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Is American Health Care Uniquely Inefficient?

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  • Alan M. Garber
  • Jonathan Skinner

Abstract

The U.S. health system has been described as the most competitive, heterogeneous, inefficient, fragmented, and advanced system of care in the world. In this paper, we consider two questions: First, is the U.S. healthcare system productively efficient relative to other wealthy countries, in the sense of producing better health for a given bundle of hospital beds, physicians, nurses, and other factor inputs? Second, is the United States allocatively efficient relative to other countries, in the sense of providing highly valued care to consumers? For both questions, the answer is most likely no. Although no country can claim to have eliminated inefficiency, the United States has high administrative costs, fragmented care, and stands out with regard to heterogeneity in treatment because of race, income, and geography. The U.S. healthcare system is also more likely to pay for diagnostic tests, treatments, and other forms of care before effectiveness is established and with little consideration of the value they provide. A number of proposed reforms that are designed to ameliorate shortcomings of the U.S. healthcare system, such as quality improvement initiatives and coverage expansions, are unlikely by themselves to reduce expenditures. Addressing allocative inefficiency is a far more difficult task but central to controlling costs.

Suggested Citation

  • Alan M. Garber & Jonathan Skinner, 2008. "Is American Health Care Uniquely Inefficient?," Journal of Economic Perspectives, American Economic Association, vol. 22(4), pages 27-50, Fall.
  • Handle: RePEc:aea:jecper:v:22:y:2008:i:4:p:27-50
    Note: DOI: 10.1257/jep.22.4.27
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    File URL: http://www.aeaweb.org/articles.php?doi=10.1257/jep.22.4.27
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    Blog mentions

    As found by EconAcademics.org, the blog aggregator for Economics research:
    1. Sam Watson’s journal round-up for 26th March 2016
      by Sam Watson in The Academic Health Economists' Blog on 2018-03-26 11:00:43

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    Cited by:

    1. Simona Grassi & Ching-To Albert Ma, 2015. "Information Acquisition, Referral, and Organization," Boston University - Department of Economics - Working Papers Series wp2015-007, Boston University - Department of Economics.
    2. Novignon, Jacob & Nonvignon, Justice, 2015. "Fiscal space for health in Sub-Saharan African countries: an efficiency approach," MPRA Paper 63015, University Library of Munich, Germany.
    3. Larry G. Epstein & Hiroaki Kaido & Kyoungwon Seo, 2016. "Robust Confidence Regions for Incomplete Models," Econometrica, Econometric Society, vol. 84, pages 1799-1838, September.
    4. Erika Laranjeira & Helena Szrek, 2016. "Going beyond life expectancy in assessments of health systems’ performance: life expectancy adjusted by perceived health status," International Journal of Health Economics and Management, Springer, vol. 16(2), pages 133-161, June.
    5. Branko Milanovic & Sean Higgins & Nora Lustig & Whitney Ruble & Timothy M. Smeeding, 2016. "Comparing the Incidence of Taxes and Social Spending in Brazil and the United States," Review of Income and Wealth, International Association for Research in Income and Wealth, vol. 62, pages 22-46, August.
    6. Juan Contreras & Elena Patel & Ignez Tristao, 2013. "Production Factors, Productivity Dynamics and Quality Gains as Determinants of Healthcare Spending Growth in U.S. Hospitals," Working Papers 2013-13, Banco de México.
    7. James Banks & James P. Smith, 2011. "International Comparisons in Health Economics Evidence from Aging Studies," Working Papers WR-880, RAND Corporation.
    8. Carine Milcent, 2016. "Upcoding and heterogeneity in hospitals’ response: A Natural Experiment," Working Papers halshs-01340557, HAL.
    9. Novignon, Jacob, 2015. "On the efficiency of public health expenditure in Sub-Saharan Africa: Does corruption and quality of public institutions matter?," MPRA Paper 39195, University Library of Munich, Germany.
    10. Amitabh Chandra & Douglas O. Staiger, 2017. "Identifying Sources of Inefficiency in Health Care," NBER Working Papers 24035, National Bureau of Economic Research, Inc.
    11. Stephen Hall & P. Swamy & George Tavlas, 2012. "Generalized cointegration: a new concept with an application to health expenditure and health outcomes," Empirical Economics, Springer, vol. 42(2), pages 603-618, April.
    12. Jabłonowski, Janusz & Müller, Christoph & Raffelhüschen, Bernd, 2010. "A fiscal outlook for Poland using generational accounts," FZG Discussion Papers 47, University of Freiburg, Research Center for Generational Contracts (FZG).
    13. Stoddard Christiana & Stock Wendy A. & Hogenson Elise, 2016. "The Impact of Maternity Leave Laws on Cesarean Delivery," The B.E. Journal of Economic Analysis & Policy, De Gruyter, vol. 16(1), pages 321-364, January.
    14. Janet Currie & W. Bentley MacLeod & Jessica Van Parys, 2015. "Physician Practice Style and Patient Health Outcomes: The Case of Heart Attacks," NBER Working Papers 21218, National Bureau of Economic Research, Inc.
    15. Jonathan Gruber & Helen Levy, 2009. "The Evolution of Medical Spending Risk," Journal of Economic Perspectives, American Economic Association, vol. 23(4), pages 25-48, Fall.
    16. David Powell & Seth A. Seabury, 2014. "Medical Care Spending and Labor Market Outcomes Evidence from Workers' Compensation Reforms," Working Papers WR-1028-1, RAND Corporation.
    17. Eric Nauenberg, 2014. "Changing healthcare capital-to-labor ratios: evidence and implications for bending the cost curve in Canada and beyond," International Journal of Health Economics and Management, Springer, vol. 14(4), pages 339-353, December.
    18. Dominic Coey, 2013. "Physician Incentives and Treatment Choices in Heart Attack Management," Discussion Papers 12-027, Stanford Institute for Economic Policy Research.
    19. Janet Currie & W. Bentley MacLeod, 2017. "Diagnosing Expertise: Human Capital, Decision Making, and Performance among Physicians," Journal of Labor Economics, University of Chicago Press, vol. 35(1), pages 1-43.
    20. Eric Nauenberg, 2014. "Changing Healthcare Capital-To-Labor Ratios: Evidence and Implications for Bending the Cost Curve in Canada and Beyond," Working Papers 140002, Canadian Centre for Health Economics, revised Jul 2014.
    21. Melberg, Hans Olav, 2011. "Some problems with international comparisons of health spending – and a suggestion about how to quantify the size of the problems," HERO On line Working Paper Series 2011:4, Oslo University, Health Economics Research Programme.
    22. Jason Abaluck & Leila Agha & Christopher Kabrhel & Ali Raja & Arjun Venkatesh, 2014. "Negative Tests and the Efficiency of Medical Care: What Determines Heterogeneity in Imaging Behavior?," NBER Working Papers 19956, National Bureau of Economic Research, Inc.
    23. Samuel H. Preston & Jessica Y. Ho, 2009. "Low Life Expectancy in the United States: Is the Health Care System at Fault?," NBER Working Papers 15213, National Bureau of Economic Research, Inc.
    24. Pablo Hernández de Cos & Enrique Moral-Benito, 2011. "Health care expenditure in the oecd countries: efficiency and regulation," Occasional Papers 1107, Banco de España;Occasional Papers Homepage.
    25. Hendrik Jürges & Vincent Pohl, 2012. "Medical guidelines, physician density, and quality of care: evidence from German SHARE data," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 13(5), pages 635-649, October.

    More about this item

    JEL classification:

    • H51 - Public Economics - - National Government Expenditures and Related Policies - - - Government Expenditures and Health
    • I11 - Health, Education, and Welfare - - Health - - - Analysis of Health Care Markets
    • I18 - Health, Education, and Welfare - - Health - - - Government Policy; Regulation; Public Health

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