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This paper examines the role of medical care in improving health and compares that value of better health produced by medical care with the costs of that care. Valuing medical care requires measuring the health of the population. We start by developing a measure of the nation's health capital -- the dollar value of health a person will have over the course of their remaining life. We estimate health capital empirically using data on the length of life, the prevalence of adverse conditions for those alive, and the quality of life conditional on having an adverse condition. For a newborn in 1990, we estimate health capital at about $3 million, while for the elderly, health capital is nearly $1 million. Health capital has increased greatly over time -- by roughly $40,000 to $50,000 per decade. Comparing the change in health capital with the increase in medical spending, we estimate that, for most plausible assumptions, increased medical technology has been worth its cost. In our preferred specification, only about 30 percent of the improvement in health capital in the past 40 years would need to result from medical care advances for the improvement of medical technology to justify its cost. While we find that on average value of medical technology is high, we discuss other evidence that substantial amounts of medical care is provided in situations where its value is low. We thus suggest a fundamental repositioning of the public debate about medical spending. Traditionally, the question that has been posed in the public sector is: how can society (or the government) limit medical costs so that we can afford medical care in the future on our budget today? Our results suggest that a more appropriate question is: how can we get more of the spending that is valuable but avoid the spending that is not valuable?

Medical care.

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Managed care plans (Medical care) --- Managed care programs (Medical care) --- Managed care systems (Medical care) --- Managed health care --- Plans, Managed care (Medical care) --- Programs, Managed care (Medical care) --- Systems, Managed care (Medical care) --- Health insurance --- Medical care

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Critical Care --- methods. --- Critical care medicine --- Intensive care units

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Medical care --- Managed care plans (Medical care) --- Quality control.

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Many questions about technology growth and development in health care call for a broad-based characterization of technology availability. In this paper, we explore the possibility of producing aggregated estimates of technology availability by constructing an index of technology availability in hospitals. Our index is based on the number of services provided by a hospital, weighted by how rare those services are. We use the index to examine the relationship between managed care and technology availability in hospitals. We find that managed care may have slowed technology growth in the mid 1980s, but in the early 1990s we find little evidence that technology growth in areas with high-HMO market share is any slower than growth in lower market share areas. To the extent that our index captures variation in the costs of new technologies, this finding leaves open the question of whether managed care can help control long term cost growth by slowing technology adoption. We also discuss the general strengths and weaknesses of indices of the type we develop. One concern arises from the considerable variation across individual technologies. We profile several individual technologies and note that conclusions drawn from the aggregated index may not apply to each of the constituent technologies. Nonetheless, this exercise shows that it is feasible to develop and analyze hospital technology indices if aggregated information about technologies is appropriate to the research question.

Medical care, Cost of. --- Managed care plans (Medical care)