강좌 소개

보건의료경제학

2014. 9. 3.

The Scope of Health Economics

• Health Economics lies at the interface of economics and medicine and applies the discipline of economics to the topic of health.

Source: National Information Center on Health Services Research and Health Care Technology (2003)

Medicine/Health Care Economics

Structure of Discipline (Health Economics)

Source: National Information Center on Health Services Research and Health Care Technology (2003)

What do Health Economists do? (USA)

• 50% study the behavior of individuals• 34% study the behavior of firms• 50% study government policies• 48% study health insurance• 50% study outcomes research (eg. CEA, CBA)• 31% study other issues

Copyright © 2010 Pearson Education, Inc.Publishing as Prentice Hall

Note: Respondents may have indicated more than one subspecialty.

Who are the Health Economists? (USA)

• 96% hold academic doctorate degrees, nearly ¾ in economics

• 64% work in a university setting, 15% for nonprofit organizations and 12% for government, mainly federal

• Only 24% of health economists hold appointments in economics departments, 26% in schools of public health, 18% in schools of medicine

Copyright © 2010 Pearson Education, Inc.Publishing as Prentice Hall

Academic societies• 한국보건경제정책학회

• iHEA: International Health Economics Association• Regional: ASHEcon, …• ISPOR: International Society For Pharmacoeconomics

and Outcomes Research• HTAi: Health Technology Assessment international

Academic Journals in Health Economics

• 보건경제와정책연구

• Journal of Health Economics• Health Economics• Value in Health• PharmacoEconomics• Many more…

Economic concepts

• Decision-making• Limited resources and trade-offs• Preferences• Incentives• Information• Risk and uncertainty

Applications to health

• Topics in public health– Value of medical care, health, and life– Disparities– Behaviors: smoking, drinking, obesity– Insurance– HIV/AIDS in sub-Saharan Africa

• Controversial topics– Cost of drug development– Cost-sharing and user fees

Methods

• Introduction to common analytic methods– Basic multivariate regression– Establishing causal relationships

• Study design, randomization, experiments– Evaluating the impact of policies– Cost-effectiveness

Deadweight Loss of Christmas

Waldfogel, J. 1993. The Deadweight Loss of Christmas. American Economic Review 83(5):1328-1336.

크리스마스(혹은 추석) 선물

• Imagine the worst gift under the tree– (e.g., ill-fitting yellow and brown paisley

sweater)

• Wouldn’t you rather have the cash?

Deadweight Loss

• Deadweight loss (in this context)– Difference between market value of gift and

amount recipient is willing to pay for gift

• Deadweight loss isZero: if Santa brings exact wish listLarge: if Santa brings unwanted expensive gifts

Christmas• 1992 Holiday expenditures

$400 per household$40 billion total

• 2007 Holiday expenditures – Adjusted for CPI inflation and population growth$600 per household$66 billion total

• How much is the deadweight loss?• Are there better ways to give?

– Cash, debit cards, gift certificates

When is Cash Preferred?

• Economists generally think cash value of gift is preferred to gift

• Extreme view: can do no better than give cash, because recipient knows own tastes, anything else is not as highly valued

• Problem of knowing tastes is greater if do not know person well

When is a Gift Preferred?

• If gift valued more than what would have bought with the cash– Giver gets better deal than recipient would – From another country, impossible to get

• New item, unknown to recipient• If cash (or gift card) imposes burden of

shopping, delays gratification of gift• Sentimental value

– Made by child, grandmother

Waldfogel (1993, AER)

• Provides framework for gift giving• Conducts two small experiments

– Asks Yale undergraduates about gifts– What is market value of gifts received?– What is recipient’s valuation?

• Two different ways

Results

• Deadweight loss is 10%−33% of price (T1)• Deadweight loss similar for all prices (T2)• Closeness of relationship matters (T3)

– Less loss from significant others, siblings– More loss from aunts/uncles, grandparents– Loss increases with age difference

• However, results explicitly exclude sentimental value, which may be large

Debate

• Debate about Waldfogel’s (1993) results– Series of short articles, commentaries– Who to ask? What to ask?– How representative are Yale undergrads?– Ability to value gifts?– How accurate are estimates of $ values?

• Other researchers calculate negative deadweight loss (prefer gifts to cash)

Lessons

• Economists think about the world differently than normal people

• Useful tools for policy analysis– Valuation, utility, regression

• Apply to policy problems

Importance for Public Policy

• In-kind transfers vs. cash transfers• In-kind transfers

– Public housing, Medicare, Medicaid– 9 to 39 percent deadweight loss (Smolensky

et al., 1977)• Near-cash transfers

– Food stamps, rent supplements– Near zero deadweight loss

Importance for Health

• Changes in public health– How much do people value clean water?

• Many technological advances– How much do patients value new drugs?

• Much health care is covered by insurance– How do insured patients value health care?

Economists think differently than normal people:Suicide as another example

• Medicine/Public health– Depression, physical illness, & other risk factors

• Sociology– Durkheim (1897) Suicide– 4 types: egoistic, altruistic, anomic, & fatalistic

• Economic model of suicide (Hamermesh and Soss, 1974)– Suicide occurs when the present value of discounted expected

utility for the rest of one’s life is very low or negative– That is, suicide is a rational behavior to maximize their utility– Q: Should public policy care about suicides?

Economists use different terms than normal people do

• “Public” in Public good– Different than in Public health or Public policy– Public goods should meet two criteria: 1) non-rivarly &

2) non-excludability.– Ex.: public parks, national defense

• “Moral” in Moral hazard– Has little to do with ethics– Behavioral change arising because of being insured– Ex. Being insured, people tend to use more health care

than would otherwise do.

Why do we care about the way economists think?:In Health Policy, why Health Economics?

• Examples of Health policy– BCG vaccination at birth– No smoking in certain

places – Medical savings accounts

• Usefulness of the economic way of thinking– Recognizing scarcity of

societal resources– Recognizing trade-offs and

opportunity costs– Improving rationality in policy

decision-making (priority setting, etc)

– Improving efficiency in policy outcomes

– Predicting intended effects and unintended consequences

Economics: the biggest fraud ever perpetrated on the world? (Lancet, 2013)