Health Policy
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Health Policy

Choice, Equality and Cost

David Reisman

This lucid and comprehensive book explores the ways in which the State, the market and the citizen can collaborate to satisfy people’s health care needs. It argues that health care is not a commodity like any other. It asks if its unique properties mean that there is a role for social regulation and political management. Apples and oranges can be left to the buyers and the sellers. Health care may require an input from the consensus, the experts, the insurers, the politicians and the bureaucrats as well. David Reisman makes a fresh contribution to the debate. He argues that the three policy issues that are of primary importance are choice, equality and cost.
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Chapter 16: Cost containment

David Reisman


The share of care is going up. It is going up as a share of the gross domestic product (GDP), of total public expenditure and of the median household budget. There is nothing wrong with that. If society wants better health, and if it is convinced that more care is the best means to the end, then it ought to welcome the rise. We do not cut or curtail the cost of something that is doing us good. The question is simply whether an equivalent health status can be delivered at a lower unit cost. This chapter explores the possibility that it can. There is no consensus on medical effectiveness, value for money or clinical priority. There is no consensus on the target share of health. Where there is consensus is that spending is escalating and that the price times the quantity is becoming a threat. Choice in health must extend to the choice of cost: ‘Health care expenditures cannot grow at rates 2 per cent or 3 per cent higher than GDP indefinitely’ (McGuire et al., 2012: 140). At some point the members of the community must call a halt. What that point will be is, however, not a matter for doctors or even economists to prescribe: ‘Ultimately … the level of expenditure will be determined by the preferences for health care displayed by individual countries’ (McGuire et al., 2012: 142). Each country’s consensus is the suprema lex. Agreement is all. Without agreement it would be civil war.

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