The relevance of Health The relevance of Health Economics Research for the Economics Research for the

Health Policy AgendaHealth Policy Agenda

Prof. Guillem López-CasasnovasProf. Guillem López-CasasnovasDepart. de Economía Univ. Pompeu Fabra. CataluñaDepart. de Economía Univ. Pompeu Fabra. Cataluña

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introintro

HEALTH ECONOMICS AS A A HEALTH ECONOMICS AS A A DISCIPLINE: ECONOMICS!!!!DISCIPLINE: ECONOMICS!!!!

HEALTH ECONOMICS AS A RESEARCH HEALTH ECONOMICS AS A RESEARCH AREA: SCOPE WITH THE ADDED AREA: SCOPE WITH THE ADDED VALUE OF INTERDISCIPLINARITY…VALUE OF INTERDISCIPLINARITY…

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AB

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E F

GH

WHAT INFLUENCES HEALTH? (OTHER THAN HEALTH CARE) Occupational hazards; consumption patterns; Education; Income etc

WHAT IS HEALTH? WHAT IS ITS VALUE? Perceived attributes of health; health status indexes; value oflife; utility scaling of health

DEMAND FOR HEALTH CARE Influences of A + B on health care seeking behaviour; barriers to access (price, time, psychological,formal); agency relationship; need

MARKET EQUILIBRIUM Money prices, time prices,waiting lists & non-price rationing systemsas equilibrating mechanisms and their differential effects

MICRO-ECONOMIC EVALUATION AT TREATMENT LEVEL Cost effectiveness & cost benefit analysis of alternative ways of delivering care (e.g. choice of mode, place, timing or amount) at all phases (detection, diagnosis,treatment, after care etc.)

SUPPLY OF HEALTH CARE Costs of production; alternative production techniques; input substitution; markets for inputs (workforce, equipment, drugs etc.); remuneration methods and incentives

EVALUATION AT WHOLE SYSTEM LEVEL Equity & allocative efficiency criteria brought to bear on E + F; inter-regional & international comparisons of performance

PLANNING, BUDGETING & MONITORING MECHANISMS Evaluation of effectiveness of instruments available for optimising the system; including the interplay of budgeting, workforce allocations; norms; regulation etc. and the incentive structures they generate.

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I.- I.- Health Economics is ‘what Health Economics is ‘what health economists do’health economists do’ Some selected 2007 & 2008 papers for the Some selected 2007 & 2008 papers for the

Arrow’s Award Arrow’s Award

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in the research-frontier agenda under the in the research-frontier agenda under the Williams’ frame of the discipline areas…Williams’ frame of the discipline areas…

‘‘A’ areaA’ area: Grossman’s demand for health in the H : Grossman’s demand for health in the H K tradition, expanded at the macro level by K tradition, expanded at the macro level by reframing the neoclassical production function reframing the neoclassical production function

‘‘B’ areaB’ area: QALY common ground analysis: QALY common ground analysis– Psychometrics at the microPsychometrics at the micro

– Time series analysis for the value of health at the Time series analysis for the value of health at the macro level (controlling for exogenous factors other macro level (controlling for exogenous factors other than health care!!)than health care!!)

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... ... in the research-frontier agendain the research-frontier agenda

‘‘C’ areaC’ area: demand for health care, under : demand for health care, under uncerainty (ie. Insurance). Premia (actuarilly uncerainty (ie. Insurance). Premia (actuarilly fair), prices, copayments, deductibles. The Rand fair), prices, copayments, deductibles. The Rand experiment (70s!). Models of principal-agent experiment (70s!). Models of principal-agent relationship, moral hazard (HSAs in the policy relationship, moral hazard (HSAs in the policy arena), explaining waiting lists...arena), explaining waiting lists...

‘‘D’ areaD’ area: supply -induces demand: how many : supply -induces demand: how many doctors, professional incentives, team production doctors, professional incentives, team production (and free riding), productivity, pay per (and free riding), productivity, pay per performance, variation in clinical practice, performance, variation in clinical practice, ‘moonlighting’...‘moonlighting’...

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... ... in the research-frontier agendain the research-frontier agenda

‘‘E’ areaE’ area: public intervention in health care: : public intervention in health care: ‘welfarists’ against ‘non-welfarists’. Eliciting ‘welfarists’ against ‘non-welfarists’. Eliciting preferences (eg. Conjoint analysis) vs. willingness to preferences (eg. Conjoint analysis) vs. willingness to pay models. Plus cost analysis, bayesian approach to pay models. Plus cost analysis, bayesian approach to economic evaluation, prioritisation...economic evaluation, prioritisation...

‘‘F’ areaF’ area: markets in health care (information theory, : markets in health care (information theory, uncertainty), third party payment systems, optimal uncertainty), third party payment systems, optimal rate setting (semi-parametric cost frontier analysis) rate setting (semi-parametric cost frontier analysis) and optimal risk pooling, efficient prices (‘blending’ and optimal risk pooling, efficient prices (‘blending’ prospective and retrospective), risk adjustment prospective and retrospective), risk adjustment techniques for risk selection avoidance....techniques for risk selection avoidance....

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... ... in the research-frontier agendain the research-frontier agenda

‘‘G’ areaG’ area: Global system evaluation in the public health : Global system evaluation in the public health tradition + WB + WHO + EQUTY project + global tradition + WB + WHO + EQUTY project + global burden of disease impacts + analysis on how to combine burden of disease impacts + analysis on how to combine public and private (insurance) systems... Under policy public and private (insurance) systems... Under policy evaluation techniques ‘matching samples’, double and evaluation techniques ‘matching samples’, double and triple difference in difference models...triple difference in difference models...

‘‘H’ areaH’ area: in the NHS tradition, Markov’s models, : in the NHS tradition, Markov’s models, simulation techniques for changed scenarios, needs simulation techniques for changed scenarios, needs estimation, normative standarisation of utilisation, estimation, normative standarisation of utilisation, political devolution, the provision-production split, the political devolution, the provision-production split, the Health System Integration Study, coordination in health Health System Integration Study, coordination in health care delivery, the optimal decentralisation and risk care delivery, the optimal decentralisation and risk transfer to providers, rol for private care in public health transfer to providers, rol for private care in public health systems...systems...