What's Your Life Worth? Health Care

Calculate the value of your own life in tomorrow's health care system Which diseases are worth curing? Which medicines are worth paying for? The best ways to ration health care--and the worst Health care costs keep soaring. Insurers, employers, andgovernments won't tolerate it anymore. They're beginning toaggressively ration health care--through huge co-payments,limits on new technologies, and long waiting lists.The debate of the decade won't be whether to ration, but how.This book introduces "rational rationing," which focusesresources on the medical interventions that provide thebiggest bang for the buck. Ration the right way, says DavidDranove, and rationing can save thousands of lives andbillions of dollars. Do it wrong, and it'll cause unnecessarypain, suffering, and death.Right now, experts are calculating which diseases are worthcuring, which treatments are worth paying for, and whicharen't. They're putting a price on your life. This book tellsyou who they are, what they're up to, what they think yourlife's worth--and what to do about it.Health care rationing has arrived--with a vengeance. Ifyou value your health, you'd better understand it--and beready. In this book, one of the world's leading health careeconomists offers a hard-nosed analysis of today's soaringhealth care costs--and shows how it will feel to be at themercy of a system that might choose not to cure you.David Dranove previews the transition from today's adhoc rationing to an era of "rational rationing," in whicheconomic analysis of the value of human lives and specifictreatments is both explicit and routine. He assesses themixed results of rational rationing in Great Britain,Australia, and Oregon, where government decision makersstruggle with balancing science and politics in the face ofbudgets that place an alarmingly low value on life.You'll discover that health services researchers have learnedto numerically score different diseases to determine whichare most worth curing; even how to calculate the value ofyour own life. They use this information to assess whichnew technologies are worth the steep price. What they findis at odds with the prevailing view of employers, insurers,and, especially, government regulators who want to stophealth spending in its tracks. Most new technologies areworth every dollar, and then some. Calculate the value of your own life Do the math! One up your friends! Why payers are so eager to ration health care Are we better off increasing health care spending? Will rationing save lives--or destroy them? Will we choose "rational" rationing--or cross our fingers? Where will we draw the line? When life's at stake, which services are really too expensive? QWBs and QALYs Refocusing health care research on cost-effectiveness What lies ahead The coming of rationing to HMOs and Medicare

David Dranove is the Walter McNerney Distinguished Professor of Health Industry Management at Northwestern University's Kellogg Graduate School of Management, as well as Director of the Center for Health Industry Market Economics there.

(NOTE: Each chapter ends with Endnotes.)
Introduction.
1. Is It NICE to Ration?
Putting a Price on Your Life. The Pressure to Ration. Cutting to the Chase. Rationing Drugs Down Under. The National Institute for Clinical Excellence (NICE). The Beta-Interferon Controversy. Medicine versus Economics.

2. Defending Rationing in Principle.
Rationing and Toy Shopping. Are We Wasting Money on Health Care? Moral Hazard. The RAND Study. Demand Inducement. Bad Buys in Health Care. The Wennberg Variations. Defending Rationing.

3. Rationing Around the World.
Rationing in Germany. Controlling Drug Costs in Germany. If It Looks Like Rationing. Rationing in Canada. The Consequences of Waiting Lists. The Future of Rationing in Canada. Rationing in England. Rationing Elsewhere in the World.

4. Rationing in the U.S. Health Care Marketplace.
Rationing Through the Market Mechanism: The Uninsured in the United States. Attempts to Provide Universal Coverage. Rationing Among Insured Americans. Government-Sponsored Rationing in the United States. A Brief History of Managed Care. MCO Strategies for Containing Costs. Whither Rationing in America? Enough Is Enough.

5. Doing Cost-Effectiveness and Cost-Benefit Research.
Some Background on CEA. Is It Valid to Use CEA for Health Care? Doing CEA/CBA. Measuring Costs. Discounting. Is CEA/CBA Research Valid? CBA/CEA in Practice.

6. Measuring the Quality of Life.
Using Rating Scales to Measure Health States. Working with QALYs. Putting QALYs into Practice. All QALYs Are Equal. Measuring QALYs. How Do Your QALY Scores Measure Up? The Quality of Well-Being (QWB) Scale. Concerns about QALYs. Discrimination and QALYs. Limitations of QALY Surveys. Summing Up CEA/CBA Methods. What about the PSA Test?

7. The Oregon Plan.
Rationing in Oregon. The Story of Coby Howard. Toward a Rational Rationing Plan. The Creation of the Oregon Health Plan. The Oregon Plan and HMOs. Creating the List. The New List. More Protests. The Performance of the Rationing Plan. Oregon Ten Years Later. Where Do We Draw the Line?

8. What Is Your Life Worth?
Willingness to Pay, Human Capital, and Intrinsic Value. Pricing Life in the Real World. The Cost-of-Illness (COI) Approach. Using Surveys to Put a Price. on Good Health. Some WTP Measures. Willingness to Pay for Life. How Useful Are WTP Measures? Statistical versus Identified Lives. The Economic Approach to Valuing Statistical Lives. Other Evidence on the Value of Life. What Is Your Life Worth? Value of a QALY. Responding to Mr. Mortimer. The Bottom Line.

9. Rising Costs and Rational Rationing.
The Health Care Budget “Crisis” . The Drain on the U.S. Economy. Targeting Technology. The Fallacy of Cost Containment. The Steady Drumbeat of Rational Rationing. Can Patients Be Rational? Who Should Ration? Rational Rationing in the Public Sector. Rational Rationing and Managed Care. The Real Obstacles. Rational Rationing in the 21st Century.

Index.

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What's Your Life Worth? Health Care Rationing... Who Lives? Who Dies? And Who Decides?

Summary

Author Biography

Table of Contents

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