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Topic 3 Reading Counting Health Care Costs In The United States Notes

Accounting Notes > Accounting in the New Public Sector Notes

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"Counting health care costs in the United States: A Hermeneutical Study of Cost Benefit Research" - Oaks, Considine and Gould (1994)

"Countng health care costs in the United States: A Hermeneutcal Study of Cost Beneft Research" - Oaks, Considine and Gould (1994) Introducton

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Economic analysis of health care is not a new phenomena o Cost benefit studies existed in the 1930s and 1950s (Donabedian, 1985) Since the mid-1980s all the major players in US health care have called for expansion of measurement efforts including cost benefic analysis, and have argued that the measurement of costs and benefits should underlie the allocation of health care resources Health Care Financing Administration (the US Federal agency overseeing Medicare): o Desire to "purchase value, the optimal mix of high quality and reasonable cost" (Roper and Hackbarth, 1988) Early advocates of Diagnosis Related Groupings (DRGs) argued that the introduction of DRGs would lead to better information about costs and benefits Several accounting researchers have suggested that it is important to study accounting numbers as they appear in situ o i.e. in real institutions and debates o e.g. Cooper and Sherer (1984), Hopwood (1987) Cost benefit analysis involves a particular way of informing and/or justifying resource allocations Cost benefit studies as texts which have both a surface, "common-sense" meaning and a less apparent meaning which reflects the institutions are structures surrounding their production, content and distribution The importance of cost benefit analysis is not just that it might be a way of co-ordinating physician behavior at a distance, or that it reflects the way physicians take up the language of economists o But that physicians take up this technology to protect and construct authority over resources

Examinaton of the Producton and Transmission or Diffusion of Messages: Cost Beneft Studies in the Current US Context

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All of the studies we examine were published in the USA during 1987-1990 Two themes emerge from discussions of health care during this period: o 1) Provision of health care in the USA is in crisis and chaos o 2) Perception of physicians under siege

A Discourse of Crisis and Chaos

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Few individuals pay for all their health care costs directly, although many pay part of the bill for hospitalization, drugs and office visits Frequently the term "consumer" refers to employers concerned about the costs of providing employees with health insurance benefits "It is consumer groups and large purchasers of care who will ultimately exert the strongest pressures for cost-effective care" (Bunker, 1988) Much of the support for President Clinton's health care policy comes from US businesses concerned about their own share of health insurance expenditures (Arnold et al., 1994) Health Maintenance Organizations (HMOs) o Sometimes operate their own hospitals and hire their own physicians The Veterans Administration runs hospitals but is also fiscally responsible for the care of US military veterans

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