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Clinical Corner

Health Care Supply & Demand

Published August 5, 2009 9:45 AM by Carol Kleinman

While most goods and services adhere to the basic economic principle of supply and demand, in many ways healthcare does not. The principle of supply and demand describes a balance that develops between the supply of an item or service and the demand for it. The variable is that of price.  There is a simple balance in which as price goes up, demand goes down, and vice versa. Generally, supply reflects demand as who would continue to develop a product or supply a service for which demand has dropped? 

The problem in healthcare is that the consumer often pays little or nothing for services, despite the current reality of deductibles and copayments. When this is the case, price stops being a factor in demand and demand increases to virtually unlimited levels. 

There was a time when my health insurance cost me nothing (100% of the premium was paid by my employer), I had no deductible and no copayment.  So I had no out-of-pocket expenses whatsoever associated with healthcare.  Now I really don't like going to the doctor, so it did not matter to me all that much, I still did not use a great deal of care.  But many people, when costs are not a factor, use services at the drop of a hat. 

This is the reality that triggered the current healthcare crisis. Even now, despite out-of-pocket costs, utilization is at record levels.  People even tend to feel that since they are paying more for premiums (though nothing close to what employers are paying), they should get their money's worth. There is little to stop them from using services except the managed care initiatives that have been implemented in the last 20 years to address this situation. People in the first half of the 20th century paid for healthcare themselves and were cautious about what services they used. When cost (price) stopped being a factor, desire for the product exploded and we have the runaway train that is currently eating up over 15 percent of our gross domestic product. 

So, how do we deal with this situation? How do we provide the comprehensive care for everyone indicated in this week's question? 

More importantly, how will we pay for it?

 

posted by Carol Kleinman
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2 comments

I disagree that affordable health care leads to overuse. People are either sick or healthy. If they are healthy, they're not going to need care at any cost--even none. They won't suddenly sense a bargain and want to visit the doctor. But if they are sick, then the decision to seek care is based upon need--not cost. Of course, if they can't afford it, they won't use it, but that's not a sign of increased responsibility. Forgoing needed care is dangerous.

Allow me to provide a personal example. I have asthma. And I've had it longer than I've had health insurance, so there have been many instances when I've had to forego preventive medications. Asthma meds aren't cheap. So sometimes I'd have an attack and need to go to the ER. Of course I couldn't afford it, so I'd wait. I'd wait until the asthma was so bad that I'd wonder if I was going to die on my way to the hospital. In other words, I'd wait to make sure I REALLY actually needed to go. Ambulances, incidentally, are expensive, so I never took one. By the time I'd arrive, I didn't just need a nebulizer, I'd need ABGs, IV steroids and a long visit to stabilize.  In other words--it drove the cost up.

Now that I have insurance and affordable co-pays, I don't run the hospital willy nilly. I still hate the waits, the germs, the long stay. But I'm eternally thankful that I have the option to get care when I need it without having to worry about bankruptcy--at least for now. Of course, with asthma, I can't get private insurance, so if I were to lose my employer-coverage, I'd be right back where I started--gambling my health because the bills is due.

Carrie Ali August 14, 2009 2:40 PM

Please explain to me then how Britain's healthcare system has not collapsed. I don't understand how arguments like this are being made when there are examples right now of countries that according to this idea (that lack of out-of-pocket cost causes demand to skyrocket) should have completely buckled under the weight of the financial costs.

Bret August 14, 2009 2:17 PM

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