Disease, diagnoses, and dollars : facing the ever-expanding market for medical care / Robert M. Kaplan.

Format:

Book

Author/Creator:

Kaplan, Robert M. (Robert Malcolm), 1947-

Language:

English

Subjects (All):

Medical economics.

Medical policy.

Physical Description:

xvii, 187 pages : illustrations ; 25 cm

Place of Publication:

New York : Copernicus Books/Springer, [2009]

Summary:

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.

Contents:

1 Disease, Outcomes, and Money 1

Buying Health, Buying Healthcare 2

Is More Better? 3

What It Wrong? 4

2 The Disease-Reservoir Hypothesis 7

What Is Disease? 9

Testing the Disease-Reservoir Hypothesis 11

The Geographic Distribution of Health Services 13

Studies of Regional Variation in Service and Spending 15

Variation and Cost 17

3 Mental Models of Health and Healthcare 21

The Human Body: Component Parts or Systems? 23

Chronic versus Acute Disease 24

Common-Sense Models 26

Statistics and Mental Models 27

Mental Models and the People We Most Trust 31

4 What Is Disease and When Does It Begin? 35

Common Perceptions of Chronic Disease 35

More Is More, But Is More Better? 36

When Does Chronic Disease Begin? 38

What are the Implications of These Findings? 40

Primary versus Secondary Prevention 44

5 Screening for Cancer 47

Public Enthusiasm for Screening 48

Questions about the Value of Screening on Public Health 49

Biases in the Interpretation of Screening Studies 50

Lead-Time Bias 50

Length Bias 51

Does Screening Find the Wrong Cases? 53

What do RCTs on Screening Tell Us? 55

Evidence-Based Medicine Approach 60

Interpretation of Cancer-Screening Evidence by Peer Panels 61

The Mammography Paradox 63

How Many Screening Tests are Needed to Prevent a Death? 66

Variations in Screening Rates and Impacts on Healthcare Costs 67

6 Deciding When Blood Pressure Is Too High 73

Definition of Health Outcomes 75

What Is Blood Pressure? 77

Does Blood Pressure Treatment Save Lives? 78

Review of Controversies 79

JNC-7 81

Justification for Lowering the Threshold 82

Likelihood of Benefit-Chances of Side Effects 86

How Many People Will be Affected by the New Guidelines? 88

Paradoxical Treatment Effects 90

7 The Cholesterol Cutoff 95

Cholesterol Screening 100

ATP III 102

Concerns and Conflicts of Interest 103

How Many People are Affected by the Changing Definitions? 103

How Many Will Progress to CVD? 106

8 Diabetes, Obesity, and the Metabolic Syndrome 111

Pathophysiology 112

The Changing Definition of Diabetes and Impaired Fasting Glucose 114

IFG and Its Consequences 115

Obesity and Overweight 118

The Metabolic Syndrome 125

9 Cost-Effectiveness and Opportunity Costs 131

Uninsured Americans: A Result of Too Many Tests? 134

The Costs of Care 136

Outcomes in Chronic Illness 136

Mortality 137

Health-Related Quality of Life 138

Opportunity Costs 139

Primary-Prevention Approaches 141

Physical Activity 142

League Table 144

10 Shared Medical Decision-Making 149

Uncertainty in Medicine 149

Shared Decision-Making 150

Why Shared Decisions are Necessary 152

The Reliability and Consistency of Clinical Decisions 154

Do Patients Want to Participate in Decision-Making? 155

What Is the Patient's Role in Making Decisions? 155

Shared Decision-Making and the Overuse of Medical Services 157

Consumer-Driven Health Plans 162

11 Putting the Pieces Together 167

Costs are Out of Control 167

The Proliferation of Services 168

Changes in Communications with Patients 170

We Need to Re-examine the Process of Developing Practice Guidelines 173.

Notes:

Includes bibliographical references and index.

ISBN:

9780387740447

0387740449

OCLC:

172984358