Money and Medicine

A unique historical review that traces health spending from ancient times to the present and forecasts 21st century trends.There are many histories of medicine, yet none that assess the dynamics of expenditures over decades and centuries. Economists have not yet addressed the magnitude of the transformation that occurred during the twentieth century as payments shifted from solo physician practices to health systems, nor the legacy effects of social practices accumulated over millennia that will shape health spending in the twenty-first. In Money and Medicine, Thomas E. Getzen provides a unified narrative of medical spending from ancient Egypt and Babylonia to the present day. Drawing on a wealth of historical reports, data, and documents, Getzen concentrates on a single ratio-the share of income devoted to medical care-to frame the evolutionary path of medicine, revealing an S-shaped growth curve that rose rapidly after 1900 as science made therapies more effective and more expensive, inflected as national healthsystems coalesced and rates of expansion peaked in the 1960s, then decelerated after 1975. International trends in forty-three countries are graphically illustrated with analysis supporting a parsimonious financial model. Significant lags are seen between medical innovation or macroeconomic shocks and thecorresponding changes in national health expenditures. Getzen explains inertial responses to the 2008 financial crisis and Covid-19 recession, provides a method for projecting trends over the next fifty years, and suggests why spending is so much higher in the United States than other countries.As rising costs and unequal distribution of medical care have created a sense of crisis in many countries, Money and Medicine shows that we must look beyond the last few years to craft sensible solutions.

Money and Medicine weaves a clear, unified narrative about the rise of national health care systems and medical spending over time that will be of great interest to readers in health care and economics alike., Political debates about health care almost always come down to money. There is no one better than Tom Getzen to explain how nations count up what they spend on health care, to peer into the future to understand where spending is heading, and to dissect why the United States is such an outlier when it comes to health expenditures., The founder of the International Health Economics Association takes a characteristically bold and ambitious view of the evolution of healthcare spending. His book reflects a lifetime of research and scholarship, having a historical and geographic sweep that brings fascinating details together with rigorous statistical evidence to highlight the macroeconomic and historical dimensions of the economics of health care., Professor Getzen offers a surprisingly personal and engaging survey of the history of health care expenditures. Taking a panoramic tour across time and space illuminates the co-transformations of the health care sector and the modern nation state. He brings to the table every relevant scrap of evidence, and then-refreshingly, with humility—highlights the limits to what we can know, and we can say, about the future as it unfolds., Global growth in health spending by people and their governments means more of our money will be headed into the world's inscrutable health systems. Getzen's mastery of the subject across time and space is a gift to everyone who wants health dollars to achieve value, fairness, and health for all.

Thomas E. Getzen is Professor Emeritus of Risk, Insurance, and Health Management at Temple University. Founder of iHEA-International Health Economics Association and its executive director for 22 years, he was instrumental in the formation of AfHEA-African Health Economics Association, ASHEcon-American Health Economics Association, and EUHEA - European Health Economics Association. His textbook Health Economics & Financing is now in its6th edition and used at universities around the world. Formerly Editor-in-Chief for HEN-Health Economics Network at SSRN, associate editor for Health Economics, and a member of the Institute of Medicine committee for the future of public health, Professor Getzen currently produces the Model of Long Run Medical Cost Trends eachyear for the Society of Actuaries.