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.

From the reviews:

"This book discusses points of tension in the U.S. healthcare system and places the burden on readers to critically think about the paradoxes consumers face. … The intended audience includes health providers and consumers." (Carole A. Kenner, Doody’s Review Service, February, 2009)

"Disease, Diagnoses, and Dollars is an exceptionally practical, carefully argued study of what can be done to control health care costs by improving the approach to medical decision making. Kaplan persuasively demonstrates the practical wisdom he has learned from wide-ranging research and insightful clinical observations. His book challenges the assumptions of patients and physicians. I believe that many of his concrete recommendations can save not only dollars but the health of patients and the satisfaction of physicians in their professional practice." (James F. Bresnahan,  JAMA, Vol 302, No. 3)

Robert M. Kaplan is Professor and Chair of the Department of Health Services at the UCLA School of Public Health. He is also a Professor of Medicine at the UCLA David Geffen School of Medicine. He has been elected president of four different academic societies and has served as editor-in-chief for two major journals. Kaplan is the author or editor of 16 books and more than 400 articles or chapters. In 2005, he was elected to the Institute of Medicine of the National Academies of Science.