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Health care spending in the U.S. continues to outpace inflation and wage growth, which is likely to keep the burden of rising health care costs in the spotlight. As health care costs increase, health insurers face the challenges of providing quality health care at a reasonable cost. Some health care providers and insurers use economic measures such as return on investment to assess the effectiveness of health care. How does one measure the value of health? What are some of the advantages and disadvantages of using economic measures to evaluate health care?

This paper looks health care costs and who pays for them. What portion of health care costs is borne by employers? What portion by employees? Who does or should pay for health care of people who are uninsured? What is the role of insurance? If people do not have health care insurance, does it matter whether the reason they are uninsured is because they cannot afford it or because they choose not to be insured?

Selvam (2002) belives that the number one ethical dilemma in the U.S. is how to address the almost 40 million Americans who lack health care coverage. With rising hospital costs, even the hardest-working and most prudent persons are at risk. Many workers do not have health insurance and even if they are covered, they may not get what they need. What are some of the ethical issues facing patients, health care providers and insurers? What role should government have in assuring that all people receive quality health care?

During the last two decades the share of foreign-born residents in Italy has grown considerably, from just over 1 percent to about 8 percent. This chapter seeks to clarify the status of immigrants in Italy by examining the evolution of their economic situation and, in particular, the presence of economic hardship. Poverty is measured by considering not only the usual income-based indicators but also others that take into account households’ real and financial wealth. The picture that emerges is one of a higher incidence of economic hardship among immigrant households that strongly affects the dynamics of poverty nationwide. The economic gap with respect to natives appears to increase in the years considered, but the condition of poverty is not more persistent for immigrants than for Italians.