HEALTH ECONOMICS Mild P. Mchd (crdindr) Félix Lb Alu SYLLABUS: 1. Inrducin: Why is Hlh Ecnmics Imprn? [Sigliz, chp 12.] 2. Grwh nd Hlh 3. Th Hlh Prducin Funcin [Phlps chp. 3] 4. Evluin Mhds [Zwifl chp2.] 5. Hlh Sysms: 1. Gnrl Furs - [J. Hurs] 2. Gnrl Chrcrisics f h Hlh Cr Mrks [Arrw (1963) ] 3. Ehics, Efficcy, Effcivnss nd Efficincy [FGS chp. 1, 4; Zwifl chp 1, 4, Orún chp1; 3.1, 3.2, 3.3] 4. Equiy [Rdríguz, Clng nd Rñ (1988), Rdríguz nd Clng (1998)] 5. Rgulin f Phrmcis: [Grcí Fns nd Mssim M] 6. Grssmn s Mdl [FGS chp. 5, McGuir chp. 7) 1
SYLLABUS: 7. Hlh Insurnc 1. Dmnd fr Hlh Insurnc [Phlps, chp 1; FGS pp 185-187] 2. Mrl Hzrd nd Cpymns [FGS pp 27-275; McGuir pp 189-193; Murill 1992] 3. Advrs Slcin: h Rhschild nd Sigliz Mdl [FGS 151-162 nd 289-292; Sigliz (1993) - Aril Ecnmí pp 175-18; Rhschild nd Sigliz (1976)- n mndry rding] 8. Supply Inducd Dmnd [FGS pp 24-211; McGuir 16-166] 9. Rimbursmn Mhds [Zwifl chp. 9] REFERENCES IN SPANISH: LÓPEZ CASASNOVAS, Guillm y ORTÚN RUBIO, Vicn (1998): Ecnmí y slud: fundmns y plíics", Encunr, Mdrid. ORTÚN, Vicn (199): L Ecnmí n snidd y mdicin: insrumns y limicins, Escl Univrsiri d Trbll Scil y L LLr dl LLibr, Brcln. STIGLITZ, Jsph. L Ecnmí dl Scr Públic. 2ª Edición IN ENGLISH [FGS] FOLLAND, Shrmn; GOODMAN, Alln C. y STANO, Mirn (1993): Th Ecnmics f Hlh nd Hlh Cr, Mcmilln, Nuv Yrk, Oxfrd. ZWEIFEL, Pr y BREYER, Fridrich (1997): Hlh Ecnmics, Oxfrd Univrsiy Prss, Oxfrd. MCGUIRE, A; HENDERSON, J. y MOONEY, G.(1.988): Th Ecnmics f Hlh Cr, Ruldg, Lndrs y Nuv Yrk. PHELPS, Chrls E. (1992): Hlh Ecnmics, Hrpr Cllins, Nuv Yrk. STIGLITZ, (): Th Ecnmics f h Public Scr. 2
1.1. INTRODUCTION Th Ecnmics f Hlh nd Hlh Cr Sm smnics: Individuls wn hlh, n hlh cr pr s. Th dmnd fr hlh cr is drivd dmnd such s dmnd fr n inpu in prducin funcin. Hlh Prvidrs d n supply hlh bu hlh cr Hlh Insurnc is n insurnc n ur hlh bu n h mnry xpndiurs ndd in hlh cr rcvr i. Hlh Ecnmics mrgd in h 6s fr h publicin f Knnh Arrw ppr. Th imprnc f Hlh Ecnmics hs grwn vr h ls 4 yrs du h rpid grwh f h xpndiurs wih hlh, priculrly in h US. This curs is msly n h Ecnmics f hlh cr, i.. w r ging lk bu Dmnd nd Supply f hlh cr srvics. 2. Hlh Expndiurs s % f Grss Dmsic Prduc p r c n g f G D P 18. 16. 14. 12. 1. 8. 6. 4. 2.. Scil Scuriy Ac 1965 - Mdicr, Mdicid Fun: Yr Spin Unid Ss OECD simpl vrg (n pp wighd) 3
9 Tl Hlh Expndiurs pr cpi in US$ PPP 8 7 D l P l P P s r 6 5 4 3 2 1 Yr Spin Unid Ss OECD Simpl Avrg (n wighd by pp) 25 Phrmcuicl Expndiurs s % f Tl P r c n g f 2 15 1 l 5 Yr Spin Unid Ss OECD Simpl Avrg (n wighd by pp) 4
9. Public Hlh Expndiurs s Prcng f Tl Hlh Expndiurs P r c n g f l 8. 7. 6. 5. 4. 3. 2. 1. Yr Spin Unid Ss OECD simpl vrg (n wighd by pp) POSSIBLE EXPLAINATIONS : Du svrl rsns, individuls dmnd mr hlh cr srvics nd mdicins : Incm ffc. Th incrsd prvlnc f insurnc In USA: Th public insurnc prgrms brn wih h Scil Scuriy Ac in 1965: Mdicid (fr h pr) nd Mdicr (fr h ldrly) In Eurp, Th Ninl Hlh Sysms (NHS) Bynd h incrs in pric nd quniis, h incrs in xpndiurs ls rflcs drmic chng in h bsk f gds nd srvics in hlh hs chngd. Tchnlgicl innvin is prsn in h bsic pckg f hlh cr ssisnc (ypiclly incrsing h css. Inflin in h scr is highr hn h vrg 5
Why will Hlh Ecnmics cninu b n imprn pic f sudy? Hlh Cr xpndiur is high nd incrsing prcng f h GDP High Prcng f h Public Spnding Scr f gr chnlgicl innvin nd invsmn (.g. Phrmcuicls hr is dmnd fr hs innvins, ppl r willing py fr hir hlh) High numbr f jbs Why will Hlh Ecnmics cninu b n imprn pic f sudy? Alchl Tbcc Obsiy Grwing lif Expcncy nd h grwing numbr f ldrly ppl (ldr hn 65) wh nd mr hlh cr 6
ALCOHOL LITRES PER CAPITA (POPULATION OLDER THAN 15 YEARS OLD) 25 Alchl Cnsumpin (lirs pr cpi 15+) 2 15 1 5 Yr Spin Unid Ss Unid Kingdm OECD vrg (n wighd by pp) TOBACCO % DAILY CONSUMERS (POPULATION OLDER THAN 15 YEARS OLD) 6 % ppulin 15+ wh r dily smkrs 5 4 3 2 1 Yr Spin Unid Ss Unid Kingdm OECD Avrg (n wighd by pp) 7
OBESITY 2 % f Obs Ppulin in Spin (slf-rprd) 18 16 14 12 1 8 6 4 2 1978 1979 198 1981 1982 1983 1984 1985 1986 1987 1988 1989 199 1991 1992 1993 1994 1995 1996 1997 1998 1999 2 21 22 23 24 25 26 27 28 29 21 Yr Spin - ll Spin - Fmls Spin - Mls 25 Lif Expcncy 65 2 15 1 5 Yr Spin - mls Unid Ss - Mls OECD vrg - Mls (n wighd by pp) Spin - Fmls Unid Ss - Fml OECD vrg - Fmls (n wighd by pp) 8