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Preface | |
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Acknowledgments | |
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About the Author | |
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Foreword | |
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Choices: Money, Medicine and Health | |
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Questions | |
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What Is Economics? | |
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Terms of Trade | |
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Value | |
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Can We Pay Somebody to Care? | |
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Financing Health Care | |
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Full Cost: Paying For Medical Care | |
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The Flow of Funds | |
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Health Care Spending in the United States | |
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Sources of Financing | |
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Health Care Providers: The Uses of Funds | |
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Economic Principles As Conceptual Tools | |
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Scarcity (Budget Constraints) | |
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Opportunity Cost | |
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Willingness to Pay | |
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Trade | |
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Money Flows in a Circle | |
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The Margin: What Matters? | |
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Maximization: Marginal Costs and Marginal Benefits | |
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Choice: Are Benefits Greater Than Costs? | |
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Investment | |
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Contracts: Complex Exchanges to Deal with Timing and Risk | |
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Organizations Adapt and Evolve | |
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Distribution: Who Gets What | |
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Health Disparities | |
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Whose Choices:� Personal, Group or Public? | |
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Social Science and Rational Choice Theory | |
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Suggestions for Further Reading | |
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Summary | |
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Problems | |
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Endnotes | |
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Demand and Supply | |
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Questions | |
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The Demand Curve | |
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The Diamonds?Water Paradox: An Example of Marginal Analysis | |
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Consumer Surplus: Marginal versus Average Value of Medicine | |
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Ceteris Paribus | |
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Individual, Firm, and Market Demand Curves | |
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The Supply Curve | |
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Marginal Revenue | |
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Price Sensitivity | |
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Price Elasticity and Marginal Revenue | |
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Price Discrimination | |
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Is Money the Only Price? | |
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Inputs and Production Functions | |
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Production Functions | |
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Marginal Productivity | |
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Markets: The Intersection of Demand and Supply | |
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Need versus Demand | |
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How Much is a Doctor Visit Worth? | |
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The Demand for Medical Care is Derived Demand | |
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The Demand for Health: What Makes Medical Care Different | |
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The Determinants of Health | |
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Efficiency | |
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Suggestions for Further Reading | |
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Summary�������������������������������� | |
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Problems��� | |
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Endnotes | |
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Cost?benefit And Cost-Effectiveness Analysis | |
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Questions | |
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Cost?Benefit Analysis is About Making Choices | |
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An Everyday Example: Knee Injury | |
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Stepwise Choices:� Yes or No? How Much? | |
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Calculating Marginal and Average Costs | |
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Defining Marginal: What is the Decision? | |
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Maximization: Finding the Optimum | |
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Declining Marginal Benefits | |
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Optimization: Maximum Net Benefits Expected Value | |
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The Value of Life | |
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Quality-Adjusted Life Years | |
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Discounting Over Time | |
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QALY League Tables | |
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Perspectives: Patient, Payer, Government, Provider, Society | |
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Distribution: Whose Costs and Whose Benefits? | |
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CBA Is a Limited Perspective | |
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CBA and Public Policy Decision Making | |
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CBA Is a Limited Perspective/ | |
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Suggestions for Further Reading | |
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Summary | |
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Problems | |
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Endnotes | |
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Health Insurance: Financing Medical Care | |
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Questions | |
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Methods for Covering Risks | |
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Savings | |
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Family and Friends | |
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Charity | |
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Private Market Insurance Contracts | |
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Social Insurance | |
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Strengths and Weaknesses of Different Forms of Risk Spreading | |
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Insurance: Third-Party Payment | |
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Why Third-Party Payment? | |
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Variability | |
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Third-Party Transactions | |
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Who Pays? How Much? | |
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How Are Benefits Determined? | |
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Risk Aversion | |
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Adverse Selection | |
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Moral Hazard | |
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Welfare Losses Due to Moral Hazard | |
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Ex Ante Moral Hazard | |
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Tax Benefits | |
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Effects of Health Insurance on Labor Markets | |
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History of Health Insurance | |
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Suggestions for Further Reading | |
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Summary | |
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Problems | |
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Endnotes | |
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Insurance Contracts And Managed Care | |
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Questions | |
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Sources of Insurance | |
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Employer-Based Group Health Insurance | |
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Medicare | |
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Medicaid | |
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State Children?s Health Insurance Program | |
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Other Government Programs and Charity | |
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The Uninsured | |
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Contracting and Payments | |
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Risk Bearing: From Fixed Premiums to Self-Insurance | |
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Purchasing Medical Care for Groups | |
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Medical Loss Ratios | |
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Claim Processing | |
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The Underwriting Cycle | |
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ERISA, Taxes, and Mandated Benefits | |
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Other People?s Money: Rising Costs and Mediocre Benefits | |
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Consumer-Driven Health Plans: High Deductibles and Health Savings Accounts | |
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Defined Contribution Health Plans | |
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Managed Care | |
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Closed-Panel Group Practice HMOs | |
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IPA-HMOs and Open Contracts | |
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Managed Care Contract Provisions | |
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The Range of Managed Care Contracts: POS, PPO, HMO | |
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Provider Networks and Legal Structure | |
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Management: The Distinctive Feature of Managed Care | |
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Contractual Reforms to Control Costs | |
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Unresolved Issues: Split Incentives, Divided Loyalties | |
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Suggestions for Further Reading | |
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Summary | |
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Problems | |
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Endnotes | |
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Physicians | |
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Questions | |
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Financing Physician Services: Revenues | |
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Copayments, Assignment, and Balance Billing | |
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Physician Payment in Managed Care Plans | |
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Incentives: Why Differences in the Type of Payment Matter | |
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A Progression: From Prices to Reimbursement Mechanisms | |
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Physician Incomes | |
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Physician Financing: Expenses | |
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Physician Practice Expenses | |
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The Labor versus Leisure Choice | |
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The Doctor's Workshop and Unpaid Hospital Inputs | |
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Malpractice | |
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The Medical Transaction | |
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Asymmetric Information | |
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Agency: Whose Choices? | |
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Uncertainty | |
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Licensure: Quality or Profits? | |
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How Does Licensure Increase Physician Profits? | |
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Supply and Demand Response in Licensed versus Unlicensed Professions | |
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How Does Licensure Improve Quality? | |
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A Test of the Quality Hypothesis: Strong Versus Weak Licensure | |
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Suggestions for Further Reading | |
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Summary | |
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Problems | |
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Endnotes | |
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Medical Education, Organization, and Business Practices | |
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Questions | |
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Medical Education | |
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The Origins of Licensure and Linkage to Medical Education | |
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AMA Controls Over Physician Supply, 1930?1965 | |
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Breaking the Contract: The Great Medical Student Expansion of 1970 to | |
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Building Pressure: Fixed Domestic Graduation Rates 1980 to | |
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Adjusting Physician Supply | |
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The Flow of New Entrants and the Stock of Physicians | |
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Immigration of International Medical Graduates | |
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Growth in Non-MD Physicians | |
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Balancing Supply and Incomes: Tracing the Past and Projecting the Future | |
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Group Practice: How Organization and Technology Affect Transactions | |
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Kickbacks, Self-Dealing, and Side Payments | |
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Price Discrimination | |
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Practice Variations | |
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Insurance, Price Competition, and the Structure of Medical Markets | |
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Choices by and for Physicians | |
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Suggestions for Further Reading | |
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Summary | |
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Problems | |
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Endnotes | |
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Hospitals | |
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Questions | |
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From Charitable Institutions to Corporate Chains: Development of the Modern Hospital | |
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Hospital Financing: Revenues | |
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Sources of Revenues | |
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Hospital Financing: Expenses | |
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Financial Management and Cost Shifting | |
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How Do Hospitals Compete? | |
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Competing for Patients | |
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Competing for Physicians | |
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Competing for Contracts | |
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Measuring Competitive Success | |
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Measuring the Competitiveness of Markets | |
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Organization: Who Controls the Hospital and for What Ends? | |
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Suggestions for Further Reading | |
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Summary | |
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Problems | |
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Endnotes | |
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Management And Regulation Of Hospital Costs | |
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Questions | |
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Why Do Some Hospitals Cost More than Others? | |
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How Management Controls Costs | |
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Short-Run versus Long-Run Cost Functions | |
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Uncertainty and Budgeting | |
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Conflict Between Economic Theory and Accounting Measures of Per Unit Cost | |
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Timing | |
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Whose Costs? | |
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Economies of Scale | |
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The Hospital is a Multiproduct Firm | |
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Contracting Out | |
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Quality and Cost | |
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Technology: Cutting Costs or Enhancing Quality? | |
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Improved Efficiency Can Raise Total Spending | |
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Hospital Charges, Costs, and Prices: Confusion and Chaos | |
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Chargemaster and Negotiated Fees | |
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Cost Finding: Gross Revenues and the RCCAC | |
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Medicare as a Standard for Pricing | |
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Controlling Hospital Costs through Regulation | |
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Suggestions for Further Reading | |
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Summary | |
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Problems | |
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Endnotes | |
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Long-Term Care | |
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Questions | |
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Development of the Long-Term Care Market | |
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Age and Health Care Spending | |
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Defining LTC: Types of Care | |
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Medicaid: Nursing Homes as a Two-Part Market | |
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Certificate of Need: Whose Needs? | |
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Money and Quality | |
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Competing for Certificates of Need, Not for Patients | |
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Evidence on the Effects of Certificates of Need | |
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Cost Control by Substitution | |
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Case-Mix Reimbursement | |
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Long-term Care Insurance | |
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Is Long-Term Care ?Medical?? | |
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Retirement, Assisted Living, and the Wealthy Elderly | |
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Financial Reimbursement Cycles | |
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Suggestions for Further Reading | |