About the Book
As health costs in the U.S. soar past $1.5 trillion, much evidence indicates that the nation does not get good value for its money. It is widely agreed that we could do better by using cost-effective analysis (CEA) to help determine which health care services are most worthwhile. American policy makers, however, have largely avoided using CEA, and researchers have devoted little attention to understanding why this is so. By considering the economic, social, legal, and ethical factors that contribute to the situation, and how they can be negotiated in the future, this book offers a unique perspective. It traces the roots of EA in health and medicine, describes its promise for rational resource allocation, and discusses the nature of the opposition to it, using Medicare and the Oregon health plans as examples. In exploring the disconnection between the promise of CEA and the persistent failure of rational intentions, the book seeks to find common ground and practical solutions. It analyzes the prospects for change and presents a roadmap for getting there.
It offers pragmatic advice for cost-effectiveness analysts, discussing ways in which they can better translate their research findings into the basis for action. The book also offers advice for policy makers and politicians, including lessons from Europe, Canada, and Australia, and underlines the need for leadership to establish the conditions for change.
Table of Contents:
1: Introduction
2: The Promise and Promotion of CEA
3: Resistance to CEA in the United States
4: Understanding the Resistance
5: Legal, Political, and Ethical Concerns
6: Lessons from Oregon
7: Does Anyone in America Really use CEA?
8: CEA Abroad
9: Imagining a Future for CEA
10: Advice for CEA
11: Advice for Policy makers and Politicians
Review :
"Despite the growth in the cost-effectiveness literature and the numerous methodological advances, very little is known about the usefulness of these studies to decision-makers and the extent to which studies are actually used. Peter Neumann's book is the first detailed and authoritative exploration of these issues. It is well-constructed, highly readable and should be of interest both to the practitioners and users of cost-effectiveness studies." -- Michael
F.Drummond, Ph.D., Professor of Health Economics, University of York
". . .makes the subject unexpectedly compelling."--British Medical Journal
"The U.S. is finally embarking on a consumer-focused quest for value in its unrealistically costly healthcare system. Consumers will soon learn that all is not what it appears to be in medical practice or use of medical technology. Peter Neumann is ready with an important policy tool which has been tested plenty, but tried little. You must try this book." --Hon. David F. Durenberger, U.S. Senator from Minnesota, 1978-1995. President, Medical Technology
Leadership Forum
"Peter Neumann's book is essential reading for those interested in gaining a broad and deep understanding of the challenges and potential associated with the use of cost-effectiveness analysis in health care. Getting the most value for money spent on health care is an increasingly urgent priority in health care policy, and this book offers many valuable insights for those who would engage in the public dialog on this critical subject. " -- Sean R.Tunis
MD, MSc., Chief Medical Officer, Centers for Medicare & Medicaid Services
"In this stimulating book, Peter Neumann sets out to explain why medical decisions in the United States are seldom based on formal cost-effectiveness analysis. But the book's real subjects - and the reasons it deserves to be read by anyone with a serious interest in the future of health care in the U.S. -- are why we are so reluctant to acknowledge that resources are finite, and what it will take to spend our health care dollars more wisely. Readers will find
a rich discussion of political, social, and economic challenges, and an illuminating description of the experiences of other nations. They will also find recommendations that are both thoughtful and feasible, and could hardly be more timely." --Alan M. Garber, M.D., Ph.D., Henry J. Kaiser, Jr.
Professor and Professor of Medicine, Professor of Economics, Stanford University
"Neumann's book is a thorough and very readable insight into the possible reasons for the wariness of US public opinion towards the use of cost-effectiveness analysis (CEA) and its role in supporting resource allocation decisions in the healthcare systems in the USA...His book is a well structured and authoritative contribution which should be studied by researchers and policy makers alike."--Health Economics
"In this stimulating book, Peter Neumann sets out to explain why medical decisions in the United States are seldom based on formal cost-effectiveness analysis. But the book's real subjects - and the reasons it deserves to be read by anyone with a serious interest in the future of health care in the U.S. -- are why we are so reluctant to acknowledge that resources are finite, and what it will take to spend our health care dollars more wisely. Readers will find
a rich discussion of political, social, and economic challenges, and an illuminating description of the experiences of other nations. They will also find recommendations that are both thoughtful and feasible, and could hardly be more timely." --Alan M. Garber, M.D., Ph.D., Henry J. Kaiser, Jr.
Professor and Professor of Medicine, Professor of Economics, Stanford University
"Peter Neumann's book is essential reading for those interested in gaining a broad and deep understanding of the challenges and potential associated with the use of cost-effectiveness analysis in health care. Getting the most value for money spent on health care is an increasingly urgent priority in health care policy, and this book offers many valuable insights for those who would engage in the public dialog on this critical subject. " -- Sean R.Tunis
MD, MSc., Chief Medical Officer, Centers for Medicare & Medicaid Services
"The U.S. is finally embarking on a consumer-focused quest for value in its unrealistically costly healthcare system. Consumers will soon learn that all is not what it appears to be in medical practice or use of medical technology. Peter Neumann is ready with an important policy tool which has been tested plenty, but tried little. You must try this book." --Hon. David F. Durenberger, U.S. Senator from Minnesota, 1978-1995. President, Medical Technology
Leadership Forum
"Despite the growth in the cost-effectiveness literature and the numerous methodological advances, very little is known about the usefulness of these studies to decision-makers and the extent to which studies are actually used. Peter Neumann's book is the first detailed and authoritative exploration of these issues. It is well-constructed, highly readable and should be of interest both to the practitioners and users of cost-effectiveness studies." -- Michael
F.Drummond, Ph.D., Professor of Health Economics, University of York
". . .makes the subject unexpectedly compelling."--British Medical Journal
"Neumann's book is a thorough and very readable insight into the possible reasons for the wariness of US public opinion towards the use of cost-effectiveness analysis (CEA) and its role in supporting resource allocation decisions in the healthcare systems in the USA...His book is a well structured and authoritative contribution which should be studied by researchers and policy makers alike."--Health Economics
