Is health care the only business where companies and institutions are actively turning away customers rather than fi nding innovative ways to serve them? Health care reform that is aimed at managing demand-as opposed to rationing supply-is a much more compelling answer to today' s seemingly intractable problem of fi nding the necessary resources to meet the growing demands of health care.

Get the Answers You Need to Shape Your Strategy

Nothing about health care rationing is straightforward, transparent, or even rational. How is health care rationing perceived by various stakeholders? What problems does it present? The percentage of the population that is aged 65+ ranges from 12% to 19% and will grow even larger. How will this inverted population pyramid affect health care economics? What demands will this constituency make? Expectations for health care delivery have changed. How does this relate to the rise of "lifestyle drugs," and how does that trend in health care perpetuate the problem? How do changing expectations clash with the original design of health care funding systems? What impact do technology improvements have? The concept of managing demand might appear to limit commercial opportunities for pharmaceutical companies. Is that the case? Or are there remaining, or new, areas of opportunities for these stakeholders?

Scope

The critical need for health care reform and why efforts to date have failed: We explain how four trends have widened the gap between the demand for health care and the ability to fund and provide it, and we plumb the inadequacies of health care reform efforts to date (e.g., effi ciency improvements, limited coverage, covert rationing, distributed justice).
Health care economics 101: Understand the overarching trends at work that feed the demand and supply problem.
Modifying health care demand: We discuss eight opportunities to effect demand-side change.
Expert Commentary: A Decision Resources analyst explains how results of a survey point to the impact of rationing on the quality of health care.

Executive Summary
- Strategic Considerations
- Stakeholder Implications
A Conundrum Wrapped in an Enigma
Health Care Rationing by Any Other Name
Why Health Care Reform Is Necessary
- Staggering Impacts of Health Care Demographics
- Shifting Disease Patterns
- Society' s Expanding Expectations
- Expensive New Medical Technologies
Health Care Economics 101
Why Health Care Reform Has Failed
- Buying Your Way Out of Trouble
- Increasing Effi ciencies
- Invisible Hand of the Market
Rationing by Stealth, Not by Fiat
- Insuring Only Healthy Patients
- Limiting Access Among the Elderly and to New Treatments
- Determining a Person' s Worth and Adopting Futile Care Approaches
Rationing: Do Not Resuscitate
- Ascendancy of the Gray Panthers
- Requisites for Chronic Disease Care
- Added Strains from Preventable Illnesses
  - Iatrogenic Illnesses in the United States
  - Iatrogenic Illnesses in the United Kingdom
  - Nosocomial Infections
Modifying Health Care Demand
- Factors Driving Demand
- Upstream Prevention
- Educational Programs Aimed at Behavior
- Incentives for Changing Behavior
- Herd Immunization
- Environmental Disease Burden
- Behavioral Changes to Address Quality of Care
- Evidence-Based Medicine and Value for Money
  - Technology Assessments to Determine Value
  - Problems with Quality-of-Life-Adjusted-Year Thresholds
  - Real and Assumed Value of New Medical Technologies
- The Concept of Care: Lifestyle Choice or Illness?
The Bottom Line

Tables:

1. The Accelerating Aging of the Population and the Decline in the Rate of Population Replacement
2. Current Vaccine-Preventable Diseases
3. Select Infectious Disease and Cancer Vaccines in Late-Stage Development or in Registration, August 2007
4. High-Mortality Diseases with Environmentally Modifi able Factors
5. The 90% Solution: Saving 100,000 Additional Lives Annually in the United States by Increasing the Use of Preventive Services
6. Select Lifestyle Drugs That Do Not Treat or Prevent Illness
A. Tyrosine Kinase Inhibitor Treatment Costs and Medicare Prescription Drug Plan Coinsurance Requirements

Figures:

1. A Growing Rift Between the Ability to Fund and the Capability to Provide Health Care: Four Trends from the Late 1980s
2. Waste and Overconsumption in Both Private and Public Systems Due to a Silo Approach to Health Care as Opposed to Holistic Health Care Management
3. A World Pharma Market Dominated by Annuity Drugs Offering Symptomatic Treatment for Chronic Diseases
4. Preventable or Modifi able Health Care Risk Factors
5. Proactive, Not Reactive, Health Care
A. Tyrosine Kinase Inhibitor Cost Controls Used by Private Health Care Plans