Health Care and Markets

Publication Date: January 2007

Publisher: Library of Congress. Congressional Research Service

Author(s):

Research Area: Health

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Abstract:

Health care spending is one of the most rapidly growing portions of the federal budget. Projections suggest if the rapid growth in health care costs is not curtailed, governments at all levels will face an uncomfortable choice between significant cuts in other spending priorities or major tax increases. This report examines the economic justification for government intervention and involvement in health care markets.

Many analysts claim market-oriented policies, in certain instances, could lower costs and enhance efficiency in health care. This report discusses the Invisible Hand Theorem, which states that when certain assumptions hold, market outcomes will be efficient. These assumptions require that no one has an informational advantage over another, that no spillover effects exist in consumption or production, that no one exerts market power, and that no scale economies exist in production.

Many characteristics of health care markets fail to satisfy the assumptions of the Invisible Hand Theorem. Moreover, fundamental characteristics of health care (such as informational asymmetries between patients and health care professionals and between payers and providers, as well as ethical and distributional concerns) complicate efforts to expand the use of market or market-like incentives in health care.

Rising health care costs in part reflect the cost of technological advances, whose benefits exceed their costs, and the aging of the U.S. population. The growing role of third-party reimbursement over the past half century weakened incentives to minimize costs and thus has also led to higher health care costs. Many analysts have called for initiatives which would improve the functioning of health care markets, such as improving consumer information and allowing greater use of bargaining. These initiatives may help reduce or slow the growth of health care costs, but may also have unintended negative consequences. Greater use of market-like incentives can improve the efficiency of the health care system, but only if they take into account the special characteristics of health care.