Making Medical Spending Decisions: The Law, Ethics, and Economics of Rationing Mechanisms / Edition 1

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Overview

A fresh and comprehensive exploration of how health care rationing decisions are made, this book offers not specific criteria for rationing—like age or quality of life—but a comparative analysis of three alternative decision makers: consumers paying out of pocket, government and insurance officials setting limits on treatments and coverage, and physicians making decisions at the bedside. Hall's analysis reveals that none of these alternatives is uniformly superior, and, therefore, a mix of all three is inevitable.
The author develops his analysis along three lines of reasoning: political economics, ethics, and law. The economic dimension addresses the practical feasibility of each method for making spending decisions. The ethical dimension discusses several theories—principally classic liberalism, social contract theory, and communitarianism—as well as concepts like autonomy and coercion. The legal dimension follows recent developments in legal doctrine such as informed consent, insurance coverage disputes, and the emerging direction of federal regulation. Hall concludes that physician rationing at the bedside is far more promising than medical ethicists and the medical profession have traditionally allowed.

The book contains no figures.

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Editorial Reviews

Doody's Review Service
Reviewer: Mark C. Mantooth, JD (Rush University Medical Center)
Description: In this book, Professor Mark Hall provides a detailed review and analysis of current medical spending decision making and discusses alternative mechanisms.
Purpose: The author attempts the daunting task of presenting a clear impression of what each institutional structure that participates in medical decision making has to offer, with the ultimate goal of finding the least-imperfect mix of institutions and incentives for public policy. The author makes a valiant and scholarly attempt to reach his laudable, though unattainable, goal.
Audience: As implied in the Preface, this book has been written for lay persons to assist them in understanding how their health insurance influences medical spending decisions. Because of the complexity and dryness of the subject matter, however, healthcare and public policy enthusiasts will likely be the actual audience. The author, a professor of law and public health, has sufficient credentials to be a credible authority.
Features: Replete with references and an extensive bibliography, this book appears to have been well researched. The author has divided the material into seven chapters, organized according to an analytical framework peculiar to the author's stated purpose. This work neither has nor needs any illustrations, and the index is adequate for the reader's needs.
Assessment: If nothing else, the pertinence of the subject matter and the underlying research make this book invaluable. Additionally, the author at times offers innovative and intriguing insights that prove refreshing to a discussion of medical resource reallocation. He makes a strong case, for instance, for the increased use of medical savings accounts. The analyses of policy issues proves to be thorough — though sometimes bordering on the pedantic — and thought-provoking. The book also frequently rambles, and some of the author's points rely on broad assumptions that can be easily challenged.
Mark C. Mantooth
In this book, Professor Mark Hall provides a detailed review and analysis of current medical spending decision making and discusses alternative mechanisms. "The author attempts the daunting task of presenting a clear impression of what each institutional structure that participates in medical decision making has to offer, with the ultimate goal of finding the least-imperfect mix of institutions and incentives for public policy. The author makes a valiant and scholarly attempt to reach his laudable, though unattainable, goal. "As implied in the Preface, this book has been written for lay persons to assist them in understanding how their health insurance influences medical spending decisions. Because of the complexity and dryness of the subject matter, however, healthcare and public policy enthusiasts will likely be the actual audience. The author, a professor of law and public health, has sufficient credentials to be a credible authority. "Replete with references and an extensive bibliography, this book appears to have been well researched. The author has divided the material into seven chapters, organized according to an analytical framework peculiar to the author's stated purpose. This work neither has nor needs any illustrations, and the index is adequate for the reader's needs. "If nothing else, the pertinence of the subject matter and the underlying research make this book invaluable. Additionally, the author at times offers innovative and intriguing insights that prove refreshing to a discussion of medical resource reallocation. He makes a strong case, for instance, for the increased use of medical savings accounts. The analyses of policy issues proves to be thorough —though sometimes bordering on the pedantic — and thought-provoking. The book also frequently rambles, and some of the author's points rely on broad assumptions that can be easily challenged.

4 Stars! from Doody
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Product Details

  • ISBN-13: 9780195092196
  • Publisher: Oxford University Press, USA
  • Publication date: 12/28/1996
  • Edition description: New Edition
  • Edition number: 1
  • Pages: 312
  • Product dimensions: 6.37 (w) x 9.50 (h) x 1.12 (d)

Meet the Author

Mark A. Hall is Professor of Law and Public Health at the Bowman Gray School of Medicine at Wake Forest University.

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Table of Contents

1 Introduction: Who Decides? 3
2 Patient Spending Decisions 15
3 Third-Party Rules 63
4 Physician Bedside Discretion 113
5 Motivating Physicians With Financial Incentives 171
6 Informed Consent to Rationing 193
7 Conclusion: Deciding Who Decides 241
Bibliography 265
Index 295
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