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 health systems 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 the corresponding 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.
Industry Reviews
"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." -- David Cutler, Otto Eckstein Professor of Applied Economics, Harvard University
"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." -- Larry Levitt, Executive Vice President for Health Policy, Kaiser Family Foundation
"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." -- Andrew M. Jones, Department of Economics
and Related Studies, University of York
"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 humilityDLhighlights the limits to what we can know, and we can say, about the future as it unfolds." -- Chapin White, Deputy
Director, Health Analysis Division, Congressional Budget Office
"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." -- David Bishai, MD MPH PhD, Professor, Johns Hopkins University
"This book has been a major project for a number of years. I cannot think of any source documenting the key influences on health expenditure in more detail, with such a large number of citations. Much of the research for the book was conducted during the period during which Tom was establishing the International Health Economics Association (IHEA). That enduring professional society and this book will be his legacy." -- Michael Drummond, Professor of Health
Economics, University of York
"This text intriguingly poses the enigma of why health expenditure has grown exponentially in the developed world, most acutely in the US, over the last 150 years, offering a riddle that may keep the curious reader obsessively engaged, unable to put down the book." -- Choice
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