Frank A. Sloan - Böcker

This book addresses a topic of great concern in the fields of medicine and medical economics. The cost of malpractice insurance to physicians has been increasing rapidly in recent years, and in some areas is not even available. The book describes and analyses, in a non-technical way, the workings of physicians' own liability insurance.

Medical malpractice suits today can result in multi-million-dollar settlements, and a practicing physician can pay $100,000 or more annually for malpractice insurance. Some complain that lawyers and plaintiffs are overcompensated by exorbitant judgments that add to the rising cost of health care. But there has been very little evidence to show whether these arguments are true. In this timely work, six experts in health policy, law, and medicine study nearly 200 malpractice claims to show that, contrary to popular perceptions, victims of malpractice are not overcompensated and our legal system for dealing with malpractice claims is not defective. The authors survey claims filed in Florida between 1986 and 1989 by people who suffered permanent injury or death during birth or during treatment in an emergency room. How often did illegitimate claims result in financial awards? What was the relation between the injury and the amount the patient lost economically? How much did the plaintiffs actually recover? How did the claimants choose their lawyers and what kind of relationship did they have?Contrary to common perceptions, in the majority of cases the claims were merited, and the authors found that claimants were on average substantially undercompensated--only about one-fifth of plaintiffs recovered more than their economic loss caused by injury or death. The evidence in this book suggests that placing dollar limits on malpractice cases is unjustified and that our tort system is not so faulty after all.

According to the United States Public Health Service, over 100,000 deaths a year are attributable to alcohol, including 20,000 highway fatalities. In response, legislatures have enacted various forms of regulation intended both to reduce alcohol consumption and to curb its harmful effects. This groundbreaking study focuses on one such form of regulation, the liability imposed on alcohol servers and social hosts by tort law. Basing their analysis on important new data from their extensive research and in-depth interviews with actors on all sides of the issue, the authors conclude that, despite their relative unpopularity, tort laws are very effective in reducing accidents—even more than criminal sanctions. Extraordinary in scope and exacting in detail, Drinkers, Drivers, and Bartenders: Balancing Private Choices and Public Accountability links alcohol problems, deterrence, and serving practices in a way no other work has been able to do and is certain to become a crucial reference point for researchers and policymakers alike.

Cancer is low or absent on the health agendas of low- and middle-income countries (LMCs) despite the fact that more people die from cancer in these countries than from AIDS and malaria combined. International health organizations, bilateral aid agencies, and major foundations—which are instrumental in setting health priorities—also have largely ignored cancer in these countries. This book identifies feasible, affordable steps for LMCs and their international partners to begin to reduce the cancer burden for current and future generations. Stemming the growth of cigarette smoking tops the list to prevent cancer and all the other major chronic diseases. Other priorities include infant vaccination against the hepatitis B virus to prevent liver cancers and vaccination to prevent cervical cancer. Developing and increasing capacity for cancer screening and treatment of highly curable cancers (including most childhood malignancies) can be accomplished using "resource-level appropriateness" as a guide. And there are ways to make inexpensive oral morphine available to ease the pain of the many who will still die from cancer.

Medicare is the largest health insurer in the United States, providing coverage for 39 million people aged 65 and older and 8 million people with disabilities, and reaching more than an estimated $500 billion in payments in 2010. Although Medicare is a national program, it adjusts fee-for-service payments according to the geographic location of a practice. While there is widespread agreement about the importance of providing accurate payments to providers, there is disagreement about how best to adjust payment based on geographic location. At the request of Congress and the Department of Health and Human Services (HHS), the Institute of Medicine (IOM) examined ways to improve the accuracy of data sources and methods used for making the geographic adjustments to payments. The IOM recommends an integrated approach that includes moving to a single source of wage and benefits data; changing to one set of payment areas; and expanding the range of occupations included in the index calculations.The first of two reports, Geographic Adjustment in Medicare Payment: Phase I: Improving Accuracy, assesses existing practices in regards to accuracy, criteria consistency, evidence for adjustment, sound rationale, transparency, and separate policy adjustments to reform the current payment system. Adopting the recommendations outlined in this report will mean a change in the way that the indexes are calculated, and will require a combination of legislative, rule-making, and administrative actions, as well as a period of public comment. Geographic Adjustment in Medicare Payment will inform the work of government agencies such as HHS, the Centers for Medicare and Medicaid Services, congressional members and staff, the health care industry, national professional organizations and state medical and nursing societies, and Medicare advocacy groups.

Medicare, the world's single largest health insurance program, covers more than 47 million Americans. Although it is a national program, it adjusts payments to hospitals and health care practitioners according to the geographic location in which they provide service, acknowledging that the cost of doing business varies around the country. Under the adjustment systems, payments in high-cost areas are increased relative to the national average, and payments in low-cost areas are reduced. In July 2010, the Department of Health and Human Services, which oversees Medicare, commissioned the IOM to conduct a two-part study to recommend corrections of inaccuracies and inequities in geographic adjustments to Medicare payments. The first report examined the data sources and methods used to adjust payments, and recommended a number of changes. Geographic Adjustment in Medicare Payment - Phase II:Implications for Access, Quality, and Efficiency applies the first report's recommendations in order to determine their potential effect on Medicare payments to hospitals and clinical practitioners. This report also offers recommendations to improve access to efficient and appropriate levels of care.Geographic Adjustment in Medicare Payment - Phase II:Implications for Access, Quality, and Efficiency expresses the importance of ensuring the availability of a sufficient health care workforce to serve all beneficiaries, regardless of where they live.

As expenditure on health care has increasingly become an area of public debate and concern, public and private health care decision-makers have called for more rigorous use of cost-benefit and cost-effectiveness analysis to guide spending. Concerns have arisen, however, about the overall quality of such analyses. This book discusses and evaluates best-practice methods of conducting cost-benefit and cost-effectiveness studies of pharmaceuticals and other medical technologies. It encompasses a wide variety of topics, ranging from measuring cost and effectiveness to discounting to the use of dynamic modelling of cost-effectiveness. The book also includes conceptual and practical aspects of cost-effectiveness analysis by researchers who have conducted applied research in these areas. Rarely does the book provide a singular solution to a measurement problem; rather, the reader is directed to choices among alternative approaches and an analysis of the advantages and disadvantages of each.

The pharmaceutical industry worldwide is a rapidly burgeoning industry contributing to growth of gross domestic product and employment. Technological change in this field has been very rapid, with many new products being introduced. For this reason in part, health care budgets throughout the world have increased dramatically, eliciting growing pressures for cost containment. This book explores four important issues in pharmaceutical innovations: (1) the industry structure of pharmaceutical innovation; (2) incentives for correcting market failures in allocating resources for research and development; (3) competition and marketing; and (4) public evaluation of the benefits and costs of innovation. The lessons are applicable to countries all over the world, at all levels of economic development. By discussing existing evidence this book proposes incentive arrangements to accomplish social objectives.

How do smokers evaluate evidence that smoking harms health? Some evidence suggests that smokers overestimate health risks from smoking. This book challenges this conclusion. The authors find that smokers tend to be overly optimistic about their longevity and future health if they quit later in life. Older adults' decisions to quit smoking require personal experience with the serious health impacts associated with smoking. Smokers over fifty revise their risk perceptions only after experiencing a major health shock--such as a heart attack. But less serious symptoms, such as shortness of breath, do not cause changes in perceptions. Waiting for such a jolt to occur is imprudent. The authors show that well-crafted messages about how smoking affects quality of life can greatly affect current perceptions of smoking risks. If smokers are informed of long-term consequences of a disease, and if they are told that quitting can indeed come too late, they are able to evaluate the risks of smoking more accurately, and act accordingly.

Ensuring long-term care (LTC) is one of the most urgent problems in health care today. This text addresses important objectives surrounding long-term healthcare, including: the arrangements and institutions designed to protect the disabled and dependent elderly people in various countries, and evaluation of their respective merits; the projections of future costs of protection for dependent elderly; and assessment of the impact of improvements in disability-free life expectancy on the future cost of care and choices between informal and formal care. The text also analyzes different theoretical approaches in modeling decisions referring to LTC services to be provided both within and between generations.