HCA 451 Economics of Health
Spring, 2008
Richard L. Tradewell, MBA, Ph.D.
Ph: 562.985.5694
E-Mail: rtradewe@csulb.edu
Office: ETec 101
COURSE DESCRIPTION
Introduction to general microeconomic principles, demand and supply model, four theoretical
models of competition—perfect competition, monopoly, monopolistic competition, oligopoly,
and the firm and consumer maximization. Discussion of basic health economics concepts
and their application to health care sector such as opportunity cost, production of good
health, the demand for medical care, production and cost theory, cost-benefit analysis, and
health care systems and institutions, the behavior of health care providers; profit
maximization, perfect and imperfect competition, nonprofit firms’ objectives, pharmaceutical
industry and long term care. Presentation of the role of government in health matters and
medical care markets as well as a review of various plans dealing with healthcare reform
along with basic and applied research.
STUDENT OUTCOMES / COURSE OBJECTIVES
The student will be able to:
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demonstrate an understanding of the laws and principles of economics at
the micro and macro levels and the impact of these laws and principles
on healthcare organizations,
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describe the various kinds of economic markets,
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demonstrate an understanding of the cost-benefit concept and its
application in health services delivery,
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understand the determinants of health and health improvements

learn the conceptual model of demand for medical care
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demonstrate an understanding of governmental regulations on health
care,
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analyze the economic impact of various healthcare policies and
proposals on the health care sector,
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learn the competitive model and how it relates to healthcare supply and
demand,
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demonstrate an understanding of the marketing aspects of healthcare
and how they relate to supply and demand,

learn and demonstrate strong working knowledge of economic concepts
when they are discussed in day-to-day meetings with fellow healthcare
professional.

understand concepts of market failure and government failure

understand steps involved in correcting market or government failure and
the unintended consequences that can follow
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
classify different kinds of health services by whether they are
rivalrous/excludable (private) or nonrivalrous/nonexcludable (public)
COURSE EVALUATION AND CUTOFF POINTS
In this course, students can accumulate up to 200 points form all course requirements (see
schedule below). Course grades will be determined based on the following:
90%
80%
70%
60%
<60%
A
B
C
D
F
EVALUATION TOOLS
Final exam
Quizzes 4 @ 20 points each
Critical essay
Class participation
Total
50 points
80 points
50 points
20 points
200 points
ACADEMIC INTEGRITY
Academic Integrity is defined as not cheating and not plagiarizing; honesty.
Plagiarism
Plagiarism is the dishonest act of presenting the words or thoughts of another writer as if they
were your own. You commit plagiarism whenever you use a source in any way without
indicating that you have used it. If you quote anything at all, even a phrase, you must put
quotation marks around it, or set it off from your text; if you summarize or paraphrase an
author's words, you must clearly indicate where the summary or paraphrase begins and
ends; if you use an author's idea, you must say that you are doing so. In every instance, you
must also formally acknowledge the written source from which you took the material.
Reprinted from Writing: A College Handbook, James A. W Heffernan and John E. Lincoln. By
Permission W. W. Norton & Co., Inc. Copyright 1982 by W. W. Norton & Co. Inc.
If there is anything about plagiarism you do not understand, ask your professor. The
University Student Handbook may be a good source if you need more information.
REQUIRED TEXT
Slavin, S.L. Economics/A Self-Teaching Guide, 1999, John Wiley Publishing
Getzen, T.E. Fundamentals & Flow of Funds, 2004, John Wiley Publishing
THE LIBRARY E-RESERVE SYSTEM
Other readings and materials will be available on the CSULB Library’s E-Reserve system. To
access the system type the following address in your web browser: eReserves.library.csulb.edu.
Type “Tradewell” in the space for “ERes QuickSearch” and click on the “search” button. You will
then see the course password page. Enter the password for the course, which is “think,” and
then click on the “accept” button. You should now be in the main course folder. You will see a
folder titled “Readings,” click on it and you will see each reading. Click on the reading and you
can read the article on screen or download and print it.
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READINGS AND QUESTIONS
WEEK 1: “Economics is the study of the use of scarce resources which have alternative
uses.” – Lionel Robbins
Core Principles
Review of basic economic concepts
Economic resources
Opportunity cost
Production possibilities curve
Demand and supply
Competition
Profit maximization
Utility Theory
Types of Markets
SELF TEST
Readings
Chapters 1-4 and 11-14, Slavin, S.L. Economics: A Self-Teaching Guide, 1999, John Wiley
Publishing
Survey: “The Health of Nations.” The Economist. (July 15, 2004).
Goodman, Musgrave and Herrick. 2005. Lives at Risk: Single-Payer National Health
Insurance Around the World. Chapter 24: Designing Ideal Health Insurance.
“A Survey of the World Economy: The Future of the State.” The Economist (September 20,
1997).
Chapter 8: “Limits to Public Intervention: Government Failures” in Weimer, David L. and
Aidan R. Vining. 2005. Policy Analysis: Concepts and Practice. Prentice Hall.
Milton Friedman, “How to Cure Health Care”
http://www.thepublicinterest.com/archives/2001winter/article1.html
WEEK 2 and 3
Core Principles
 Sources and uses of health care funds
 Flow of funds
 Income and ethnicity as determinants of mortality
 Cost-Benefit analysis (CBA) is about making choices
 Example of marginal analysis
 Value, benefits, costs
 The value of life
 Need versus demand
 Demand for medical care
Readings
Chapter 1, 2, 3 in Getzen, T.E. Fundamentals & Flow of Funds, 2004, John Wiley Publishing
The American Health Care System: Expenditures, John Iglehart, The New England Journal of
Medicine, Jan. 7, 1999, v. 340(1); 70-76.
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Tracking Health Care Costs, Paul B. Ginsburg and Jeremy D. Pickreign, Health Affairs, 1996,
v. 15(3); 140-149.
Cost Effectiveness Analysis of Bicycle Helmet Subsidies in a Defined Population, Robert S.
Thompson, and et al., Pediatrics, 1993, v. 91 (5); 902-907.
Questions
1. What happened to the health care spending in the 1990s and early
2000s, increased or decreased? List the most important reasons for this
trend and discuss?
2. If most college students are poor, why do they spend so much on
discretionary goods such as CDs? Are the ones who go on to medical
school richer or poorer than the ones who take jobs upon graduation?
3. Many experts recommend that people get at least 30 minutes of vigorous
exercise three to five times a week; is the actual participation in exercise
less than the amount (a) needed or (b) demanded. Why do most college
students get more exercise in the summer than the winter? Does need,
demand, or differences in opportunity cost of time account for the fact
that most actors get more exercise than most accountants?
4. Which are more elastic, dental visits or visits for the treatment of
diabetes? Physician visits or hospital days? Psychiatry or orthopedics?
Why?
5. Who pays for health care? Is there any change in the composition of
payers or their share in the last decade or two?
QUIZ I
WEEK 4 and 5
Core Principles
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Methods of covering risks
Risk aversion & adverse selection
Moral hazard
Third party transactions
Managed care plans
Fixed premiums, ASO, and self-Insurance
ERISA, taxes and mandated benefits
Readings
Chapters 4, 5 in Getzen, T.E. Fundamentals & Flow of Funds, 2004, John Wiley Publishing
The American Health Care System: Health Insurance Coverage, Robert Kuttner, The New
England Journal of Medicine, Jan. 14, 1999, v. 340(2); 163-168.
The American Health Care System: Employer Sponsored Health Coverage, Robert Kuttner,
The New England Journal of Medicine, Jan. 21, 1999, v. 340(3); 248-252.
“The Health System in Transition: Care, Cost, and Coverage, Kenneth Thorpe, Journal of
Health Politics, Policy and Law, 1997, v. 22(2); 339-361.
Questions
1. When medical care is reimbursed through employer-provided insurance, whose
welfare is ultimately affected when the cost of medical care rises: the owners of the
firm that pays the premiums, the people in government whose revenues are reduced
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because insurance benefits are not taxable like wages, or the public at large in their
roles of workers, consumers, and taxpayers? Is there any difference between shortrun and long-run effects?
2. The law now gives a worker who becomes unemployed the right to buy continuing
health insurance coverage after leaving the company. Why might it be rational for a
factory worker who loses their job to give up this legal right to purchase coverage and
be uninsured, even knowing that he or she is at risk for high medical expenditures?
3. Which government insurance program is more affected by adverse selection,
Medicare or Medicaid?
4. Does insurance increase or decrease the demand for medical care? Does this
represent a problem for any parties involved in health care? Why?
5. Contact six people (or read required readings to respond) and find out how much
they spent on health care last year. Try to estimate how much they spent out of their
own pocket, and how much was spent by their employer, insurance company, or
government. Did they personally end up paying a larger or smaller percentage of
their total health bills?
WEEK 6 and 7
Core Principles
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Physician payment, incomes, costs
Licensures: quality or profits
Medical education/adjusting physician supply
Price discrimination
Kickbacks, self-dealing & side payments
Practice variations
Readings
Chapters 6, 7 in Getzen, T.E. Fundamentals & Flow of Funds, 2004, John Wiley Publishing
The American Health Care System: Physicians and the Changing Medical Marketplace,
Thomas Bodenheimer, The New England Journal of Medicine, Feb. 18, 1999, v. 340 (7); 584588.
Questions
1. Do you think that radiologists prefer to be compensated fee-for-service, by relative
value scale, on salary, or as part of a capitated rate? Why? Why might different
specialties prefer different forms of payment? What organization provides the largest
amount of payment to physicians in the United States? How do they choose to make
these payments? Has the form of payment changed over time? Why?
2. How do agency and information asymmetry lead to licensure? Do agents get more or
less of the gains from trade as the degree of information asymmetry increases?
Explain why and how the strength of licensure is related to the extent of information
asymmetry.
3. What advantages does a large physician group have over a solo physician? What
disadvantages?
4. Why are the markets for health insurance so much more price-competitive than the
markets for medical care?
5.
Is medical care “sold” like other goods and services? Explain how irregularities in
health care markets differ from others?
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QUIZ II
WEEK 8 and 9
Core Principles
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Development of the modern hospital
Revenues & costs
Capital financing
Organization: Who controls the hospital and for what ends
Economies of scale
How do hospitals compete?
Controlling costs through regulation
Readings
Chapters 8, 9 in Getzen, T.E. Fundamentals & Flow of Funds, 2004, John Wiley Publishing
Competition Versus Regulation: Its Effect on Hospitals, Gerard Anderson, Robert Heyssel, and
Robert Dickler, Health Affairs, 1993, v. 12(1).
Strategies for More Efficient Performance Through Hospital Merger, Tony Sinay and Claudia
Campbell, Health Care Management Review, 2002, 27(1); 33-49.
Questions
1. Which input accounts for the largest portion of hospital costs? Which input is
responsible for most of the growth in hospital cost per patient day?
2. Over the past hundred years, the major source of hospital revenues has changed
three times. Name these types of payments, and explain why each one gave way to
the next.
3. Why do people spend so long waiting to be treated in the emergency room? Would it
be more efficient if there were sufficient doctors available so that they could be
treated right away?
4. Why have quality improvements in health care caused costs to rise while quality
improvements in computers have caused costs to fall?
5. What major factors create economies of scale in hospitals? Diseconomies of scale?
Are most hospitals of optimal size, too small, too large?
WEEK 10 and 11 (Week 10 is Easter Break)
Core Principles
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Range of managed care plans
Controlling costs
The evolution of an HMO
Ownership & capital markets: signs of failure
Managed competition
Readings
Chapter 10 in Getzen, T.E. Fundamentals & Flow of Funds, 2004, John Wiley Publishing
In Our New Competitive World, Is Health Field Headed for Investor-Owned Takeover? Is it for
Better or Worse? Walter McNerney, The Journal of Health Administration Education, 1996, v.
14(1); 77-91.
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The American Health Care System: Wall Street and Health Care, Robert Kuttner, The New
England Journal of Medicine, Feb. 25, 1999, v. 340(8); 664-668.
The American Health Care System: The Movement for Improved Quality in Health Care,
Thomas Bodenheimer, The New England Journal of Medicine, Feb. 11, 1999, v. 340 (6); 488492.
Questions
1. What incentives does a capitated physician have to keep his patients happy? What
incentive does a FFS physician have? If Mr. Jones is a cranky old man who smokes
and drinks so much that his liver and other organs are going downhill, which payment
system provides more incentive to keep Mr. Jones satisfied? Which provides the
most incentive to render extra care? Which provides the most incentive to make sure
that the level of care is optimized?
2. If an HMO reduces the patient’s marginal cost of surgery, hospitalization,
chemotherapy and other expensive items to zero, how can it provide incentives for
reduced utilization?
3. Does a surplus of hospital beds in an area make it easier or harder to start an HMO?
A surplus of doctors? A surplus of insurance companies?
4. Does capitation payments shift the risks of paying for ill health to hospitals and
physicians? How?
5. How do HMOs use financial contracts to align the interests of patients and doctors?
QUIZ III
WEEK 12 and 13
Core Principles
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Development of the Long Term Care Market
Certificate of Need
CCRC’s & the wealthy elderly
History and Regulation of Pharmaceuticals
Research and development
Competition in Pharmaceutical Markets
Current trends
Readings
Chapters 11, 12 in Getzen, T.E. Fundamentals & Flow of Funds, 2004, John Wiley Publishing
Long Term Care for Frail Elderly People - The On Look Model, Thomas Bodenheimer, The
New England Journal of Medicine, Oct. 21, 1999, v. 341(17); 1324-1328.
The American Health Care System: Medicare, John Iglehart, The New England Journal of
Medicine, Jan. 28, 1999, v. 340(4); 327-332.
Perspectives on the Pharmaceutical Industry, Uwe Reinhardt, Health Affairs, 2001, v. 20(3);
136-149.
Financing Long Term Care: Options for Policy
http://econwpa.wustl.edu:8089/eps/mac/papers/0004/0004030.pdf
Questions
1. Hospitals compete for doctors, and for the newest technology. How do nursing
homes compete? Does price play more or less of a role? Technology?
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2. Marketing accounts for a much larger portion of the cost of pharmaceuticals than the
cost of other forms of care. Why? To whom are most pharmaceutical marketing
efforts targeted?
3. The major form of health insurance coverage for the elderly Medicare, and the elderly
are much heavier users of pharmaceuticals than other groups. It would seem
reasonable to expect that Medicare is the largest source of payment for drugs. Is it?
4. What fraction of the total cost of pharmaceuticals is paid for directly by patients?
Does this mean that price is more or less important than for other types of medical
care?
5. When a brand name drug loses patent protection after seventeen years and
competing generic products enter the market, will the price of the brand name drug
increase or decrease? Why?
WEEK 14 and 15
Core Principles
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Introduction to macro health economics
Properties of the individual vs. properties of the system
Abstractions & complications
Role of Government
Externalities and public good
Market failure
Pros & Cons of regulation
Readings
Chapters 13, 14, in Getzen, T.E. Fundamentals & Flow of Funds, 2004, John Wiley
Publishing
Questions
1. What aspects of the economic organization of U.S. medical care are due to market
failure?
2. Do all economic exchanges have a monetary price? How would a politician pay the
price of changing insurance legislation to cover hospital-sponsored HMOs? To whom
would the price be paid? Do laws regulating exchange make trade more or less
expensive?
3. Which results in lower prices, competition or regulation?
4. When do you think we have more rules and regulations in the economy or in part of
the economy? Who makes the rules that govern the economy? Who challenges
them?
5. Medical savings accounts tend to favor which groups of people? Why?
QUIZ IV
Week 16
Core Principles
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Public and private goods
Externalities and infectious diseases
Income Redistribution
Economic growth and the shape of health care
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Reducing uncertainty: The value of health & economic security
Wide differences between nations
Micro vs. Macro allocation: Health as a national luxury good
International trade in healthcare
Readings
Chapters 15, 17 in Getzen, T.E. Fundamentals & Flow of Funds, 2004, John Wiley Publishing
Cross National Comparison of Health Systems Using OECD, 1999, Uwe Reinhardt, and et
al., 2002, Health Affairs, v. 21(3); 169-181.
Chapter 10: “The Design of Health Systems” in M Merson, R Black, A Mills, International
Public Health, Gaithersburg: Aspen Publishers, Inc. 2001.
Questions
1.
As an officer of the World Health Organization, what programs would you fund if you
wished to make the largest impact on health, measured as the increase in life
expectancy multiplied by the number of people affected, for a given budgetary
allocation of $100 million?
2. Which has more externalities, cigars or chewing tobacco? Guns or knives? Laptop
computers or portable telephones?
3. There are many goods that are desired by some people and not by others. Since
diversity of tastes is universal, why does it create more problems for public goods
than for private goods?
4. Suppose that you read Sunday’s paper and find out that price controls have been
placed limiting the cost of health insurance to $2,500 per employee, significantly
below the current average. What effects would you predict to occur?
5. How much is spent per person on health care in China? How much is spent per
person on health care in the US? In the United Kingdom? What are the primary
factors accounting for these differences?
WEEK 17
FINAL EXAM TO BE POSTED
9
SUPPLEMENTAL READINGS
Andrulis, D. P. 1997. ‘The Public Sector in Health Care: Evolution or Dissolution?’ Health
Affairs 16(4), 131-9.
Anton, T. J. 1997. ‘New Federalism and Intergovernmental Fiscal Relationships: The
Implications for Health Policy.’ Journal of Health Politics, Policy, and Law, 22(3), 691-720.
Barer, M. L., Lomas, J., and Sanmartin, C. 1996. ‘Re-minding our Ps and Qs: Cost Controls
in Canada.’ Health Affairs, 15(2), 216-34.
Brooks, G. R. and Jones, V. G. 1997. ‘Hospital Mergers and Market Overlap.’ Health
Services Research 31(6), 701-722.
Buchmueller, T. C. and Feldstein, P. J. 1996. ‘Hospital Community Benefits Other than
Charity Care: Implications for Tax Exemption and Policy.’ Hospital & Health Services
Administration 41(4), 461-71.
Buchmueller, T. C. and Feldstein, P. J. 1996. ‘Consumers’ Sensitivity to Health Plan
Premiums: Evidence from a Natural Experiment In California.’ Health Affairs 15(1), 143-51.
Davis, K. 1997. ‘Uninsured in an Era of Managed Care.’ Health Services Research 31(6),
641-649.
Dranove, D., Durkac, A., and Shanley, M. 1996. ‘Are Multihospital Systems More Efficient?’
Health Affairs 15(1), 100-4.
Enthoven, A. C. and Kronick, R. 1991. ‘Universal Health Insurance through Incentives
Reform.’ Journal of the American Medical Association, 265(19), 2532-6.
Etheredge, L., Jones, S. B., and Lewin, L. 1996. ‘What is Driving Health System Change?’
Health Affairs 15(4), 93-104.
Finocchio, L. J., Dower, C. M., McMahon, T., Gragnola, C. M., and the Taskforce on Health
Care Workforce Regulation. Reforming Health Care Workforce Regulation: Policy
Considerations for the 21st Century. San Francisco, CA: Pew Health Professions
Commission. 1995.
Frech, H. E. Competition and Monopoly in Medical Care. Washington, D.C.: AEI Press, 1996.
Fuchs V. in Mark Perlman, ed. ‘Some Economic Aspects of Mortality in Developed
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Gardiner, L. R., Oswald, S. L., and Jahera, J. S. 1996. ‘Prediction of Hospital Failure: A PostPPS Analysis.’ Hospital & Health Services Administration 41(4), 441-60.
Getzen, T. E. Health Economics Fundamentals and Flow of Funds. New York, NY: John
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Gold, M. 1997. ‘Markets and Public Programs: Insights from Oregon and Tennessee.’ Journal
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Goldman, D. P., Leibowitz, A., Buchanan, J. L., and Keesey, J. 1997. ‘Redistributional
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Greenberg, W. Competition, Regulation, and Rationing in Health Care. Ann Arbor, MI: Health
Administration Press, 1991.
Grumet, G. W. 1989. ‘Health Care Rationing Through Inconvenience.’ The New England
Journal of Medicine 321(9), 607-611.
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Hacker, J. S. and Skocpol, T. 1997. ‘The New Politics of U. S. Health Policy.’ Journal of
Health Politics, Policy, and Law, 22(2), 315-38.
Hsiao, W. C., and et al. 1988. ‘Results, Potential Effects, and Implementation Issues of the
Resource-Based Relative Value Scale.’ JAMA 260(16), 2429-2437.
Herzlinger, R. E., and Krasker, W. S. 1987. ‘Who profits from nonprofits.’ Harvard Business
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Iglehart, J. K. (Ed.) Debating Health Care Reform: A Primer From Health Affairs. Bethesda,
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Jacobs, P. The Economics of Health and Medical Care, 4th ed. Rockville, MD: Aspen, 1997.
Jenson, G. A., Morrisey, M. A., Gaffney, S., and Liston, D. K. 1997. ‘The New Dominance of
Managed Care: Insurance Trends in the 1990s.’ Health Affairs 16(1), 125-136.
Lewin, M. E. and Lifoff, E. (eds.) Information Trading: How Information Influences the Health
Policy Process. Washington, DC: National Academy Press, 1997.
Litman, T. J. and Robins, L. S. (eds.) Health Politics and Policy, 3rd ed. Albany, NY: Delmar
Publishers Inc., 1996.
Longest, B. B. Seeking Strategic Advantage Through Health Policy Analysis. Chicago, IL:
Health Administration Press, 1996.
Luke, R. D., Ozcan, Y. A., and Olden, P. C. 1995. ‘Local Markets and Systems: Hospital
Consolidations in Metropolitan Areas.’ Health Services Research 30(4), 555-75.
Marquis, M. S. and Long, S. H. 1996. ‘Reconsidering the Effect of Medicaid on Health Care
Services Use’. Health Services Research 30 (6), 791-808.
McKay, N. L. and Coventry, J. A. 1995. ‘Access Implications of Rural Hospital Closures and
Conversions.’ Hospital & Health Services Administration 40(2), 227-46.
Moran, D. W. 1997. ‘Federal Regulation of Managed Care: An Impulse in Search of a
Theory?’ Health Affairs, 16(6), 7-21.
Morrisey, M. A., Jenson, G. A., and Morlock, R. J. 1994. ‘Small Employers and the Health
Insurance Market.’ Health Affairs 13(4), 149-61.
Nguyen, N. X. and Derrick, F. W. 1997. ‘Physician Behavioral Response to a Medicare Price
Reduction.’ Health Services Research 32 (3), 283-298.
Olden, P. C. 1996. ‘Managing Managed Care Market Competition.’ Medical Group
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Reinhardt, U. E. 1991. ‘Breaking American Health Policy Gridlock.’ Health Affairs, 10(2), 96103.
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Stewart, C. T. Healthy, Wealthy, or Wise? Issues in American Health Care Policy. Armonk,
NY: M. E. Sharpe, 1995.
Sinay, U. T. 1998. ‘Hospital Mergers and Closures: Survival of Rural Hospitals.’ The Journal
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Sinay, U. T. 1998. ‘Pre-and Post-Merger Investigation of Hospital Mergers.’ Eastern
Economic Journal 24(1), 83-97.
Succi, M. J., Lee, S. D., and Alexander, J. A. 1997. ‘Effects of Market Position and
Competition on Rural Hospital Closures.’ Health Services Research 31(6), 679-99.
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Thompson, F. J. 1996. ‘The Evolving Challenge of Health Policy Implementation.’ In Litman,
T. J. and Robins, L. S. (eds.) Health Politics and Policy, 3rd ed. Albany, NY: Delmar
Publishers Inc., 1996.
Welch, H. G. 1994. ‘Physician profiling: An Analysis of Inpatient Practice Patterns in Florida
and Oregon.’ The New England Journal of Medicine 330(9), 607-611.
Zwanziger, J. and Melnick, G. 1996. ‘Can Managed Care Plans Control Health Care
Costs?’Health Affairs, 15(2), 185-99.
Halm, Ethan A. NancyAnne Causimo, & David Blumenthal. "Is Gatekeeping Better Than
Traditional Care? Journal of the American Medical Association, 278 (Nov. 1997) pp. 1677-81.
Levit, Katherine R., et al. "National Health Spending Trends in 1996." Health Affairs 17 (Jan.Feb. 1998), pp. 35-51
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Compeition". The Wall Street Journal, June 20, 1994, p86.
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881-84.
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Economic Inquiry 14 (Dec. 1976), pp. 493-510.
Hoergar, Thomas J. "Profit Variability in For-Profit and Not-for-Profit Hospitals." Journal of
Health Economics 10 (Oct. 1991), pp. 259-89.
Obealander, Jonathan B. "Managed Care and Medicare Reform." Journal of Health Politics,
Policy & Law 22 (April 1997), pp. 595-632.
Jensen, Gail A., Michael A. Morrisey, Shannon Gaffney, and Derek K. Liston. "The New
Dominance of Managed Care: Insurance Trends in the 1990’s" Health Affairs 1 (Jan/Feb
1997), pp. 125-36.
Leffler, Keith B. "Physician Licensure: Competition and Monopoly in American Medicine."
Journal of Law & Economics 21 (1978), pp. 165-86.
Gaynor, Martin, and Gerard F. Anderson. "Uncertain Demand, the Structure of Hospital Costs
and the Cost of Empty Beds." Journal of Health Economics 14 (1995) pp. 291-317.
DiMasi, Joseph A., "Success Rates for New Drugs Entering Clinical Testing in the United
States." Clinical & Pharmacology Therapeutics 58 (July 1995), pp. 1-14.
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