摘要：Petroleum is used widely in health care—primarily as a transport fuel and feedstock for pharmaceuticals, plastics, and medical supplies—and few substitutes for it are available. This dependence theoretically makes health care vulnerable to petroleum supply shifts, but this vulnerability has not been empirically assessed. We quantify key aspects of petroleum use in health care and explore historical associations between petroleum supply shocks and health care prices. These analyses confirm that petroleum products are intrinsic to modern health care and that petroleum supply shifts can affect health care prices. In anticipation of future supply contractions lasting longer than previous shifts and potentially disrupting health care delivery, we propose an adaptive management approach and outline its application to the example of emergency medical services. Modern medicine relies on petroleum, particularly to transport patients, staff, and supplies, and to manufacture supplies and pharmaceuticals. 1 , 2 This reliance is particularly heavy in the United States, which consumes petroleum disproportionately on a per capita basis compared with other nations. There is increasing consensus that petroleum production has already declined or will soon begin to decline and that constrained supplies will adversely affect most sectors, including health care. (Those unfamiliar with this body of evidence should consult the introductory article in this special issue by Schwartz et al. 3 ) Several authors have highlighted health care's exposure to declines in petroleum production, but the issue has received little attention from economists or policymakers, and little has been done to further assess and manage the potential risk. In particular, there is no publicly available account of health care's utilization of petroleum-based products, and there have been no econometric studies evaluating historical associations between petroleum production and health care costs. While risk management activities are justified based on the precautionary principle, inattention to this issue has impeded interpretation of and action on the existing preliminary evidence. For instance, a concerned health system administrator who wants to assess a hospital's vulnerability to decreasing petroleum supplies and prioritize risk management strategies has no recommendations to follow. We attempt to address these concerns within the constraints of a limited evidence base. We first explore evidence of the health care system's vulnerability to petroleum shortages, decomposing vulnerability into exposure, susceptibility, and resilience. We explore exposure by evaluating the magnitude of the US health care system's petroleum dependence, focusing on transport, medical plastics, and pharmaceuticals. We explore susceptibility by analyzing historical associations between the prices of petroleum and of health care goods and services. We explore resilience by assessing system disturbances from historical price shocks. We then propose an adaptive management framework for engaging the issue. Adaptive management is useful for managing dynamic systems whose complexity complicates linear management decisions. The framework emphasizes stakeholder engagement, modeling, and iterative decision-making, putting a premium on learning about the system being managed and its responses to management decisions. After introducing the framework, we illustrate its application to an emergency medical services (EMS) system as an example of how this approach can be used to manage the health care system's extensive, if latent, risk.
