The Health Care Marketplace

Category: Healthcare

This title is part of the Healthcare Administration list.

Of Interest:

Competition in the Health Care Sector

Competition, Regulation, and Rationing in Health Care

Health Care Risk Management: Organization and Claims Administration

Hospitals, Health and People

Hospital Turnarounds: Lessons in Leadership

Managing a Health Care Alliance: Improving Community Cancer Care

Managing Doctors

The White Labyrinth: Guide to the Health Care System

Written by a leading health economist, this reprint of a 1998 book is a thought -provoking analysis of the 1.2 trillion-dollar health care industry. It presents a balanced view of the successes and failures of market forces in health care, with particular emphasis and analysis on the current employer-based health care system. The lack of solid information on the quality of health care provided by physicians and hospitals is a particular target of analysis. Legal interventions in the health care industry, with a synopsis of a legal case at the end of many of the chapters, add a real world dimension to the book. Here is an informed insight into a vital and controversial subject of importance to everyone.

Greenberg is an economist who analyzes the healthcare field from the perspective that "health care is a business [in which] the principles of supply and demand are as applicable...as to other businesses." This perspective does not ignore or minimize the question of the quality of health, but rather focuses sharply on the relationship between the quality of healthcare and economic factors and practices.

For better or worse, the American healthcare system to a considerable degree embodies the beliefs, principles, and aims of a free-market capitalist economic system driven by competition. In the early sections of The Health Care Marketplace, Greenberg takes up the question of how physicians and how hospitals compete in this system. "Competition among physicians takes place locally among primary care physicians and on a wider geographical scale among specialists. There is competition also between M.D.s and allied practitioners: for example, between ophthalmologists and optometrists and between psychiatrists and psychologists. Regarding competition between physicians in a fee-for-service practice and those in managed care plans, Greenberg cites statistics and studies that there was lesser utilization of healthcare services, such as hospitalization and tests, with managed care plans.

Some of the factors affecting the economics of different areas of the healthcare field are self-evident, albeit may be little recognized or little realized by consumers. One of these factors is physician demeanor. Most readers would see a physician's demeanor as a type of personality exhibited during the course of the day. But after the author notes that "[c]ompetition also takes place in professional demeanor, location, and waiting time," the word "demeanor" takes on added meaning. The demeanor of a big-city plastic surgeon, for example, would be markedly different from that of a rural pediatrician. Thus, demeanor has a relationship to the costs, options, services, and payments in the medical field, and also a relationship to doctor education and government funding for public health.

Greenberg does not follow his economic data and summarizations with recommendations or advice. He leaves it to the policymakers to make decisions on the basis of the raw economic data and indisputable factors such as physician demeanor. Nor does he take a political position when he selects what data to present or emphasize. It is this apolitical, unbiased approach that makes The Health Care Marketplace of most value to readers interested in understanding the economics of the healthcare field.

Without question, a thorough understanding of the factors underlying the healthcare marketplace is necessary before changes can be made so that the health needs of the public are better met. Conditions that are often seen as intractable because they are regarded as social or political problems such as the overcrowding of inner-city health centers or preferential treatment of HMOs are, in Greenberg's view, problems amenable to economic solutions. According to the author, the basic economic principle of supply-and-demand goes a long way in explaining exorbitantly high medical costs and the proliferation of specialists.

Greenberg's rigorous economic analysis similarly yields an informative picture of the workings of other aspects of the healthcare field. Among these are hospitals, insurance, employee health benefits, technology, government funding of health programs, government regulation, and long-term health care. In the closing chapter, Greenberg applies his abilities as a keen-eyed observer of the economic workings of the U.S. healthcare field to survey healthcare systems in three other countries: Canada, Israel, and the Netherlands. "An analysis of each of the three systems will explain the relative doses of competition, regulation, and rationing that might be used in financing of health care in the United States," he says. But even here, as in his economic analyses of the U.S. healthcare system, Greenberg remains nonpartisan and does not recommend one of these three foreign systems over the other. Instead he critiques the Canadian, Israel, and Netherlands systems - "none [of which] makes use of the employer in the provision of health insurance," he says - to prompt the reader to look at the present state and future of U.S. healthcare in new ways.

The Health Care Marketplace is not a book of limited interest, and the author's focus on the economics of the health field does not make for dry reading. Healthcare is a central concern of every individual and society in general. Greenberg's book clarifies the workings of the healthcare field and provides a starting point for addressing its long-recognized problems and moving down the road to dealing effectively with them.

Warren Greenberg is Professor of Health Economics and Health Care Sciences at George Washington University, and also a Senior Fellow at the University's Center for Health Policy Research. Prior to these positions, in the 1970s he was a staff economist with the Federal Trade Commission. He has written a number of other books and numerous articles on economics and healthcare.

This book is an economist's view of the health care sector with little economics jargon, accessible to the informed layperson as well as the professional. Knowledge of the basic economic concepts, however, will enable the reader to understand the recent tremendous changes in the U.S. health care industry. Excerpts from health industry antitrust litigations are featured at the end of many chapters, providing a real world understanding of how the health care marketplace behaves. Comparisons with the systems of Canada, Israel, and the Netherlands further illustrate the opportunities and complex dilemmas inherent in any proposed reform of the U.S. health care marketplace.

There have been a number of major changes in the health care market in the last decade. In this wide-ranging book, Warren Greenberg surveys the health care industry using the economics of industrial organizations approach. By doing so, the author provides the reader with an understanding of the differences between health care and other industries in the economy. As a result, this book will be ideal for students in health care economy and policy who need to gain an understanding of this, the single largest sector of the economy.

An economist's view of the health care marketplace. Examines the role of physicians, patients, firms, and government in the health care sector. For professionals and the layperson. Includes excerpts from antitrust litigations and comparisons to the Canadian, Israeli, and Dutch systems. George Washington Univ., Washington, DC.

An economist's view of the health care marketplace. Examines the role of physicians, patients, firms, and government in the health care sector. For professionals and the layperson.

Emphasizes business & profit aspects of health care; legal & insurance issues; international experiences.

Warren Greenberg, Ph.D. is a professor of health economics and health care sciences and a senior fellow with the Center for Health Policy Research at the George Washington University. He is also a scholar in residence at the Agency for Health Care Research and Quality. Mr. Greenberg�s research at AHCRQ focuses on the quality of care in horizontal and vertical consolidations of hospitals within an industrial organization context. He also examines the structure of vertical integration in health care. From 1971 until 1979, Mr. Greenberg was a staff economist with the Federal Trade Commission. He was a lead economist on many of the FTC�s activities in the health care industry and was responsible for economic analysis of antitrust litigation. Mr. Greenberg was a visiting associate professor of managerial economics at the University of Maryland and a visiting professor at Ben-Gurion University (Israel). He is the author of numerous articles on industrial organization economics and health care that have been published in the Journal of Law and Economics, Economic Inquiry, Journal of Risk and Insurance, Health Services Research, and other leading journals.