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Health Care, the Market and Consumer Choice

Alain C. Enthoven, Marriner S. Eccles Professor of Public and Private Management Emeritus and Center for Health Policy/PCOR Core Faculty Member, Stanford University, US
In this well-documented book, Alain Enthoven develops the ideas of consumer choice and managed competition of alternative health care financing and delivery systems, as well as describing ways to improve quality and reduce the cost of health care. He demonstrates how these ideas could be applied in the American employment-based health insurance model, how similar ideas have been introduced in the British National Health Service; how these ideas have been applied in the Netherlands; and the need for integrated comprehensive care systems.
Extent: 336 pp
Hardback Price: $155.00 Web: $139.50
Publication Date: 2012
ISBN: 978 0 85793 918 0
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  • Economics and Finance
  • Health Policy and Economics
  • Politics and Public Policy
  • Public Policy
  • Social Policy and Sociology
  • Comparative Social Policy
  • Health Policy and Economics
In this well-documented book, Alain Enthoven develops the ideas of consumer choice and managed competition of alternative health care financing and delivery systems, as well as describing ways to improve quality and reduce the cost of health care. He demonstrates how these ideas could be applied in the American employment-based health insurance model, how similar ideas have been introduced in the British National Health Service; how these ideas have been applied in the Netherlands; and the need for integrated comprehensive care systems.

This unique anthology traces the development of two important and related themes. Firstly, the ‘output’ of the health services industry has been produced by disaggregated physicians, nurses and other health professionals, hospitals, drugs and device companies that somehow combine to serve the patient. Progress in quality and the economy requires the services of these components to be integrated into coherent systems in which the incentives of all providers are aligned with the needs and wants of patients for quality affordable care. Secondly, the book argues that the framework that can provide such incentives, is an appropriately designed form of market competition among systems of care seeking to serve value-conscious patients.

Public officials, scholars and policy analysts from developing countries will find here a set of ideas for how to improve incentives for greater value for money. Students of health economics, policy and organization, as well as journalists and public officials interested in the use of public policy to improve efficiency in health care systems, will also find much to interest them in this book.
Contents:

Introduction

1. ‘Competition of Alternative Delivery Systems’, in Warren Greenberg (ed.), Competition in the Health Care Sector: Past, Present and Future, 1978, 255–77

2. ‘Consumer-Choice Health Plan: Inflation and Inequality in Health Care Today: Alternatives for Cost Control and an Analysis of Proposals for National Health Insurance’ and ‘Consumer-Choice Health Plan: A National-Health-Insurance Proposal Based on Regulated Competition in the Private Sector’, New England Journal of Medicine, 298 (12 and 13), 1978, 650–58 and 709–20

3. ‘Shattuck Lecture – Cutting Cost Without Cutting the Quality of Care’, New England Journal of Medicine, 298, June 1, 1978, 1229–38

4. ‘Consumer-centered vs. Job-centered Health Insurance’, Harvard Business Review, 57 (1), 1979, 38–49

5. ‘A New Proposal to Reform the Tax Treatment of Health Insurance’, Health Affairs, 3 (1), 1984, 21–39

6. ‘Managed Competition in Health Care and the Unfinished Agenda’, Health Care Financing Review, Annual Supplement, 1986, 105–19

7. ‘Effective Management of Competition in the FEHBP’, Health Affairs, 8 (3), 1989, 33–50

8. ‘What Can Europeans Learn from Americans?’, Health Care Financing Review, Annual Supplement, 1989, 49–63

9. ‘Internal Market Reform of the British National Health Service’, Health Affairs, 10 (3), 1991, 60–70

10. ‘Quality Management in the NHS: The Doctor’s Role – I and II’, BMJ: British Medical Journal, 304 (6821 and 6822), 1992, 235–39 and 304–8 (with D.M. Berwick and J.P. Bunker)

11. ‘The History and Principles of Managed Competition’, Health Affairs, 12 (Supplement 1), 1993, 24–48

12. ‘In Pursuit of an Improving National Health Service’, Health Affairs, 19 (3), 2000, 102–19

13. ‘Modernising the NHS: A Promising Start, but Fundamental Reform is Needed’, BMJ: British Medical Journal, 320, 13 May 2000, 1329–31

14. ‘Employment-Based Health Insurance is Failing: Now What?’, Health Affairs Web Exclusive, http://content.healthaffairs.org/content/early/2003/05/28/hlthaff.w3.237.citation, 28 May 2003, w3-237–49

15. ‘Clinically Integrated Health Care in the English NHS’, Journal of Health Services Research & Policy, 14 (2), 2009, 65–7

16. ‘Going Dutch – Managed-Competition Health Insurance in the Netherlands’, New England Journal of Medicine, 357 (24), 2007, 2421–3 (with Wynand P.M.M. van de Ven)

17. ‘A Living Model of Managed Competition: A Conversation with Dutch Health Minister Ab Klink’, Health Affairs, 27 (3), 2008, w196–203

18. ‘Consumer Choice of Health Plan: Connecting Insurers and Providers in Systems’, Keynote Address for the Dutch/Flemish Association of Health Economists (VGE), Annual Conference at Erasmus University, Rotterdam, November 30, 2006, 1–16

19. ‘Competition in Health Care: It Takes Systems to Pursue Quality and Efficiency’, Health Affairs, Web Exclusive, http://content.healthaffairs.org/content/early/2005/09/07/hlthaff.w5.420.citation, 7 September 2005 w5-420–33 (with Laura A. Tollen)

20. ‘“Redefining Health Care”: Medical Homes or Archipelagos to Navigate?’, Health Affairs, 26 (5), 2007, 1366–72 (with Francis J. Crosson and Stephen M. Shortell)

21. ‘The U.S. Experience with Managed Care and Managed Competition’, in Jane Sneddon Little (ed.), Wanting It All: The Challenge of Reforming the U.S. Health Care System, 2005, 97–117

22. ‘Curing Fragmentation with Integrated Delivery Systems: What They Do, What Has Blocked Them, Why We Need Them, and How to Get There from Here?’, in Einer Elhauge (ed.), The Fragmentation of U.S. Health Care: Causes and Solutions, 2010, 61–85