“The most pernicious
doctrine in health services research, the greatest impediment to clear
thought and successful action, is that health care is different. Of
course the medical sector has features not found elsewhere in the
economy and polity, but then there is a uniqueness to every other
industry.
Each of the salient characteristics of health care, including professionalism, licensure, nonprofit organization, third-party payment, and heavy government regulation, can be found in other sectors, albeit not bundled in quite the same distinct and dysfunctional manner. The uniqueness doctrine hence proves too much. More importantly, the principle serves as a two-way barrier to entry between the health and non-health sectors.
In one direction it discourages mainstream economists from importing the principles of industrial organization, game theory, and transactions costs to health care issues by raising a wall of acronyms and institutional trivia that impedes dialogue.
In the other direction it fosters a complacency among the virtuosi of health policy analysis, allowing us to achieve fame and fortune in our small pond without fear of competition from denizens of the scholarly shark tank.”
“To some within the health care community, the uniqueness doctrine is self-evident and needs no justification. After all, health care is essential to health.
That food and shelter are even more vital and seem to be produced without professional licensure, nonprofit organization, compulsory insurance, class action lawsuits, and 133,000 pages of regulatory prescription in the Federal Register does not shake the faith of the orthodox.
For the sophisticates, however, the uniqueness doctrine does demand a foundation or least a pedigree. It is here that the theory of asymmetric information enters, gets comfortable, and decides to reside permanently in the intellectual edifice of health economics, medical sociology, health politics, and the other subspecialties of this faction-ridden but homologous research community. Which brings me to “Uncertainty and the Welfare Economics of Medical Care” (Arrow 1963).”
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Each of the salient characteristics of health care, including professionalism, licensure, nonprofit organization, third-party payment, and heavy government regulation, can be found in other sectors, albeit not bundled in quite the same distinct and dysfunctional manner. The uniqueness doctrine hence proves too much. More importantly, the principle serves as a two-way barrier to entry between the health and non-health sectors.
In one direction it discourages mainstream economists from importing the principles of industrial organization, game theory, and transactions costs to health care issues by raising a wall of acronyms and institutional trivia that impedes dialogue.
In the other direction it fosters a complacency among the virtuosi of health policy analysis, allowing us to achieve fame and fortune in our small pond without fear of competition from denizens of the scholarly shark tank.”
“To some within the health care community, the uniqueness doctrine is self-evident and needs no justification. After all, health care is essential to health.
That food and shelter are even more vital and seem to be produced without professional licensure, nonprofit organization, compulsory insurance, class action lawsuits, and 133,000 pages of regulatory prescription in the Federal Register does not shake the faith of the orthodox.
For the sophisticates, however, the uniqueness doctrine does demand a foundation or least a pedigree. It is here that the theory of asymmetric information enters, gets comfortable, and decides to reside permanently in the intellectual edifice of health economics, medical sociology, health politics, and the other subspecialties of this faction-ridden but homologous research community. Which brings me to “Uncertainty and the Welfare Economics of Medical Care” (Arrow 1963).”
READ MORE
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