The U.S. health care system is in crisis. At stake are the quality of care for millions of Americans and the financial well-being of individuals and employers squeezed by skyrocketing premiums—not to mention the stability of state and federal government budgets. In Redefining Health Care, internationally renowned strategy expert Michael Porter and innovation expert Elizabeth Teisberg reveal the underlying—and largely overlooked—causes of the problem, and provide a powerful prescription for change. The authors argue that competition currently takes place at the wrong level—among health plans, networks, and hospitals—rather than where it matters most, in the diagnosis, treatment, and prevention of specific health conditions. Participants in the system accumulate bargaining power and shift costs in a zero-sum competition, rather than creating value for patients. Based on an exhaustive study of the U.S. health care system, Redefining Health Care lays out a breakthrough framework for redefining the way competition in health care delivery takes place—and unleashing stunning improvements in quality and efficiency. With specific recommendations for hospitals, doctors, health plans, employers, and policy makers, this book shows how to move health care toward positive-sum competition that delivers lasting benefits for all.

Many Americans believe that people who lack health insurance somehow get the care they really need. Care Without Coverage examines the real consequences for adults who lack health insurance. The study presents findings in the areas of prevention and screening, cancer, chronic illness, hospital-based care, and general health status. The committee looked at the consequences of being uninsured for people suffering from cancer, diabetes, HIV infection and AIDS, heart and kidney disease, mental illness, traumatic injuries, and heart attacks. It focused on the roughly 30 million-one in seven-working-age Americans without health insurance. This group does not include the population over 65 that is covered by Medicare or the nearly 10 million children who are uninsured in this country. The main findings of the report are that working-age Americans without health insurance are more likely to receive too little medical care and receive it too late; be sicker and die sooner; and receive poorer care when they are in the hospital, even for acute situations like a motor vehicle crash.

Consolidation in the private health insurance (PHI) industry may be resulting in less competitive markets and contributing to rising health insurance rates paid by consumers and employers. However, measuring the extent of changes in market competition over time or the effects of changes is challenging. Researchers have used the data available to study competition in PHI markets, typically using one of two measures of competition: HMO market concentration; or the number of HMOs in a market. This report summarizes the findings of peer-reviewed research on concentration in PHI markets and the relationship between the level of competition and other variables, such as premium prices and provider reimbursement rates. Illustrations.

These lectures review the research and experience on the subject of health care economy. The author also sets down a moderately rigorous statement of the economic concepts underlying the kind of competition that he regards as the most promising way to achieve a reasonable degree of equity and efficiency in health care. The first lecture is on the public policy goals of health care financing and delivery and discusses efficiency in health care. The second presents an economic analysis of the systems for organizing and financing medical care systems in the United States. The third lecture is about ``managed competition'', and the fourth reviews American experience with efforts to convert from the traditional system to a competitive system.The book is addressed primarily to economists, health policy makers and health services researchers. It explains how market forces may be managed in pursuit of equity and efficiency in health care. It addresses systematically many of the causes of market failure and proposes a strategy (``managed competition'') for overcoming them. It should be of interest to policy makers in any country interested in incentives for more efficient health care delivery. It should also be very useful supplemental reading for courses in health care economics.