Developments in Health Economics and Public Policy – serie

Improving Healthcare: A Dose of Competition systematically examines the American health care system from a competition-oriented perspective. The volume surveys the performance of each major sector of the health care system, and identifies impediments to more effective competition. Improving Healthcare examines such issues as competition v. regulation, public and private sector approaches to health care financing, cross-subsidies, licensure, provider market concentration, financial and clinical integration, payment for performance, quality, pharmacy benefit managers, direct-to-consumer advertising of pharmaceuticals, certificates of need, mandates, unionization, the significance of organizational status (nonprofit v. for-profit), and the role of antitrust and consumer protection in health care. It offers concrete recommendations to improve the quality and cost-effectiveness of the American health care marketplace.

This volume reflects both the main issues confronting health economics and the state of the art in health economics a decade before the end of the twentieth century. It contains a selection from almost 150 papers presented at the Second World Congress on Health Economics, held at the University of ZUrich, Switzerland, 10-14 September 1990. This is ten years after the last Congress (held in Leiden, The Netherlands) and more than 17 years after the Tokyo meeting organized by the International Economic Associ­ ation (which might be called the First World Congress were it not for its small size and symposium-like character). Out of the 16 papers appearing in this book, only four were invited, and they were refereed like all the others. The remaining contributions are survivors of stiff competition. However, in spite of the large sample of papers we were able to draw from, certain gaps of coverage persist. In particular, environmental impacts on health were designated as a field of priority interest in the call for papers to this Congress. Yet, not even half a dozen contribu­ tions were submitted, which is remarkable in view of the intense interest of the public in the health effects of environmental degradation, ranging from noise level to ozone concentration. Another specially designed field was the political economy of health, dealing with the behavior of policy makers when deciding about changes in the health care systems. It did not attract as many contributions as we had hoped for or expected.

Confronted with the continuing cost expansion in the health care sector, policy makers face a dilemma: limiting moral hazard in medical care requires that consumers participate in the cost, yet copayment is strongly resisted by today's socially insured. Thus, the experiences of three private German health insurers will be of interest to physicians, social scientists, and policy makers. Insurer A writes conventional plans with deductibles and coinsurance; B pays back three-monthly premiums as a fixed rebate for no claims; while C runs an experience-rated bonus system starting with a rebate of three-monthly premiums for the first year without a claim, reaching a maximum of five after three years. While both rebates and bonuses are quite popular among insureds, this study shows that bonus options are particularly effective in limiting the demand for ambulatory and even hospital care. But what about adverse effects on health caused by the desire to save one's bonus? On this issue, there is some surprising empirical evidence.

Hospital Cost Analysis provides an overview of theoretical developments in the economic analysis of production and costs in the multiproduct firm, and discusses these developments. Following a lucid explanation of the concepts of jointness, input/output separability and returns to scale, a detailed discussion of the concept measurement and classification of hospital output is provided. A fundamental dilemma confronting economists interested in estimating hospital cost functions is highlighted, viz. the trade-off between flexibility in functional form and homogeneity within hospital output categories. Empirical results on the effects of case mix, scale and utilisation, public/private ownership, and the centralised administration of hospital systems on hospital costs are presented. The implications of hospital cost analysis for public policy with respect to hospital payment schemes, including schemes based on Diagnosis Related Groups (DRGs), are also considered. This book brings together the literature on hospital cost analysis with theoretical developments in the analysis of the multiproduct cost functions. It will be of considerable interest to teachers and students of health economics and health policy advisers interested in the determinants of hospital costs and the design of hospital payment schemes.

Most economic evaluations of health care programmes at the moment are cost­ effectiveness and cost-utility analyses. The problem with these methods is that their theoretical foundations are unclear. This has led to confusion about how to define the costs and health effects and how to interpret the results of these studies. In the environmental and traffic safety fields it is instead common to carry out traditional cost-bene:fit analyses of health improving programmes. This striking difference in how health programmes are assessed in different fields was the original motivation for writing this book. The aim of the book is to tty and provide a coherent framework within cost-bene:fit analysis and welfare economics for the different methods of economic evaluation in the health care field. The book is written in an easily accessible manner and several examples of applications of the different methods are provided. It is my hope that it will be useful both for teaching purposes and as a guide for practitioners in the field. Glenn C. Blomquist, John D. Graham, Rich O'Conor and four anonymous referees provided helpful comments on previous versions of the manuscript. I would also like to express my gratitude to the following persons for helping me to prepare the manuscript: Carl-Magnus Berglund, Carin Blanksvard, Ann Brown, and Ziad Obeid.

This study presents recent evidence concerning health and the environment, inequality of health in many countries, and the compatibility of different quality of life measurements, along with new solutions to problems of health policy. The book is grouped into three sections. Section One, comprising six papers, looks into the determinants of people's health. Section Two consists of three papers and deals with the supply side of the market for health care services. Finally, Section Three contains three contributions devoted to health regulation. The intended market for this volume includes, but is not limited to, health economists, policy makers, insurers, and governmental advisors who need to stay abreast of the latest developments in health services research worldwide.

Health care arguably is the single most regulated industry in industrial countries, and possibly in newly industrialized and developing countries as well. But what exactly is being regulated, what are the instruments used, and what are the effects and side-effects of such regulation? This text seeks to resolve problems in answering key questions regarding the health care sector in two countries - Sweden and Switzerland. The volume contains a series of studies that compare the regulation of health and health care in these two apparently very similar countries, in considerable detail. The contributing teams acquired a great deal of knowledge about health regulation in both countries; they also derived comparative predictions when regulation differs, using actual observations to check whether these predictions are borne out. These comparisons are based on the conditions prevailing in the mid-1990s.

Ensuring long-term care (LTC) is one of the most urgent problems in health care today. Demographic trends are expected to lead to a higher proportion of old and very old people in the global population. As a result, an increased proportion of global income will be devoted to LTC services. With this in mind, Long-term Care: Economic Issues and Policy Solutions aims to address the following important objectives: to provide a detailed analysis of the arrangements and institutions designed to protect the disabled and dependent elderly people in various countries, and to try to evaluate their respective merits. to discuss the projections of future costs of protection for dependent elderly, and to assess the impact of improvements in disability-free life expectancy on the future cost of care and choices between informal and formal care. to present empirical research on these decisions, with special consideration of primary caregivers, and on the substitution between in kind and cash benefits as well as between institutional (or formal) care and home (or informal) care. to analyze different theoretical approaches in modeling decisions referring to LTC services to be provided both within and between generations. With its mix of empirical, theoretical and policy-related contributions, Long-term Care: Economic Issues and Policy Solutions will be of interest not only to health economists, but also to social scientists, health insurers, and public policy advocates.

In the future, as our society becomes older and older, an increasing number of people will be confronted with Alzheimer's disease. Some will suffer from the illness themselves, others will see parents, relatives, their spouse or a close friend afflicted by it. Even now, the psychological and financial burden caused by Alzheimer's disease is substantial, most of it borne by the patient and her family. Improving the situation for the patients and their caregivers presents a challenge for societies and decision makers. Our work contributes to improving the in decision making situation con­ cerning Alzheimer's disease. At a fundamental level, it addresses methodo­ logical aspects of the contingent valuation method and gives a holistic view of applying the contingent valuation method for use in policy. We show all stages of a contingent valuation study beginning with the design, the choice of elicitation techniques and estimation methods for willingness-to-pay, the use of the results in a cost-benefit analysis, and finally, the policy implica­ tions resulting from our findings. We do this by evaluating three possible programs dealing with Alzheimer's disease. The intended audience of this book are health economists interested in methodological problems of contin­ gent valuation studies, people involved in health care decision making, plan­ ning, and priority setting, as well as people interested in Alzheimer's disease. We would like to thank the many people and institutions who have pro­ vided their help with this project.

Most economic evaluations of health care programmes at the moment are cost­ effectiveness and cost-utility analyses. The problem with these methods is that their theoretical foundations are unclear. This has led to confusion about how to define the costs and health effects and how to interpret the results of these studies. In the environmental and traffic safety fields it is instead common to carry out traditional cost-bene:fit analyses of health improving programmes. This striking difference in how health programmes are assessed in different fields was the original motivation for writing this book. The aim of the book is to tty and provide a coherent framework within cost-bene:fit analysis and welfare economics for the different methods of economic evaluation in the health care field. The book is written in an easily accessible manner and several examples of applications of the different methods are provided. It is my hope that it will be useful both for teaching purposes and as a guide for practitioners in the field. Glenn C. Blomquist, John D. Graham, Rich O'Conor and four anonymous referees provided helpful comments on previous versions of the manuscript. I would also like to express my gratitude to the following persons for helping me to prepare the manuscript: Carl-Magnus Berglund, Carin Blanksvard, Ann Brown, and Ziad Obeid.

In the future, as our society becomes older and older, an increasing number of people will be confronted with Alzheimer's disease. Some will suffer from the illness themselves, others will see parents, relatives, their spouse or a close friend afflicted by it. Even now, the psychological and financial burden caused by Alzheimer's disease is substantial, most of it borne by the patient and her family. Improving the situation for the patients and their caregivers presents a challenge for societies and decision makers. Our work contributes to improving the in decision making situation con­ cerning Alzheimer's disease. At a fundamental level, it addresses methodo­ logical aspects of the contingent valuation method and gives a holistic view of applying the contingent valuation method for use in policy. We show all stages of a contingent valuation study beginning with the design, the choice of elicitation techniques and estimation methods for willingness-to-pay, the use of the results in a cost-benefit analysis, and finally, the policy implica­ tions resulting from our findings. We do this by evaluating three possible programs dealing with Alzheimer's disease. The intended audience of this book are health economists interested in methodological problems of contin­ gent valuation studies, people involved in health care decision making, plan­ ning, and priority setting, as well as people interested in Alzheimer's disease. We would like to thank the many people and institutions who have pro­ vided their help with this project.

Health care arguably is the single most regulated industry in industrial countries, and possibly in newly industrialized and developing countries as well. But what exactly is being regulated, what are the instruments used, and what are the effects and side-effects of such regulation? Regulation of Health: Case Studies of Sweden and Switzerland seeks to resolve problems in answering these key questions regarding the health care sector in two countries - Sweden and Switzerland. The volume contains a series of studies that compare the regulation of health and health care in these two apparently very similar countries, in considerable detail. The contributing teams acquired a great deal of knowledge about health regulation in both countries; they also derived comparative predictions when regulation differs, using actual observations to check whether these predictions are borne out. These comparisons are based on the conditions prevailing in the mid-nineties.

Ensuring long-term care (LTC) is one of the most urgent problems in health care today. Demographic trends are expected to lead to a higher proportion of old and very old people in the global population. As a result, an increased proportion of global income will be devoted to LTC services. With this in mind, Long-term Care: Economic Issues and Policy Solutions aims to address the following important objectives: to provide a detailed analysis of the arrangements and institutions designed to protect the disabled and dependent elderly people in various countries, and to try to evaluate their respective merits. to discuss the projections of future costs of protection for dependent elderly, and to assess the impact of improvements in disability-free life expectancy on the future cost of care and choices between informal and formal care. to present empirical research on these decisions, with special consideration of primary caregivers, and on the substitution between in kind and cash benefits as well as between institutional (or formal) care and home (or informal) care. to analyze different theoretical approaches in modeling decisions referring to LTC services to be provided both within and between generations. With its mix of empirical, theoretical and policy-related contributions, Long-term Care: Economic Issues and Policy Solutions will be of interest not only to health economists, but also to social scientists, health insurers, and public policy advocates.

Health, The Medical Profession, and Regulation presents new evidence concerning health and the environment, inequality of health in many countries, and the compatibility of different quality of life measurements, along with new solutions to problems of health policy. The book is grouped into three sections. Section I, comprising six papers, looks into the determinants of people's health. Section II consists of three papers and deals with the supply side of the market for health care services. Finally, Section III contains three contributions devoted to health regulation. The intended market for this volume includes, but is not limited to, health economists, policy makers, insurers, and governmental advisors who need to stay abreast of the latest developments in health services research worldwide.

Improving Healthcare: A Dose of Competition systematically examines the American health care system from a competition-oriented perspective. The volume surveys the performance of each major sector of the health care system, and identifies impediments to more effective competition. Improving Healthcare examines such issues as competition v. regulation, public and private sector approaches to health care financing, cross-subsidies, licensure, provider market concentration, financial and clinical integration, payment for performance, quality, pharmacy benefit managers, direct-to-consumer advertising of pharmaceuticals, certificates of need, mandates, unionization, the significance of organizational status (nonprofit v. for-profit), and the role of antitrust and consumer protection in health care. It offers concrete recommendations to improve the quality and cost-effectiveness of the American health care marketplace.

This book examines the drivers of inbound medical tourism in Germany. In light of growing international trade of medical services, it provides a quantitative analysis of the determinants of international patients’ choice of destination. It develops coherent definitions of medical tourism and medical travel, and presents multiple unique data sets to identify inbound medical travelers in Germany. Further, it introduces an empirical modeling framework for investigating and quantifying the drivers and effects of a patient's choice of destination at the national, hospital and individual level. A particular focus of the analysis lies on cultural proximity and personal networks as key channels to convey trust in a destination’s service. In addition, real consideration sets of international patients are presented. The findings presented are embedded in a global context and will help inform future empirical investigations and modeling.

As the need for long-term care expands, evaluating the roles of its primary providers—the state, the market, and the family—becomes increasingly essential. This book first examines recent research on the contributions of families and the marketplace to long-term care. Noting the decreasing involvement of families and the limitations of market-based solutions, it then shifts focus to studies that explore public policy development aimed at supporting elderly individuals without family assistance or adequate resources. These policies aim to create a comprehensive support system by utilizing both market mechanisms and family resources to meet the needs of the dependent elderly.The book also provides a comparative analysis of how various countries, especially in Europe and North America, address disability and dependence in their long-term care systems, offering insights into diverse strategies and solutions. This cross-country perspective identifies effective practices and highlights areas requiring further development in social insurance and support frameworks. Through this exploration, the book seeks to deepen understanding of the influence of social norms and family solidarity on long-term care provision, emphasizing how these elements can be integrated into more resilient public policy structures.

Recreational drug policies and regulations are complex issues with many dimensions. This book attempts to answer several questions raised in current drug policy debates. Developing cost-effective drug programs and policies require a sound knowledge of drug users and their characteristics and the relationship across drugs. Who are the drug users? Can demographic factors help towards predicting drug usage? What sub-population groups should be targeted for drug campaigns and educational programs? Can a drug policy aimed at discouraging the use of one drug likely to affect the use of other drugs which are its economic substitutes or complements? What are the implications of drug use? Policymakers and researchers in the area of health and social development would find this book very useful.

Developing cost-effective drug programs and policies require a sound knowledge of drug users and their characteristics and the relationship across drugs. Can a drug policy aimed at discouraging the use of one drug likely to affect the use of other drugs which are its economic substitutes or complements?

As a contribution to the search for suitable and sustainable solutions to finance rising medical care expenditures, the book proposes a typology of healthcare financing and insurance schemes, based on the dimensions of basic vs. supplementary services and mandatory vs. voluntary coverage, to analyse the design and the complex interactions between various financing and insurance arrangements in several OECD countries. This study provides a better understanding of the strengths and weaknesses of the financial and organisational structures of different countries’ healthcare financing and insurance schemes. Its main contributions are the development of a novel and rigorous theoretical framework analysing the economic rationales for the optimal design of healthcare financing and insurance schemes, and an empirical and institutional analysis investigating the consequences for efficiency and affordability of the complex interactions between basic and supplementary sources of financing.

As a contribution to the search for suitable and sustainable solutions to finance rising medical care expenditures, the book proposes a typology of healthcare financing and insurance schemes, based on the dimensions of basic vs. supplementary services and mandatory vs. voluntary coverage, to analyse the design and the complex interactions between various financing and insurance arrangements in several OECD countries. This study provides a better understanding of the strengths and weaknesses of the financial and organisational structures of different countries’ healthcare financing and insurance schemes. Its main contributions are the development of a novel and rigorous theoretical framework analysing the economic rationales for the optimal design of healthcare financing and insurance schemes, and an empirical and institutional analysis investigating the consequences for efficiency and affordability of the complex interactions between basic and supplementary sources of financing.

Patient mobility across Europe is markedly increasing and new generations will actively ask to be treated by the health-care system that best meets their needs. At a political level, the EU issued the EU Directive no. 24/2011/CE of 9th March 2011 concerning the application of patients’ rights in cross-border health care and has contributed to improving the level of freedom of choice for the European citizen, but it does not seem to have increased actual patient mobility across Europe. Freedom to choose is necessary to grant the people of Europe the same access to public-sector health-care services. The latter is a key instrument for an efficiently functioning “single market” ensuring real mobility within the EU. The aim of this book is to study the current European health care market and discuss the hypothesis of a European right of citizenship with reference to health-care services. It examines patients' mobility from several perspectives: determinants of patient mobility, governance of cross-border mobility at EU level as concerns patients and health-care professionals, policy implications, and case studies. It is intended for health researchers, decision-makers and professionals concerned with health-care provision and patient mobility. The goal is to provide, through scientific and methodological rigor, new informative tools useful for the implementation of new policies in the health-care sector in order to implement effective health-care integration in the European Union.

Patient mobility across Europe is markedly increasing and new generations will actively ask to be treated by the health-care system that best meets their needs. At a political level, the EU issued the EU Directive no. 24/2011/CE of 9th March 2011 concerning the application of patients’ rights in cross-border health care and has contributed to improving the level of freedom of choice for the European citizen, but it does not seem to have increased actual patient mobility across Europe. Freedom to choose is necessary to grant the people of Europe the same access to public-sector health-care services. The latter is a key instrument for an efficiently functioning “single market” ensuring real mobility within the EU. The aim of this book is to study the current European health care market and discuss the hypothesis of a European right of citizenship with reference to health-care services. It examines patients' mobility from several perspectives: determinants of patient mobility, governance of cross-border mobility at EU level as concerns patients and health-care professionals, policy implications, and case studies. It is intended for health researchers, decision-makers and professionals concerned with health-care provision and patient mobility. The goal is to provide, through scientific and methodological rigor, new informative tools useful for the implementation of new policies in the health-care sector in order to implement effective health-care integration in the European Union.

Hospital Cost Analysis provides an overview of theoretical developments in the economic analysis of production and costs in the multiproduct firm, and discusses these developments. Following a lucid explanation of the concepts of jointness, input/output separability and returns to scale, a detailed discussion of the concept measurement and classification of hospital output is provided. A fundamental dilemma confronting economists interested in estimating hospital cost functions is highlighted, viz. the trade-off between flexibility in functional form and homogeneity within hospital output categories. Empirical results on the effects of case mix, scale and utilisation, public/private ownership, and the centralised administration of hospital systems on hospital costs are presented. The implications of hospital cost analysis for public policy with respect to hospital payment schemes, including schemes based on Diagnosis Related Groups (DRGs), are also considered. This book brings together the literature on hospital cost analysis with theoretical developments in the analysis of the multiproduct cost functions. It will be of considerable interest to teachers and students of health economics and health policy advisers interested in the determinants of hospital costs and the design of hospital payment schemes.

This volume reflects both the main issues confronting health economics and the state of the art in health economics a decade before the end of the twentieth century. It contains a selection from almost 150 papers presented at the Second World Congress on Health Economics, held at the University of ZUrich, Switzerland, 10-14 September 1990. This is ten years after the last Congress (held in Leiden, The Netherlands) and more than 17 years after the Tokyo meeting organized by the International Economic Associ­ ation (which might be called the First World Congress were it not for its small size and symposium-like character). Out of the 16 papers appearing in this book, only four were invited, and they were refereed like all the others. The remaining contributions are survivors of stiff competition. However, in spite of the large sample of papers we were able to draw from, certain gaps of coverage persist. In particular, environmental impacts on health were designated as a field of priority interest in the call for papers to this Congress. Yet, not even half a dozen contribu­ tions were submitted, which is remarkable in view of the intense interest of the public in the health effects of environmental degradation, ranging from noise level to ozone concentration. Another specially designed field was the political economy of health, dealing with the behavior of policy makers when deciding about changes in the health care systems. It did not attract as many contributions as we had hoped for or expected.