Medical care is composed of myriad goods and
services that maintain, improve, or restore a person’s health. For example, a
young man might have shoulder surgery to repair a torn rotator cuff so that he
can return to work, an elderly woman may have hip replacement surgery so she
can walk without pain, or a parent may bring a child to the hygienist for an
annual teeth cleaning to prevent future dental problems. Prescription drugs,
wheelchairs, and dentures are examples of medical goods, while surgeries,
annual physical exams, and visits to physical therapists are examples of
medical services.
Because of the heterogeneous nature of medical
care, units of medical care are difficult to measure precisely. Units of
medical care are also hard to quantify because most represent services rather
than tangible products. As a service, medical care exhibits the four Is that
distinguish it from a good: intangibility, inseparability, inventory, and
inconsistency.
The first characteristic, intangibility,means
that a medical service is incapable of being assessed by the five senses.
Unlike a new car, a steak dinner, or a new CD, the consumer cannot see, smell,
taste, feel, or hear a medical service.
Inseparability means that the production and
consumption of a medical service take place simultaneously. For example, when
you visit your dentist for a checkup, you are consuming dental services at the
exact time the dentist is producing them. In addition, a patient often acts as both
producer and consumer. Without the patient’s active participation, the medical
product is likely to be poorly produced.
Inventory is directly related to
inseparability. Because the production and consumption of a medical service
occur simultaneously, health care providers are unable to stockpile or maintain
an inventory of medical services. For example, a dentist cannot maintain an
inventory of dental checkups to meet demand during peak periods.
Finally, inconsistency means that the
composition and quality of medical services consumed vary widely across medical
events. Although everyone visits a physician at some time or another, not every
visit to a physician is for the same reason. One person may go for a routine
physical, while another may go because he needs heart bypass surgery. The
composition of medical care provided or the intensity at which it is consumed
can differ greatly among individuals and at different points in time.
The quality of medical care is also difficult
to measure. Quality differences are reflected in the structure, process, and/or
outcome of a medical care provider. Structural qualityis refl ected in the
physical and human resources of the medical care provider, such as the
facilities (level of amenities), medical equipment (type and age), personnel
(training and experience), and administration (organization structure). Process
qualityreflects the specific actions health care providers take on behalf of
patients in delivering and following through with care. Process quality might
include access (waiting time), data collection (background history and
testing), communication with the patient, and diagnosis and treatment (type and
appropriateness). Outcome qualityrefers to the impact of care on the patient’s health
and welfare as measured by patient satisfaction, work time lost to disability,
or postcare mortality rate. Because it is extremely diffi cult to keep all
three aspects of quality constant for every medical event, the quality of
medical services, unlike that of physical goods, is likely to be inconsistent.
As you can see, medical care services are
extremely difficult to quantify. In most instances, researchers measure medical
care in terms of either availability or use. If medical care is measured on an
availability basis, such measures include the number of physicians or hospital
beds available per 1,000 people. If medical care is measured in terms of use,
the analyst employs data indicating how often a medical service is actually
delivered. For example, the quantity of office visits or surgeries per capita
is often used to represent the amount of physician services rendered, whereas
the number of inpatient days is frequently used to measure the amount of
hospital or nursing home services consumed.
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