Health economics:
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| Main Authors: | , , |
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| Format: | Book |
| Language: | English German |
| Published: |
Dordrecht [u.a.]
Springer
2009
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| Edition: | 2. ed. |
| Subjects: | |
| Online Access: | Inhaltstext Inhaltsverzeichnis |
| Physical Description: | XX, 529 S. graph. Darst. |
| ISBN: | 9783540278047 9783540685401 |
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| 245 | 1 | 0 | |a Health economics |c Peter Zweifel ; Friedrich Breyer ; Mathias Kifmann |
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| adam_text |
Titel: Health economics
Autor: Zweifel, Peter
Jahr: 2009
Contents Overview
Preface v
Detailed Table of Contents ix
1 Introduction 1
2 Economic Valuation of Life and Health 17
3 Individuals as Producers of Their Health 75
4 Empirical Studies of the Production of Health 119
5 Health Goods, Market Failure and Justice 155
6 Optimal Health Insurance Contracts 203
7 Risk Selection in Health Insurance Markets 253
8 Physicians as Suppliers of Medical Services 293
9 Hospital Services and Efficiency 311
10 Paying Providers 331
11 Forms of Delivery of Medical Care 379
12 The Market for Pharmaceuticals 401
13 The Political Economy of Health Care 429
14 Future Challenges to Health Care Systems 447
References 483
Author Index 505
Subject Index 513
Detailed Table of Contents
Preface v
Contents Overview vii
1 Introduction 1
1.1 Health - a Priceless Commodity? 1
1.2 The Micro- and Macroeconomic Views of Health 3
1.2.1 A Simplified Microeconomic View of Health 3
1.2.2 Health Care at the Macroeconomic Level 6
1.2.3 A Critique of Global Budgeting 7
1.3 'Economics of Health' vs. 'Economics of Health Care' 10
1.3.1 Economics of Health 10
1.3.2 Health and the Use of Health Care Services 11
1.3.3 Economics of Health Care 11
1.4 A System Analysis of the Economics of Health and Health Care . 12
1.5 Summary 15
2 Economic Valuation of Life and Health 17
2.1 Introduction 17
2.2 Approaches to the Economic Evaluation of Health 18
2.3 Cost-Utility Analysis 25
2.3.1 Concepts of Utility Measurement 25
x Detailed Table of Contents
2.3.2 The QALY Concept 26
2.3.2.1 Calculating QALYs 26
2.3.2.2 Decision-Theoretic Foundation 28
2.3.2.3 QALYs and Consumption 32
2.3.2.4 Aggregation of QALYs and Collective
Decision-Making 34
2.3.3 Evaluating Health States 36
2.3.3.1 Rating Scale 36
2.3.3.2 Time Trade-Off 36
2.3.3.3 Standard Gamble 38
2.4 Cost-Benefit Analysis 40
2.4.1 Ethical Objections and Counterarguments 40
2.4.1.1 Objections Against Weighing Life Against Money 40
2.4.1.2 Arguments Against a Finite Value of Life 42
2.4.2 The Human-Capital Approach 43
2.4.3 The Willingness-To-Pay Approach 45
2.4.4 Aggregating Willingness To Pay and Principles of
Collective Decision-Making 47
2.4.4.1 Cost-Benefit Analysis and the Potential Pareto
Criterion 48
2.4.4.2 Cost-Benefit Analysis with Many Interventions . 49
2.4.4.3 Cost-Benefit Analysis and Social Welfare Analysis 49
2.4.5 Measuring Willingness To Pay: Using Surveys 54
2.4.5.1 General Problems of Surveys 54
2.4.5.2 The Contingent Valuation Method 55
2.4.5.3 Discrete Choice Experiments 58
2.4.6 Measuring Willingness to Pay: Using Market Data 61
2.5 Cost-Utility, Cost-Benefit and Social Welfare Analysis 63
2.5.1 Comparing Cost-Utility and Cost-Benefit Analysis 63
2.5.2 Social Welfare and QALYs 66
2.6 Summary 69
2.7 Further Reading 70
2.E Exercises 71
Detailed Table of Contents xi
3 Individuals as Producers of Their Health 75
3.1 Introduction 75
3.2 The Concept of Health Production 77
3.3 Health as Part of Human Capital 79
3.3.1 A Simplified Grossman Model 79
3.3.2 The Demand for Health and Medical Services 83
3.3.2.1 The Structural Demand Function for Medical
Services 83
3.3.2.2 The Demand Functions in the Investment Model. 84
3.3.2.3 The Demand Functions in the Consumption Model 85
3.3.3 Preliminary Assessment of the Grossman Model 86
3.4 The Production of Health as the Modification of a Stochastic Process 89
3.4.1 Conditional Health Production Functions 89
3.4.2 Short-run Optimization and Willingness to Pay for Health . 91
3.4.3 A Model with State-Dependent Production Possibilities:
The Short Term 94
3.4.3.1 State-Dependent Optimization of a Stochastic
Process 94
3.4.3.2 The Elements of the Model 96
3.4.3.3 Conditional Short-term Production Frontiers 98
3.4.3.4 Alleged Instability of Health Behavior 101
3.4.4 State-Dependent Production Possibilities: The Longer Run . 103
3.4.4.1 The Longer-Run Trade-Off Given Good Health . 104
3.4.4.2 The Longer-Run Trade-Off Given Bad Health 106
3.4.5 Complementarity or Substitutability in the Production of
Health? 107
3.4.5.1 Significance of the Issue 107
3.4.5.2 Substitutability in the Healthy State 108
3.4.5.3 Complementarity in the Sick State 109
3.5 Summary 109
3.6 Further Reading 110
3.A Appendix to Chapter 3 HI
3.E Exercises 118
xii Detailed Table of Contents
4 Empirical Studies of the Production of Health 119
4.1 Introduction 119
4.2 Studies Based on Aggregate Data 121
4.2.1 Mortality Rates and Life Expectancy as Measures of Output? 121
4.2.2 Marginal Productivity of a Health Care System 122
4.2.2.1 Early Evidence from the United States 122
4.2.2.2 Recent Evidence from the United States 127
4.2.2.3 Evidence from Industrialized Countries 129
4.2.2.4 Evidence from a Comparison of Two Neighboring
Areas 131
4.2.2.5 Evidence from a Developing Region
(Sub-Saharan Africa) 132
4.2.3 Marginal Productivity of Selected Medical Interventions . 135
4.2.4 Environmental Determinants of Health Status 136
4.2.5 Economic Instability and Health 137
4.3 Studies Based on Individual Data 140
4.3.1 Measurement of Health Status 140
4.3.2 Marginal Productivity of Medical Infrastructure at the
Individual Level 141
4.3.3 The Productivity of Medical Interventions at the Individual
Level 142
4.3.4 Environmental Quality and the State of Health 143
4.3.4.1 Air Quality and Smoking as Exogenous Factors. 143
4.3.4.2 Smoking as an Endogenous Factor 146
4.4 Demand for Health, Demand for Health Services 148
4.5 Summary 152
4.6 Further Reading 152
4.E Exercises 153
5 Health Goods, Market Failure and Justice 155
5.1 Introduction 155
5.2 Market Failure in Markets for Health Goods 157
5.2.1 Externalities and the Problem of Public Goods 157
5.2.2 Option-Good Property of Medical Services 159
Detailed Table of Contents xiii
5.2.3 Lack of Consumer Sovereignty 160
5.2.3.1 Incapability of Rational Decision Making 160
5.2.3.2 Excess Discounting of Future Needs 161
5.2.4 Lack of Perfect Information in Markets for Health Goods . 161
5.3 Market Failure in Health Insurance Markets 163
5.3.1 The Basic Model 163
5.3.2 The Free-Rider Problem 166
5.3.3 Asymmetric Information in the Health Insurance Market . 171
5.3.3.1 Risk Types 171
5.3.3.2 Market Equilibrium under Symmetric Information 172
5.3.3.3 Market Equilibrium under Asymmetric Information 173
5.3.3.4 Welfare-Enhancing Government Intervention in
Insurance Markets 176
5.3.3.5 Alternative Equilibrium Definitions 178
5.3.4 Premium Risk 180
5.3.4.1 Pure-Market Solutions 181
5.3.4.2 Community Rating as a Solution 185
5.3.4.3 Comparing the Solutions 187
5.4 Justice as an Argument in Favor of Government Intervention in
Health Care 189
5.4.1 Willingness and Ability to Pay and Access to Health Care . 189
5.4.2 Congenital Differences in Health and Access to Health
Insurance 192
5.4.2.1 Redistribution and the Veil of Ignorance 192
5.4.2.2 Implementing Cross-Subsidies between High and
Low Risks 193
5.5 Rationing of Health Care Services 194
5.5.1 The Concept of Rationing 195
5.5.2 Types of Primary Rationing 196
5.6 Summary 198
5.7 Further Reading 199
5.E Exercises ^00
xiv Detailed Table of Contents
6 Optimal Health Insurance Contracts 203
6.1 Introduction 203
6.2 Types of Health Insurance Contracts 205
6.3 Optimal Insurance Protection in the Absence of Moral Hazard 208
6.3.1 Financial Consequences of Illness Only 208
6.3.1.1 A Model with Two Health States 209
6.3.1.2 A Model with an Arbitrary Number of Health States215
6.3.2 Direct Utility Effects of Illness 221
6.3.3 Summary 224
6.4 Optimal Insurance Coverage with Moral Hazard 224
6.4.1 Ex-Ante Moral Hazard 224
6.4.1.1 Assumptions 224
6.4.1.2 Optimal Prevention without Insurance 226
6.4.1.3 The Optimum with Observable Prevention 227
6.4.1.4 The Optimum with Unobservable Prevention 228
6.4.1.5 Implications 232
6.4.1.6 Empirical Evidence on Ex-Ante Moral Hazard. 232
6.4.2 Ex-Post Moral Hazard 233
6.4.2.1 Assumptions 233
6.4.2.2 Optimal Insurance Coverage with Observable
State of Health 235
6.4.2.3 Optimal Insurance Coverage with Unobservable
State of Health 237
6.4.2.4 Implications 241
6.4.2.5 The Empirical Relationship Between Insurance
Coverage and the Demand for Health Care Services 242
6.5 Consequences for the Design of Social Health Insurance 244
6.6 Summary 246
6.7 Further Reading 247
6.A Appendix 248
6.E Exercises 250
Detailed Table of Contents xv
7 Risk Selection in Health Insurance Markets 253
7.1 Introduction 253
7.2 Modeling Risk Selection 255
7.2.1 Direct Risk Selection 255
7.2.2 Indirect Risk Selection 257
7.2.2.1 Indirect Risk Selection Using the Quantity of
Benefits 259
7.2.2.2 Risk Selection Using the Structure of Benefits 270
7.3 Further Arguments in Favor of Risk Adjustment and Cost
Reimbursement 276
7.3.1 Fair Competition in the Health Insurance Market 277
7.3.2 Stabilization of the Health Insurance Market 277
7.4 Designing Risk Adjustment Schemes 278
7.4.1 An Overview of Risk Adjusters 278
7.4.2 Costs and Payment Flows 280
7.4.3 Calculating Risk Adjustment Payments 282
7.4.3.1 The Statistical Approach to Risk Adjustment 282
7.4.3.2 The Incentive Approach to Risk Adjustment 283
7.5 Designing Cost Reimbursement Schemes 284
7.5.1 The Basis of Cost Reimbursement 285
7.5.2 The Structure of Cost Reimbursement 285
7.5.3 Findings of Empirical Studies 286
7.6 Summary 287
7.7 Further Reading 289
7.E Exercises 290
8 Physicians as Suppliers of Medical Services 293
8.1 Introduction 293
8.2 The Relationship Between Physician Density and the Utilization of
Medical Services 294
8.3 The Hypothesis of Supplier-Induced Demand for Ambulatory
Medical Services 295
xvi Detailed Table of Contents
8.4 Utility Maximization of the Physician and Supplier-Induced Demand 298
8.4.1 A Model of Physician Behavior 298
8.4.2 Increasing Physician Density 300
8.4.3 Increasing Fee Level 304
8.5 Physician Density and Utilization of Medical Services: Alternative
Explanations 304
8.6 Empirical Examination of the Supplier-Induced Demand Hypothesis 306
8.6.1 Physician Density and Volume of Services 306
8.6.2 Regulated Fees and Volume of Services 307
8.7 Summary 308
8.8 Further Reading 309
8.E Exercises 309
9 Hospital Services and Efficiency 311
9.1 Introduction 311
9.2 The Hospital as a Productive Unit 312
9.2.1 Hospital Output: Health as a Latent Variable 312
9.2.2 The Multi-Stage Character of Production in the Hospital . 313
9.2.3 The Heterogeneity of Hospital Output 317
9.3 Comparing Hospital Efficiency 318
9.3.1 Regulation and Asymmetric Information 318
9.3.2 Hospital Cost Functions 319
9.3.3 Data Envelopment Analysis 322
9.3.3.1 Introduction 322
9.3.3.2 Comparing the Efficiency of Swiss Hospitals 324
9.3.4 Potential and Limits of Efficiency Measurement 328
9.4 Summary 328
9.5 Further Reading 329
9.E Exercises 329
10 Paying Providers 331
10.1 Introduction 331
10.2 Paying Providers to Achieve Cost Control 333
10.2.1 The Principle of Full Cost Responsibility 333
Detailed Table of Contents xvii
10.2.1.1 The Basic Model 333
10.2.1.2 The First-Best Payment System 334
10.2.1.3 Implementing the First-Best Solution 336
10.2.2 Paying Risk-Averse Providers 338
10.2.2.1 Contractible Effort to Control Costs 338
10.2.2.2 Noncontractible Effort to Control Costs 340
10.2.3 Casemix and Information Rent 344
10.2.3.1 Symmetric Information about Casemix 344
10.2.3.2 Asymmetric Information about Casemix 344
10.3 Concerns Beyond Cost Control 348
10.3.1 Quality of Treatment 348
10.3.1.1 Extending the Basic Model 348
10.3.1.2 Verifiable Quality or Treatment Outcomes 350
10.3.1.3 Unverifiable Quality and Treatment Outcomes 351
10.3.2 Patient Selection 355
10.3.2.1 Extending the Basic Model 356
10.3.2.2 Symmetric Information about Patients' Cost Types 358
10.3.2.3 Asymmetric Information about Patients' Cost Types359
10.4 Implications for the Design of Payment Systems 363
10.4.1 General Considerations 363
10.4.2 Paying Physicians 365
10.4.2.1 Overview of Payment Systems 365
10.4.2.2 Optimal Physician Payment 366
10.4.3 Paying Hospitals 368
10.4.3.1 Overview of Payment Systems 368
10.4.3.2 Optimal Hospital Payment 368
10.4.3.3 Hospital Payment Based on Diagnosis Related
Groups 370
10.5 Summary 371
10.6 Further Reading 372
10.A Appendix 372
10.E Exercises 374
xviii Detailed Table of Contents
11 Forms of Delivery of Medical Care 379
11.1 Introduction 379
11.2 The Physician as the Patient's Agent 382
11.3 Complementary Principal-Agent Relationships in Health Care 384
11.3.1 The Employer as Complementary Agent 384
11.3.2 The Government as Complementary Agent 384
11.3.2.1 National Health Service 385
11.3.2.2 National Health Insurance 385
11.3.3 Private Health Insurers as Complementary Agents 386
11.4 The Managed Care Organization as an Alternative Form of
Provision of Care 387
11.4.1 The Managed Care Organization as a Complementary Agent 387
11.4.2 Cost Advantages of Managed Care 388
11.4.3 Cost Effects of Managed Care Organizations at the System
Level 390
11.4.4 Final Assessment of Managed Care Organizations 395
11.5 Summary 396
11.6 Further Reading 396
11.A Appendix 397
ll.E Exercises 400
12 The Market for Pharmaceuticals 401
12.1 Introduction 401
12.2 The Development of a New Drug 403
12.2.1 The Consumption Technology of a Drug 403
12.2.2 Regulation of Market Access by Public Authorities 404
12.2.3 Effect of Copayment 404
12.3 Pharmaceutical Innovation as an Investment 406
12.3.1 The Chronology of a Pharmaceutical Innovation 407
12.3.2 Probability of Success and the Cost of Innovation 408
12.3.3 Excessive Returns to Pharmaceutical Innovation? 410
12.4 The Role of Patent Protection 412
12.4.1 Why Patent Protection? 412
12.4.2 The Decision Situation of the Innovator 413
Detailed Table of Contents xix
12.4.3 The Length of Patent Protection from the Regulator's Point
of View 416
12.5 Price Regulation of Pharmaceuticals 418
12.5.1 Reasons for Price Regulation 418
12.5.2 The Conflict Between National Regulation and Global
Optimization 420
12.5.3 Types of Price Regulation and Their Consequences 422
12.5.3.1 Direct Price Regulation 422
12.5.3.2 Reference Prices 423
12.5.3.3 Rate-of-Return Regulation 423
12.5.3.4 Pharmaceutical Budgets Imposed on Physicians . 424
12.6 Price Competition on Pharmaceutical Markets 424
12.7 Summary 427
12.8 Further Reading 427
12.E Exercises 428
13 The Political Economy of Health Care 429
13.1 Introduction 429
13.2 Collectively Financed Health Care in a Democracy 430
13.2.1 Basic Assumptions 431
13.2.2 The Decision Process 432
13.2.3 Purchase of Private Health Insurance and Demand for
Health Care 433
13.2.4 Voting on Public Health Care for a Given Regime 434
13.2.5 Choice of Regime 436
13.2.6 Empirical Implications of the Analysis 437
13.3 The Role of Professional Associations in Health Care 439
13.3.1 Why Are Professional Associations so Important in Health
Care? 439
13.3.2 Tasks of Associations in Health Care 441
13.3.3 Competition among Service Providers, Competition among
Associations 443
13.4 Summary 445
13.5 Further Reading 445
13.E Exercises 446
xx Detailed Table of Contents
14 Future Challenges to Health Care Systems 447
14.1 Introduction 447
14.2 The Technological Challenge 449
14.2.1 Three Types of Innovation 449
14.2.2 Criteria for an Optimal Allocation of Innovative Effort 451
14.2.3 Distortions of Criteria at the Aggregate Level 454
14.3 The Demographic Challenge 457
14.3.1 Ageing of the Population 457
14.3.1.1 Improved Control over Health Thanks to Medicine? 457
14.3.1.2 The Redistributive Effects of Ageing 459
14.3.2 Changes in Household Composition 461
14.4 Demographic Ageing, Medical Progress, and Health Care
Expenditure 462
14.4.1 The 'Sisyphus Syndrome' in Health Care 463
14.4.1.1 A Simple Dynamic Model of the Sisyphus
Syndrome 463
14.4.1.2 Empirical Evidence 465
14.4.2 Ageing of Population and Health Care Expenditure 471
14.4.3 Funding of Health Insurance 474
14.5 International Challenges 476
14.5.1 Integration of Insurance Markets 476
14.5.2 Migration of Health Care Personnel 478
14.5.3 Direct International Investment in Hospitals 478
14.6 Summary 480
14.7 Further Reading 482
14.E Exercises 482
References 483
Author Index 505
Subject Index 513 |
| adam_txt |
Titel: Health economics
Autor: Zweifel, Peter
Jahr: 2009
Contents Overview
Preface v
Detailed Table of Contents ix
1 Introduction 1
2 Economic Valuation of Life and Health 17
3 Individuals as Producers of Their Health 75
4 Empirical Studies of the Production of Health 119
5 Health Goods, Market Failure and Justice 155
6 Optimal Health Insurance Contracts 203
7 Risk Selection in Health Insurance Markets 253
8 Physicians as Suppliers of Medical Services 293
9 Hospital Services and Efficiency 311
10 Paying Providers 331
11 Forms of Delivery of Medical Care 379
12 The Market for Pharmaceuticals 401
13 The Political Economy of Health Care 429
14 Future Challenges to Health Care Systems 447
References 483
Author Index 505
Subject Index 513
Detailed Table of Contents
Preface v
Contents Overview vii
1 Introduction 1
1.1 Health - a Priceless Commodity? 1
1.2 The Micro- and Macroeconomic Views of Health 3
1.2.1 A Simplified Microeconomic View of Health 3
1.2.2 Health Care at the Macroeconomic Level 6
1.2.3 A Critique of Global Budgeting 7
1.3 'Economics of Health' vs. 'Economics of Health Care' 10
1.3.1 Economics of Health 10
1.3.2 Health and the Use of Health Care Services 11
1.3.3 Economics of Health Care 11
1.4 A System Analysis of the Economics of Health and Health Care . 12
1.5 Summary 15
2 Economic Valuation of Life and Health 17
2.1 Introduction 17
2.2 Approaches to the Economic Evaluation of Health 18
2.3 Cost-Utility Analysis 25
2.3.1 Concepts of Utility Measurement 25
x Detailed Table of Contents
2.3.2 The QALY Concept 26
2.3.2.1 Calculating QALYs 26
2.3.2.2 Decision-Theoretic Foundation 28
2.3.2.3 QALYs and Consumption 32
2.3.2.4 Aggregation of QALYs and Collective
Decision-Making 34
2.3.3 Evaluating Health States 36
2.3.3.1 Rating Scale 36
2.3.3.2 Time Trade-Off 36
2.3.3.3 Standard Gamble 38
2.4 Cost-Benefit Analysis 40
2.4.1 Ethical Objections and Counterarguments 40
2.4.1.1 Objections Against Weighing Life Against Money 40
2.4.1.2 Arguments Against a Finite Value of Life 42
2.4.2 The Human-Capital Approach 43
2.4.3 The Willingness-To-Pay Approach 45
2.4.4 Aggregating Willingness To Pay and Principles of
Collective Decision-Making 47
2.4.4.1 Cost-Benefit Analysis and the Potential Pareto
Criterion 48
2.4.4.2 Cost-Benefit Analysis with Many Interventions . 49
2.4.4.3 Cost-Benefit Analysis and Social Welfare Analysis 49
2.4.5 Measuring Willingness To Pay: Using Surveys 54
2.4.5.1 General Problems of Surveys 54
2.4.5.2 The Contingent Valuation Method 55
2.4.5.3 Discrete Choice Experiments 58
2.4.6 Measuring Willingness to Pay: Using Market Data 61
2.5 Cost-Utility, Cost-Benefit and Social Welfare Analysis 63
2.5.1 Comparing Cost-Utility and Cost-Benefit Analysis 63
2.5.2 Social Welfare and QALYs 66
2.6 Summary 69
2.7 Further Reading 70
2.E Exercises 71
Detailed Table of Contents xi
3 Individuals as Producers of Their Health 75
3.1 Introduction 75
3.2 The Concept of Health Production 77
3.3 Health as Part of Human Capital 79
3.3.1 A Simplified Grossman Model 79
3.3.2 The Demand for Health and Medical Services 83
3.3.2.1 The Structural Demand Function for Medical
Services 83
3.3.2.2 The Demand Functions in the Investment Model. 84
3.3.2.3 The Demand Functions in the Consumption Model 85
3.3.3 Preliminary Assessment of the Grossman Model 86
3.4 The Production of Health as the Modification of a Stochastic Process 89
3.4.1 Conditional Health Production Functions 89
3.4.2 Short-run Optimization and Willingness to Pay for Health . 91
3.4.3 A Model with State-Dependent Production Possibilities:
The Short Term 94
3.4.3.1 State-Dependent Optimization of a Stochastic
Process 94
3.4.3.2 The Elements of the Model 96
3.4.3.3 Conditional Short-term Production Frontiers 98
3.4.3.4 Alleged Instability of Health Behavior 101
3.4.4 State-Dependent Production Possibilities: The Longer Run . 103
3.4.4.1 The Longer-Run Trade-Off Given Good Health . 104
3.4.4.2 The Longer-Run Trade-Off Given Bad Health 106
3.4.5 Complementarity or Substitutability in the Production of
Health? 107
3.4.5.1 Significance of the Issue 107
3.4.5.2 Substitutability in the Healthy State 108
3.4.5.3 Complementarity in the Sick State 109
3.5 Summary 109
3.6 Further Reading 110
3.A Appendix to Chapter 3 HI
3.E Exercises 118
xii Detailed Table of Contents
4 Empirical Studies of the Production of Health 119
4.1 Introduction 119
4.2 Studies Based on Aggregate Data 121
4.2.1 Mortality Rates and Life Expectancy as Measures of Output? 121
4.2.2 Marginal Productivity of a Health Care System 122
4.2.2.1 Early Evidence from the United States 122
4.2.2.2 Recent Evidence from the United States 127
4.2.2.3 Evidence from Industrialized Countries 129
4.2.2.4 Evidence from a Comparison of Two Neighboring
Areas 131
4.2.2.5 Evidence from a Developing Region
(Sub-Saharan Africa) 132
4.2.3 Marginal Productivity of Selected Medical Interventions . 135
4.2.4 Environmental Determinants of Health Status 136
4.2.5 Economic Instability and Health 137
4.3 Studies Based on Individual Data 140
4.3.1 Measurement of Health Status 140
4.3.2 Marginal Productivity of Medical Infrastructure at the
Individual Level 141
4.3.3 The Productivity of Medical Interventions at the Individual
Level 142
4.3.4 Environmental Quality and the State of Health 143
4.3.4.1 Air Quality and Smoking as Exogenous Factors. 143
4.3.4.2 Smoking as an Endogenous Factor 146
4.4 Demand for Health, Demand for Health Services 148
4.5 Summary 152
4.6 Further Reading 152
4.E Exercises 153
5 Health Goods, Market Failure and Justice 155
5.1 Introduction 155
5.2 Market Failure in Markets for Health Goods 157
5.2.1 Externalities and the Problem of Public Goods 157
5.2.2 Option-Good Property of Medical Services 159
Detailed Table of Contents xiii
5.2.3 Lack of Consumer Sovereignty 160
5.2.3.1 Incapability of Rational Decision Making 160
5.2.3.2 Excess Discounting of Future Needs 161
5.2.4 Lack of Perfect Information in Markets for Health Goods . 161
5.3 Market Failure in Health Insurance Markets 163
5.3.1 The Basic Model 163
5.3.2 The Free-Rider Problem 166
5.3.3 Asymmetric Information in the Health Insurance Market . 171
5.3.3.1 Risk Types 171
5.3.3.2 Market Equilibrium under Symmetric Information 172
5.3.3.3 Market Equilibrium under Asymmetric Information 173
5.3.3.4 Welfare-Enhancing Government Intervention in
Insurance Markets 176
5.3.3.5 Alternative Equilibrium Definitions 178
5.3.4 Premium Risk 180
5.3.4.1 Pure-Market Solutions 181
5.3.4.2 Community Rating as a Solution 185
5.3.4.3 Comparing the Solutions 187
5.4 Justice as an Argument in Favor of Government Intervention in
Health Care 189
5.4.1 Willingness and Ability to Pay and Access to Health Care . 189
5.4.2 Congenital Differences in Health and Access to Health
Insurance 192
5.4.2.1 Redistribution and the Veil of Ignorance 192
5.4.2.2 Implementing Cross-Subsidies between High and
Low Risks 193
5.5 Rationing of Health Care Services 194
5.5.1 The Concept of Rationing 195
5.5.2 Types of Primary Rationing 196
5.6 Summary 198
5.7 Further Reading 199
5.E Exercises ^00
xiv Detailed Table of Contents
6 Optimal Health Insurance Contracts 203
6.1 Introduction 203
6.2 Types of Health Insurance Contracts 205
6.3 Optimal Insurance Protection in the Absence of Moral Hazard 208
6.3.1 Financial Consequences of Illness Only 208
6.3.1.1 A Model with Two Health States 209
6.3.1.2 A Model with an Arbitrary Number of Health States215
6.3.2 Direct Utility Effects of Illness 221
6.3.3 Summary 224
6.4 Optimal Insurance Coverage with Moral Hazard 224
6.4.1 Ex-Ante Moral Hazard 224
6.4.1.1 Assumptions 224
6.4.1.2 Optimal Prevention without Insurance 226
6.4.1.3 The Optimum with Observable Prevention 227
6.4.1.4 The Optimum with Unobservable Prevention 228
6.4.1.5 Implications 232
6.4.1.6 Empirical Evidence on Ex-Ante Moral Hazard. 232
6.4.2 Ex-Post Moral Hazard 233
6.4.2.1 Assumptions 233
6.4.2.2 Optimal Insurance Coverage with Observable
State of Health 235
6.4.2.3 Optimal Insurance Coverage with Unobservable
State of Health 237
6.4.2.4 Implications 241
6.4.2.5 The Empirical Relationship Between Insurance
Coverage and the Demand for Health Care Services 242
6.5 Consequences for the Design of Social Health Insurance 244
6.6 Summary 246
6.7 Further Reading 247
6.A Appendix 248
6.E Exercises 250
Detailed Table of Contents xv
7 Risk Selection in Health Insurance Markets 253
7.1 Introduction 253
7.2 Modeling Risk Selection 255
7.2.1 Direct Risk Selection 255
7.2.2 Indirect Risk Selection 257
7.2.2.1 Indirect Risk Selection Using the Quantity of
Benefits 259
7.2.2.2 Risk Selection Using the Structure of Benefits 270
7.3 Further Arguments in Favor of Risk Adjustment and Cost
Reimbursement 276
7.3.1 Fair Competition in the Health Insurance Market 277
7.3.2 Stabilization of the Health Insurance Market 277
7.4 Designing Risk Adjustment Schemes 278
7.4.1 An Overview of Risk Adjusters 278
7.4.2 Costs and Payment Flows 280
7.4.3 Calculating Risk Adjustment Payments 282
7.4.3.1 The Statistical Approach to Risk Adjustment 282
7.4.3.2 The Incentive Approach to Risk Adjustment 283
7.5 Designing Cost Reimbursement Schemes 284
7.5.1 The Basis of Cost Reimbursement 285
7.5.2 The Structure of Cost Reimbursement 285
7.5.3 Findings of Empirical Studies 286
7.6 Summary 287
7.7 Further Reading 289
7.E Exercises 290
8 Physicians as Suppliers of Medical Services 293
8.1 Introduction 293
8.2 The Relationship Between Physician Density and the Utilization of
Medical Services 294
8.3 The Hypothesis of Supplier-Induced Demand for Ambulatory
Medical Services 295
xvi Detailed Table of Contents
8.4 Utility Maximization of the Physician and Supplier-Induced Demand 298
8.4.1 A Model of Physician Behavior 298
8.4.2 Increasing Physician Density 300
8.4.3 Increasing Fee Level 304
8.5 Physician Density and Utilization of Medical Services: Alternative
Explanations 304
8.6 Empirical Examination of the Supplier-Induced Demand Hypothesis 306
8.6.1 Physician Density and Volume of Services 306
8.6.2 Regulated Fees and Volume of Services 307
8.7 Summary 308
8.8 Further Reading 309
8.E Exercises 309
9 Hospital Services and Efficiency 311
9.1 Introduction 311
9.2 The Hospital as a Productive Unit 312
9.2.1 Hospital Output: Health as a Latent Variable 312
9.2.2 The Multi-Stage Character of Production in the Hospital . 313
9.2.3 The Heterogeneity of Hospital Output 317
9.3 Comparing Hospital Efficiency 318
9.3.1 Regulation and Asymmetric Information 318
9.3.2 Hospital Cost Functions 319
9.3.3 Data Envelopment Analysis 322
9.3.3.1 Introduction 322
9.3.3.2 Comparing the Efficiency of Swiss Hospitals 324
9.3.4 Potential and Limits of Efficiency Measurement 328
9.4 Summary 328
9.5 Further Reading 329
9.E Exercises 329
10 Paying Providers 331
10.1 Introduction 331
10.2 Paying Providers to Achieve Cost Control 333
10.2.1 The Principle of Full Cost Responsibility 333
Detailed Table of Contents xvii
10.2.1.1 The Basic Model 333
10.2.1.2 The First-Best Payment System 334
10.2.1.3 Implementing the First-Best Solution 336
10.2.2 Paying Risk-Averse Providers 338
10.2.2.1 Contractible Effort to Control Costs 338
10.2.2.2 Noncontractible Effort to Control Costs 340
10.2.3 Casemix and Information Rent 344
10.2.3.1 Symmetric Information about Casemix 344
10.2.3.2 Asymmetric Information about Casemix 344
10.3 Concerns Beyond Cost Control 348
10.3.1 Quality of Treatment 348
10.3.1.1 Extending the Basic Model 348
10.3.1.2 Verifiable Quality or Treatment Outcomes 350
10.3.1.3 Unverifiable Quality and Treatment Outcomes 351
10.3.2 Patient Selection 355
10.3.2.1 Extending the Basic Model 356
10.3.2.2 Symmetric Information about Patients' Cost Types 358
10.3.2.3 Asymmetric Information about Patients' Cost Types359
10.4 Implications for the Design of Payment Systems 363
10.4.1 General Considerations 363
10.4.2 Paying Physicians 365
10.4.2.1 Overview of Payment Systems 365
10.4.2.2 Optimal Physician Payment 366
10.4.3 Paying Hospitals 368
10.4.3.1 Overview of Payment Systems 368
10.4.3.2 Optimal Hospital Payment 368
10.4.3.3 Hospital Payment Based on Diagnosis Related
Groups 370
10.5 Summary 371
10.6 Further Reading 372
10.A Appendix 372
10.E Exercises 374
xviii Detailed Table of Contents
11 Forms of Delivery of Medical Care 379
11.1 Introduction 379
11.2 The Physician as the Patient's Agent 382
11.3 Complementary Principal-Agent Relationships in Health Care 384
11.3.1 The Employer as Complementary Agent 384
11.3.2 The Government as Complementary Agent 384
11.3.2.1 National Health Service 385
11.3.2.2 National Health Insurance 385
11.3.3 Private Health Insurers as Complementary Agents 386
11.4 The Managed Care Organization as an Alternative Form of
Provision of Care 387
11.4.1 The Managed Care Organization as a Complementary Agent 387
11.4.2 Cost Advantages of Managed Care 388
11.4.3 Cost Effects of Managed Care Organizations at the System
Level 390
11.4.4 Final Assessment of Managed Care Organizations 395
11.5 Summary 396
11.6 Further Reading 396
11.A Appendix 397
ll.E Exercises 400
12 The Market for Pharmaceuticals 401
12.1 Introduction 401
12.2 The Development of a New Drug 403
12.2.1 The Consumption Technology of a Drug 403
12.2.2 Regulation of Market Access by Public Authorities 404
12.2.3 Effect of Copayment 404
12.3 Pharmaceutical Innovation as an Investment 406
12.3.1 The Chronology of a Pharmaceutical Innovation 407
12.3.2 Probability of Success and the Cost of Innovation 408
12.3.3 Excessive Returns to Pharmaceutical Innovation? 410
12.4 The Role of Patent Protection 412
12.4.1 Why Patent Protection? 412
12.4.2 The Decision Situation of the Innovator 413
Detailed Table of Contents xix
12.4.3 The Length of Patent Protection from the Regulator's Point
of View 416
12.5 Price Regulation of Pharmaceuticals 418
12.5.1 Reasons for Price Regulation 418
12.5.2 The Conflict Between National Regulation and Global
Optimization 420
12.5.3 Types of Price Regulation and Their Consequences 422
12.5.3.1 Direct Price Regulation 422
12.5.3.2 Reference Prices 423
12.5.3.3 Rate-of-Return Regulation 423
12.5.3.4 Pharmaceutical Budgets Imposed on Physicians . 424
12.6 Price Competition on Pharmaceutical Markets 424
12.7 Summary 427
12.8 Further Reading 427
12.E Exercises 428
13 The Political Economy of Health Care 429
13.1 Introduction 429
13.2 Collectively Financed Health Care in a Democracy 430
13.2.1 Basic Assumptions 431
13.2.2 The Decision Process 432
13.2.3 Purchase of Private Health Insurance and Demand for
Health Care 433
13.2.4 Voting on Public Health Care for a Given Regime 434
13.2.5 Choice of Regime 436
13.2.6 Empirical Implications of the Analysis 437
13.3 The Role of Professional Associations in Health Care 439
13.3.1 Why Are Professional Associations so Important in Health
Care? 439
13.3.2 Tasks of Associations in Health Care 441
13.3.3 Competition among Service Providers, Competition among
Associations 443
13.4 Summary 445
13.5 Further Reading 445
13.E Exercises 446
xx Detailed Table of Contents
14 Future Challenges to Health Care Systems 447
14.1 Introduction 447
14.2 The Technological Challenge 449
14.2.1 Three Types of Innovation 449
14.2.2 Criteria for an Optimal Allocation of Innovative Effort 451
14.2.3 Distortions of Criteria at the Aggregate Level 454
14.3 The Demographic Challenge 457
14.3.1 Ageing of the Population 457
14.3.1.1 Improved Control over Health Thanks to Medicine? 457
14.3.1.2 The Redistributive Effects of Ageing 459
14.3.2 Changes in Household Composition 461
14.4 Demographic Ageing, Medical Progress, and Health Care
Expenditure 462
14.4.1 The 'Sisyphus Syndrome' in Health Care 463
14.4.1.1 A Simple Dynamic Model of the Sisyphus
Syndrome 463
14.4.1.2 Empirical Evidence 465
14.4.2 Ageing of Population and Health Care Expenditure 471
14.4.3 Funding of Health Insurance 474
14.5 International Challenges 476
14.5.1 Integration of Insurance Markets 476
14.5.2 Migration of Health Care Personnel 478
14.5.3 Direct International Investment in Hospitals 478
14.6 Summary 480
14.7 Further Reading 482
14.E Exercises 482
References 483
Author Index 505
Subject Index 513 |
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| author | Zweifel, Peter 1946- Breyer, Friedrich 1950- Kifmann, Mathias 1970- |
| author_GND | (DE-588)120982196 (DE-588)123466911 (DE-588)123700272 |
| author_facet | Zweifel, Peter 1946- Breyer, Friedrich 1950- Kifmann, Mathias 1970- |
| author_role | aut aut aut |
| author_sort | Zweifel, Peter 1946- |
| author_variant | p z pz f b fb m k mk |
| building | Verbundindex |
| bvnumber | BV022947434 |
| callnumber-first | R - Medicine |
| callnumber-label | RA410 |
| callnumber-raw | RA410 |
| callnumber-search | RA410 |
| callnumber-sort | RA 3410 |
| callnumber-subject | RA - Public Medicine |
| classification_rvk | QX 700 |
| classification_tum | WIR 497f MED 722f |
| ctrlnum | (OCoLC)432303643 (DE-599)DNB984631267 |
| dewey-full | 614 |
| dewey-hundreds | 600 - Technology (Applied sciences) |
| dewey-ones | 614 - Forensic medicine; incidence of disease |
| dewey-raw | 614 |
| dewey-search | 614 |
| dewey-sort | 3614 |
| dewey-tens | 610 - Medicine and health |
| discipline | Wirtschaftswissenschaften Medizin |
| discipline_str_mv | Wirtschaftswissenschaften Medizin |
| edition | 2. ed. |
| format | Book |
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| illustrated | Illustrated |
| index_date | 2024-07-02T19:00:26Z |
| indexdate | 2024-07-20T09:26:11Z |
| institution | BVB |
| isbn | 9783540278047 9783540685401 |
| language | English German |
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| spelling | Zweifel, Peter 1946- Verfasser (DE-588)120982196 aut Gesundheitsökonomie Health economics Peter Zweifel ; Friedrich Breyer ; Mathias Kifmann 2. ed. Dordrecht [u.a.] Springer 2009 XX, 529 S. graph. Darst. txt rdacontent n rdamedia nc rdacarrier Economics, Medical Medical economics Gesundheitsökonomie (DE-588)4130935-2 gnd rswk-swf 1\p (DE-588)4123623-3 Lehrbuch gnd-content Gesundheitsökonomie (DE-588)4130935-2 s DE-604 Breyer, Friedrich 1950- Verfasser (DE-588)123466911 aut Kifmann, Mathias 1970- Verfasser (DE-588)123700272 aut text/html http://deposit.dnb.de/cgi-bin/dokserv?id=2974751&prov=M&dok_var=1&dok_ext=htm Inhaltstext HBZ Datenaustausch application/pdf http://bvbr.bib-bvb.de:8991/F?func=service&doc_library=BVB01&local_base=BVB01&doc_number=016151972&sequence=000004&line_number=0001&func_code=DB_RECORDS&service_type=MEDIA Inhaltsverzeichnis 1\p cgwrk 20201028 DE-101 https://d-nb.info/provenance/plan#cgwrk |
| spellingShingle | Zweifel, Peter 1946- Breyer, Friedrich 1950- Kifmann, Mathias 1970- Health economics Economics, Medical Medical economics Gesundheitsökonomie (DE-588)4130935-2 gnd |
| subject_GND | (DE-588)4130935-2 (DE-588)4123623-3 |
| title | Health economics |
| title_alt | Gesundheitsökonomie |
| title_auth | Health economics |
| title_exact_search | Health economics |
| title_exact_search_txtP | Health economics |
| title_full | Health economics Peter Zweifel ; Friedrich Breyer ; Mathias Kifmann |
| title_fullStr | Health economics Peter Zweifel ; Friedrich Breyer ; Mathias Kifmann |
| title_full_unstemmed | Health economics Peter Zweifel ; Friedrich Breyer ; Mathias Kifmann |
| title_short | Health economics |
| title_sort | health economics |
| topic | Economics, Medical Medical economics Gesundheitsökonomie (DE-588)4130935-2 gnd |
| topic_facet | Economics, Medical Medical economics Gesundheitsökonomie Lehrbuch |
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