{"id":"https://openalex.org/W2113633798","doi":"https://doi.org/10.1056/nejmp0907172","title":"Getting Past Denial \u2014 The High Cost of Health Care in the United States","display_name":"Getting Past Denial \u2014 The High Cost of Health Care in the United States","publication_year":2009,"publication_date":"2009-09-10","ids":{"openalex":"https://openalex.org/W2113633798","doi":"https://doi.org/10.1056/nejmp0907172","mag":"2113633798","pmid":"https://pubmed.ncbi.nlm.nih.gov/19741220"},"language":"en","primary_location":{"id":"doi:10.1056/nejmp0907172","doi":"https://doi.org/10.1056/nejmp0907172","is_oa":false,"landing_page_url":"https://doi.org/10.1056/nejmp0907172","pdf_url":null,"source":{"id":"https://openalex.org/S62468778","display_name":"New England Journal of Medicine","issn_l":"0028-4793","issn":["0028-4793","0096-6762","1533-4406","2331-4710"],"is_oa":false,"is_in_doaj":false,"is_core":true,"listed_in":["anvur-class-a","anvur-scientific","cwts-core","dongbi-a","doyens","jufo-3","ki-jl-3","medline","norway-2","poland-200","russia-white-list-1","vabb-shw"],"host_organization":"https://openalex.org/P4310320239","host_organization_name":"Massachusetts Medical Society","host_organization_lineage":["https://openalex.org/P4310320239"],"host_organization_lineage_names":["Massachusetts Medical Society"],"type":"journal"},"license":null,"license_id":null,"version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"New England Journal of Medicine","raw_type":"journal-article"},"volume":null,"type":"article","indexed_in":["crossref","pubmed"],"open_access":{"is_oa":false,"oa_status":"closed","oa_url":null,"any_repository_has_fulltext":false},"authorships":[{"author_position":"first","author":{"id":"https://openalex.org/A5010167527","display_name":"Jason Murray Sutherland","orcid":"https://orcid.org/0000-0002-1857-2432","observed_orcids":["https://orcid.org/0000-0002-1857-2432"]},"institutions":[{"id":"https://openalex.org/I126688049","display_name":"Dartmouth Institute for Health Policy and Clinical Practice","ror":"https://ror.org/0511yej17","country_code":"US","type":"healthcare","lineage":["https://openalex.org/I126688049"]}],"countries":["US"],"is_corresponding":false,"raw_author_name":"Jason M. Sutherland","raw_affiliation_strings":["Dartmouth Institute for Health Policy and Clinical , Lebanon, NH, USA","Dartmouth Institute for Health Policy and Clinical Practice"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Dartmouth Institute for Health Policy and Clinical , Lebanon, NH, USA","institution_ids":["https://openalex.org/I126688049"]},{"raw_affiliation_string":"Dartmouth Institute for Health Policy and Clinical Practice","institution_ids":["https://openalex.org/I126688049"]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5112042687","display_name":"Elliott S. Fisher","orcid":"https://orcid.org/0000-0002-9571-4879","observed_orcids":["https://orcid.org/0000-0002-9571-4879","https://orcid.org/0000-0001-9558-7665"]},"institutions":[{"id":"https://openalex.org/I107672454","display_name":"Dartmouth College","ror":"https://ror.org/049s0rh22","country_code":"US","type":"education","lineage":["https://openalex.org/I107672454"]}],"countries":["US"],"is_corresponding":false,"raw_author_name":"Elliott S. Fisher","raw_affiliation_strings":["Dartmouth Medical School"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Dartmouth Medical School","institution_ids":["https://openalex.org/I107672454"]}]},{"author_position":"last","author":{"id":"https://openalex.org/A5091310966","display_name":"Jonathan Skinner","orcid":"https://orcid.org/0000-0002-4760-9396","observed_orcids":["https://orcid.org/0000-0002-4760-9396"]},"institutions":[{"id":"https://openalex.org/I107672454","display_name":"Dartmouth College","ror":"https://ror.org/049s0rh22","country_code":"US","type":"education","lineage":["https://openalex.org/I107672454"]},{"id":"https://openalex.org/I126688049","display_name":"Dartmouth Institute for Health Policy and Clinical Practice","ror":"https://ror.org/0511yej17","country_code":"US","type":"healthcare","lineage":["https://openalex.org/I126688049"]}],"countries":["US"],"is_corresponding":false,"raw_author_name":"Jonathan S. Skinner","raw_affiliation_strings":["Dartmouth College, Hanover, NH","Dartmouth Institute for Health Policy and Clinical Practice"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Dartmouth College, Hanover, NH","institution_ids":["https://openalex.org/I107672454"]},{"raw_affiliation_string":"Dartmouth Institute for Health Policy and Clinical Practice","institution_ids":["https://openalex.org/I126688049"]}]}],"institutions":[],"countries_distinct_count":1,"institutions_distinct_count":2,"corresponding_author_ids":[],"corresponding_institution_ids":[],"apc_list":null,"apc_paid":null,"fwci":44.4646,"has_fulltext":false,"cited_by_count":146,"citation_normalized_percentile":{"value":0.99752861,"is_in_top_1_percent":true,"is_in_top_10_percent":true},"cited_by_percentile_year":{"min":95,"max":100},"biblio":{"volume":"361","issue":"13","first_page":"1227","last_page":"1230"},"is_retracted":false,"is_paratext":false,"is_xpac":false,"primary_topic":{"id":"https://openalex.org/T10391","display_name":"Healthcare Policy and Management","score":0.9146000146865845,"subfield":{"id":"https://openalex.org/subfields/2002","display_name":"Economics and Econometrics"},"field":{"id":"https://openalex.org/fields/20","display_name":"Economics, Econometrics and Finance"},"domain":{"id":"https://openalex.org/domains/2","display_name":"Social Sciences"}},"topics":[{"id":"https://openalex.org/T10391","display_name":"Healthcare Policy and Management","score":0.9146000146865845,"subfield":{"id":"https://openalex.org/subfields/2002","display_name":"Economics and Econometrics"},"field":{"id":"https://openalex.org/fields/20","display_name":"Economics, Econometrics and Finance"},"domain":{"id":"https://openalex.org/domains/2","display_name":"Social Sciences"}},{"id":"https://openalex.org/T13555","display_name":"Healthcare cost, quality, practices","score":0.07900000363588333,"subfield":{"id":"https://openalex.org/subfields/3600","display_name":"General Health Professions"},"field":{"id":"https://openalex.org/fields/36","display_name":"Health Professions"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}},{"id":"https://openalex.org/T11531","display_name":"Healthcare Systems and Reforms","score":0.0026000000070780516,"subfield":{"id":"https://openalex.org/subfields/2003","display_name":"Finance"},"field":{"id":"https://openalex.org/fields/20","display_name":"Economics, Econometrics and Finance"},"domain":{"id":"https://openalex.org/domains/2","display_name":"Social Sciences"}}],"keywords":[{"id":"https://openalex.org/keywords/health-care-costs","display_name":"health care costs","score":0.9300000071525574},{"id":"https://openalex.org/keywords/health-care-spending-growth","display_name":"health care spending growth","score":0.8220000267028809},{"id":"https://openalex.org/keywords/health-care-reform","display_name":"health care reform","score":0.9509999752044678},{"id":"https://openalex.org/keywords/uninsured-population","display_name":"uninsured population","score":0.503000020980835}],"concepts":[{"id":"https://openalex.org/C2775994111","wikidata":"https://www.wikidata.org/wiki/Q843478","display_name":"Rationing","level":3,"score":0.7213325500488281},{"id":"https://openalex.org/C2780900520","wikidata":"https://www.wikidata.org/wiki/Q100268981","display_name":"Denial","level":2,"score":0.7110918760299683},{"id":"https://openalex.org/C24518262","wikidata":"https://www.wikidata.org/wiki/Q16197023","display_name":"Threatened species","level":3,"score":0.591507077217102},{"id":"https://openalex.org/C71924100","wikidata":"https://www.wikidata.org/wiki/Q11190","display_name":"Medicine","level":0,"score":0.5736231207847595},{"id":"https://openalex.org/C160735492","wikidata":"https://www.wikidata.org/wiki/Q31207","display_name":"Health care","level":2,"score":0.4908760190010071},{"id":"https://openalex.org/C2994140446","wikidata":"https://www.wikidata.org/wiki/Q31207","display_name":"Health spending","level":4,"score":0.4778934717178345},{"id":"https://openalex.org/C100001284","wikidata":"https://www.wikidata.org/wiki/Q2248246","display_name":"Public economics","level":1,"score":0.42011046409606934},{"id":"https://openalex.org/C47768531","wikidata":"https://www.wikidata.org/wiki/Q1127188","display_name":"Development economics","level":1,"score":0.37893906235694885},{"id":"https://openalex.org/C50522688","wikidata":"https://www.wikidata.org/wiki/Q189833","display_name":"Economic growth","level":1,"score":0.37381109595298767},{"id":"https://openalex.org/C162324750","wikidata":"https://www.wikidata.org/wiki/Q8134","display_name":"Economics","level":0,"score":0.2886708974838257},{"id":"https://openalex.org/C2983635472","wikidata":"https://www.wikidata.org/wiki/Q334911","display_name":"Health insurance","level":3,"score":0.21186041831970215},{"id":"https://openalex.org/C15744967","wikidata":"https://www.wikidata.org/wiki/Q9418","display_name":"Psychology","level":0,"score":0.09898629784584045},{"id":"https://openalex.org/C11171543","wikidata":"https://www.wikidata.org/wiki/Q41630","display_name":"Psychoanalysis","level":1,"score":0.0},{"id":"https://openalex.org/C86803240","wikidata":"https://www.wikidata.org/wiki/Q420","display_name":"Biology","level":0,"score":0.0},{"id":"https://openalex.org/C185933670","wikidata":"https://www.wikidata.org/wiki/Q52105","display_name":"Habitat","level":2,"score":0.0},{"id":"https://openalex.org/C18903297","wikidata":"https://www.wikidata.org/wiki/Q7150","display_name":"Ecology","level":1,"score":0.0}],"mesh":[{"descriptor_ui":"D001294","descriptor_name":"Attitude to Health","qualifier_ui":null,"qualifier_name":null,"is_major_topic":true},{"descriptor_ui":"D003695","descriptor_name":"Delivery of Health Care","qualifier_ui":"Q000458","qualifier_name":"organization & administration","is_major_topic":false},{"descriptor_ui":"D005102","descriptor_name":"Health Expenditures","qualifier_ui":"Q000706","qualifier_name":"statistics & numerical data","is_major_topic":true},{"descriptor_ui":"D005843","descriptor_name":"Geography","qualifier_ui":"Q000191","qualifier_name":"economics","is_major_topic":false},{"descriptor_ui":"D006278","descriptor_name":"Medicare","qualifier_ui":"Q000191","qualifier_name":"economics","is_major_topic":true},{"descriptor_ui":"D006278","descriptor_name":"Medicare","qualifier_ui":"Q000706","qualifier_name":"statistics & numerical data","is_major_topic":false},{"descriptor_ui":"D006296","descriptor_name":"Health Services","qualifier_ui":"Q000191","qualifier_name":"economics","is_major_topic":false},{"descriptor_ui":"D006296","descriptor_name":"Health Services","qualifier_ui":"Q000706","qualifier_name":"statistics & numerical data","is_major_topic":true},{"descriptor_ui":"D006801","descriptor_name":"Humans","qualifier_ui":null,"qualifier_name":null,"is_major_topic":false},{"descriptor_ui":"D011320","descriptor_name":"Primary Health Care","qualifier_ui":"Q000191","qualifier_name":"economics","is_major_topic":false},{"descriptor_ui":"D011320","descriptor_name":"Primary Health Care","qualifier_ui":"Q000458","qualifier_name":"organization & administration","is_major_topic":false},{"descriptor_ui":"D014481","descriptor_name":"United States","qualifier_ui":null,"qualifier_name":null,"is_major_topic":false},{"descriptor_ui":"D016526","descriptor_name":"Workload","qualifier_ui":null,"qualifier_name":null,"is_major_topic":false},{"descriptor_ui":"D017046","descriptor_name":"Cost Savings","qualifier_ui":null,"qualifier_name":null,"is_major_topic":false},{"descriptor_ui":"D017048","descriptor_name":"Health Care Costs","qualifier_ui":null,"qualifier_name":null,"is_major_topic":false},{"descriptor_ui":"D018166","descriptor_name":"Health Care Reform","qualifier_ui":"Q000191","qualifier_name":"economics","is_major_topic":true},{"descriptor_ui":"D019472","descriptor_name":"Universal Health Insurance","qualifier_ui":"Q000191","qualifier_name":"economics","is_major_topic":false},{"descriptor_ui":"D054624","descriptor_name":"Health Status Disparities","qualifier_ui":null,"qualifier_name":null,"is_major_topic":true}],"locations_count":3,"locations":[{"id":"doi:10.1056/nejmp0907172","doi":"https://doi.org/10.1056/nejmp0907172","is_oa":false,"landing_page_url":"https://doi.org/10.1056/nejmp0907172","pdf_url":null,"source":{"id":"https://openalex.org/S62468778","display_name":"New England Journal of Medicine","issn_l":"0028-4793","issn":["0028-4793","0096-6762","1533-4406","2331-4710"],"is_oa":false,"is_in_doaj":false,"is_core":true,"listed_in":["anvur-class-a","anvur-scientific","cwts-core","dongbi-a","doyens","jufo-3","ki-jl-3","medline","norway-2","poland-200","russia-white-list-1","vabb-shw"],"host_organization":"https://openalex.org/P4310320239","host_organization_name":"Massachusetts Medical Society","host_organization_lineage":["https://openalex.org/P4310320239"],"host_organization_lineage_names":["Massachusetts Medical Society"],"type":"journal"},"license":null,"license_id":null,"version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"New England Journal of Medicine","raw_type":"journal-article"},{"id":"pmid:19741220","doi":null,"is_oa":false,"landing_page_url":"https://pubmed.ncbi.nlm.nih.gov/19741220","pdf_url":null,"source":{"id":"https://openalex.org/S4306525036","display_name":"PubMed","issn_l":null,"issn":null,"is_oa":false,"is_in_doaj":false,"is_core":false,"listed_in":[],"host_organization":"https://openalex.org/I1299303238","host_organization_name":"National Institutes of Health","host_organization_lineage":["https://openalex.org/I1299303238"],"host_organization_lineage_names":[],"type":"repository"},"license":null,"license_id":null,"version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"The New England journal of medicine","raw_type":"Journal Article"},{"id":"pmh:oai:repository.library.georgetown.edu:10822/1026781","doi":null,"is_oa":false,"landing_page_url":"http://worldcatlibraries.org/registry/gateway?version=1.0&url_ver=Z39.88-2004&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&atitle=Getting+past+denial+the+high+cost+of+health+care+in+the+United+States&title=New+England+Journal+of+Medicine+&volume=361&issue=13&date=2009-09&au=Sutherland,+Jason+M.;+Fisher,+Elliott+S.;+Skinner,+Jonathan+S.","pdf_url":null,"source":{"id":"https://openalex.org/S4306402467","display_name":"DigitalGeorgetown (Georgetown University Library)","issn_l":null,"issn":null,"is_oa":false,"is_in_doaj":false,"is_core":false,"listed_in":[],"host_organization":"https://openalex.org/I4210145449","host_organization_name":"Center for Security and Emerging Technology","host_organization_lineage":["https://openalex.org/I4210145449"],"host_organization_lineage_names":[],"type":"repository"},"license":null,"license_id":null,"version":"submittedVersion","is_accepted":false,"is_published":false,"raw_source_name":"eweb:327402","raw_type":null}],"best_oa_location":null,"sustainable_development_goals":[],"study_designs":[],"awards":[],"funders":[],"has_content":{"pdf":false,"grobid_xml":false},"content_urls":null,"referenced_works_count":5,"referenced_works":["https://openalex.org/W1970716113","https://openalex.org/W2037733131","https://openalex.org/W2057681349","https://openalex.org/W2058964202","https://openalex.org/W2129327240"],"related_works":["https://openalex.org/W2058964202","https://openalex.org/W2047432877","https://openalex.org/W7099428505","https://openalex.org/W2423931561","https://openalex.org/W2061525488","https://openalex.org/W2052512595","https://openalex.org/W2414480862","https://openalex.org/W3111300547","https://openalex.org/W2130134589","https://openalex.org/W57760518"],"abstract_inverted_index":{"What":[0],"seemed":[1],"to":[2,7,16,27,37,74,83,88],"be":[3,17,38,81],"a":[4,75],"golden":[5],"opportunity":[6],"achieve":[8],"badly":[9],"needed":[10,58],"health":[11],"care":[12,87],"reform":[13],"now":[14],"appears":[15],"threatened.":[18],"Many":[19],"Americans":[20],"believe":[21,48],"that":[22,49],"we":[23,50,79],"simply":[24],"cannot":[25],"afford":[26],"cover":[28],"the":[29,41,43],"uninsured,":[30],"since":[31],"doing":[32],"so":[33],"would":[34],"require":[35],"taxes":[36],"raised":[39],"beyond":[40],"level":[42],"public":[44],"can":[45,51],"sustain.":[46],"Others":[47],"slow":[52],"spending":[53,69],"growth":[54],"only":[55],"by":[56],"rationing":[57],"care.":[59],"Neither":[60],"option":[61],"is":[62,97],"attractive.":[63],"Evidence":[64],"regarding":[65],"regional":[66],"variations":[67],"in":[68],"and":[70,85,91],"growth,":[71],"however,":[72],"points":[73],"more":[76],"hopeful":[77],"alternative:":[78],"should":[80],"able":[82],"reorganize":[84],"improve":[86],"eliminate":[89],"wasteful":[90],"unnecessary":[92],"services.1":[93],"But":[94],"not":[95],"everyone":[96],"convinced.":[98],"Some":[99],".":[100,101,102]},"counts_by_year":[{"year":2026,"cited_by_count":2},{"year":2024,"cited_by_count":4},{"year":2023,"cited_by_count":3},{"year":2022,"cited_by_count":3},{"year":2021,"cited_by_count":3},{"year":2020,"cited_by_count":5},{"year":2019,"cited_by_count":3},{"year":2018,"cited_by_count":3},{"year":2017,"cited_by_count":8},{"year":2016,"cited_by_count":10},{"year":2015,"cited_by_count":10},{"year":2014,"cited_by_count":13},{"year":2013,"cited_by_count":19},{"year":2012,"cited_by_count":17}],"updated_date":"2026-11-03T10:50:19.383937","created_date":"2016-06-24T00:00:00"}
