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The relevance of Health Economics Research for the Health Policy Agenda

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!!!!

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The relevance of Health Economics Research for the Health Policy Agenda

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  1. The relevance of Health Economics Research for the Health Policy Agenda Prof. Guillem López-Casasnovas Depart. de Economía Univ. Pompeu Fabra. Cataluña

  2. intro • HEALTH ECONOMICS AS A A DISCIPLINE: ECONOMICS!!!! • HEALTH ECONOMICS AS A RESEARCH AREA: SCOPE WITH THE ADDED VALUE OF INTERDISCIPLINARITY…

  3. A B WHAT INFLUENCES HEALTH? (OTHER THAN HEALTH CARE) Occupational hazards; consumption patterns; Education; Income etc WHAT IS HEALTH? WHAT IS ITS VALUE? Perceived attributes of health; health status indexes; value of life; utility scaling of health F E C MICRO-ECONOMIC EVALUATION AT TREATMENT LEVEL Cost effectiveness & cost benefit analysis of alternative ways of delivering care (e.g. choice of mode, place, timing or amount) at all phases (detection, diagnosis,treatment, after care etc.) DEMAND FOR HEALTH CARE Influences of A + B on health care seeking behaviour; barriers to access (price, time, psychological, formal); agency relationship; need MARKET EQUILIBRIUM Money prices, time prices, waiting lists & non-price rationing systems as equilibrating mechanisms and their differential effects D SUPPLY OF HEALTH CARE Costs of production; alternative production techniques; input substitution; markets for inputs (workforce, equipment, drugs etc.); remuneration methods and incentives G H PLANNING, BUDGETING & MONITORING MECHANISMS Evaluation of effectiveness of instruments available for optimising the system; including the interplay of budgeting, workforce allocations; norms; regulation etc. and the incentive structures they generate. EVALUATION AT WHOLE SYSTEM LEVEL Equity & allocative efficiency criteria brought to bear on E + F; inter-regional & international comparisons of performance

  4. I.- Health Economics is ‘what health economists do’ • Some selected 2007 & 2008 papers for the Arrow’s Award

  5. 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!!)

  6. ... 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’...

  7. ... 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....

  8. ... 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...

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