Kinh tế học - Medicaid - Professor vivian ho health economics fall 2009State Children’s Health Insurance Program Part of 1997 BBA Gave federal funding to states to reduce # of uninsured children States have considerable latitude in programs Expand Medicaid Develop separate children’s health insurance program Both SCHIP enrollment >7m in 2007. Income eligibility levels vary from 300% of federal poverty level in...
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Kinh tế học - Medicare - Professor vivian ho health economics fall 2009No hospital inpatient coverage after 90 days Except for 60-day lifetime reserve Medicare offers no coverage in “catastrophic circumstances.”
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Kinh tế học - Government regulation and intervention - Part 1: Vivian ho health economics>1 individual simultaneously receives benefits from the good. i.e., no rivalry in consumption. Costly to exclude nonpayers from consumption of the good. Private firms unwilling to produce and sell public goods. Are most medical services public goods?
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Kinh tế học - The pharmaceutical industry - Part 2: Professor vivian ho health economics fall 2009Promotion Magnitude: Research-based firms spend as much as 20-30% of sales on promotion. 70% pharmaceutical salespersons (detailing). 27% advertising. 3% direct mail. Impact: 22,000 drugs on market timely, valuable information. May impede competition.
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Kinh tế học - The pharmaceutical industry - Professor vivian ho health economics fall 2009Even if consumers exert little influence over drug choice, 3rd parties are making the market more competitive Formularies - list of selected drugs physicians may prescribe Used by hospitals to limit inventories and costs Used by most HMOs and many PPOs Used by many state Medicaid programs
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Kinh tế học - The hospital market - Part 2: Professor vivian ho health economics fall 2007Maybe further HMO penetration required. Government still a dominant payer, and reimburses generously. Maybe managed care doesn’t work. Outcomes for patients covered by HMOs similar & sometimes better than those for fee-for-service patients.
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Kinh tế học - The physician market - Part 1: Professor vivian ho health economics fall 2009MCOs hope to modify physician behavior in order to control costs. 88% of all practicing docs in 2001 had at least one managed care contract. In 2001, 49¢ of every $1 of physician revenue came from an MCO.
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Kinh tế học - Market structure in the healthcare industryWhat is the profit-maximizing price and quantity for a monopolist? Recall that all firms will maximize profits where MR=MC We have already seen that the marginal cost curve for a firm depends on its production function and input prices What does the firm’s MR curve look like?
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Kinh tế học - The demand for medical insuranceAn individual’s subjective probability of illness (P1) will depend on her health stock, age, lifestyle, etc. Then without insurance, the individual’s expected utility for next year is: E(U) = P0U($40,000) + P1U($20,000) = P0•90 + P1•70
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Kinh tế học - Health economics fall 2009Potential for substitutability If price of 1 input increases, can minimize impact on total costs by substituting away. Elasticity of substitution : r = [D(I1/I2)/I1/I2] : [D(MP2/MP1)/MP2/MP1] % change in input ratio, divided by % change in ratio of inputs’ MPs.
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