Flat-of-the-Curve Medicine

What is Flat-of-the-Curve Medicine?

Popularized by health economists such as Alain Enthoven, Robert Evans, and Victor Fuchs, the concept underlying flat-of-the-curve medicine is analogous to the economic law of diminishing marginal returns; that is, as inputs are applied to a production process in successively larger amounts, there will be successively smaller increases in outputs. At some point, additional inputs may result in zero or even negative outputs. Used frequently in economics, this law has been applied in many instances to the production of many goods and services, environment, energy production, national defense, and medicine.

Figure 1 shows a theoretical curve to explain the concept of flat-of-the-curve medicine. An example would be the length of an inpatient hospital stay for a patient with a particular diagnosis. The horizontal x-axis in the figure reflects the inputs—in this case, cost in dollars for each day. These costs may be for personnel, equipment, supplies, overhead, and so on. The vertical y-axis reflects health outcomes depicted by improved health status. Each letter (A, B, C, D, and E) represents one inpatient hospital day. The first inpatient day (A) is clearly beneficial. Likewise, the second inpatient day (B) is beneficial but less so. Inpatient Day C is beneficial but less so than either of the previous days. That is, there is an added (marginal) benefit relative to the added (marginal) cost after the first inpatient day, but this benefit accrues at a diminishing rate. Finally, Inpatient Day 4 (D) and Inpatient Day 5 (E) add marginal costs but no discernable marginal benefit. In this instance, the marginal benefit after the third inpatient day relative to costs is zero. Likewise, additional inpatient days beyond C would add only costs without any concomitant benefits.

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