The author shows how today’s health care system is the product of economic and financial influences in both the policy realm and on the ground, in the offices of hospitals, insurers, and physicians throughout America. Taking advantage of the most recent data available, he shows how factors such as physician income and quality-of-life issues, medical training costs, and new technologies affect the specialties and geographic distribution of doctors.

Scheffler then offers a template for enhancing the overall efficiency and cost-effectiveness of the health care system.  This includes increased use of team-based medicine, with physician assistants and nurse practitioners playing larger roles in patient care; IT implementation; improvements in patient safety and medical outcomes; pay-for-performance programs; modest increases in the number of physicians; and, most importantly, physician payment systems that attract doctors to the venues where they are needed most.

In addition, Scheffler brings his findings to bear on a set of predictions for the U.S. and global physician workforce, which extend five to ten years into the future and could aid efforts to avoid projected disparities in access to doctors.  For example, the World Health Organization (WHO) recently unveiled a forecast that describes serious, global disparities in access to doctors in the future. The study predicts that by 2015, Africa will need 65 percent more doctors than it will be projected to have—almost seven times as many doctors as will be required in Europe.  The WHO’s predictions remind us that the supply of doctors is the linchpin of the medical system and has enormous influence on the quality of health care available around the world.

In the groundbreaking second half of the book, the author, a health policy expert himself, tests his ideas in conversations with leading figures in health policy, medical education, health economics, and physician practice.  Their unguarded give-and-take offers a window on the best thinking currently available anywhere. Finally, Scheffler combines their insights with his own to offer observations that will change the way health care’s stakeholders should think about the future.

Richard M. Scheffler is Distinguished Professor of Health Economics and Public Policy at the University of California, Berkeley and holds the Chair in Healthcare Markets & Consumer Welfare endowed by the Office of the Attorney General for the State of California and a Human Resources for Health Editorial Board member .

The 224 pages book was published by Stanford University Press, in September 2008.
Price :   $27.95 (978-0-8047-0032-0)