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Biomedical subjects

A Wagstaff

Publications and source records attributed to A Wagstaff.

At least 37 records · Page 2Linked to original sources
PubMed1993

Equity and equality in health and health care.

This paper explores four definitions of equity in health care: equality of utilization, distribution according to need, equality of access, and equality of health. We argue that the definitions of 'need' in the literature are inadequate and propose a new definition. We also argue that, irrespective of how need and access are defined, the four definitions of equity are, in general, mutually incompatible. In contrast to previous authors, we suggest that equality of health should be the dominant principle and that equity in health care should therefore entail distributing care in such a way as to get as close as is feasible to an equal distribution of health.

Cost-Benefit Analysis↗
PubMed1993

QALYs (quality-adjusted life-years) versus HYEs (healthy years equivalents)

This paper explores the claim that QALYs are liable to misrepresent consumer preferences and hence lead to decision-makers choosing options which are not those preferred by the public. It also considers the claim that HYEs do not suffer from this defect. We argue that none of the examples offered to date demonstrate the alleged tendency of QALYs to misrepresent preferences. We also show that HYEs are identical to QALY scores obtained from a time tradeoff experiment and therefore that the assumptions about preferences underlying HYEs are just as restrictive as those underlying TTO-based QALYs.

Consumer Behavior↗
PubMed1992

Equity in the finance of health care: some international comparisons.

This paper presents the results of a ten-country comparative study of health care financing systems and their progressivity characteristics. It distinguishes between the tax-financed systems of Denmark, Portugal and the U.K., the social insurance systems of France, the Netherlands and Spain, and the predominantly private systems of Switzerland and the U.S. It concludes that tax-financed systems tend to be proportional or mildly progressive, that social insurance systems are regressive and that private systems are even more regressive. Out-of-pocket payments are in most countries an especially regressive means of raising health care revenues.

Cross-Cultural Comparison↗
PubMed1992

Equity in the delivery of health care: some international comparisons.

This paper presents the results of an eight-country comparative study of equity in the delivery of health care. Equity is taken to mean that persons in equal need of health care should be treated the same, irrespective of their income. Two methods are used to investigate inequity: an index of inequity based on standardized expenditure shares, and a regression-based test. The results suggest that inequity exists in most of the eight countries, but there is no simple one-to-one correspondence between a country's delivery system and the degree to which persons in equal need are treated the same.

Cross-Cultural Comparison↗
PubMed1991

On the measurement of horizontal inequity in the delivery of health care.

This paper offers a critical appraisal of the various methods used to date to investigate inequity in the delivery of health care. It concludes that none of the methods used to date is particularly well equipped to provide unbiassed estimates of the extent of inequity. It also concludes that Le Grand's (1978) approach is likely to point towards inequity favouring the rich even when none exists. The paper offers an alternative approach, which builds on the approaches to date but seeks to overcome their deficiencies.

Acute Disease↗
PubMed1991

QALYs and the equity-efficiency trade-off.

As the volume of research on quality-adjusted life years (QALYs) has increased, concern has begun to be expressed about the equity aspects of resource allocation decisions based on the results of this research. This paper suggests that a common theme running through the criticisms of the QALY approach is a concern about inequality. It also suggests that the method for incorporating distributional concerns which is currently being pursued by advocates of the QALY approach will only ever capture concerns other than a concern about inequality. The paper suggests a method for incorporating both sets of concerns into resource allocation decisions.

Cost-Benefit Analysis↗
PubMed1991

On the measurement of inequalities in health.

This paper offers a critical appraisal of the various methods employed to date to measure inequalities in health. It suggests that only two of these--the slope index of inequality and the concentration index--are likely to present an accurate picture of socioeconomic inequalities in health. The paper also presents several empirical examples to illustrate of the dangers of using other measures such as the range, the Lorenz curve and the index of dissimilarity.

Abstracting and Indexing↗
PubMed1990

Uncertainty and the demand for medical care.

This paper provides an analysis of the effects of uncertainty on the demand for medical care using a simplified version of Grossman's human capital model of the demand for health. Two types of uncertainty are analysed: the uncertainty surrounding the incidence of illness and the uncertainty surrounding the effectiveness of medical care. In the first the consumer's basic level of health is assumed to be a random variable; in the second the effectiveness of medical care is assumed to be random. Comparative static results are reported indicating the effects on the demand for medical care of both increases in the means of these distributions and mean-preserving spreads of the distributions.

Health Services↗
PubMed1989

Econometric studies in health economics. A survey of the British literature.

This paper provides a survey of British applied econometric work in the field of health economics. As well as reviewing the literature, it suggests some avenues for future research. It covers six main areas: the supply of health care; the demand for health care; non-medical influences on health; market and non-price rationing; evaluation of health care systems; and planning, budgeting and monitoring mechanisms.

Costs and Cost Analysis↗
PubMed1989

Economic aspects of illicit drug markets and drug enforcement policies.

This paper reviews the economics literature on illicit drug markets and drug enforcement policies. The first part of the paper examines the problems involved in establishing the parameters of the illicit market. The second part of the paper examines the contribution economics can make to the evaluation of drug enforcement policies: the discussion covers the determination of both the appropriate level of enforcement expenditure and the appropriate mix of policy measures.

Drug and Narcotic Control↗
PubMed1987

Uncertainty, inequalities in health and the demand for health.

As it has become increasingly recognized that inequalities in health stem more from inequalities in wealth, rather than from inequalities in access to medical care, economists have begun to suggest that Michael Grossman's model of the demand for health may be a useful analytical framework for investigating the issue. Ironically, the more popular of Grossman's two submodels--the 'pure-investment' model--provides little by way of insights into the relationship between inequalities in wealth and inequalities in health. In common with other pure investment models of human capital formation, Grossman's model predicts that an individual's health investment decisions at each stage in the lifecycle will be independent of his initial wealth. This paper shows that if uncertainty is introduced into the model, this result no longer holds. It also shows that if individuals display decreasing absolute risk aversion, wealthier individuals will invest more in health capital than individuals who start life with relatively small stocks of financial capital.

Health Services Needs and Demand↗
PubMed1986

The demand for health: some new empirical evidence.

This paper presents some new estimates of the 'pure investment' and 'pure consumption' models of the demand for health. In contrast to previous studies, the paper presents parameter estimates of both reduced-form and structural demand for health care equations. The latter--which are obtained by treating health capital as a latent variable in a recursive equation system--provide a safer way of checking the consistency of the model's predictions with the data. The present analysis of the pure consumption model differs from previous analyses in its recognition of the dependency of the shadow price of initial assets on the entire lifetime profiles of the model's exogenous variables. The paper also explores the implications in terms of reliability of parameter estimates of the failure on the part of previous studies to recognize this.

Costs and Cost Analysis↗
PubMed1986

The demand for health: theory and applications.

The concern of this paper lies with the economic theory of the "demand for health". It develops a conceptual apparatus for analysing the interaction of socioeconomic determinants of health and indicates how this can be used to shed light on a variety of topical policy issues such as socioeconomic inequalities in health and the design of prevention policies. It is written with the aim of making what has hitherto been a mathematically sophisticated literature accessible to the non-economist.

Health Services Needs and Demand↗