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September 18, 2008
Is There A Doctor In The House? Market Signals and Tomorrow's Supply of Doctors
Author: Richard M. Scheffler
Publisher: Stanford University Press
Published: September 2008
Cloth $27.95 256 pp.
15 tables, 17 figures.
ISBN-10: 080470032X
ISBN-13: 9780804700320
ORDER: http://www.sup.org/book.cgi?id=15968
“Professor Richard Scheffler provides a refreshing new perspective on the origins and possible solutions to the U.S. and global health workforce crisis. His book is a must-read for both U.S. policy-makers and the international development community.”
—Alexander S. Preker, Lead Economist, The World Bank
“Will there be a doctor—a good doctor—when I need one?” This is the bedrock health care concern for Americans, encompassing as it does additional concerns about affordability, accessibility, efficiency, and specialty expertise. It is also a crucial, timely question for the United States and the world.
The United States spends more than 16 percent of its total GDP on health care, according to Centers for Medicaid & Medicare Services figures—yet 56 million Americans lack adequate access to a primary care provider. And demand will continue to rise—according to estimates from the John D. Stoeckle Center for Primary Care Innovation, the number of Americans over age 85 is projected to increase 50 percent by 2010, while 83 percent of Americans over age 65 are now diagnosed with a chronic medical condition.
In Is There A Doctor In The House? Richard M. Scheffler upends conventional thinking, as he shows how the United States is not suffering from a shortage of doctors—rather, we are seeing the results of decades of misguided public policies. These policies have created a health care marketplace that often fails to deliver the right number of doctors, of the right specialty, in the right locations. Health care reform, Scheffler argues, is not just a matter of training more doctors. What this country needs is a reform of health care policy, which will spur the development of an efficient, cost-effective, and high-quality health care system.
Using his economist’s perspective to define what it means to find “the right number of doctors,” Scheffler places questions about the supply and demand of doctors in the framework of the market—showing how shifts in market power underlie workforce changes.
The author shows how today’s health care system is the product of economic and financial influences in both the policy realm and on the ground, in the offices of hospitals, insurers, and physicians throughout America. Taking advantage of the most recent data available, he shows how factors such as physician income and quality-of-life issues, medical training costs, and new technologies affect the specialties and geographic distribution of doctors.
Scheffler then offers a template for enhancing the overall efficiency and cost-effectiveness of the health care system. This includes increased use of team-based medicine, with physician assistants and nurse practitioners playing larger roles in patient care; IT implementation; improvements in patient safety and medical outcomes; pay-for-performance programs; modest increases in the number of physicians; and, most importantly, physician payment systems that attract doctors to the venues where they are needed most.
In addition, Scheffler brings his findings to bear on a set of predictions for the U.S. and global physician workforce, which extend five to ten years into the future and could aid efforts to avoid projected disparities in access to doctors. For example, the World Health Organization (WHO) recently unveiled a forecast that describes serious, global disparities in access to doctors in the future. The study predicts that by 2015, Africa will need 65 percent more doctors than it will be projected to have—almost seven times as many doctors as will be required in Europe. The WHO’s predictions remind us that the supply of doctors is the linchpin of the medical system and has enormous influence on the quality of health care available around the world.
In the groundbreaking second half of the book, the author, a health policy expert himself, tests his ideas in conversations with leading figures in health policy, medical education, health economics, and physician practice. Their unguarded give-and-take offers a window on the best thinking currently available anywhere. Finally, Scheffler combines their insights with his own to offer observations that will change the way health care’s stakeholders should think about the future.
ADVANCE PRAISE FOR THE BOOK
“This book shows that there is no easy answer to the question that the title poses. The author pleads for a change in the way we pose questions that are at the heart of the role played by the medical profession in a market-oriented economy.”
— Barbara Starfield, Johns Hopkins School of Public Health
“Physicians are central to the delivery of medical services. Physician supply affects not only access to care, but also physicians’ willingness to participate in new delivery systems, such as managed care plans. This thoughtful and timely discussion will be of particular value to those concerned with health care workforce policy.”
— Paul Feldstein, Paul Merage School of Business, Univ. of California, Irvine
Richard M. Scheffler is Distinguished Professor of Health Economics and Public Policy at the University of California, Berkeley and holds the Chair in Healthcare Markets & Consumer Welfare endowed by the Office of the Attorney General for the State of California.
Stanford University Press
ORDER A COPY http://www.sup.org/book.cgi?id=15968
