Page 1165 Peter D. University of Michigan School of Public Health Debates over the role of government in the private economy date back to the emergence of the U.S. market economy in the early nineteenth century. At that time, the Federalists, led by Alexander Hamilton, argued that a governmental presence was needed to guarantee property rights, enforce contracts, and encourage the nascent entrepreneurial ethos (Sellers 1991). In contrast, the Jeffersonians argued against intrusive government and in favor of self-reliance. That dynamic intersection between economics and political theory continues today regarding the proper regulatory oversight of health care delivery. Arrowâs Theory The health care incarnation of this debate emerged when Kenneth Arrow (1963) identiï¬ed key market failures in health care, namely âthe existence of uncertainty in the incidence of disease and in the efï¬cacy of treatmentâ (941). Underlying these failures were the ânonmarketability of the bearing of suitable risks and the imperfect marketability of informationâ (947) (i.e., information asymmetries between patient and physician), making it nearly impossible for patients to verify the quality of medical care. Arrowâs analysis presumes that health care markets will not reach a competitive equilibrium without nonmarket intervention but The author appreciates the ï¬nancial support
Journal of Health Politics, Policy and Law – Duke University Press
Published: Oct 1, 2001
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