Health economics

Health economics is a branch of economics concerned with issues related to scarcity in the allocation of
health and health care.

Four factors that are important to Health Economics: Government Intervention, Uncertainty, Asymmetric
Knowledge, and Externalities.[1] Governments tend heavily regulate the Healthcare industry and also tend to
be the largest payor within the market. Uncertainty is intrinsic to health, both in patient outcomes and
financial concerns. The knowledge gap that exists between a physician and a patient creates a situation of
distinct advantage for the physician, which is called Asymmetric Knowledge. Finally, there are many effects
that happen between two parties without monetary compensation, called externalities, within healthcare,
from catching a cold from someone to practicing safe sex.

The scope of health economics is neatly encapsulated by Alan William's "plumbing diagram" [2] dividing the
discipline into eight distinct topics:

 what influences health? (other than health care)

 what is health and what is its value
 the demand for health care
 the supply of health care
 micro-economic evaluation at treatment level
 market equilibrium
 evaluation at whole system level; and,
 planning, budgeting and monitoring mechanisms.

What influences health? Health of a country or the residence of that country is greatly dependent not only on
the geographic location but the legal and economic stabilities of the nation. With healthcare industry having
such a major impact on the economy of a nation(roughly 10%), it becomes the indispensable attention of all
governments.

A stable legal policy not only aids in the on time improvement of the industry but its impact on the society as
well.The exclusive government body focussed on the industry enhances the research and development
along with the underpinning infrastructure required.

What is health and what is its value?

 Private goods
 Public goods
 Merit goods

Health care demand

The demand for health care is a derived demand from the demand for health, more generally. Health care is
demanded as a means for consumers to achieve a larger stock of "health capital." The demand for health is
unique, because individuals allocate resources in order to both consume and produce health.

Michael Grossman's 1972 model of health production has been extremely influential in this field of study and
has several unique elements that make it notable. The model views each individual as both a producer and a
consumer of health, as measured in "health stock" or health capital, the flow of which is known as health
status. It acknowledges that health care is both a consumption good that yields direct satisfaction and utility,
and an investment good, which yields satisfaction to consumers indirectly (more productive, fewer sick days,
higher wages, etc.) Since individuals in this model demand health care only as a result of their desire to
increase their health stock, health care demand is a derived demand. The model takes into account health
production (investments in health such as time spent exercising, money spent on medical care, etc.) as well
as the production of non-health goods against the overall utility that results from ones investments. These
factors are used to determine the optimal level of health that an individual will demand, taking into account
the marginal cost of health capital and depreciation rates.

The optimal level of investment in health occurs where the marginal cost of health capital is equal to the
marginal benefit resulting from it (MC=MB). With the passing of time, health depreciates at some rate
%u03B4. The general interest rate in the economy is denoted by r. The marginal cost of health capital can
be found by adding these variables: . The marginal benefit of health capital is the rate of return from this
capital in both market and non-market sectors. In this model, the optimal health stock can be impacted by
factors like age, wages and education. As an example, increases with age, so it becomes more and more
costly to attain the same level of health capital or health stock as one ages. Age also decreases the marginal
benefit of health stock. The optimal health stock will therefore decrease as one ages.[3]

When studying Health Care, it is beneficial to reference the fundamental laws of Supply and Demand. Health
Care, just like anything else, is a finite resource. This is to say, Health Care is a scarce resource - whether
one lives in a society in which Health Care is privitized or publicized. In either scenario, demand for Health
Care will be high. Logically, demand will increase more if Health Care is made a Public Good (see Universal
Health Care). There are positives and negatives to such a system. The most obvious positive is the fact that
everyone can receive care.

However, what also must be noted is the fact that Universal Health Care will cause a spike in the Demand for
it. Being a scarce resource, sacrifices are usually made. This is the main reason why there can be such long
waits in a public Health Care system - quality health care is diverted to those who can afford to wait in line
the longest.

This is not to say that a privatized Health Care policy does not have its flaws. Health insurance in the United
States is largely a case of market failure. A large reason for this is asymmetrical information. Someone
applying for health insurance knows more about their health than the insurance company does (see adverse
selection and moral hazard). People who have health care may act more recklessly than if they didn't have it
resulting in higher costs for the insurance company. Someone who applies for health insurance as an
individual will usually pay higher rates than group plans for an equal level of insurance. Statistically, people
who apply individually are more likely to need health care than those with group plans. Healthy people can't
get health care via a group plan are more likely to go without any insurance at all. The higher rates for
individuals and the low risk of a healthy person needing medical treatment that costs more than their
deductible makes insurance more expensive than its worth. Thus individuals are perceived as more risky,
individual plans are made more expensive and the rate of healthy people falls further as they decide that it
isn't worth the expense.

The supply of health care

Micro-economic evaluation at treatment level

A large focus of health economics, particularly in the UK, is the microeconomic evaluation of individual
treatments. In the UK, the National Institute for Health and Clinical Excellence (NICE) appraises certain new
and existing pharmaceuticals and devices using economic evaluation.

Economic evaluation is the comparison of two or more alternative courses of action in terms of both their
costs and consequences (Drummond et al.). Economists usually distinguish several types of economic
evaluation, differing in how consequences are measured:

 Cost minimisation analysis

 Cost benefit analysis
 Cost-effectiveness analysis
 Cost-utility analysis

In cost minimisation analysis (CMA), the effectiveness of the comparators in question must be proven to be
equivalent. The 'cost-effective' comparator is simply the one which costs less (as it achieves the same
outcome). In cost-benefit analysis (CBA), costs and benefits are both valued in cash terms. Cost
effectiveness analysis (CEA) measures outcomes in 'natural units', such as mmHg, symptom free days, life
years gained. Finally cost-utility analysis (CUA) measures outcomes in a composite metric of both length and
quality of life, the Quality Adjusted Life Year (QALY). (Note there is some international variation in the
precise definitions of each type of analysis).

A final approach which is sometimes classed an economic evaluation is a cost of illness study. This is not a
true economic evaluation as it does not compare the costs and outcomes of alternative courses of action.
Instead, it attempts to measure all the costs associated with a particular disease or condition. These will
include direct costs (where money actually changes hands, e.g. health service use, patient co-payments and
out of pocket expenses), indirect costs (the value of lost productivity from time off work due to illness), and
intangible costs (the 'disvalue' to an individual of pain and suffering). (Note specific definitions in health
economics may vary slightly from other branches of economics.)
Market equilibrium

Health care markets

The five health markets typically analyzed are:

 Healthcare financing market

 Physician and nurses services market
 Institutional services market
 Input factors market
 Professional education market

Although assumptions of textbook models of economic markets apply reasonably well to health care
markets, there are important deviations. Insurance markets rely on risk pools, in which relatively healthy
enrollees subsidize the care of the rest. Insurers must cope with "adverse selection" which occurs when they
are unable to fully predict the medical expenses of enrollees; adverse selection can destroy the risk pool.
Features of insurance markets, such as group purchases and preexisting condition exclusions are meant to
cope with adverse selection.

Insured patients are naturally less concerned about health care costs than they would if they paid the full
price of care. The resulting "moral hazard" drives up costs, as shown by the famous RAND Health Insurance
Experiment. Insurers use several techniques to limit the costs of moral hazard, including imposing
copayments on patients and limiting physician incentives to provide costly care. Insurers often compete by
their choice of service offerings, cost sharing requirements, and limitations on physicians.

Consumers in health care markets often suffer from a lack of adequate information about what services they
need to buy and which providers offer the best value proposition. Health economists have documented a
problem with "supplier induced demand", whereby providers base treatment recommendations on economic,
rather than medical criteria. Researchers have also documented substantial "practice variations", whereby
the treatment a patient receives depends as much on which doctor they visit as it does on their condition.
Both private insurers and government payers use a variety of controls on service availability to rein in
inducement and practice variations.

The U.S. health care market has relied extensively on competition to control costs and improve quality.
Critics question whether problems with adverse selection, moral hazard, information asymmetries, demand
inducement, and practice variations can be addressed by private markets. Competition has fostered
reductions in prices, but consolidation by providers and, to a lesser extent, insurers, has tempered this effect.

Competitive equilibrium in the five health markets

While the nature of healthcare as a private good is preserved in the last three markets, market failures occur
in the financing and delivery markets due to two reasons: (1) Perfect information about price products is not
a viable assumption (2) Various barriers of entry exist in the financing markets (i.e. monopoly formations in
the insurance industry)

Efficiency vs equity

The First Theorem of Welfare Economics states that any Walrasian equilibrium (that is, any competitive
equilibrium) is Pareto-efficient. Its implications are that competitive markets will always be efficient. This
result follows from the definition of a Walrasian equilibrium and the definition of Pareto efficiency. A key
assumption to the proof of the theorem is local nonsatiation of consumer preferences. It is that assumption
that is often violated in the first two of the health markets and therefore the First Welfare Theorem does not
hold for these markets.

In addition, even if the outcome in a health market is Pareto optimal, the government may deem it to be
inequitable due to health disparity or lower than desired availability of healthcare services.

Supporters of government intervention argue that it is warranted for two reasons:

 Absence of Pareto Optimality in a health market

 Pareto Optimality with socially inequitable health outcome.
Ideological bias in the debate about the financing and delivery health markets

The healthcare debate in public policy is often informed by ideology and not sound economic theory. Often,
politicians subscribe to a moral order system or belief about the role of governments in public life that guides
biases towards provision of healthcare as well. The ideological spectrum spans: individual savings accounts
and catastrophic coverage, tax credit or voucher programs combined with group purchasing arrangements,
and expansions of public-sector health insurance. These approaches are advocated by health care
conservatives, moderates and liberals, respectively.

Evaluation at a whole system level

Planning, budgeting, and monitoring mechanisms

Other issues

Medical economics

Often used synonimously with Health Economics Medical economics, according to Culyer,[4] is the branch
of economics concerned with the application of economic theory to phenomena and problems associated
typically with the second and third health market outlined above. Typically, however, it pertains to cost-
benefit analysis of pharmaceutical products and cost-effectiveness of various medical treatments. Medical
economics often uses mathematical models to synthesise data from biostatistics and epidemiology for
support of medical decision making, both for individuals and for wider health policy.

Further reading

 Michael F. Drummond (2005) Methods for the Economic Evaluation of Health Care Programmes,
Oxford University Press. Preview. ISBN 0-19-852945-7
 Victor R. Fuchs (1987). "Health economics" The New Palgrave: A Dictionary of Economics, v. 2, pp.
614-19.

 Health insurance
 Important publications in health economics
 Philosophy of Healthcare
 Journal of Health Care for the Poor and Underserved
 Health consumerism
 Health policy analysis
 Health care
 Health care politics