What Is Different About the Market for Health Care?
Notice bibliographique
Résumé
ECONOMICS IS A SOCIAL SCIENCE THAT DESCRIBES HOW society produces and consumes goods and services. It is concerned with both efficiency (getting the most out of a fixed amount of resources) and distribution (who gains and who loses). The use of free markets as a mechanism of promoting efficiency has been touted by the majority of economists since the time of Adam Smith. His theory was that in free markets each individual, pursuing his or her own self-interests, will be led, as if by some “invisible hand,” to produce an allocation that maximizes society’s utility. However, certain conditions are required for free markets to result in efficient allocations. First among these is perfect competition, ie, a market in which no individual buyer or seller can affect the price by his or her actions. Without this condition, structural imperfections or market distortions arise and result in inefficient allocations. For example, the oil market is distorted because the Organization of the Petroleum Exporting Countries (OPEC) has exerted influence on the price of oil by restricting its supply since the 1970s. The market for health care contains many distortions, including asymmetry of information between clinicians and patients; clinicians’ dual roles as patient agent and independent business owner (profiting by ordering or providing certain medical services); the effect of insurance in reducing the apparent cost of health care services to patients (since the full cost of health care is not charged to patients, also known as the “price-wedge” distortion); tax subsidies that have a similar effect on consumers’ decisions to purchase insurance; and monopoly power bestowed on certain professions and, in some countries, health insurance plans, thereby limiting competition. Over the last 40 years, health economists have devoted considerable attention to the impact of these distortions on the market for health care. Feldstein was one of the first to write about the distorting effect of health insurance tax subsidies on market efficiency. Detsky described asymmetry of information and impact of clinician as agent. Arrow noted that when markets fail, public policies are often derived to ameliorate the consequences. In this Commentary we review 3 classic efforts to describe, to quantify, and to propose solutions to market distortions in health care. These efforts framed policy initiatives over the last 40 years and remain relevant to health policy debates today.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,005 | 0,019 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,001 |
| Bibliométrie | 0,002 | 0,002 |
| Études des sciences et des technologies | 0,004 | 0,022 |
| Communication savante | 0,013 | 0,023 |
| Science ouverte | 0,002 | 0,003 |
| Intégrité de la recherche | 0,012 | 0,011 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,019 | 0,002 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».