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General background in Health Economics

ملتقى الجودة وسلامة المرضى
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قديم 02-25-2011, 03:19 AM
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تحسين الآداء will become famous soon enough


General background
Health is determined by many factors among which medical care is only one

These factors include social class, work environment, employment status, income, housing conditions, heating, education, diet and lifestyle

The relative importance of inequalities in these types of resources cannot be determined unless there is an understanding of the links between resources,
behavior and Health

The human capital approach
Becker (1965) time allocation theory -households are producers of “commodities”. They derive utility from the basic commodities they produce by combining their own time with market goods. Therefore the utility associated with a market good is conditional on the time that is allocated to its consumption (i.e. leisure). This results in a more restricted utility maximization- budget and time
Grossman (1972) used this household production framework to develop his model of the demand for health. He defined health as a durable capital stock, and hence implied that the end product is not health as such but the services this capital good yields. Individuals derive utility from the services that health capital yields and from the consumption of other commodities. The stock of health capital depreciates over time and the consumer can produce gross investments in it according to a household production function using medical care and their own time as inputs. It is assumed that the efficiency of the production process depends on individuals’ stocks of other forms of human capital, especially education.
The human capital model
The individual is a producer of H (amongst other things): they buy market inputs (medical care, food, clothing), and combine them with their own time to produce services that increase their utility
The analysis is based on human capital theory which shows how individuals invest in themselves e.g. through training or education, to increase their productivity
The optimal amount of investment in human capital is determined by the relative Costs and Benefits: usually the Costs occur in the short-term whilst the Benefits accrue in the future in the form of enhanced job opportunities

The demand for health
Health demand consists of two elements:
(1) Consumption effects:
health yields direct utility i.e. you feel better when you are healthier
(2) Investment effects:
health increases the number of days available to participate in market and non-market activities – and enhances productivity of the individual

Health as a capital good
H Stockt= H Stockt-1dep’n(d) + inv. in H (I)
A person is born with initial endowment of H, which they add to by investment.
The rate of H production will depend on the efficiency of investment in H.
There will be d in the value of the stock of H through age, accident, carelessness, sudden disease.
As we are considering Utility over a life-time we also need to be aware of the issue of time-preference
Investing in health
Health Production function
Production function = Technical relationship between a combination of inputs and the resulting output
Production possibilities curve = tradeoff between different possible outputs for a given set of resources
Technical efficiency – get the maximum output for given inputs
Economic efficiency – least costly combination of inputs for producing a given output
What is the objective?
The investment decision
Household production functions:
Health Investiment
I = f(M,TH;E)
Consumption goods
Z =f(X,TC;E)
I = investment in health
M = market health care inputs
TH= time spent on improving health
Z = composite consumption good
X = market produced goods
TC = time spent on composite consumption good
E = education
Health production function
Health Production
H = f(M, Z, TH,;E)
Consumption goods - Z
Z =f(X,TC;E)
I = investment in health
M = market health care inputs
TH= time spent on improving health
Z = composite consumption good
X = market produced goods
TC = time spent on composite consumption good
E = education
H= f[ M, X,TC,TH,;E]
Medical Care
Medical care plays two roles:
Output – produced by physicians, hospitals etc – efficient? - input mix and industrial structure
Input in production of good health – efficient? (resource allocation to medical sector vs prevention)
Characteristics of medical production function
Substitutable inputs
Declining marginal productivity ceteris paribus
Short run and Long run
Law of variable proportions (law of diminishing marginal input productivity)
Economies of scale (returns to scale)
Technical change
Efficient Resource allocation between programs
Marginal analysis – change in output relative to change in inputs of the competing programs
RULE: Select programs whose marginal benefit per dollar spent is greatest
Empirical findings: Marginal benefits of lifestyle changes greater than those from medical expenditures
What is the government’s objective? – health or wealth redistribution?
Technical and Allocative Efficiency
Technical efficiency = producing the maximum output from a given input combination (i.e. production within a given firm – the firm is on the production possibilities frontier).
Allocative efficiency: efficient allocation of inputs between firms or outputs – i.e. each production input is employed in its most productive/rewarding use
Input Substitution in production
In some industries there is no input substitution (see fig. 6-1 A)
Elasticity of Substitution measures the producer responsiveness (through input substitution) to changes in input prices
Es = (% change in factor input ratio)/ (%change in factor price ration)
Measure of how much a firm shifts from the costlier input to the less costly inputs
Economies of Scale and of Scope
Economies of scale = as firm output levels increases the per unit cost of production decreases
Economies of scope = as the firm broadens its scope of production (i.e. the number of products) the per unit cost of production decreases.
Structural V Behavioral Cost Functions
Structural cost functions – based on economic theory and derived in a consistent manner (e.g. Long run costs, average costs, e.t.c.)
Behavioral = derived from actual data based on activities of health providers so that the behavioral differences between the different firms are reflected.
Changes in Technology
Cost Saving changes = new methods of producing current products at a lower cost (no change in quality)
Producing improved products (better quality)
New products or product mix that results in higher average costs
Diffusion of new technologies
Adoption of new technologies influenced by:
age
Profits
Risk aversion vs risk taking
Regulatory/mandatory rates
Supply
Market Structure
Concentration ratio

The concentration ratio is expressed in the terms
CRx, which stands for the percentage of the market sector controlled by the biggest x firms. For example, CR3 = 70% would indicate that the top three firms control 70% of a market.
CR4 is the most typical concentration ratio for judging what kind of an oligopoly it is. A CR44 of over 50% is generally considered a tight oligopoly; CR4 between 25 and 50 is generally considered a loose oligopoly. A CR44 of under 25 is no oligopoly at all. We would add that a CR3 of over 90% or a CR2 of over 80% should be considered a super-tight oligopoly.
The problem with this measure is that CR4 does not indicate what the relative size of the four largest companies is. It may be that a CR4 of 80 means that one company controls 50% of the market, while the others have 10% apiece. That's a very different market structure than one where every firm has a 20% share.
Herfindahl (or Herfindahl Hirschman) index
The H index is a far more precise tool for measuring concentration. It is obtained by squaring the market-share of each of the players, and then adding up those squares
The formula for this index is: H = (%S1)2 + (%S2) 2 + (%S3) 2 +….(%Sn) 2 Here %S stands for the percentages of the market owned by each of the larger companies, so that %S1 is the percentage owned by the largest company, %S2 by the second, and so on. n stands for the total number of firms you are counting.
The H index gives added weight to the biggest companies. The higher the index, the more concentration and (within limits) the less open market competition. A monopoly, for example, would have an H index of S12 or 1002, or 10,000. By definition, that's the maximum score. By contrast, an industry with 100 competitors that each has 1% of the market would have a score of 12 + 12 + 12+ ...12 or a total of 100.
Now that we've seen the limits, a more typical situation might be a duopoly. If each of the two firms has a market shares of 50%, the H index would be (50) 2 + 502 =2500 + 2500 = 5000. With two firms that have of 75% and 25% respectively, the H index would be: (75) 2 + (25) 2 = 5,625 + 625 = 6,250
A 1,000-1,800 value generally indicates moderate concentration. Anything over 1,800 is taken to be acute concentration. The US Antitrust Department has traditionally judged the "seriousness" of a merger by using the Herfindahl Index. If a merger or acquisition increases the index by 100 or more or pushes the overall index over 1,000, it is likelier to attract FTC scrutiny
Herfindahl-Hirschman Index - HHI
The U.S. Department of Justice uses the HHI for evaluating mergers.
As a General rule, mergers that increase the HHI by more than 100 points in concentrated markets raise antitrust concerns.

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من مواضيعي : تحسين الآداء
موضوع مغلق

مواقع النشر (المفضلة)

الكلمات الدليلية (Tags)
background, economics, general, health


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