Distributing Health Care: Economic and Ethical Issues (Oxford Medical Publications)

Contents......Page 10
1.1 What is health care?......Page 14
1.2 What is health?......Page 16
1.3 What does health care—and health—do for people?......Page 18
1.4 The determinants of (ill) health......Page 20
1.5 The health of nations......Page 22
1.6 Conclusion......Page 24
Suggested reading......Page 25
2 Economics and efficiency......Page 26
2.1 Microeconomics—studying markets and their actors......Page 28
2.1.1 More in means more out—but at a diminishing rate......Page 29
2.1.2 Substitution—‘there is more than one way to skin a cat’......Page 32
2.1.3 Scarcity: a dismal reality for the dismal science......Page 36
2.1.4 Supply and demand—and the magic equilibrium......Page 40
Suggested reading......Page 43
3 Justice and fairness......Page 44
3.1.1 Utility......Page 45
3.1.2 Primary goods......Page 47
3.2 How is it to be distributed?......Page 48
3.2.2 Maximin......Page 49
3.2.3 Egalitarianism......Page 50
3.3.1 Choosing a point on the utility possibility frontier......Page 51
3.3.2 The social welfare function......Page 53
3.4.1 Rights......Page 55
3.4.2 Procedural justice......Page 57
3.4.3 Medical ethics: different principles at the bedside?......Page 58
3.5 Conclusion......Page 60
Suggested reading......Page 61
4.1 The perfect market model and the imperfect market for health care......Page 62
4.2.1 The welfare gain from insurance......Page 66
4.2.2 The probability and the loss......Page 68
4.2.3 Actuarially fair insurance......Page 69
4.3 Adverse selection......Page 70
4.4 Moral hazard......Page 72
4.5 Asymmetric information and the agency relationship......Page 73
4.5.1 The doctor–patient relationship......Page 74
4.5.2 Supplier-induced demand......Page 75
4.5.3 The agency relationship and social welfare......Page 78
4.6 Externalities—selfishly motivated......Page 79
4.6.1 Contagion......Page 80
4.6.2 Productivity......Page 82
4.7 Conclusion......Page 83
Suggested reading......Page 84
5 Equity-motivated responses to market failures......Page 85
5.1 Reasons for caring—defining altruism......Page 86
5.2 Transfers in cash or in kind......Page 88
5.3 Concerns for more than one individual......Page 91
5.4 Concerns for the community......Page 92
5.5 Conclusion......Page 93
Suggested reading......Page 94
6 Providing health care: finance and regulation......Page 95
6.1 Flows of money: the ‘revenue–expenditure–income’ identity......Page 96
6.1.1 Limited revenue......Page 97
6.1.2 Keeping expenditures in line with revenues......Page 98
6.2 Disaggregation: a closer look at gainers and losers......Page 99
6.2.1 Shifting the financial burdens......Page 100
6.3 The split between purchasers and providers......Page 101
6.4 Labour supply......Page 105
6.5 Conclusion......Page 109
Suggested reading......Page 110
7.1 Different techniques with some basic similarities......Page 111
7.2.1 Non-preference-based measures of monetary benefits......Page 114
7.2.2 Preference-based measures of monetary benefits......Page 118
7.3.1 Non-preference-based health benefits......Page 121
7.3.2 Quality-adjusted life-years......Page 122
7.3.3 Measuring health-related quality of life......Page 123
7.4.1 Marginal costs......Page 125
7.4.2 Social costs......Page 126
7.5 Discounting—a preference for the present......Page 127
7.5.2 Some formulae and examples......Page 128
7.5.3 Some views on discounting......Page 129
7.6 Conclusion......Page 131
Suggested reading......Page 133
8 The ethics of economic evaluation in priority setting......Page 134
8.1.1 Aggregation in monetary terms......Page 135
8.1.2 The distribution of health benefits......Page 136
8.2.1 The no-treatment health stream......Page 137
8.2.2 Age and the previous stream of health......Page 138
8.3 The importance of non-health characteristics......Page 139
8.3.1 The causes of ill health......Page 140
8.4.1 The type of preferences required......Page 141
8.4.2 The nature of individual preferences......Page 143
8.5 Quantifying rights and procedures......Page 144
8.6 Conclusion......Page 146
Suggested reading......Page 147
9.1 The boundaries of health economics......Page 148
9.2 The demand for curves......Page 150
9.3 Justice and fairness: societal judgements......Page 152
9.5 Caring for others......Page 153
9.6 Purchasing and providing health care......Page 154
9.7 Economic evaluation......Page 155
9.8 Beyond health benefits......Page 156
9.9 A new normative health economics?......Page 157
References......Page 159
E......Page 164
O......Page 165
X......Page 166