《健康經(jīng)濟(jì)學(xué)》課件Chapter1

Whyishealtheconomicsinteresting?TheU.S.healthcareeconomyismassiveandexpensive.Healthisamajorsourceofuncertaintyandrisk.Governmentsaroundtheworldaredeeplyinvolvedinfinancinghealthsystems.TheU.S.healthcareeconomyismassiveandexpensiveTheU.S.GDPin2008wasapproximately$14trillion.OneoutofeverysixdollarsspentintheU.S.thatyearwasspentonhealthcare.In1960,barelyonedollaroutofeverytwentyspentintheU.S.wenttowardhealthcare.Thetrendhasbeensimilarincountriesaroundtheworld,butnocountryspendsquiteasmuchonhealthcareastheU.S.Whatdowegetforallthismoney?HealthcareexpendituresintheUSHealthisuncertainandcontagiousThehealtheconomymaybehuge,buthowisitdifferentfromother,smallermarketslikethemarketforbananasandthemarketfortelevisions?TwointerestingeconomicpropertiesUncertainty:mostpeoplecanpredicthowmanybananasorTVstheywillbuyinthenextweek,butnothowmanyemergencyheartsurgeriestheywillneedinthenextweek.Contagiousness:itdoesn’tmattertoyouifyourneighborbuysabananaoraTV,butitdoesmatterifheskipshisflushot.UncertaintyandinsuranceAnunforeseenbrokenlegorheartattackcansuddenlycreatedemandforexpensivehealthcareservices.Becausemostpeopleareriskaverse,health-relateduncertaintymotivatesindividualstodemandhealthinsurance.Thisinturncreatesproblemsthatariseininsurancemarkets:adverseselectionandmoralhazard.Thesetwophenomenaarewhatmakehealthpolicyreallydifficult(andreallyinteresting).ContagiousnessandexternalitiesThefactthatotherpeople’shealthdecisionsaffectyoucreatesexternalitiesExamples:VaccinationsandotherpreventativemeasurescreatepositiveexternalitiesGoingoutinpublicwithEbolaviruscreatesnegativeexternalitiesExternalitiesunderminetheefficientfunctionofmarketsandoftenrequiregovernmentintervention.Healtheconomics=publicfinanceGovernmentsplayahugeroleinhealthmarketsbecauseofthefeaturesjustdiscussed.IncountriesliketheUnitedKingdom,Sweden,andCanada,thegovernmentisresponsibleforthevastmajorityofhealthcareexpenditures.EvenintheUS,withitsprivatehealthcaresystem,thegovernmentisresponsibleforhalfofallhealthcarespending.Healthcareisonlygettingbiggerandmoreexpensiveforgovernmentsandtaxpayers

Increasinglifeexpectanciesandgrayingpopulationsthroughoutthedevelopedworldwillplacestressonpublichealthinsurancesystems.Governmentswillhavetocopewithongoingquestionsaboutwhethertopayforexpensivenewmedicaltechnologies.Giventhesetrendswecanconfidentlyexpecthealthcaretobeanever-growinglineitemongovernmentbalancesheets.PositivevsnormativequestionsNormativequestionsDoeseveryonedeserveaccesstohealthcare,eveniftheycannotpay?Shouldpeoplebecompelledtopurchaseinsurance?Whenisitethicaltodenycaretoadyingpatient?Shouldthegovernmentbancertainunhealthyfoods?PositivequestionsHowmuchwoulditcosttoprovidefreecheckupsanddrugsforeveryoneinapopulation?Dostrictpatentprotectionsfornewdrugsspurinnovation?Howmuchwouldconsumerssaveifdoctorswerenotrequiredtohavemedicaldegreesormedicallicenses?Wouldataxonsaturatedfatmakeanationhealthier?Economicreasoningcannotanswernormativequestions,butitcananswerpositivequestions,andthatcanhelpusformopinionsaboutnormativequestions.TheuniqueUShealthcaremarketIntheU.S.,patientssometimespayoutofpocketforroutinehealthcare,likeflushotsandhealthcheckups.Inmanyothercountries,includingCanadaandtheUnitedKingdom,patientsalmostneverpayoutofpocketwhentheyreceivebasichealthcare.IntheU.S.,somepeoplearenoteligibleforgovernmentinsuranceandcannotafford(ordonotwant)tobuyprivateinsurance.Inalmostalldevelopedcountries,uninsuranceisextremelyrareorevennonexistent.Insuranceiseitherprovidedforfreebythegovernment,orprovidedbyamixofpublicandprivateinsurers.TheuniqueUShealthcaremarketEventhoughtheUSmarketisuniqueinthisway,muchofourempiricalevidencewillcomefromtheUS.Thisallowsustounderstandthemaladiesthatcanoccur