Disease, Diagnoses, and Dollars

Disease, Diagnoses, and Dollars is about the costs of health care and their impact on health. The U.S. health care system is the largest sector in the biggest economy, and the US spends significantly more per capita on health care than any other country, yet it ranks last among comparison nations on the major health indicators. Within the U.S., there is evidence that regions that spend more do not have better outcomes, and some evidence suggests that quality of care is lower in the regions that spend more, not less, on health care.

Robert Kaplan takes the controversial position that mass markets have been created for services that may offer little or no benefit to patients. Many of these markets are for preventive medicine, making healthy people a market for expensive pharmaceutical products and tests. These include cancer screening tests and medications to control blood pressure, cholesterol, and glucose. Kaplan forcefully argues that the overuse of medications and tests runs up the costs of health care. As more employers drop health insurance for their employees when costs accelerate, the expanded use of ineffective preventive medicine may have the unintended consequence of increasing the number of uninsured patients, potentially damaging the health of others in the community.

The concluding chapters of Disease, Diagnoses, and Dollars offer suggestions for policy makers and for patients. Methods for systematically evaluating the cost-effectiveness of new guidelines are discussed. The final chapter provides practical suggestions to enable patients to share in decisions about treatments or tests that can have uncertain benefits.