Disease, Diagnoses, and Dollars (eBook)

Facing the Ever-Expanding Market for Medical Care

Robert M. Kaplan (Autor)

eBook Download: PDF

2009 | 2009
XVIII, 190 Seiten
Springer New York (Verlag)
978-0-387-74045-4 (ISBN)

Infos

Here's a conundrum: the U.S. health care system is the largest sector in the biggest economy in the world, and the US spends significantly more per capita on health care than any other country. Yet it ranks last among comparison nations on the major health indicators. Robert Kaplan attempts to tackle these anomalies head-on by taking the controversial position that mass markets have been created for services that may offer little or no benefit to patients. Kaplan forcefully argues that the overuse of medications and tests runs up the costs of health care, and offers potential solutions for policy makers and for patients.

Robert M. Kaplan is Professor and Chair of the Department of Health Services at the UCLA School of Public Health. He is also a Professor of Medicine at the UCLA David Geffen School of Medicine. He has been elected president of four different academic societies and has served as editor-in-chief for two major journals. Kaplan is the author or editor of 16 books and more than 400 articles or chapters. In 2005, he was elected to the Institute of Medicine of the National Academies of Science.

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Disease, Diagnoses, and Dollars is about the costs of health care and their impact on health. The U.S. health care system is the largest sector in the biggest economy, and the US spends significantly more per capita on health care than any other country, yet it ranks last among comparison nations on the major health indicators. Within the U.S., there is evidence that regions that spend more do not have better outcomes, and some evidence suggests that quality of care is lower in the regions that spend more, not less, on health care.Robert Kaplan takes the controversial position that mass markets have been created for services that may offer little or no benefit to patients. Many of these markets are for preventive medicine, making healthy people a market for expensive pharmaceutical products and tests. These include cancer screening tests and medications to control blood pressure, cholesterol, and glucose. Kaplan forcefully argues that the overuse of medications and tests runs up the costs of health care. As more employers drop health insurance for their employees when costs accelerate, the expanded use of ineffective preventive medicine may have the unintended consequence of increasing the number of uninsured patients, potentially damaging the health of others in the community.The concluding chapters of Disease, Diagnoses, and Dollars offer suggestions for policy makers and for patients. Methods for systematically evaluating the cost-effectiveness of new guidelines are discussed. The final chapter provides practical suggestions to enable patients to share in decisions about treatments or tests that can have uncertain benefits.

Inhalt

Disease, Diagnoses, and Dollars 2
Preface 5
Reference 7
Contents 8
List of Figures 11
List of Tables 14
Disease, Outcomes, and Money 15
Buying Health, Buying Healthcare 16
Is More Better? 17
What Is Wrong? 18
References 19
The Disease-Reservoir Hypothesis 21
What Is Disease? 23
Testing the Disease-Reservoir Hypothesis 25
The Geographic Distribution of Health Services 27
A Case Study 28
Studies of Regional Variation in Service and Spending 29
Variation and Cost 31
References 32
Mental Models of Health and Healthcare 35
The Human Body: Component Parts or Systems? 37
Chronic versus Acute Disease 38
Common-Sense Models 40
Statistics and Mental Models 41
Mental Models and the People We Most Trust 45
References 48
What Is Disease and When Does It Begin? 49
Common Perceptions of Chronic Disease 49
More Is More, But Is More Better? 50
When Does Chronic Disease Begin? 52
What are the Implications of These Findings? 54
Primary versus Secondary Prevention 58
References 58
Screening for Cancer 61
Public Enthusiasm for Screening 62
Questions about the Value of Screening on Public Health 63
Biases in the Interpretation of Screening Studies 64
Lead-Time Bias 64
Length Bias 65
Does Screening Find the Wrong Cases? 67
What do RCTs on Screening Tell Us? 69
Evidence-Based Medicine Approach 74
Interpretation of Cancer-Screening Evidence by Peer Panels 75
The Mammography Paradox 77
How Many Screening Tests are Needed to Prevent a Death? 80
Variations in Screening Rates and Impacts on Healthcare Costs 81
Conclusions 83
References 84
Deciding When Blood Pressure Is Too High 87
Definition of Health Outcomes 89
What Is Blood Pressure? 91
Does Blood Pressure Treatment Save Lives? 92
Review of Controversies 93
JNC-7 95
Justification for Lowering the Threshold 96
Likelihood of Benefit-Chances of Side Effects 100
How Many People Will be Affected by the New Guidelines? 102
Paradoxical Treatment Effects 104
Conclusions 105
References 106
The Cholesterol Cutoff 109
Cholesterol Screening 114
Atp III 116
Concerns and Conflicts of Interest 117
How Many People are Affected by the Changing Definitions? 117
How Many Will Progress to CVD? 120
Conclusions 122
References 122
Diabetes, Obesity, and the Metabolic Syndrome 125
Pathophysiology 126
The Changing Definition of Diabetes and Impaired Fasting Glucose 128
IFG and Its Consequences 129
Obesity and Overweight 132
The Metabolic Syndrome 139
Conclusions 142
References 143
Cost-Effectiveness and Opportunity Costs 145
Uninsured Americans: A Result of Too Many Tests? 148
The Costs of Care 150
Outcomes in Chronic Illness 150
Mortality 151
Health-Related Quality of Life 152
Opportunity Costs 153
Primary-Prevention Approaches 155
Physical Activity 156
Leagu Table 158
Summary 159
References 160
Shared Medical Decision-Making 162
Uncertainty in Medicine 162
Shared Decision-Making 163
Why Shared Decisions are Necessary 165
The Reliability and Consistency of Clinical Decisions 167
Do Patients Want to Participate in Decision-Making? 168
What Is the Patient’s Role in Making Decisions? 168
Shared Decision-Making and the Overuse of Medical Services 170
Consumer-Driven Health Plans 175
Conclusions 176
References 176
Putting the Pieces Together 179
Costs are Out of Control 179
The Proliferation of Services 180
Changes in Communications with Patients 182
We Need to Re-examine the Process of Developing Practice Guidelines 185
References 190
Index 191

Produkt-Details

• Erscheint lt. Verlag: 21.4.2009
• Zusatzinfo: XVIII, 190 p. 81 illus.
• Verlagsort: New York
• Sprache: englisch
• Themenwelt: Sachbuch/Ratgeber ► Gesundheit / Leben / Psychologie
• Themenwelt: Schulbuch / Wörterbuch ► Lexikon / Chroniken
• Themenwelt: Medizin / Pharmazie ► Gesundheitswesen
• Themenwelt: Sozialwissenschaften ► Politik / Verwaltung
• Themenwelt: Technik
• Themenwelt: Wirtschaft
• Schlagworte: Diabetes • Diagnosis • disease prevention • Health Administration • Health Care Economics • Health Care Policy • Medical Costs • Preventive Medicine • Public Health
• ISBN-10: 0-387-74045-7 / 0387740457
• ISBN-13: 978-0-387-74045-4 / 9780387740454