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.
Disease, Diagnoses, and Dollars
Facing the Ever-Expanding Market for Medical Care
Robert M. Kaplan, UCLA School of Public Health, Los Angeles, CA
Close to 50 Million Uninsured,
Steeply Rising Insurance Premiums,
Employers Cutting Healthcare Benefits . . .
There's plenty wrong with this picture. In Disease, Diagnoses, and Dollars, public health expert Robert Kaplan takes America's healthcare industry to task and challenges readers to examine their own roles in it.
Provocative, timely, and comprehensively researched, this book analyzes the current healthcare crisis in terms of medical culture, economics, and advertising. The findings reveal a system fraught with conflicts-contradictory healthcare policies, providers who over-test and over-prescribe, patients with unrealistic demands fueled by the media-and throughout, an absence of accountability. Much of preventive medicine, Kaplan persuasively argues, comes down to the selling of expensive pills and procedures that drive up costs while subjecting the population to unneeded risks and complications. And the end result, he argues, is excess care for many people, and a dearth of care for many more.
Kaplan's informed, practical, and constructive approach makes Disease, Diagnoses, and Dollars a "must-read" volume for policymakers and professionals in public health and healthcare, and for business owners as well as ordinary citizens and consumers concerned with the viability of healthcare in America.
