7. Equity and Efficiency
In 2010, President Obama signed the Patient Protection and Affordable Care Act (PPACA) into law to address issues of access and cost in healthcare. In this lecture, we discuss these issues in healthcare and the role of the PPACA in addressing these issues to demonstrate how a public policy tool can be used to address many of the economic problems discussed throughout the course.
Health economics is a branch of economics concerned with issues related to efficiency, effectiveness, value and behavior in the production and consumption of health and healthcare. In broad terms, health economists study the functioning of healthcare systems and health-affecting behaviors such as smoking.
A seminal 1963 article by Kenneth Arrow, often credited with giving rise to health economics as a discipline, drew conceptual distinctions between health and other goods. Factors that distinguish health economics from other areas include extensive government intervention, intractable uncertainty in several dimensions, asymmetric information, barriers to entry, externalities and the presence of a third-party agent. In healthcare, the third-party agent is the physician, who makes purchasing decisions (e.g., whether to order a lab test, prescribe a medication, perform a surgery, etc.) while being insulated from the price of the product or service.
Health economists evaluate multiple types of financial information: costs, charges and expenditures.
Uncertainty is intrinsic to health, both in patient outcomes and financial concerns. The knowledge gap that exists between a physician and a patient creates a situation of distinct advantage for the physician, which is called asymmetric information.
Externalities arise frequently when considering health and health care, notably in the context of infectious disease. For example, making an effort to avoid catching the common cold affects people other than the decision maker.
Although China has the world’s largest economy, the average individual is actually fairly poor. Average incomes in the country are less than $15,000 per year, ranking #121 in the world. However, a vast majority of Chinese have health insurance due to some recent reforms.
A paper by Zhang et al. (2016) uses data from the 2011-2012 China Health and Retirement Longitudinal Study (CHARLS) and finds that:
The two new programs, the New Rural Cooperative Medical Scheme (NCMS) and the Urban Resident Medical Insurance (URMI), expanded rapidly since their introduction in 2003 and 2007, respectively. These two programs, together with the existing Urban Employee Medical Insurance (UEMI), covered nearly 95% of the population by the end of 2011, that is, almost reaching the goal of universal coverage.
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