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At least 793 records · Page 44Linked to original sources
PubMed1992

An alternative framework for evaluating welfare losses in the health care market.

A recurring theme in the health economics literature is that 'excess' health insurance reduces society's welfare. This proposition is considered to be a truism by most health economists. Feldman and Morrisey (1990) report that two-thirds of American and Canadian health economists surveyed agree with the statement that, 'the level and type of health insurance held by most U.S. families generate substantial welfare loss due to over-consumption of medical services'. Consequently, most research in the area has attempted to identify the exact dollar value of this welfare loss. In this note, I will try to show that the traditional method of calculating welfare losses from excess health insurance is severely flawed because it is based on assumptions about consumer behavior that are not supported by the available empirical evidence. Furthermore, the methodology masks other, potentially greater societal welfare losses that are likely to exist in the health care sector, and blinds us from seeking the most effective public policy remedies. This note suggests an alternative framework for considering welfare losses based on researchers' evaluations of medical necessity.

Community Participation↗
PubMed1992

Estimating the indirect costs of teaching.

Medicare's Prospective Payment System pays teaching hospitals using a regression coefficient in a log-log cost function. Previous literature showed that this coefficient is sensitive to the covariates included in the function, but specified teaching intensity as the logarithm of one plus the intern and resident-to-bed ratio. Provided the true relationship is log-log, adding one biases the coefficient substantially but not predicted cost. In a re-specified equation that makes this bias negligible, the coefficient is not nearly as sensitive to the inclusion of other covariates. Because further issues remain to be explored, it is premature to use our results for policy purposes.

Centers for Medicare and Medicaid Services, U.S.↗
PubMed1992

The determinants and effects of health expenditure in developed countries.

Previous studies of international differences in health spending have been restricted to the use of relatively small samples of cross-sectional data. Our objective here is to re-examine the results of previous work using a sample of 560 pooled time-series and cross-section observations. Results confirm the importance of GDP as a determinant of health spending, with an estimated income elasticity at or around unity, but also suggest that OECD countries should not be regarded as a single, homogeneous group. The importance of some non-income variables is also confirmed, although the direct effect of these factors appears to be small.

Australia↗
PubMed1993

Economics, health and health economics: HYEs (healthy-years equivalent) versus QALYs (quality-adjusted live-year)

This paper responds to Culyer and Wagstaff's (CW) and Buckingham's (B) arguments. We refute their claim about the equivalence of HYEs and QALYs; they fail to distinguish between choice under uncertainty and under certainty. CW assume that all individuals have a specific form of utility function, which yields their conclusion of equivalence. B's arguments confuse the measurement technique and the utility theory from which it stems; his argument about the normative superiority of the QALY construct is inconsistent with economic thinking. The HYE, by being compatible with the principles of economics, is superior to the QALY for economic evaluations of health care interventions.

Canada↗
PubMed1993

Agency in health care: getting beyond first principles.

This paper is concerned with the application of the theory of agency to health care. It is argued that the basic theory of agency raises more questions than it provides answers when it is applied to the doctor-patient relationship. More research is needed into the nature of both the patient's and the doctor's utility functions. Only then can we begin to devise optimal incentive structures to encourage doctors to take adequate account of patient preferences.

Contract Services↗
PubMed1993

Elasticity estimates from a dynamic model of interrelated demands for private and public acute health care.

This paper investigates the private/public mix in acute health care provision in the UK. It uses an interrelated shares model derived from a translog function combined with dynamic adjustment. Using prices for public care constructed from NHS waiting lists, the insurance cost of private care and the retain price index, impact, intermediate and long run elasticities of demand for private and public care are obtained. The role of hospital consultants and of an aging population are also considered.

Acute Disease↗
PubMed1993

What does the demand curve for medical care measure?

In summary, we stand by our method of using the consumer's willingness to pay for medical care to measure consumer surplus. We have not doubt that consumers' decisions will change as the science of medical effectiveness improves and results are disseminated to consumers and physicians. However, we never expect to see an exact correspondence between consumers' decisions and experts' advice. We believe that measurement of consumer welfare should be based on the consumer's valuation of the advice, not the advice itself. Finally, we note that if there is an inefficiently low level of information in medical care markets, the solution is to inform consumers, not to insure them fully.

Community Participation↗
PubMed1993

Evaluating welfare losses in the health care market.

According to traditional welfare analysis, consumers facing a price increase forego consumption of the least valued units of a commodity. Studies, such as the Rand HIE, show that patients decrease their consumption of all types of health care when faced with a price increase for health care. From this observation, Thomas Rice (1992) concludes that traditional welfare analysis is inadequate for evaluating insurance-related welfare losses in health care. In this note, I argue that it is not traditional welfare analysis which is inadequate, but the method of assigning marginal valuations to units of health care.

Community Participation↗
PubMed1993

Uncertainty and health care spending by the poor: the health capital model revisited.

This short theoretical paper examines health care utilization by the poor in the context of Grossman's (1972) health capital model. Earlier work has shown that uncertainty can reduce the attractiveness to the poor of health capital investments. This paper demonstrates that uncertainty can also have precisely the opposite effect. That is, while there may be cases in which it is excessively risky for the poor to invest in their health, there may also be cases in which the poor can ill-afford the risks that arise from not making timely investments in their health.

Attitude to Health↗
PubMed1995

QALYs and HYEs (healthy year equivalents): under what conditions are they equivalent?

The paper examines what restrictions have to be imposed on the individual's preference structure for QALYs and HYEs to yield identical results. It is shown that using QALYs involves imposing three additional restrictions. Empirical evidence suggests that these restrictions cannot be expected to hold in all applications. The main problem in using HYEs appears to be practical. An alternative index is proposed, that may help to bridge the gap between QALYs and HYEs by combining to some extent the advantages of the two measures.

Health Care Rationing↗
PubMed1995

Wealth from optimal health.

Recently, much research has been devoted to the question of how the conventional net national product measure should be augmented so as to cover changes in the stocks of natural resources. This paper investigates the treatment of health (capital) and the risk of 'doomsday' caused by pollution in such welfare measures. Our problem is not a standard optimal control problem because the survival probability depends on state variables. We show how to handle this complication. The resulting welfare measure is contrasted with the conventional net national product measure. Finally, we address the matter of how to design a subsidy on health investment such that a market economy provides the optimal level of health.

Capital Expenditures↗
PubMed1995

The friction cost method for measuring indirect costs of disease.

A new approach for estimating the indirect costs of disease, which explicitly considers economic circumstances that limit production losses due to disease, is presented (the friction cost method). For the Netherlands the short-term friction costs in 1990 amount to 1.5-2.5% of net national income (NNI), depending on the extent to which short-term absence from work induces production loss and costs. The medium-term macro-economic consequences of absence from work and disability reduce NNI by an additional 0.8%. These estimates are considerably lower than estimates based on the traditional human capital approach, but they better reflect the economic impact of illness.

Absenteeism↗