4/17/2015. Health Insurance. The Framework. The importance of health care. the role of government, and reasons for the costs increase

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1 Health Insurance PhD. Anto Bajo Faculty of Economics and Business, University of Zagreb The Framework The importance of healthcare, the role of government, and reasons for the costs increase Financing health care models The importance of health care It's an important determinant both personal and social welfare. Endangered health and restricted ability to work, serious treat in a family, limit the ability to find employment, to be promoted at work, and to exit from poverty. 1

2 Why are health expenditures increasing? Are large expenditures any guarantee for health care? No, this does not necessarily guarantee the effectiveness and accessibility of necessary protection. According to WHO research, the country that spend the most on health care (the USA almost $6.5 thousand p.c. in the last decade) can not in any event be considered a positive example because a large proportion of the population is not health insured and/or has very low quality health protection. 2

3 Why does government need to get involved in the healthcare market? Weak information and asymmetric of information Adverse selection the average purchaser of insurance has a larger risk than the average person in the group Moral hazard if people know that they are insured, perhaps they will avoid danger less Paternalism people need to be forced into taking out insurance for their own good Asymmetric information Domination by the profession is the feature of the healthcare sector because of the asymmetry of information between personnel and patients Healthcare staff can use their monopoly position to increase the demand for services, which leads to rise in costs and reduction of the quality of services Moral hazard If everyone is insured by the public health system, people won't look after their own health, and won't invest in it (Arrow, 1963) People will use public health services even if they have no real reason to do so. The demand for public services can be reduced if individuals pay for their own health services. 3

4 Price per unit 4/17/2015 Moral Hazard Flat-of-the-curve medicine deadweight loss P 0 a b S m.2p 0 h D m 0 M 0 M 1 Medical services per year The principal / agent problem Because of the inadequately developed mechanism for the control of the financing of health, health care institutions (the agents) have more information available to them than the ministry (the principal) because of which there are difficulties and inefficiencies with the allocation of resources to given health care institutions. The principal-agent problem and the principal actors in the health care system state, insurance company, social insurance institution health service patient doctor out-of-pocket payment 4

5 Main reasons for rise of costs of health care Ageing of the population Rise in income Improvement of quality of health protection Availability of municipal infrastructure Level of education Price of services Manner and quality of life State of the environment Corruption Organisation of the market Further reasons Inefficient transfer of authority for financing health care institutes. Poor system of financing, and of control and supervision of expenditure. Returns from health care can be reduced because of greater inducements for corruption linked with the financing system. The rent seeking of an interests group in health can lead to the investment of funds in a project that suits them, although the benefits from such projects are quite uncertain. Framework of analysis of health care Input P.C. expenditure on health care Expenditure as % of GDP -Public -Private Hospital beds per 1000 pop Output Aggregate Efficiency Equality Life expectancy Infant mortality Other Satisfaction (access) In production of services In access Obtaining benefits (the regional aspect for example) in financing No of doctors per 1000 pop -General medicine -Specialists -Price of inputs for health care sector 5

6 A few empirical findings Income elasticities of demand for health services. Variables defined as logarithms (Evans, 2002): log(expenditure p.c.) = *log(Income p.c.) (-10) (17) R2=0.93 1% increased income per capita correlates with a p.c. rise in expenditure of 1.8% The size of the health sector (measured as p.c. expenditure) grows faster than revenue, and more wealthy countries have relatively greater healthcare expenditure. Cost containment measures on the side of supply of public health care services and goods: the gatekeeper remunerations for doctors payments for hospitals pharmaceuticals rationing (queuing) Health expenditure by providers in 2010 (%) United States Switzerland Hospitals Sweden Spain Slovenia Slovak Republic Portugal Poland New Zealand Netherlands Korea Iceland Hungary Germany France Finland Estonia Denmark Czech Republic Canada Belgium Nursing and residential care facilities Providers of ambulatory health care Retail sale and other providers of medical goods Provision and administration of public health programs General health administration and insurance Other industries (rest of the economy) Rest of the world Austria

7 Models of financing health care The health care financing equation T + SIC + UC + SA = P x Q where T - taxation SIC contributions UC charges SA - savings Financing models Taxes Contributions Taxes and contributions Albania Croatia Belgium Denmark Czech R. Switzerland Italia Estonia Latvia Hungary Romania Slovakia Poland Slovenia Portugal Netherland Spain France Sweeden Germany UK Source: Mossialos i Dixon,

8 Financing with taxation Advantages Broad revenue base Disadvantages Non-special purpose revenue and lack of trust on the part of the population Easier determination of priorities in resource allocation Influence of interest group Contributions for health care Advantages Transparent Organisation fund Special revenue into Disadvantages higher labour costs Different sources of income (capital) purpose Difficulties in collecting contributions; greater number of self employed, of people in the unofficial economy, part time workers, student employment contracts. Not related with risk, and assessed only on the basis o income Paid by both employers and employees 8

9 Private health insurance Involves calculation of insurance premiums according to risks and insurances, with special manner of determining benefits Private insurer Classification of insured's according to income increases the burden of the public sector because of low-income insured's The redistributive effect is annulled Private insurance as a whole does not control costs. Health care savings account and direct payment for services Part of income goes into a private savings account for health care The patients are well aware of the costs of health care It is always a component part of the whole system of financing Cost containment measures on the side of demand for public health care services and goods: Deductibles (the insured persons pays the first x dollars (or euros) of the health service Coinsurance (the insured person pays a percentage of the total cost of service) 9

10 Austria Belgium Canada Czech R Denmark Estonia Finland France Germany Hungary Iceland Korea Netherlands New Zealand Norway Poland Portugal Slovak Republic Slovenia Spain Sweden Switzerland United States 4/17/2015 Financing agent in Corporations (other than health insurance) Non-profit institutions serving households Private households out-ofpocket exp. 40 Private insurance Social security funds 10 0 General government (excl. social security) = Territorial government 10

11 Quantity of all other goods Quantity of all other goods Quantity of all other goods 4/17/2015 Does public insurance crowd out privat insurance? A F A F A F B B B C C C 0 M 0 Insurance M 0 insurance M Health Health Health insurance Amount of publicly Amount of publicly Amount of publicly Provided insurance provided insurance provided insurance 11

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