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					      The relevance of Health
    Economics Research for the
       Health Policy Agenda

          Prof. Guillem López-Casasnovas
Depart. de Economía Univ. Pompeu Fabra. Cataluña
intro

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

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


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                                                                                                   A
                                    B                                    WHAT INFLUENCES HEALTH? (OTHER
                                                                         THAN HEALTH CARE) Occupational
                WHAT IS HEALTH? WHAT IS ITS
                                                                         hazards; consumption patterns; Education;
                VALUE? Perceived attributes of health;
                                                                         Income etc
                health status indexes; value of
                life; utility scaling of health


            E                                                    C                                                F
MICRO-ECONOMIC                           DEMAND FOR HEALTH CARE Influences of A                        MARKET
EVALUATION AT TREATMENT                  + B on health care seeking behaviour; barriers                EQUILIBRIUM Money
LEVEL Cost effectiveness & cost          to access (price, time, psychological,                        prices, time prices,
benefit analysis of alternative          formal); agency relationship; need                            waiting lists & non-
ways of delivering care (e.g.                                                                          price rationing systems
choice of mode, place, timing or                                       D                               as equilibrating
amount) at all phases (detection,                                                                      mechanisms and their
diagnosis,treatment, after care            SUPPLY OF HEALTH CARE Costs of                              differential effects
etc.)                                      production; alternative production
                                           techniques; input substitution; markets
                                           for inputs (workforce, equipment, drugs
                                           etc.); remuneration methods and incentives


                          H                                                                  G
    PLANNING, BUDGETING &                                  EVALUATION AT WHOLE SYSTEM LEVEL Equity &
    MONITORING MECHANISMS Evaluation                       allocative efficiency criteria brought to bear on E + F; inter-
    of effectiveness of instruments available              regional & international comparisons of performance
    for optimising the system; including the
    interplay of budgeting, workforce
    allocations; norms; regulation etc. and the
    incentive structures they generate.
                                                                                                                             3
I.- Health Economics is ‘what
health economists do’
   Some selected 2007 & 2008 papers for the
    Arrow’s Award




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

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

   ‘B’ area: QALY common ground analysis
    – Psychometrics at the micro
    – Time series analysis for the value of health at the
      macro level (controlling for exogenous factors other
      than health care!!)
                                                             24
... in the research-frontier agenda

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

   ‘D’ area: supply -induces demand: how many
    doctors, professional incentives, team production
    (and free riding), productivity, pay per
    performance, variation in clinical practice,
    ‘moonlighting’...
                                                       25
    ... in the research-frontier agenda

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

   ‘F’ area: markets in health care (information theory,
    uncertainty), third party payment systems, optimal
    rate setting (semi-parametric cost frontier analysis)
    and optimal risk pooling, efficient prices (‘blending’
    prospective and retrospective), risk adjustment
    techniques for risk selection avoidance....
                                                       26
... in the research-frontier agenda

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

   ‘H’ area: in the NHS tradition, Markov’s models,
    simulation techniques for changed scenarios, needs
    estimation, normative standarisation of utilisation,
    political devolution, the provision-production split, the
    Health System Integration Study, coordination in health
    care delivery, the optimal decentralisation and risk
    transfer to providers, rol for private care in public health
    systems...                                                   27

				
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