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Investing in Health Care

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Abstract

This chapter and the next one deal with developments in health care since the end of the Second World War. It should be noted that, for the first 10 to 15 years after the Second World War, there is hardly any useful aggre- gated information available, either quantitative or qualitative. An analysis in financial terms, therefore, must start in 1960. From that time on, the coun- tries of the European Union started to collect data systematically. These data have been collated by the OECD.

Keywords

Health Care Health Expenditure Medical Establishment Labor Relation Health Care Expenditure 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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References

Chapter 8

  1. 3.
    OECD: New Directions in Health Care Policy, Health Policy Studies No. 7, OECD, Paris 1995, table 4, p. 12.Google Scholar
  2. 4.
    Banta, D.: ibid., p. 5.Google Scholar
  3. 5.
    NZR: Sectie Psychiatrische Instituten. Rapport van de Subwerkgroep LIT, ingesteld door de werkgroep fase II/III van het tripartite overleg, March 1975, appendix.Google Scholar
  4. 7.
    See for this history: Ludmerer, K. M.: ibid.Google Scholar
  5. 8.
    Ludmerer, K. M.: ibid., p. 24.Google Scholar
  6. 9.
    Ludmerer, K. M.: ibid., p. 38.Google Scholar
  7. 10.
    Fanu, J. le: ibid., p. 191.Google Scholar
  8. 11.
    Fanu, J. le: ibid., p. 192.Google Scholar
  9. 12.
    Fanu, J. le: ibid., p. 192.Google Scholar
  10. 13.
    Ludmerer, K. M.: ibid., pp. 141–142.Google Scholar
  11. 14.
    Ludmerer, K. M.: ibid., p. 151.Google Scholar
  12. 15.
    Ludmerer, K. M.: ibid., p. 197.Google Scholar
  13. 16.
    Ludmerer, K. M.: ibid., p. 212, table 7.Google Scholar
  14. 17.
    Ludmerer, K. M.: ibid., p. 180.Google Scholar
  15. 18.
    Ludmerer, K. M.: ibid., p. 69.Google Scholar
  16. 19.
    For a brief summary of medical progress during the first decades after the Second World War see: Healy, J. and McKee, M.: The Evolution of Hospital Systems, in: McKee, M., Healy, J., (eds.): ibid., p. 17.Google Scholar
  17. 20.
    Ludmerer, K. M.: ibid., p. 279.Google Scholar
  18. 21.
    The Panama Canal, for example, probably would not have been completed without the elimination of yellow fever (Ludmerer, K. M.: ibid., p. 23).Google Scholar
  19. 22.
    Ludmerer, K. M.: ibid., pp. 23 and 279.Google Scholar
  20. 23.
    Ludmerer, K. M.: ibid., p. 38.Google Scholar
  21. 24.
    As for test-ordering, research in the 1970s showed that 25% of the average hospital bill was for laboratory and radiological studies. Yet only 5% of laboratory information was actually used in treatment and diagnosis (Ludmerer, K. M.: ibid., p. 324).Google Scholar
  22. 25.
    Freidson, E.: ibid., pp. 22–23.Google Scholar
  23. 26.
    Ludmerer, K. M.: ibid., p. 187.Google Scholar
  24. 27.
    Fanu, J. le: ibid., p. 253.Google Scholar
  25. 28.
    Fanu, J. le: ibid., p. 261.Google Scholar
  26. 29.
    Mechanic, D.: ibid., p. 40.Google Scholar
  27. 30.
    Fanu, J, le: ibid., p. 271.Google Scholar
  28. 31.
    Fanu, J. le: ibid., p. 252.Google Scholar
  29. 32.
    OECD Health Data 2003, third edition.Google Scholar
  30. 33.
    Ludmerer, K. M.: ibid., p. 210.Google Scholar
  31. 34.
    Fanu, J. le: ibid., p. 257.Google Scholar
  32. 35.
    Ludmerer, K. M.: ibid., pp. 222 and 228.Google Scholar
  33. 36.
    Dranove, D.: The Economic Evolution of American Health Care: From Marcus Welby to Managed Care, Princeton University Press, 2000, p. 49.Google Scholar
  34. 37.
    Fanu, J. le: ibid., p. 202.Google Scholar
  35. 38.
    Nevertheless, there were millions of Americans who, though not entitled to Medicaid, could not pay for private insurance. Happily therefore, although many charitable patients had become private patients, charitable care did not disappear (Ludmerer, K. M.: ibid., p. 267).Google Scholar
  36. 39.
    Over the period 1968–1978, the number of traineeships awarded by the American National Institute of Health to doctors wishing to undertake postdoctoral research decreased from 3,000 to 1,500 (Fanu, J. le: ibid., p. 244).Google Scholar
  37. 40.
    Ludmerer, K. M.: ibid., p. 227.Google Scholar
  38. 41.
    Ludmerer, K. M.: ibid., p. 332.Google Scholar
  39. 42.
    Ludmerer, K. M.: ibid., p. 365.Google Scholar
  40. 43.
    Ludmerer, K. M.: ibid., p. 348.Google Scholar
  41. 44.
    Ludmerer, K. M.: ibid., p. 119.Google Scholar
  42. 45.
    Ludmerer, K. M.: ibid., p. 340.Google Scholar
  43. 46.
    Ludmerer, K. M.: ibid., p. 327.Google Scholar
  44. 47.
    Ludmerer, K. M.: ibid., p. 333.Google Scholar
  45. 48.
    Dranove, D.: ibid., p. 47.Google Scholar
  46. 49.
    Ludmerer, K. M.: ibid., p. 278. Characteristic of this arrogant behavior is what the Association of Medical Colleges declared, testifying before Congress in 1969: “It is interesting to speculate about the medical advances which might have occurred in the past decade if a sum equal to that invested in space exploration had been spent on health research” (Ludmerer, K. M.: ibid., p. 147).Google Scholar
  47. 50.
    Ludmerer, K. M.: ibid., p. 337.Google Scholar
  48. 51.
    Ludmerer, K. M.: ibid., pp. 286–287.Google Scholar
  49. 52.
    Mossialos, E. and Le Grand, J.: ibid., p. 57, table 1.16. According to this table, the exceptions are Belgium (99%), Germany (92.2%), Spain (99.3%), France (99.5%), the Netherlands (74.1%), and Austria (99%).Google Scholar
  50. 53.
    Financiële Overzichten Gezondheidszorg 1977–1983.Google Scholar
  51. 54.
    In this respect, research among Dutch citizens showed that over the period 1966–1985 “good health” had become by far the highest priority, climbing from 36 to 58, compared to “marriage” from 34 to 15, “family life” from 8 to 12, and “religion” from 16 to 5 (Sociaal en Cultureel Planbureau: Sociaal en Cultureel Rapport 1996). The researchers conclude that this trend applies for the whole of Western Europe (Sociaal en Cultureel Planbureau: Sociaal en Cultureel Rapport 1994, Rijswijk, 1994, p. 502).Google Scholar
  52. 55.
    Ludmerer, K. M.: ibid., p. 227.Google Scholar
  53. 56.
    Policies of corporatism were not limited to health care. Many countries of the EU in those days suffered from policy divisions along departmental lines (Trappenburg, M.: ibid., pp. 6–7).Google Scholar
  54. 57.
    Theurl, E.: Health Expenditure and Cost Control in Austria, in: Mossialos, E. and Le Grand, J., (eds.): ibid., p. 608.Google Scholar
  55. 58.
    O’Neill, P.: Health Crisis 2000, WHO Regional Office for Europe, Copenhagen, 1983, p. 15.Google Scholar
  56. 59.
    From: Measuring Health Care, 1960–1983, OECD, Paris, 1985. Portugal has been left out, since there were only figures available for 1975 and 1980.Google Scholar
  57. 60.
    See: Kanavos, P. and Yfantopoulos, J.: Cost Containment and Health Expenditure in the EU: A Macroeconomic Perspective, in: Mossialos, E. and Le Grand, J., (eds.): ibid., pp. 155–196. For a critical view regarding international comparisons, see: Turner, A.: Just Capital: The Liberal Economy, Pan Books, 2002, chapter 4.Google Scholar
  58. 62.
    Mossialos and Le Grand rightfully argue that “international comparisons are only as good as the data on which they are based” (Mossialos, E. and Le Grand, J., (eds.): ibid., pp. 42–46).Google Scholar
  59. 63.
    Mossialos, E. and Le Grand, J.: Cost Containment in the EU: An Overview, in: Mossialos, E. and Le Grand, J., (eds.): ibid., p. 46.Google Scholar
  60. 64.
    Mosseveld, C. J. P. M. van: International Comparison of Health Care Expenditure: Existing Frameworks, Innovations and Data Use, Voorburg, 2003, p. XXII.Google Scholar
  61. 65.
    All figures in US$ PPP. GDP figures do not account for the informal economy or the informal health care sector, which, particularly in the southern countries of the European Union, is probably considerable (Mossialos, E., Dixon, A., Figueras, J., Kutzin, J., (eds.): ibid., p. 8).Google Scholar
  62. 68.
    Goodin, R. E., Heady, B., Muffels, R., and Dirven, H-J.: The Real Worlds of Welfare Capitalism, in: Pierson, Chr. and Castles, F., (eds.); ibid., p. 182.Google Scholar
  63. 69.
    Baumol, W. J.: Macro-economics of Unbalanced Growth. The Autonomy of Workers Crisis, in: American Economic Review, Volume 57, no. 3, 1967.Google Scholar
  64. 70.
    Sociaal en Cultureel Planbureau: Sociaal en Cultureel Rapport 1996, Rijswijk, 1996, p. 467.Google Scholar
  65. 71.
    Sociaal en Cultureel Planbureau: Sociaal en Cultureel Rapport 1994, ibid.: p. 502.Google Scholar
  66. 72.
    Sociaal en Cultureel Planbureau: Sociaal en Cultureel Rapport 1996, ibid., p. 469.Google Scholar
  67. 73.
    Mossialos and Le Grand observe that most of the “new” highly priced pharmaceutical products are not significant innovations (Mossialos, E. and Le Grand, J.: ibid., p. 61).Google Scholar
  68. 74.
    Fanu, J. le: ibid., part two. Also see section 6.2.1.Google Scholar
  69. 75.
    Fanu, J. le: ibid., p. 272.Google Scholar
  70. 76.
    Fanu, J. le: ibid., p. 373.Google Scholar
  71. 77.
    Fanu, J. le: ibid., pp. 348–349.Google Scholar
  72. 78.
    Fanu, J. le: ibid., p. 343.Google Scholar
  73. 79.
    Fanu, J. le: ibid., p. 373 and 381.Google Scholar
  74. 80.
    Fanu, J. le: ibid., part three, chapter 1.Google Scholar
  75. 81.
    Fanu, J. le: ibid., p. 395.Google Scholar
  76. 82.
    Fanu, J. le: ibid., pp. 394–395.Google Scholar
  77. 83.
    Fanu, J. le: ibid., p. 398.Google Scholar
  78. 84.
    Coulter, A. and Magee, H., (eds.): ibid., p. 64.Google Scholar
  79. 85.
    Coulter, A. and Magee, H., (eds.): ibid., p. 145.Google Scholar
  80. 86.
    Honoré, C.: ibid., p. 119.Google Scholar
  81. 87.
    Coulter, A. and Magee, H., (eds.): ibid., p. 41.Google Scholar
  82. 88.
    Honoré, C.: ibid., p. 120.Google Scholar
  83. 89.
    Wheen, F.: ibid., p. 133.Google Scholar
  84. 90.
    Illich, I.: ibid.Google Scholar
  85. 91.
    The term iatrogeneses refers to the consequences of medical treatment which may inevitably involve unwanted and damaging side effects. The Dutch physician Tempelaar distinguishes between five damaging causes of medical intervention: (1) taking risks, (2) unexpected complications, (3) too few interventions, (4) too many interventions, and (5) wrong interventions (in: Boer, J. de: ibid., p. 13).Google Scholar
  86. 92.
    Comparable American criticism was published three years later in a report from 20 prominent physicians, economists, and politicians. In this report, it was concluded that despite tremendous success in health care, people’s health had not improved significantly (Boer, J. de: ibid., p. 4).Google Scholar
  87. 93.
    Tempelaar, A. F.: Disfunctioneren als Iatrogene Factor, in: Lens, P. and Kahn, Ph. S., (eds.): ibid., p. 232.Google Scholar
  88. 94.
    Foudraine, J.: Wie is van Hout? Een Gang door de Psychiatrie, Ambo boeken, Baarn, 1971.Google Scholar
  89. 95.
    Foudraine, J.: Oorspronkelijk Gezicht: Een Gang naar Huis, Ambo boeken, Baarn, 1979, p. 30.Google Scholar
  90. 96.
    Malleson, A.: Need Your Doctor Be So Useless? (Dutch Translation), Het Spectrum, 1974.Google Scholar
  91. 97.
    Taylor, R.: Medicine Out of Control (Dutch Translation), De Tijdstroom, Lochem, 1983.Google Scholar
  92. 98.
    Ludmerer, K. M.: ibid., p. 279.Google Scholar
  93. 99.
    O’Neill, P.: ibid., in particular pp. ix, 2, and 6.Google Scholar
  94. 100.
    O’Neill, P.: ibid., p. 42.Google Scholar
  95. 101.
    Ludmerer, K. M.: ibid., p. 280.Google Scholar
  96. 102.
    Freidson, E.: ibid., p. 73.Google Scholar
  97. 103.
    Ensor, T. and Duran-Moreno, A.: Corruption as a Challenge to Effective Regulation in the Health Sector, in: Saltman, R. B., Busse, R., Mossialos, E., (eds.): Regulating Entrepreneurial Behaviour in European Health Care Systems, Open University Press, 2003, p. 112.Google Scholar
  98. 104.
    Sparrow, M. K.: ibid.Google Scholar
  99. 105.
    Glied, S.: ibid., p. 38.Google Scholar
  100. 106.
    Ensor, T. and Duran-Moreno, A.: ibid., p. 109.Google Scholar
  101. 107.
    Ensor, T. and Duran-Moreno, A.: ibid., p. 113.Google Scholar
  102. 108.
    Ensor, T. and Duran-Moreno, A.: ibid., chapter five.Google Scholar
  103. 109.
    Department of Health: Countering Fraud in the NHS, London, October 1998.Google Scholar
  104. 110.
    Bos, M. A. J. M.: Fraudeonderzoek en Fraudebestrijding, in: Lens, P. and Kahn, Ph. S., (eds.): ibid., pp. 137–152.Google Scholar
  105. 111.
    Resultaten Inventarisatie Fraudebeleid 2003, Zorgverzekeraars Nederland.Google Scholar
  106. 112.
    European Observatory on Health Care Systems: Health Care Systems in Transition. Luxembourg 1999, WHO Regional Office for Europe, Copenhagen, 1999, p. 47.Google Scholar
  107. 113.
    European Healthcare Fraud & Corruption Conference: Countering Healthcare Fraud and Corruption in Europe, The European Healthcare Fraud and Corruption Declaration, AGIS 2004.Google Scholar

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