Download 1.Introduction - Departamento de Economía

HEALTH ECONOMICS
Matilde P. Machado (coordinadora)
Félix Lobo Aleu
SYLLABUS:
Introduction: Why is Health Economics Important?
[Stiglitz, chp 12.]
Growth and Health
The Health Production Function [Phelps chp. 3]
Evaluation Methods [Zweifel chp2.]
Health Systems:
1.
2.
3.
4.
5.
3.
General Features - [J. Hurst]
General Characteristics of the Health Care Markets [Arrow
(1963) ]
Ethics, Efficacy, Effectiveness and Efficiency [FGS chp. 1,
4.
4; Zweifel chp 1, 4, Ortún chp1; 3.1, 3.2, 3.3]
Equity [Rodríguez, Calonge and Reñe (1988) , Rodríguez and
1.
2.
Calonge (1998)]
5.
6.
Regulation of Pharmacies: [García Fontes and Massimo Motta]
Grossman’s Model [FGS chp. 5, McGuire chp. 7)
1
SYLLABUS:
7.
Health Insurance
Demand for Health Insurance [Phelps, chp 10;
FGS pp 185-187]
2.
Moral Hazard and Copayments [FGS pp 270-275;
McGuire pp 189-193; Murillo 1992]
3.
Adverse Selection: the Rothschild and Stiglitz
Model [FGS 151-162 and 289-292; Stiglitz (1993) Ariel Economía pp 175-180; Rothschild and Stiglitz
(1976)- not a mandatory reading]
Supply Induced Demand– [FGS pp 204-211; McGuire
160-166]
Reimbursement Methods [Zweifel chp. 9]
1.
8.
9.
REFERENCES
IN SPANISH:
LÓPEZ CASASNOVAS, Guillem y ORTÚN RUBIO, Vicente (1998): Economía y salud:
fundamentos y políticas", Encuentro, Madrid.
ORTÚN, Vicente (1990): La Economía en sanidad y medicina: instrumentos y limitaciones,
Escola Universitaria de Treball Social y La LLar del LLibre, Barcelona.
STIGLITZ, Joseph. La Economía del Sector Público. 2ª Edición
IN ENGLISH
[FGS] FOLLAND, Sherman; GOODMAN, Allen C. y STANO, Miron (1993): The Economics of
Health and Health Care, Macmillan, Nueva York, Oxford.
ZWEIFEL, Peter y BREYER, Friedrich (1997): Health Economics, Oxford University Press,
Oxford.
MCGUIRE, A; HENDERSON, J. y MOONEY, G.(1.988): The Economics of Health Care,
Routledge, Londres y Nueva York.
PHELPS, Charles E. (1992): Health Economics, Harper Collins, Nueva York.
STIGLITZ, (): The Economics of the Public Sector.
2
1.1. INTRODUCTION
The Economics of Health and Health Care
Some semantics: Individuals want health, not health care
per se. The demand for health care is a derived demand such
as a demand for an input into a production function.
Health Providers do not supply health but health care
Health Insurance is not a insurance on our health but on the
monetary expenditures needed in health care to recover it.
Health Economics emerged in the 60s after the publication of
Kenneth Arrow paper. The importance of Health Economics
has grown over the last 40 years due to the rapid growth of the
expenditures with health, particularly in the US.
This course is mostly on the Economics of health care, i.e. we
are going to talk about Demand and Supply of health care
services.
Health Expenditures as a % of Gross Domestic Product
20.0
18.0
p
e
r
c
e
n
t
a
g
e
16.0
14.0
12.0
10.0
8.0
o
f
G
D
P
6.0
4.0
2.0
0.0
1960
1965
1970
Spain
1975
1980
United States
1985
Year
1990
1995
2000
2005
2010
OECD simple average (not pop weighted)
Social Security Act 1965 Medicare, Medicaid
Fuente:
3
Total Health Expenditures per capita in US$ PPP
9000
8000
7000
6000
D
o
l P 5000
l P
a P 4000
s
r
3000
2000
1000
0
1960
1965
1970
Spain
1975
1980
United States
1985
Year
1990
1995
2000
2005
2010
2005
2010
OECD Simple Average (not weighted by pop)
Pharmaceutical Expenditures as % of Total
25
P
e
r 20
c
e
n
t
15
a
g
e
o 10
f
t
o
t
a
l
5
0
1960
1965
1970
Spain
1975
1980
United States
1985
Year
1990
1995
2000
OECD Simple Average (not weighted by pop)
4
Public Health Expenditures as a Percentage of
Total Health Expenditures
90.0
P
e
r
c
e
n
t
a
g
e
80.0
70.0
60.0
50.0
o
40.0
f
t 30.0
o
t
a 20.0
l
10.0
1960
1965
1970
Spain
1975
1980
United States
1985
Year
1990
1995
2000
2005
2010
OECD simple average (not weighted by pop)
POSSIBLE EXPLAINATIONS :
Due to several reasons, individuals demand more health
care services and medicines :
Income effect.
The increased prevalence of insurance
In USA: The public insurance programs born with the Social Security
Act in 1965: Medicaid (for the poor) and Medicare (for the elderly)
In Europe, The National Health Systems (NHS)
Beyond the increase in price and quantities, the increase in
expenditures also reflects a dramatic change in the basket
of goods and services in health has changed.
Technological innovation is present in the basic package of
health care assistance (typically increasing the costs.
Inflation in the sector is higher than the average
5
Why will Health Economics continue to
be an important topic of study?
Health Care expenditure is a high and
increasing percentage of the GDP
High Percentage of the Public Spending
Sector of great technological innovation
and investment (e.g. Pharmaceuticals –
there is demand for these innovations,
people are willing to pay for their health)
High number of jobs
Why will Health Economics continue to
be an important topic of study?
Alcohol
Tobacco
Obesity
Growing life Expectancy and the growing number
of elderly people (older than 65) who need more
health care
6
ALCOHOL – LITRES PER CAPITA
(POPULATION OLDER THAN 15 YEARS OLD)
Alcohol Consumption (litres per capita 15+)
25
20
15
10
5
0
1960
1965
1970
1975
1980
1985
1990
1995
2000
2005
2010
Year
Spain
United States
United Kingdom
OECD average (not weighted by pop)
TOBACCO – % DAILY CONSUMERS (POPULATION
OLDER THAN 15 YEARS OLD)
% population 15+ who are daily smokers
60
50
40
30
20
10
0
1960
1965
Spain
1970
1975
United States
1980
1985
Year
United Kingdom
1990
1995
2000
2005
2010
OECD Average (not weighted by pop)
7
OBESITY
% of Obese Population in Spain
(self-reported)
20
18
16
14
12
10
8
6
4
2
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
1979
1978
0
Year
Spain - all
Spain - Females
Spain - Males
Life Expectancy at 65
25
20
15
10
5
0
1960
1965
1970
1975
1980
1985
Year
1990
1995
2000
2005
Spain - males
Spain - Females
United States - Males
United States - Female
OECD average - Males (not weighted by pop)
OECD average - Females (not weighted by pop)
2010
8