Arrow (2001)-Reflection on the reflections.pdf

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1、JHPPL26.523Arrow10/29/014:43PMPage1197ReflectionsontheReflectionsKennethJ.ArrowStanfordUniversityAnauthorcannothelpbeingflatteredbytheattentionpaidinthisissue.Disagreementandcriticismarealmostaswelcomeaspraiseandexten-sion;theimportantthingtoanyauthoristhathisorherideasmatterandareimportantenoughtofi

2、ghtabout.Further,theseessaysofferedmeaveryinformativehistoryofthelastfortyyearsinhealthcareintheUnitedStates,fromwhichIhavelearnedmuch.Adetailedanalysisofthewritingsinthisvolumewouldnotbepossi-bleinanybriefcompass.Enoughnewideasandchallengeshavebeenraisedheretoleadtoashortvolumeintermsofspecificag

3、reements,dis-agreements,andextensions.Myresponsetakestheformoffivesome-whatlinkedsetsofremarksontheeconomicsofmedicalcareandonmoregeneralaspectsofeconomicsinwhichsimilarthemesemerge.Astheauthorswellknow,Ihavenotengagedinresearchonmedicalcareforalongtimeandsoamcertainlynotuptodateonmanyspecificempir

4、icalaspectsofthesubject.Ihavesomeimpressions,andIwillnotletmylackofknowledgeprecludemyraisingpoints,secureintheunder-standingthatIamprivilegedtoaskquestionswithoutknowingtheanswers.Iamstimulatedtorespondtocriticalcommentsabouttherelevanceofmyanalysistothepresentandrecentstatesofthemedicalcareindu

5、s-try.Someofmyremarksarehypothesesabouttheevolutioninthemed-icalcaresystem;some,clarificationsorextensionsofthepositionsinmyfirstarticleonmedicalcare.JournalofHealthPolitics,PolicyandLaw,Vol.26,No.5,October2001.Copyright©2001byDukeUniversityPress.JHPPL26.523Arrow10/29/014:43PMPage11981198JournalofH

6、ealthPolitics,PolicyandLawIwillrestatemythesisinafewwords:Theroleofmoralhazardinmedicalinsurancearisesfrominequalitiesofinformationbetweentheinsurerononehandandthephysicianandpatientontheother.Byitself,thisphenomenonwaswellknowninotherkindsofinsurance(wherethetermmoralhazardarose)andwasmetbyvario

7、usdevices,suchasdeductiblesandceilings.Directcontrolscamelater,asIconjectured.Ithencametotheviewthatthesamedegreeofasymmetricinformationalsooccurredintherelationbetweenpatientsandproviders.Iproposedthehypothesisthatman