《健康经济学》课件Chapter13.ppt

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1、Health care costs are rising,Health care costs have increased faster than inflation for decades 1960:the typical American spent 1/20 of her income on medical care2010:1 in every 6 dollars of the American economy is spent on medical careThis amounts to a total of$2.6 trillion and$8,402 per person,Hea

2、lth care expenditures over time,What are health care costs?,When we speak of“health care costs,”we really mean total health expenditures Equation for medical expenditures E:E=P Q E is expenditures on medical careP is the price of medical care Q is the quantity of medical care,E=P x Q,Hypotheses to e

3、xplain rising expenditures:Prices have increasedQuantity demanded has increasedTechnological innovations and technological overuseRest of this chapter explores each one of these hypotheses,Quantity may be increasing,An aging populationpeople demand more health care as they ageA richer populationrisi

4、ng incomes lead to more health care consumption More insurance coverageMore insurance reduces out-of-pocket prices to patients of obtaining medical careIncreasing quality of medical careeach dollar spent on health care generates a higher marginal health benefit,so demand for health care increases,Ar

5、e rising costs a bad thing?,If rising costs are due to rising demandrising health care costs is not necessarily a bad thingPeople are not necessarily worse offIf rising costs are due to rising pricesRising costs does harm consumers Health is getting more expensive to produce,so people will either ha

6、ve to cut back on health care or spend more money to stay healthy,Prices may be rising,because,Increased resource costsLess competitive markets Hospital mergers may have made the market more monopolisticExpensive new technology if modern medical care routinely incorporates new,expensive technologies

7、 like MRI machines,the price of treating many ailments will rise,Medical inflation,A medical care consumer price index(CPI)measures changes in the price level for medical goods and servicesMedical inflation:a rise in the price level for medical goods and servicesA medical care CPI can tell us how mu

8、ch more it costs this year to buy the same things we bought last year,Medical care CPI,In the last thirty years,the U.S.medical care CPI has remained consistently higher than overall inflation,Calculating the medical care CPI,Create a bundle of goods and servicesBundle should approximate typical con

9、sumption of goods and services demanded Compare the total of cost of this bundle this year to the total cost last year,Calculating the medical care CPI,Suppose for simplicity that there are only two goods in the bundle,A and B.(q0A,q0B)quantity of goods A and B in the bundle(p0A,p0B)yesterdays price

10、s of A and B(p1A,p1B)todays new prices for A and B Laspeyres index ICPI:,Interpreting the ICPI,If the Laspeyres price index rises by 5%,then consumers are 5%worse off the things they want to consume are 5%more expensive Potential Problems with the ICPITechnological changeOriginal bundle no longer re

11、flects actual purchasesEx:blood transfusions are now much safer than they were 50 years ago due to improved screening techniquesEx:polio vaccines have replaced treatments like the iron lung,New technologies in the CPI,Consider the cure for Hodgkins Lymphoma:Before 1950,no cure available Price:infini

12、te Quantity:0In 2013,cure available;price is finite and quantity positiveSo the price of Hodgkins cure has fallen dramatically,Technology overuse,Another hypothesis for explaining rising health care cost is technology overuseLots of medical innovation in recent decadesCan the introduction of more an

13、d more expensive technologies explain rising health care costs?If so,are these technologies being used efficiently?Or is there evidence of technology overuse?,The Dartmouth Atlas,The Dartmouth Atlas tracks Medicare spending across the United States The project finds:Patients with the same diagnoses

14、can receive dramatically different care depending on where they liveIn general,no correlation between more expensive treatment and health outcomes,Variations in medical spending,Medicare expenditures on patients in their last two years of life averaged$46,412 nationwideBut tremendous regional variat

15、ionMedicare spent on average$59,379 per patient in New Jersey,almost double what it spent in North DakotaAverage bill in Miami,Florida:$83,504 Average bill in La Crosse,Wisconsin:$36,949 Variation in spending even within the same city,Spending and health outcomes,Despite these variations in health e

16、xpenditures,health outcomes do not appear to differ between high expenditure and low expenditure regions:Similar self-reported health status and mortality rates between high-expenditure regions and low-expenditure onesIs this evidence of wasteful medical spending?Maybe:we consider the case of Miami&

17、La Crosse next,Ex:La Crosse vs.Miami,Average Medicare expenditures in the last two years of lifeMiami,Florida:$83,504La Crosse,Wisconsin:$36,949Despite spending less than half as much,enrollees in La Crosse did not seem to be less healthy than Miami enrollees,Ex:La Crosse vs.Miami,Ex:La Crosse vs.Mi

18、ami,Health Production Function(HPF)plots relationship between expenditures and maximal level of obtainable healthHPF increases with health expendituresHPF has diminishing returns to health care spendingWhether Miamis higher expenditures reflects wasteful spending depends on whether Miami and La Cros

19、se share the same HPF,HPFs of Miami and La Crosse,Figure A hypothesis:Miami and La Crosse lie on the same HPF,then Miami could be achieving the same level of health for much lower expenditures,Figure B hypothesis:Miami and La Crosse lie on different HPFsThey may both be investing in health optimally

20、 given local characteristics and constraintsIf so,variation in spending does not necessarily represent wasteful spending or technology overuse,HPFs of Miami and La Crosse,Theory#1:Different input costs Different locations have different costs of livingBut adjusting for local prices fails to signific

21、antly reduce the geographic variation in per patient Medicare expendituresThis hypothesis does not explain why variations in spending persist at the more local level,Why might Miami and La Crosse have different HPFs?,Why might Miami and La Crosse have different HPFs?,Theory#2:Different hospital amen

22、ities Differences in the quality of care that explain variations in spending Higher-spending hospitals may be devoting more resources on the satisfaction of patients,even if those resources do not contribute directly to health But patients in high-spending regions do not report higher levels of inpa

23、tient satisfaction,Theory#3:Different medical malpracticeenvironments Hospitals in regions with a higher rate of medical malpractice suits practice more defensive medicine Fails to explain variations in spending within states that share the same malpractice codes,Why might Miami and La Crosse have d

24、ifferent HPFs?,Why might Miami and La Crosse have different HPFs?,Theory#4:Differing levels of severity of illness Spending variation reflects differing levels of illness severity in different regionsPerhaps the diabetics in La Crosse are healthier than diabetics in Miami If lower medical expenditur

25、es in La Crosse result from healthier patients living there,the variation in spending would be warranted,Dartmouth Atlas researchers perspective,The researchers argue that these theories are insufficient for explaining all of the variation in Medicare expenditures Some evidence does suggest that dif

26、ferent regions have different local traits that cause them to lie on different HPFsbut the researchers contend that those local differences do not account for all the variation in expenditures,Dartmouth Atlas researchers perspective,If high expenditure regions such as Miami are indeed spending at su

27、boptimal points,what causes them to do so?,Supply-sensitive care and moral hazard,Supply-sensitive care refers to health services whose use depends greatly on the supply or availability of that service Example:a doctors reliance on MRI technology may depend on how accessible an MRI machine is to him

28、 Supply-sensitive care can also include hospitalizations and stays in a intensive care unit Hypothesis:doctors with greater access to resources will tend to overprescribe care,Supply-sensitive care,If demand for care is sensitive to supply,then we would expect hospitals with more resources to have l

29、arger expendituresDartmouth Atlas shows evidence of a positive correlation between#of hospital beds and#of hospital dischargesSuggestive evidence that the variation is at least in part due to technology overuse,Conclusion,Despite the evidence of overuse,returns of medical technology have been highOn

30、e study estimates that medical innovations between 1970-2000 in the US were worth$3.2 trillion per yearOverall value of medical technology high but there are also costly and only slightly effective drugs on the marketDifferentiating between good and bad technologies is the goal of Health Technology Assessment,