Technology and the Health Care Quadrilemma: A Test

摘要

Health care quadrilemma (HCQ) theory describes the reciprocal relationship between health care technology, health care insurance, quality of care and cost containment. State-space, time series models were developed to investigate these relationships for the US health care system over the period 1950-1999. The models allow HCQ theory to be restated as historical counterfactuals. The first counterfactual assumed that neither Medicare nor HMOs, two ameliorative cost-cutting approaches, had been implemented. The second counterfactual assumed that universal coverage had been implemented after WWII. Only the second counterfactual had an impact on chronic diseases, but neither had an impact on either technological change or national health expenditures. The reason for these results depends on the unique history of the late 20lh century in the USA.