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Summary

This chapter describes the discipline of health economics and the useful role it may have in debates about dealing with the ever-rising costs of the medical care system. The chapter also reviews the health economics of specific therapies and strategies used in the care of patients with heart failure, atrial fibrillation, and coronary artery disease. Widespread concern exists about the current and future costs of health care, and uncertainty about the best way to control these costs is tremendous. Health economics is the study of the production and allocation of health care resources, and is based on the ideas that society’s collective resources are finite and that choices need to be made about the best ways to use these limited resources to fulfill the needs and desires of society. Three critical questions exist for health economics (see accompanying Hurst’s Central Illustration): (1) What long-term effects does it have on health outcomes, and what is the level of evidence supporting the current state of understanding about clinical effectiveness? (2) Is it good value for money? (3) Can we afford it? Notably, the value of economic analysis is highly dependent on the quality and relevance of the data available for the work; much modeling is performed because clinical studies rarely provide all the data that are needed for a comprehensive health economics analysis.

eFig 112-01

Three critical elements in health economics.

INTRODUCTION

In March 2010, the US Congress passed and President Obama signed a historic new health care legislation, the Patient Protection and Affordable Care Act (PPACA). The full impact of this complex bill on medical practice and US healthcare expenditures will likely not be clear for many years. The passage of this legislation was preceded by a vigorous public debate on the US healthcare system and options for its reform. Complex arguments about the best way to organize, deliver, and pay for healthcare became the stuff of the daily news reports and editorials. Major participants in the healthcare industry and other interest groups jostled to advance their perspectives before the US Congress and the court of public opinion. One major reason for all this attention and the justification given for both supporting and resisting passage of this legislation was a widespread concern about the current and future costs of healthcare and tremendous uncertainty about the best way to control these costs. According to the Centers for Medicare and Medicaid Services (CMS), the United States spent 17.5% of its gross domestic product (GDP) on healthcare in 2014, amounting to approximately $3 trillion.1 Approximately 52% of this expenditure went for hospital care or physician/clinical services. Drug therapy accounted for another 10%. While the rate of growth in healthcare spending has varied in recent years, the trajectory for the national healthcare bill will continue to be upward for the foreseeable future. However, despite leading the world ...

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