
There is likewise another great advantage in my scheme, that it will prevent those voluntary abortions, and that horrid practice of women murdering their bastard children, alas! too frequent.
Sweep up a small area of your floor. Take a look at the trace evide.docxmabelf3
Sweep up a small area of your floor. Take a look at the “trace evidence” that is contained within your home. Write a short 200 word essay detailing what you found and how you could collect known samples from items in your home or outside your home that a lab could compare to your “trace evidence”.
Please use APA format, Times New Roman 12 point font with 1" page margins
.
sweep things under the rug or pre-tend it never happened. in.docxmabelf3
sweep things under the rug or pre-
tend it never happened. in worship
services, take time to share with the
people how rich they are in god’s
grace rather than just telling them
how they should behave. in this sec-
tion of the book, the author does get
very specific on how to make sure
grace is shared publicly. Whether it is
in the worship service or dealing with
visitors as they walk in the door,
making sure people experience christ
is vital.
“Portable grace,” as Eclov calls it,
reveals how to minister outside the
walls of the church through hospital
ministry, death and grief, childbirth
visits, or home and work visitation.
One practical application that pastors
should hear is that one does not need
to be invited to go. As young pastors,
we usually do not go where we are
not invited, but the author recom-
mends challenging that thinking by
going proactively. i have taken this
advice, and it really has been a great
blessing for me and for those i’m
visiting.
Probably one of the most practical
chapters in the book is “March into
the Smoke.” When times are scary,
cloudy and daunting, a leader can
easily experience disorientation and
loss of focus. this section of the book
is for such pastors who are weary and
tired. it emphasizes the importance
of being healthy on the inside so that
you can take care of those on the out-
side. the pastor may project unre-
solved anger onto the congregation
without even realizing it. the things
he brings up are valid, but one thing
he is lacking is the how-to or even
the call to action for the pastor to get
help with anger or depression.
One concluding critique: in the
midst of his stories and encounters,
the author interjects his unique doc-
trinal understandings in the mix of
his stories and illustrations.
consequently, some of the conversa-
tions and interactions with others
would be very different if processed
in different faith tradition contexts.
the reader simply needs to filter and
adapt accordingly.
Pastoral Graces is a good book for
those who need encouragement. i
found the book to be helpful when it
comes to personal connections with
parishioners. As pastors, we can get
burned out and depressed, and feel
very much alone. this book is not a
fix-all, but it is a reminder that god
really does love us and care about us
as his messengers of grace. i cannot
say this book is for every pastor, but i
do recommend it for the young pas-
tors, new pastors, and discouraged
pastors who are on the verge of giv-
ing up. i believe the author accom-
plished what he set out to accom-
plish.
StEPhEN cArLiLE is a student in the Andrews
University Master’s of Pastoral Ministry extension
program and serves as church pastor of Adventist
Fellowship in tulsa, Oklahoma.
CHANGE LEADER:
LEARNING TO DO WHAT
MATTERS MOST
By Michael Fullan
San Francisco, CA: Jossey-Bass/Wiley
(2011)
Hardback, 172 pages
Reviewed by JORGE PEREZ
in Change Leader, Michael Fullan
argues for the importance of practice
as a learning tool for .
Susan serves on the city building commission.The city is plannin.docxmabelf3
Susan serves on the city building commission.
The city is planning to build a new subway system to extend the reach of the subway further out from the city center.
Susan’s cousin, Sam, owns Subway Mobility Co., submitted the lowest bid for the system.
Susan knows that Sam could complete the job for the amount in his bid.
But she also knows that once Sam finishes this job, he will probably sell his company and retire.
Susan is concerned that Subway Mobility’s subsequent management might not be as easy to work with if revisions need to be made on the subway system after its completion.
She is torn as to whether she should tell the city about the potential changes in Subway Mobility’s management.
If the city knew about the potential change in Subway Mobility’s management, it might prefer to give the K to one of Subway’s competitors, whose bid was only slightly higher than Subway’s was..
Does Susan have an ethical obligation to disclose the information about Sam to the city planning commission?
.
Susan serves on the city building commission.The city is plann.docxmabelf3
Susan serves on the city building commission.
The city is planning to build a new subway system to extend the reach of the subway further out from the city center.
Susan’s cousin, Sam, owns Subway Mobility Co., submitted the lowest bid for the system.
Susan knows that Sam could complete the job for the amount in his bid.
But she also knows that once Sam finishes this job, he will probably sell his company and retire.
Susan is concerned that Subway Mobility’s subsequent management might not be as easy to work with if revisions need to be made on the subway system after its completion.
She is torn as to whether she should tell the city about the potential changes in Subway Mobility’s management.
If the city knew about the potential change in Subway Mobility’s management, it might prefer to give the K to one of Subway’s competitors, whose bid was only slightly higher than Subway’s was..
Does Susan have an ethical obligation to disclose the information about Sam to the city planning commission?
How would you apply duty-based ethical standards to this question?
What might be the outcome of a utilitarian analysis?
Discuss each fully
.
SUSAN GLASPELL TRIFLES SCENE The kitchen in the now aba.docxmabelf3
SUSAN GLASPELL: TRIFLES
SCENE: The kitchen in the now abandoned farmhouse of John Wright, a gloomy kitchen, and left without having been put in order—unwashed pans under the sink, a loaf of bread outside the breadbox, a dish towel on the table—other signs of incompleted work. At the rear the outer door opens, and the Sheriff comes in, followed by the County Attorney and Hale. The Sheriff and Hale are men in middle life, the County Attorney is a young man; all are much bundled up and go at once to the stove. They are followed by the two women—the Sheriff’s Wife first; she is a slight wiry woman, a thin nervous face. Mrs. Hale is larger and would ordinarily be called more comfortable looking, but she is disturbed now and looks fearfully about as she enters. The women have come in slowly, and stand close together near the door.
County Attorney (rubbing his hands): This feels good. Come up to the fire, ladies.
Mrs. Peters (after taking a step forward): I’m not—cold.
Sheriff (unbuttoning his overcoat and stepping away from the stove as if to the beginning of official business): Now, Mr. Hale, before we move things about, you explain to Mr. Henderson just what you saw when you came here yesterday morning.
County Attorney: By the way, has anything been moved? Are things just as you left them yesterday?
Sheriff (looking about): It’s just the same. When it dropped below zero last night, I thought I’d better send Frank out this morning to make a fire for us—no use getting pneumonia with a big case on, but I told him not to touch anything except the stove—and you know Frank.
County Attorney: Somebody should have been left here yesterday.
Sheriff: Oh—yesterday. When I had to send Frank to Morris Center for that man who went crazy—I want you to know I had my hands full yesterday. I knew you could get back from Omaha by today, and as long as I went over everything here myself—
County Attorney: Well, Mr. Hale, tell just what happened when you came here yesterday morning.
Hale: Harry and I had started to town with a load of potatoes. We came along the road from my place;and as I got here, I said, “I’m going to see if I can’t get John Wright to go in with me on a party telephone.” I spoke to Wright about it once before, and he put me off, saying folks talked too much anyway, and all he asked was peace and quiet—I guess you know about how much he talked himself;but I thought maybe if I went to the house and talked about it before his wife, though I said to Harry that I didn’t know as what his wife wanted made much difference to John—
County Attorney: Let’s talk about that later, Mr. Hale. I do want to talk about that, but tell now just what happened when you got to the house.
Hale: I didn’t hear or see anything; I knocked at the door, and still it was all quiet inside. I knew they must be up, it was past eight o’clock. So I knocked again, and .
SUSTAINABLE URBAN DEVELOPMENT, GOVERNANCE, AND POLICY A COMPARATIVE.docxmabelf3
SUSTAINABLE URBAN DEVELOPMENT, GOVERNANCE, AND POLICY: A COMPARATIVE OVERVIEW OF EU POLICIES AND PROJECTS
Case Studies – Energy Efficiency
• Integrating Energy Efficiency and Urban Sustainability
• The Dutch Kadaster
• The Solar Atlas of Berlin
• The Sicilian “Carta del Sole”
Need a research paper on these above 4 case studies and APA format references are mandatory.
.
Susan Wolf thinks that that meaning has both a subjective and an.docxmabelf3
Susan Wolf thinks that that meaning has both a subjective and an objective component. On one hand, a person must enjoy, appreciate, or, in some broad sense, engage positively with something in order for it to contribute to their life’s meaning. On the other hand, they must be making an objective contribution to something that is valuable on its own, not something valuable just for how it benefits them. Meaningful lives participate in something larger than the individual whose life it is. Begin your paper by explaining the "passion view," the "larger than oneself view," and Wolf's own hybrid view of meaning in life.
Then, give your own example of something that does or could ass extraordinary meaning to your life. Do not use Wolf's own examples - be creative! Explain how that thing conforms to Wolf's hybrid theory of meaning in life. Then identify what you think is the biggest obstacle to living a meaningful life in today's society. Why is it such a big obstacle? This can be either an obstacle that you yourself are facing or something that you think prevents other people from living a life that is as meaningful as it could be.
.
Sustainable Urban Development, Governance and Policy A Comparative .docxmabelf3
Sustainable Urban Development, Governance and Policy: A Comparative Overview of EU Policies and Project which should Consist of below 4 modules:
CHAPTER SUMMARY: Summarize chapter presented during the week. Identify the main point (as in "What's your point?"), thesis, or conclusion of the key ideas presented in the chapter.
SUPPORT: Do research outside of the book and demonstrate that you have in a very obvious way. This refers to research beyond the material presented in the textbook. Show something you have discovered from your own research. Be sure this is obvious and adds value beyond what is contained in the chapter itself.
EVALUATION: Apply the concepts from the appropriate chapter. Hint: Be sure to use specific terms and models directly from the textbook in analyzing the material presented and include the page in the citation.
SOURCES: Include citations with your sources. Use APA style citations and references.
.
SUSTAINABLE ENERGY
SYSTEMS
1 | P a g e
Table of Contents:
List of Tables: ................................................................................................................................ 1
Introduction: .................................................................................................................................. 2
Energy Audit of New Castle House: .............................................................................................. 2
House Description: .................................................................................................................... 2
Electronic Appliances & Energy Consumption: ......................................................................... 3
Cost of Energy Consumption: ................................................................................................... 5
Potential Saving in Electricity: ....................................................................................................... 5
Energy Saving in Refrigerators: ................................................................................................ 6
Energy Saving in Washing Machine & Dryers: ......................................................................... 6
Energy Saving in Electric Oven: ............................................................................................... 7
Energy Saving in Lighting Load: ............................................................................................... 7
Energy Saving in Water Heating & Space Heating: .................................................................. 7
Summary of Energy and Cost Saving: .......................................................................................... 7
Conclusion: ................................................................................................................................... 8
References: ................................................................................................................................... 9
List of Tables:
Table 1. Household appliances with their wattage and average daily usage ............................... 4
Table 2. Average annual consumption of energy (kWh/year) by the household appliances ........ 4
Table 3. Cost of energy consumption by the appliances annually ................................................ 5
Table 4. Potential saving in energy consumption and saving in energy cost ............................... 8
2 | P a g e
Sustainable Energy System
Introduction:
In any modern societies in the world there are continuously increasing concerns over availability
of energy, energy consumption efficiency and reduction in losses over network. In developed
countries it is a challenging task to achieve sustainability in energy efficiency and growth. On the
other hand for developing countries challenge is to achieve self-reliance and ene.
ISO/IEC 27001, ISO/IEC 42001, and GDPR: Best Practices for Implementation and...PECB
Denis is a dynamic and results-driven Chief Information Officer (CIO) with a distinguished career spanning information systems analysis and technical project management. With a proven track record of spearheading the design and delivery of cutting-edge Information Management solutions, he has consistently elevated business operations, streamlined reporting functions, and maximized process efficiency.
Certified as an ISO/IEC 27001: Information Security Management Systems (ISMS) Lead Implementer, Data Protection Officer, and Cyber Risks Analyst, Denis brings a heightened focus on data security, privacy, and cyber resilience to every endeavor.
His expertise extends across a diverse spectrum of reporting, database, and web development applications, underpinned by an exceptional grasp of data storage and virtualization technologies. His proficiency in application testing, database administration, and data cleansing ensures seamless execution of complex projects.
What sets Denis apart is his comprehensive understanding of Business and Systems Analysis technologies, honed through involvement in all phases of the Software Development Lifecycle (SDLC). From meticulous requirements gathering to precise analysis, innovative design, rigorous development, thorough testing, and successful implementation, he has consistently delivered exceptional results.
Throughout his career, he has taken on multifaceted roles, from leading technical project management teams to owning solutions that drive operational excellence. His conscientious and proactive approach is unwavering, whether he is working independently or collaboratively within a team. His ability to connect with colleagues on a personal level underscores his commitment to fostering a harmonious and productive workplace environment.
Date: May 29, 2024
Tags: Information Security, ISO/IEC 27001, ISO/IEC 42001, Artificial Intelligence, GDPR
-------------------------------------------------------------------------------
Find out more about ISO training and certification services
Training: ISO/IEC 27001 Information Security Management System - EN | PECB
ISO/IEC 42001 Artificial Intelligence Management System - EN | PECB
General Data Protection Regulation (GDPR) - Training Courses - EN | PECB
Webinars: https://pecb.com/webinars
Article: https://pecb.com/article
-------------------------------------------------------------------------------
For more information about PECB:
Website: https://pecb.com/
LinkedIn: https://www.linkedin.com/company/pecb/
Facebook: https://www.facebook.com/PECBInternational/
Slideshare: http://www.slideshare.net/PECBCERTIFICATION
it describes the bony anatomy including the femoral head , acetabulum, labrum . also discusses the capsule , ligaments . muscle that act on the hip joint and the range of motion are outlined. factors affecting hip joint stability and weight transmission through the joint are summarized.
How to Setup Warehouse & Location in Odoo 17 InventoryCeline George
In this slide, we'll explore how to set up warehouses and locations in Odoo 17 Inventory. This will help us manage our stock effectively, track inventory levels, and streamline warehouse operations.
Strategies for Effective Upskilling is a presentation by Chinwendu Peace in a Your Skill Boost Masterclass organisation by the Excellence Foundation for South Sudan on 08th and 09th June 2024 from 1 PM to 3 PM on each day.
This slide is special for master students (MIBS & MIFB) in UUM. Also useful for readers who are interested in the topic of contemporary Islamic banking.
How to Make a Field Mandatory in Odoo 17Celine George
In Odoo, making a field required can be done through both Python code and XML views. When you set the required attribute to True in Python code, it makes the field required across all views where it's used. Conversely, when you set the required attribute in XML views, it makes the field required only in the context of that particular view.
Synthesis Please click the link below to see the full description..docx
1. Synthesis Please click the link below to see the full description.
View Full Description and Attachment(s)
Personality inventories often report the distribution of
personality types by gender. The chicken-and-egg question:
· To what degree is gender a component of personality, or
personality a component of gender?
· Is there a better way to express the relationship between the
two, and if so, what is it?
Please use course concepts and outside sources to support your
answer to this forum.
INSTRUCTIONS:
Initial posts must be 250+ words, using correct grammar and
spellcheck, posted. Part of the requirement for asubstantive
post is to bring something new to the conversation. Read the
forum prompt and fully answer it, demonstrate understanding of
the lesson/content, include evidence from firsthand experience,
reference to the course materials, and apply what you’re
discussing to work, life, and reality.
U.S. Health Care Spending In
An International Context
Why is U.S. spending so high, and can we afford it?
by Uwe E. Reinhardt, Peter S. Hussey, and Gerard F. Anderson
ABSTRACT: Using the most recent data on health spending
published by the Organization
2. for Economic Cooperation and Development (OECD), we
explore reasons why U.S. health
spending towers over that of other countries with much older
populations. Prominent
among the reasons are higher U.S. per capita gross domestic
product (GDP) as well as a
highly complex and fragmented payment system that weakens
the demand side of the
health sector and entails high administrative costs. We examine
the economic burden that
health spending places on the U.S. economy. We comment on
attempts by U.S. policy-
makers to increase the prices foreign health systems pay for
U.S. prescription drugs.
F
or a brief moment in the early 1990s it seemed that the
combina-
tion of “ managed care” embedded in “ managed competition”
would allow
the United States to keep its annual growth of health care
spending roughly
in step with the annual growth of gross domestic product
(GDP). It was a short-
lived illusion. By the turn of the millennium the annual growth
in U.S. health
spending once again began to exceed the annual growth in the
rest of the GDP by
ever-larger margins.
In the United States the impact on health spending of managed
care and man-
aged competition had been controversial from the start. Skeptics
argued that
these tools might yield a one-time savings, spread over a few
4. the panacea for cost control during the 1990s.
Furthermore, as can be seen in Exhibit 1, U.S. per capita health
spending con-
tinued to exceed per capita health spending in the other OECD
countries, by huge
margins, in 2001. After expenditures are converted into
purchasing-power parity
international dollars (PPP$), Switzerland spent only 68 percent
as much on
health care per capita in 2001 as the United States.3
Neighboring Canada, with a
health care delivery system and medical practice styles fairly
similar to those in the
H e a l t h S p e n d i n g
H E A L T H A F F A I R S ~ V o l u m e 2 3 , N u m b e r 3 1 1
EXHIBIT 1
Health Spending In OECD Countries, 2001
Total health spending per capita GDP per capita
Country PPP$
As percent of
U.S. spending
Average
annual
growth,
1991–2001 (%) PPP$
Average
12. 9,934
8,903
5,734
4.6
3.1
4.4
1.3
0.8
5.9
5.7
6.3
6.0
4.8
OECD median 2,161 44 3.0 26,392 2.1 8.1
SOURCE: Organization for Economic Cooperation and
Development (OECD) data, 2002.
NOTE: Growth rates are calculated from national currency
units, not U.S. dollar purchasing power parities (PPPs). NA is
not
available.
a 1990.
b 2000.
c 1998.
United States, spent only 57 percent as much per capita as the
United States. PPP-
adjusted per capita spending in the median OECD country was
only 44 percent of
the U.S. level (PPP$2,161).
13. Finally, the median percentage of GDP absorbed by health care
in the non-U.S.
OECD countries in 2001 was only 8.3 percent, compared with
13.9 percent in the
United States. Although that percentage remained more or less
constant during
the 1990s, during the previous two decades the average annual
growth of health
spending exceeded the growth of total GDP by 2.5–3 percent.4
U.S. government
actuaries now project that during 2003–2013 U.S. health
spending will revert to
its traditional, long-term trend. They project the annual growth
in U.S. health
spending to exceed the annual growth in GDP once again by
about two percent-
age points, and total national health spending to absorb as much
as 18.4 percent of
U.S. GDP by 2013.5
In this paper we examine data from the OECD database in
detail. We begin
with a brief review of the factors that can explain the relatively
high U.S. spending
on health care, drawing on earlier papers on the subject.6 We
then discuss interna-
tional issues in pharmaceutical pricing. Next, we explore the
ways that health
spending trends might be a burden on the U.S. economy. We
conclude that while
these trends are not an imminent burden on the macro economy,
they will place an
increasing burden on the members of lower-income groups even
within the com-
ing decade. Furthermore, by 2040 these trends will force the
14. United States to
make do with actual reductions in the nonhealth GDP per capita
overall. This
prospect leads many observers to judge current trends in U.S.
health spending
“ unsustainable” or “ unaffordable,” although, as we argue
further on, these terms
are so highly subjective that they lose meaning in this context.
Factors Driving High U.S. Health Spending
� GDP per capita. No single factor explains the levels or rates
of increase in
health spending among industrialized countries.7 However,
ability to pay, as mea-
sured by GDP per capita, has repeatedly been shown to be one
of the most impor-
tant factors.8 About 90 percent of the observed cross-national
variation in health
spending across the OECD countries in 2001 can be explained
simply by GDP per
capita. An estimated bivariate relationship between GDP per
capita and per capita
health spending predicts a U.S. per capita health spending level
of $3,435 for 2001.
The actual level, $4,887, is $1,452 or 42 percent higher than the
predicted level.9 Both
policymakers and clinicians need to examine what other factors
can account for that
remaining differential.
� Distribution of market power and prices. In a previous paper
we argued that
Americans pay much higher prices for the same health services
than citizens in
other countries pay.10 There are a number of reasons why this
15. might be so.
First, the distribution of compensation in the United States is
wider than in
most of the other industrialized countries. The highly trained
and highly talented
1 2 M a y / J u n e 2 0 0 4
C o s t s & C o m p e t i t i o n
health professionals employed in health care must be recruited
from the same tal-
ent pool used by other industries offering high compensation,
such as law and fi-
nance. Because health care is a labor-intensive industry, labor is
one factor driving
up the cost of producing health care in the United States.
Second, the highly fragmented organization of the financing of
health care in
the United States serves to allocate relatively greater market
power to the supply
side of the health system than to the demand side. As we have
argued in previous
papers, multiple purchasers of care allow U.S. prices to rise
above the level at-
tained in other industrialized countries that either endow the
demand side of
their health systems with strong, monopsonistic (single-buyer)
market power
(such as the Canadian provincial health plans) or allow
multipayer systems to bar-
gain collectively with the providers of health care, sometimes
16. within government-
set overall health care budgets (as, for example, in Germany).11
� The capacity of health systems. The relatively greater market
power on the
demand side of health systems in other countries can explain
why so many countries
allocate a lower fraction of their GDP to health care even
though they appear to be
more heavily endowed with hospital capacity and health
professionals than the
United States.12
Many industrialized countries have higher physician- and nurse-
to-population
ratios than the United States (Exhibit 2).13 The supply of U.S.
physicians per ca-
pita grew only 1 percent per year between 1991 and 2001; only
six countries had
slower growth rates during this period. A large part of the
increase in the U.S. phy-
sician supply represents international medical graduates
(IMGs), as the capacity
of U.S. medical schools has stayed virtually constant since the
1970s.14 The U.S.
nurse-to-population ratio (8.1 per 1,000 population) also was
below the OECD
median (9.0) in 2001. Growth in the supply of nurses was
relatively modest in the
United States—about 1.3 percent per year—and below the
median growth rate for
the OECD (1.6 percent).
Previous comparisons indicated that in recent years the United
States has had a
relatively low supply of computed tomography (CT) scanners
17. and magnetic reso-
nance imaging (MRI) devices relative to some OECD countries.
The United States
was an early adopter of these medical technologies and then
tended to be rela-
tively well endowed with the new technology by international
standards. Ulti-
mately, however, the United States did not acquire as large a
supply as Japan and
several other countries did.15
Finally, the United States has a relatively small endowment of
hospital beds per
capita compared with most other OECD countries (Exhibit 2).
The United States
is in the bottom quartile of hospital beds per capita. The
decrease in U.S. hospital
capacity between 1991 and 2001—0.8 beds per 1,000
population—is at the median
for OECD countries with available data.
� Administrative complexity and costs. By international
standards, the U.S.
approach to financing health care is extremely complex.
Research suggests that a
H E A L T H A F F A I R S ~ V o l u m e 2 3 , N u m b e r 3 1 3
H e a l t h S p e n d i n g
sizable fraction of higher U.S. health spending, not explainable
by higher GDP per
capita, can be traced to the higher administrative overhead
required by such a com-
18. plex system.16 To quote economist Henry Aaron on this point:
“Like many other ob-
servers, I look at the U.S. health care system and see an
administrative monstrosity, a
truly bizarre mélange of thousands of payers with payment
systems that differ for no
socially beneficial reason, as well as staggeringly complex
public system with mind-
boggling administered prices and other rules expressing
distinctions that can only
1 4 M a y / J u n e 2 0 0 4
C o s t s & C o m p e t i t i o n
EXHIBIT 2
Number Of Health Professionals And Hospital Beds Per 1,000
Population In OECD
Countries, 1991–2001
Physicians Nurses Hospital beds
Country
Number,
2001
Average
annual
growth,
1991–2001 (%)
Number,
2001
Average
annual
27. Development (OECD) data, 2002.
NOTE: NA is not available.
a 2000.
b 1999.
c 1998.
be regarded as weird.”17
Aaron’s comment was part of his response to a recent paper by
Steffie
Woolhandler, Terry Campbell, and David Himmelstein, who
find that administra-
tive costs for insurers, employers, and the providers of health
care in the U.S.
health system (not even including the time costs patients bear in
choosing health
insurance and claiming reimbursement) were “at least” $294.3
billion in 1999, or
about 24 percent of total U.S. health spending.18
Aaron’s remarks may leave the impression that public insurance
programs are
the chief culprits in this “administrative monstrosity.” However,
as Common-
wealth Fund president Karen Davis observed in her recent
testimony before Con-
gress, administrative expenses for private insurance in the
United States are two-
and-one-half times as high as those for public programs.19
� Unwillingness to ration health care. A country’s health care
system—espe-
cially its research and development (R&D) infrastructure—
continually gives soci-
28. ety the option of purchasing, through health care, additional
quality-adjusted life
years (QALYs) at increasingly higher prices. Exhibit 3
illustrates the shape such sup-
ply curves are likely to have.
The hypothetical curve in Exhibit 3 reflects the fact that some
relatively low-
cost medical interventions can yield additional QALYs at
relatively low incremen-
tal costs—for example, immunizations or prenatal care. At the
other end of the
spectrum, however, the health system can wrestle additional life
years from na-
ture’s course only at increasingly higher incremental costs.
Examples of such
high-cost procedures would be diagnostic tests broadly applied
to populations
with a low incidence of the disease targeted by the test,
especially in the presence
of many false positives. Heroic medical intervention at life’s
beginning or end also
H e a l t h S p e n d i n g
H E A L T H A F F A I R S ~ V o l u m e 2 3 , N u m b e r 3 1 5
EXHIBIT 3
Hypothetical Supply Of Quality-Adjusted Life Year (QALY)
Curve Offered By A Modern
Health Care System
falls into the high-cost range of the QALY supply curve.
The thrust of modern cost-effectiveness research—a distinct
29. branch of health
services research—is aimed at identifying the approximate
shape of this curve for
policymakers. In principle, policymakers should use that
information to answer
two morally troublesome questions faced by every country.
First, how far up the
QALY supply should the health system go to procure added
QALYs? Second,
should the maximum price to be paid for added QALYs be
uniformly applied to all
members of society or be allowed to vary with the individual
patient’s ability to
pay or with other factors, such as social status?
As Julian Le Grand suggests, the National Institute for Clinical
Effectiveness
(NICE) established by the Blair government in the United
Kingdom appears to be
using a cutoff price of £30,000 (about US$53,000 at the current
exchange rate) per
QALY beyond which treatments should not be publicly
funded.20 Above this
threshold, U.K. patients with discretionary funds or
supplemental private health
insurance could procure more costly treatments from the
country’s relatively
small private health sector. That cutoff price is mentioned also
by Nancy Devlin
and colleagues, who write that “it is clear from papers presented
to NICE’s Annual
Public Meeting that £30,000 per QALY has effectively become
the benchmark for
cost-effectiveness,” although they add that “there have been no
directions from
30. the Department of Health or the National Assembly for Wales
that they consider
this to be an appropriate test.”21
Policymakers in other countries typically have shied away from
setting an ex-
plicit cutoff price per QALY (or other measure of outcome)
above which collective
funds will not be used to purchase additional output from the
health sector. Such
a pronouncement would undoubtedly be politically controversial
and divisive. In-
stead, countries typically have sought to set that upper limit
implicitly, through a
mixture of price controls and limits on capacity. If one had to
make a rough guess
on the implicit prices that health systems are willing to pay for
QALYs, the relative
overall positions of the United Kingdom, Canada, and the
United States in Exhibit
3 seem plausible, although we make no pretense that the
differentials suggested
there are accurate. It might be illuminating in future cross-
national research to ex-
tract through opinion surveys from various stakeholders in
health care more ex-
plicit notions on the maximum price that should be devoted to
wrestling an addi-
tional QALY from nature through the health care system.
In the United States neither private health insurers nor the
publicly funded
Medicare and Medicaid programs appear to observe any explicit
guidelines on the
maximum price per QALY procured through health care. Two
possible exceptions
31. are private health insurance policies that have lifetime upper
limits and the
1 6 M a y / J u n e 2 0 0 4
C o s t s & C o m p e t i t i o n
“Concern over unduly low drug prices abroad now finds
expression
in U.S. trade negotiations with other countries.”
Medicare program, which lacks catastrophic benefits. For low-
income Americans
without health insurance, there may well be much lower,
haphazardly imposed,
implicit upper limits on the price per QALY that society is
willing to pay on their
behalf.22 A series of recent reports by the Institute of Medicine
(IOM) has docu-
mented that uninsured Americans receive less care than insured
Americans and
that circumstance does affect their health status.23
The Brewing Battle Over Pharmaceutical Prices
Although health care has not traditionally been a focus of U.S.
foreign and trade
policy, the relatively high concentration of market power on the
demand side of
foreign health systems appears to have become a major irritant
to U.S. officials, at
least with respect to pharmaceutical prices. These officials
acknowledge that U.S.
prices for pharmaceuticals are high by international standards;
32. however, they ac-
cuse foreign governments of keeping those prices artificially
and unduly low
within their own health systems, thereby beggaring U.S.
patients, who now fund
the bulk of U.S. pharmaceutical R&D.
In a recent address to pharmaceutical executives, for example,
former Food and
Drug Administration (FDA) Commissioner Mark McClellan
(now head of the
Centers for Medicare and Medicaid Services, or CMS) decried
as “ unfair” that
other nations use market power on the demand side for
prescription drugs to ob-
tain lower prices. He was concerned that other countries are
shifting the burden
of financing the R&D cost of new drugs to the United States.
“Some of the world’s
richest nations are driving the world’s hardest bargains,” he
remarked. “For exam-
ple, many high-income countries regulate their prices by setting
them equal to
those in other countries that already have rigid price controls.
This system is used
in Canada, informally in Japan, and in some countries in
Europe.”24
This concern over unduly low drug prices abroad now finds
expression in U.S.
trade negotiations with other countries. As the International
Herald Tribune recently
reported, “In talks over a free-trade agreement with Australia,
U.S. officials are
pressing the Australian government to water down its system for
negotiating the
33. prices it pays for prescription drugs.”25 Countries that use price
controls to con-
strain the growth of their health spending can expect to be
pressured by the U.S.
government to raise the prices their health systems pay for
drugs sold by U.S. man-
ufacturers. Countries subjected to these tactics by U.S. trade
negotiators may re-
sent this intrusion by the U.S. government into what they may
regard as purely do-
mestic health policies.
The emerging posture among U.S. policymakers on drug prices
raises a number
of questions. First, by what mechanism would higher drug
prices paid by foreign
health systems for U.S.-manufactured drugs actually translate
into lower drug
prices for U.S. patients? Or would these price increases merely
translate into in-
creased revenues of U.S. manufacturers? Second, how much of
the added revenue
garnered by U.S. manufacturers from drug price increases
abroad would flow
H e a l t h S p e n d i n g
H E A L T H A F F A I R S ~ V o l u m e 2 3 , N u m b e r 3 1 7
through to R&D spending? In 2002 the thirteen largest U.S.
pharmaceutical com-
panies allocated their sales revenue to particular objects of
expenditures and prof-
its as follows: cost of goods sold, 25.3 percent; selling and
34. administration, 32.8 per-
cent; R&D, 14 percent; taxes, 7.3 percent; and net after-tax
profits, 20.6 percent.26
Would added revenues from increased drug prices abroad be
similarly allocated?
If so, can the U.S. government and U.S. drug manufacturers
reasonably expect
health systems abroad to underwrite with higher prices outlays
by U.S. manufac-
turers on selling and administration, including the direct-to-
consumer (DTC) ad-
vertising that is not even permitted in many of these other
countries?
Third, would the U.S. government permit other countries’s
health systems to
use approaches with tiered pricing, such as reference pricing,
which can be and
has been defended as a market-based approach to drug pricing
but is profoundly
feared by drug manufacturers in the United States and
elsewhere?27 How deeply
into other countries’ health policy would U.S. policymakers
penetrate to shore up
the revenues of U.S. drug manufacturers?
Finally, it is not clear to what extent drug prices in other
nations actually are in-
appropriately low. A recent study by Patricia Danzon and
Michael Furukawa sug-
gests that the differential in prices paid for drugs in different
countries is smaller
than a simple comparison of drug prices might suggest. They
argue that simple
comparisons of prices for particular drugs can be highly
35. misleading and that such
comparisons should be based on broader market baskets of
pharmaceutical prod-
ucts sold in the various countries. Furthermore, they argue that
such comparisons
should be made with PPP dollars rather than at current exchange
rates. On that
basis, they conclude that “U.S.– foreign differentials for broad
baskets of prescrip-
tion drugs are in line with income [differentials across
countries] and [are]
smaller for drugs than for other medical services.”28
Health Care In The Macro Economy
� Health spending and GDP. Health spending is included in the
calculation of
GDP. If spending on health care increases, other things being
equal, then GDP rises,
just as it does when there is increased spending on sport-utility
vehicles (SUVs) or
entertainment, other things being equal.
Other things, however, may not remain equal when one
component of GDP
grows over time. Under full employment of a country’s real
resources, for example,
added spending on health care would draw labor and capital
away from other sec-
tors of the economy, whose contribution to GDP would then
shrink. That dis-
placed contribution would be the opportunity cost of added
health spending.
On the other hand, under conditions of pervasive
unemployment, added health
36. spending may not need to draw real resources away from other
economic activities
and GDP; the opportunity costs of added health spending would
be low or close to
zero. This is an important point during recessions. In a speech
before the Com-
monwealth Club of California in June 2002, for example,
President George W.
1 8 M a y / J u n e 2 0 0 4
C o s t s & C o m p e t i t i o n
Bush remarked, “Much of the growth we have seen in this
quarter is the result of
consumer spending, fueled by well-timed tax deductions.”29 If
one accepts this
purely Keynesian strategy of kindling economic growth as
appropriate, as evi-
dently the president does, then added health spending, which
will create jobs, is a
good substitute for tax cuts designed to kindle added consumer
spending. The
main difference is that added health spending draws added real
resources into the
production of health care, while tax cuts draw real resources
into the production
of whatever consumers purchase with their extra disposable
income, which may,
however, include added production (and jobs) abroad from
additional imports
purchased by Americans.
Even under conditions of full employment, however, a diversion
37. of real re-
sources from other economic activities to health care might
improve economic
welfare in society. It would depend on the value of the added
health care gained
relative to the opportunity costs represented by the value of
other output given
up. In an efficiently operated economy, the benefit-cost ratios
associated with
marginal shifts of real resources from any one sector to any
other would be the
same for all pairs of sectors and would be close to or equal to
one.
The fractions of GDP allocated to particular types of output
could, of course,
vary over time, in accordance with the relative valuations
society attaches to par-
ticular types of output over time. In other words, the fact that in
most industrial-
ized countries health care has absorbed an ever-increasing
fraction of GDP while
other types of output—for example, agricultural products—have
claimed a de-
creasing share does not by itself imply an excessive allocation
of resources to
health care.
Exhibit 4 illustrates this point with the changing distribution of
personal
spending in key sectors of the U.S. economy.30 In 1970 medical
care represented
less than one-tenth of U.S. personal consumption spending, the
fifth-largest com-
ponent after food, housing, transportation, and household
operation. In that year
38. Americans spent roughly the same portion of their personal
consumption on
clothing as they did on medical care. Since that time, medical
care has been a
steadily increasing share of personal consumption. The only
other major catego-
ries that have grown since 1970 are recreation and personal
business (financial
services and similar expenses). By 2001 medical care
represented 18.2 percent of
personal consumption spending and was the largest component.
Even so, absolute
real spending on every component of personal consumption
spending—even
food—increased from 1970 to 2001.
� The alleged economic burden of health spending. How
serious a problem,
if it is one at all, is the inexorable growth of health care as a
component of GDP? On
this question the responses of policymakers can vary, depending
on their political
purview. At the local level, policymakers usually give much
weight to the employ-
ment opportunities offered by a growing health sector, which
leads them to resist
reductions in or closing of local health care facilities. On the
other hand, at the mac-
H e a l t h S p e n d i n g
H E A L T H A F F A I R S ~ V o l u m e 2 3 , N u m b e r 3 1 9
roeconomic level, policymakers often view growing health
39. spending with alarm, al-
though added consumer spending on other goods and services—
on SUVs or enter-
tainment— invariably is viewed as a sign of economic health by
both policymakers
and the media. What explains these seemingly inconsistent
views toward consumer
spending?
Singling out health spending as a macroeconomic drag on the
economy appears
to have two intellectual roots. First, while recent economic
studies have shown
that in the aggregate, “ medical spending as a whole is worth
the increased cost of
care,” the “whole” may hide many individual medical
interventions of dubious
clinical and economic merit.31 For example, the highly critical
analyses of the U.S.
health system by the IOM and the recent analyses of geographic
variations in per
capita Medicare spending by Elliot Fisher and colleagues have
contributed to this
suspicion.32 Second, there is the view that the long-run
historical divergence in the
growth rates of health spending and of the rest of GDP cannot
be “sustained” over
the long run without reducing the availability of all other goods
and services. An-
other way in which it is often expressed is that these increases
simply are not “af-
fordable.” Unfortunately, words such as “sustainable” and
“affordable” are more
easily pronounced than defined.
The word sustainable means “able to be maintained,” which
40. raises the question
what factors would make something not “ maintainable.” Here a
distinction must
be made between “economically sustainable” and “politically
sustainable.” Con-
tinuing the Medicare program in the current form into the
indefinite future would
be economically sustainable, in the sense that it could be
accommodated by an
ever-growing GDP. The program may not be politically
sustainable, however, if
2 0 M a y / J u n e 2 0 0 4
C o s t s & C o m p e t i t i o n
EXHIBIT 4
Components Of U.S. Personal Consumption Spending, 1970–
2001
SOURCE: U.S. Bureau of Economic Analysis.
NOTES: “Other” includes religious activities, education and
research, personal care, and foreign travel. Components add to
100
percent.
25
20
15
10
5
41. 0
Percent of personal consumption spending
1970 1980 1990 2000
Medical care
30 Food/tobacco
Housing
Transportation
Personal business
Recreation
Clothing/accessories
Other
Household operation
the public or its political representatives refused to countenance
the higher taxes
on the private sector or transfers from other public programs
that such a policy
would entail. A similar argument, of course, can be made with
regard to any other
tax-financed programs, including defense, transportation,
education, and farm
subsidies.
To afford something, according to the dictionary, means that
one has “the means
for acquiring it without serious inconvenience.” Evidently
“affordable” is a highly
42. subjective term as well, which should be sparingly used in the
context of health
care. What, after all, is meant by a “serious inconvenience”?
Given these ambiguities, we do not use either term in what
follows and merely
explore instead what impact further health spending growth is
likely to have on
the partitioning of future GDP into health care and non–health
care GDP, leaving
it to the reader to draw his or her own inferences from that
exploration on
“sustainability” and “affordability.”
It was noted in Exhibit 1 that during the 1990s real (inflation-
adjusted) health
spending tended to outpace the growth of GDP in most
countries. The median dif-
ferential in growth rates for the OECD countries was about one
percentage point.
Historically, that differential has been much higher in the
United States. The dif-
ference between real per capita health spending and GDP
growth averaged 3.4
percentage points during the 1960s, 2.4 during the 1970s, and
3.2 during the
1980s.33 Only in the 1990s was the differential held to 1.0
percentage points, and
most of that can be attributed to robust growth in the overall
U.S. economy, not
lower health spending. Over the entire period 1960–1999 the
differential in the
United States had been about 2.4 percentage points.34
The CMS actuaries report that the United States as a whole
spent an estimated
43. $1.5 trillion on health care in 2003, or 14.9 percent of a GDP of
$10.9 trillion.35 They
project that by 2013 the United States will spend about $3.36
trillion on health
care, or 18.4 percent of a GDP of $18.24 trillion. Stated in
constant 2003 dollars and
on a per capita basis, the actuaries’ projections imply an
average annual growth
rate in real per capita GDP of 1.9 percent, while the
corresponding growth rate in
real per capita health spending is about 3.8 percent.36 It implies
a projected
growth rate differential of 1.9 percentage points. All of these
calculations, of
course, are merely conjectures and subject to error.
Although health spending in the amount of $3.36 trillion in
2013 may seem
alarming, the nonhealth GDP projected to be available to
Americans in that year
would still be $5.6 trillion larger than it was in 2003. This
implies that in 2003 U.S.
dollars, Americans are projected to have 16.4 percent more
nonhealth GDP per ca-
pita in 2013 than they had in 2003. While nonhealth GDP’s
share of total GDP is
projected to fall over the decade (from 85.1 percent in 2003 to
81.6 percent in 2013),
in absolute real dollars Americans are projected to have more of
everything, be-
sides health care. During 1960–1990, when the percentage of
GDP spent on health
care increased rapidly as well, the absolute amount spent on
other goods and ser-
H e a l t h S p e n d i n g
44. H E A L T H A F F A I R S ~ V o l u m e 2 3 , N u m b e r 3 2 1
vices also continued to increase.
As Michael Chernew and colleagues showed in a recent paper,
however, this
relatively comfortable scenario might not last.37 They calculate
that the U.S. econ-
omy most probably could absorb a growth rate differential of
about one percent-
age point throughout the next seven decades and still have real
nonhealth GDP
per capita grow throughout that period. On the other hand, a
growth rate differ-
ential of two percentage points would keep nonhealth GDP per
capita rising until
about 2040, after which time it would begin to decline at an
ever more rapid rate.
All of these calculations, of course, are highly sensitive to
assumptions about fu-
ture overall productivity growth in the economy.
Pricing Low-Income Americans Out Of Health Care
Although from a macroeconomic perspective the United States
could afford to
let health spending grow more rapidly than overall GDP for
several decades with-
out depressing aggregate nonhealth GDP, that differential in
growth rates can in-
duce severe economic distress at the microeconomic level. To
illustrate, consider a
private business firm whose line of business and workforce skill
45. mix is such that it
can tolerate only a maximum total compensation of $35,000 per
worker per year.
At higher compensation levels, the firm would lose money on
employing such a
worker. This assumed total compensation includes the workers’
take-home pay,
all withholdings from their paychecks, and all contribution the
firm makes to pay-
roll taxes and other fringe benefits, including health insurance.
It does not matter
how these contributions are divided between employer and
employee. The crucial
point is that the health insurance premiums paid by or on behalf
of these workers
must be supported by this total compensation of $35,000 per
worker.
If we assume that these workers’ productivity (in terms of
physical units of out-
put produced) rises at an average rate of 1.5 percent and that the
prices of the
firm’s output inflate at the general price inflation in the
economy of about 2.5 per-
cent, then one can plausibly assume that the total wage base per
worker in this in-
dustry will increase at an average annual rate of 4 percent over
the next decade, to
about $50,000 a decade hence.
According to the most recent employer health benefits survey of
the Henry J.
Kaiser Family Foundation and Health Research and Educational
Trust, the total
premium for a typical employment-based health insurance
policy for a family in
46. 2003 was $8,800, split somehow between employer and
employee.38 In the past
several years these premiums have been rising at rates much in
excess of 10 per-
cent.39 If they grew at a rate of “only” 10 percent for the next
decade, the typical
family coverage would then cost about $21,000 per year a
decade hence, or 42 per-
cent of the total wage base of $50,000 projected for that year.
Small changes in the
assumed future productivity growth in this firm, product price
levels, and health
insurance premiums could easily drive the fraction of total
compensation ab-
sorbed by health insurance over 50 percent. In the end, such a
firm would be likely
2 2 M a y / J u n e 2 0 0 4
C o s t s & C o m p e t i t i o n
to cease offering its employees health insurance, and the income
of these workers
would be too small to absorb health insurance premiums in
excess of $20,000.
They would be likely to join the ranks of the uninsured. This
prospect puts U.S.
policymakers at a crossroads.
One approach would be to persuade the upper half of families in
the nation’s in-
come distribution to help purchase adequate health insurance
for families in the
lower third. One may call it the “ universal health insurance”
47. road. It would, of
course, involve added taxes and transfers flowing through
government budgets,
which would bring with them additional government regulation,
especially if the
aim were to structure the U.S. health system as a one-tier
system in which sick
people have roughly the same health care experiences regardless
of their own abil-
ity to pay.
The alternative option would be to embrace as official policy,
both in employ-
ment-based health insurance and in public insurance programs,
a multi-tier
health system in which a person’s health care experience would
be allowed to vary
by his or her ability to pay for health care. In such a system
families in the upper
half of the income distribution would have a noticeably superior
health care expe-
rience than families in the lower half would have. This is
certainly already the case
for U.S. families with good health insurance and those without
it.
The emerging political battle at this crossroads is unlikely to be
styled in stark
terms such as “rationing by income class” or “one-class” versus
“two-class” medi-
cine. Instead, it will be styled as a debate over “ market
competition versus govern-
ment regulation”; as a simple, technocratic quest for greater
“efficiency”; or as the
dubious dichotomy of “rationing versus markets,” even though
textbooks in eco-
48. nomics instruct the reader that market prices are just another
way of rationing
scarce commodities, on the basis of ability and willingness to
pay.40 At its core,
then, the debate over health care, in the United States as
elsewhere, is less a pure
macroeconomic issue than an exercise in the political economy
of sharing.
An earlier version of this paper was presented at the
Commonwealth Fund 2003 International Symposium on
Health Care Policy, “Hospitals and Health Care Delivery
Systems: Spotlight on Innovation,” 22–24 October 2003,
in Washington, D.C. The authors thank the Commonwealth Fund
for supporting this research, the Organization for
Economic Cooperation and Development (OECD) for making its
database available to the research community,
and Jonathan Cylus for his research assistance. They also thank
two anonymous peer reviewers, whose construc-
tive criticism was very helpful, and, as always, the hard-
working staff of Health Affairs. None of the foregoing is
responsible for the views expressed in this paper.
H e a l t h S p e n d i n g
H E A L T H A F F A I R S ~ V o l u m e 2 3 , N u m b e r 3 2 3
“The debate over health care is less a pure macroeconomic issue
than an exercise in the political economy of sharing.”
NOTES
1. See, for example, H.J. Aaron and W.B. Schwartz, “Managed
Competition: Little Cost Containment with-
49. out Budget Limits,” Health Affairs 12 (Supplement 1993): 204–
215.
2. Data provided by the Office of the Actuary, Centers for
Medicare and Medicaid Services (CMS), show
that the breakdown of the average percentage contribution to
total growth in U.S. health spending during
1990–2002, not adjusted for inflation, was as follows:
population growth, 15 percent; general price infla-
tion, 32 percent; medical care price inflation over and above
general price inflation, 23 percent; and use of
services (such as physician visits, inpatient days, and so on),
intensity of services (including whatever
waste there may have been in service use and intensity), and
statistical errors, 30 percent. There were,
however, considerable year-to-year variations in these
percentage contributions around these 1990–2002
averages. Katharine Levit, CMS Office of the Actuary, personal
communication, 24 January 2004.
3. Purchasing power parities (PPPs) adjust for cost-of-living
differences between countries by comparing
the price of an economywide market basket of goods.
4. M.E. Chernew, R.A. Hirth, and D.M. Cutler, “Increased
Spending on Health Care: How Much Can the
United States Afford?” Health Affairs 22, no. 4 (2003): 15–25,
Exhibit 1.
5. S. Heffler et al., “Health Spending Projections through
2013,” Exhibit 1, Health Affairs, 11 February 2004,
content.healthaffairs.org/cgi/content/abstract/hlthaff.w4.79 (12
February 2004).
6. G.F. Anderson et al., “It’s the Prices, Stupid: Why the United
States Is So Different from Other Countries,”
50. Health Affairs 22, no. 3 (2003): 89–105; U.E. Reinhardt, P.S.
Hussey, and G.F. Anderson, “Cross-National
Comparisons of Health Systems Using OECD Data, 1999,”
Health Affairs 21, no. 3 (2002): 169–181; G.F.
Anderson and P.S. Hussey, “Comparing Health System
Performance in OECD Countries,” Health Affairs 20,
no. 3 (2001): 219–232; and G.F. Anderson et al., “Health
Spending and Outcomes: Trends in OECD Coun-
tries, 1960–1998,” Health Affairs 19, no. 3 (2000): 150–157.
7. J.P. Newhouse, “An Iconoclastic View of Cost Containment,”
Health Affairs (Supplement 1993): 153–171.
8. U.-G. Gerdtham and B. Jönsson, “International Comparisons
of Health Expenditure,” in Handbook of Health
Economics, vol. 1A, ed A.J. Culyer and J.P. Newhouse (New
York: Elsevier, 2000), 11–53.
9. The estimated equation is Y = .0022G1.3623, R2 = .94, where
Y is predicted health spending per capita and
G is GDP per capita, both in PPP$. The underlying regression
equation excludes Luxembourg and Nor-
way. Luxembourg’s GDP is unusually high from international
financial services, and Norway’s is unusu-
ally high by virtue of its oil revenues.
10. Anderson et al., “It’s the Prices, Stupid.”
11. Ibid.; and P.S. Hussey and G.F. Anderson, “A Comparison
of Single- and Multi-Payer Health Insurance
Systems and Options for Reform,” Health Policy 66, no. 3
(2003): 215–228.
12. M.V. Pauly, “U.S. Health Care Costs: The Untold True
Story,” Health Affairs 12, no. 3 (1993): 152–159.
51. 13. We recognize that these data can be beset by measurement
errors—for example, by differences in the def-
inition of “nurses” or “beds,” and so on. Even so, we believe
that the OECD database in this regard does
portray a rough-and-ready index of real resource endowments.
14. Health Resources and Services Administration, Graduate
Medical Education and Public Policy: A Primer (Wash-
ington: HRSA, December 2000).
15. Anderson et al., “It’s the Prices, Stupid”; and E.P. Slade and
G.F. Anderson, “The Relationship between Per
Capita Income and Diffusion of Medical Technologies,” Health
Policy 58, no. 1 (2001): 1–14.
16. See, for example, McKinsey Global Institute, Health Care
Productivity (Los Angeles: McKinsey and Com-
pany, October, 1996), Exhibit 5. The institute concluded that in
1990 the U.S. health system had higher
clinical productivity than the German health system but that
virtually all of that higher clinical productiv-
ity was absorbed by higher administrative costs.
17. H.J. Aaron, “The Cost of Health Care Administration in the
United States and Canada—Questionable An-
swers to a Questionable Question,” New England Journal of
Medicine 349, no. 8 (2003): 801–303.
18. S. Woolhandler, T. Campbell, and David U. Himmelstein,
“Costs of Health Care Administration in the
United States and Canada,” New England Journal of Medicine
349, no. 8 (2003): 768–775.
19. Karen Davis, president, Commonwealth Fund, “American
Health Care: Why So Costly?” (Invited testi-
mony before the Senate Appropriations Subcommittee on Labor,
52. Health and Human Services, Hearing on
Health Care Access and Affordability: Cost Containment
Strategies, 11 June 2003), 2.
20. J. Le Grand, “Methods of Cost Containment: Some Lessons
from Europe” (Paper presented at the Fourth
International Health Economics Association World Congress,
San Francisco, June 2003), 6.
2 4 M a y / J u n e 2 0 0 4
C o s t s & C o m p e t i t i o n
21. N. Devlin, J. Appleby, and D. Parkin, “Patients’ Views of
Explicit Rationing: What Are the Implications for
Health Service Decision-Making?” Journal of Health Services
Research and Policy 8, no. 3 (2003): 183–186.
22. See Institute of Medicine, Care without Coverage: Too
Little, Too Late (Washington: National Academies Press,
2002), Executive Summary. For a story on explicit rationing for
uninsured Americans, see B. Wysocky Jr.,
“At One Hospital, a Stark
Solution
for Allocating Care,” Wall Street Journal, 23 September 2003.
This is a
story about the withholding of life-saving medicines from
uninsured patients.
53. 23. The sixth and final report is IOM Committee on the
Consequences of Uninsurance, Insuring America’s
Health: Principles and Recommendations (Washington: National
Academies Press, 2004). All reports can be
found on the IOM Web site, www.iom.edu/project.asp?id=4660
(31 January 2004).
24. Mark B. McClellan, commissioner, Food and Drug
Administration, “Speech before First International
Colloquium on Generic Medicine” (esp. pp. 3–5), Cancun,
Mexico, 25 September 2003, www.fda.gov/oc/
speeches/2003/genericdrug0925.html (12 December 2003).
(McClellan became the administrator of the
Centers for Medicare and Medicaid Services in 2004.)
25. E. Becker, “U.S. Fights for Higher Drug Prices Overseas,”
International Herald Tribune, 27 November 2003,
iht.com/articles/119318.htm (12 December 2003).
26. See U.E. Reinhardt, “An Information Infrastructure for the
Pharmaceutical Market,” Health Affairs 23, no. 1
(2004): 107–112, Exhibit 1.
27. See, for example, H.A. Huskamp et al., “The Medicare
54. Prescription Drug Benefit: How Will the Game Be
Played?” Health Affairs 19, no. 2 (2000): 8–23; and P. Kanavos
and U.E. Reinhardt, “Reference Pricing for
Drugs: Is It Compatible with U.S. Health Care,” Health Affairs
22, no. 3 (2003): 16–28.
28. P.M. Danzon and M.F. Furukawa, “Prices and Availability
of Pharmaceuticals: Evidence from Nine Coun-
tries,” Health Affairs, 29 October 2003,
content.healthaffairs.org/cgi/content/abstract/hlthaff.w3.521 (12
Feb-
ruary 2004).
29. President George W. Bush, “Compassionate Conservatism:
What Does It Mean Now?” The Commonwealth
(Publication of the Commonwealth Club of California), 18 June
2002, 3–8.
30. Personal expenditure, one of the main components of GDP,
includes purchases of goods and services by
individuals resident in the United States.
31. D.M. Cutler and M. McClellan, “Is Technological Change in
Medicine Worth It?” Health Affairs 20, no. 5
(2001): 11–29. See also the series of essays in K.M. Murphy
55. and R.H. Topel, Measuring the Gains from Medical
Research: An Economic Approach (Chicago: University of
Chicago Press, 2003).
32. L.T. Kohn, J.M. Corrigan, and M.S. Donaldson, eds., To Err
Is Human: Building a Safer Health System (Washing-
ton: National Academies Press, 2000); IOM, Crossing the
Quality Chasm (Washington: National Academies
Press, 2002); and E.S. Fisher et al., “The Implications of
Regional Variations in Medicare Spending, Part 1:
The Content, Quality, and Accessibility of Care,” Annals of
Internal Medicine 138, no. 4 (2003): 273–287.
33. Calculated from Chernew et al., “Increased Spending on
Health Care,” Exhibit 1.
34. Ibid.
35. Heffler et al., “Health Spending Projections through 2013,”
Exhibit 1.
36. Conversion to constant dollars is made with the chain-
weighted GDP deflator, assumed by the actuaries
to rise at a rate of 2.55 per year during the decade. The assumed
annual population growth rate is 0.81 per-
56. cent.
37. Chernew et al., “Increased Spending on Health Care.”
38. Henry J. Kaiser Family Foundation and Health Research and
Educational Trust, Employer Health Benefits
Survey: 2003, Summary and Findings (Menlo Park, Calif.:
KFF/HRET, 9 September 2003), Exhibit 1.
39. Ibid., Exhibit 2.
40. See, for example, M.L. Katz and H.S. Rosen,
Microeconomics (Homewood, Ill.: Richard D. Irwin Inc., 1991),
15–16; and U.E. Reinhardt, “Rationing in Health Care: What It
Is, What It Is Not, and Why We Cannot
Avoid It,” in Strategic Choices for a Changing Health System,
ed. S.H. Altman and U.E. Reinhardt (Chicago: Health
Administration Press, 1996), 63–99.
H e a l t h S p e n d i n g
H E A L T H A F F A I R S ~ V o l u m e 2 3 , N u m b e r 3 2 5