Talk:Health economics/Archive 1

message: The article ommits one notable contributor (if not founder) of the field of Health Economics, Victor R. Fuchs, who is the Henry J. Kaiser Jr professor emeritus at Stanford University. I took a course in Health Economics and I think I may make one or two edits to the main article soon. I prefer to work offline, do my homework, and then edit.Kyamz 14:06, 10 August 2006 (UTC)
thread_title: Notable omission

message: Thanks for Gregalton's welcome to wikipedia.  This continues to edit my first Wiki post.  I've taken his advice and incorporated the phrase "population externalities" as well as two sources. This also resulted in my correcting the reference to one of the sources--thanks for that too!
The article positions health economics as fully focused on microeconomic analysis.  There is a case to be made that multi-regional macroeconomic analysis can contribute significantly to assessing population externalities in healthcare impacts by including systemic interactions across regions and time, especially if conducted using high-end multi-regional equilibrium forecasting models such as REMI or REDYN.
As an example, consider analysing protocol training and tracking for chronic-persistent conditions affecting over half of all US health system costs.  Large-scale results from Asheville, NC for diabetes remained robust over a five-year period as reported in the Journal of the American Pharmaceutical Association (http://japha.metapress.com/link.asp?id=m5nm6h0758753345) and as replicated in a number of cities.  New York State and elsewhere corroborated these results for mental health (see New York's five year results at http://www.treatmentadvocacycenter.org/BriefingPapers/BP18.htm).  If protocol training and tracking were implemented in context with single-payor resources (i.e., Medicaid, Medicare, S-CHIP, and the Veterans Administration), then it can be posited that...
[a] Demand can be reduced for general hospital services (ERs and hospital stays) and for offices of physicians, only partly offset by less expensive increased demand for clinic and pharmacy services (integrate demand changes in [a] with changes in [b.1] spending on consumer commodities to avoid double counting),
[b] Cost can be reduced
[b.1] for individuals (due to reduced co-pays and insurance coverage cost due to reduced ER and physician visits, offset by increases in less expensive pharmacy and clinic visits, resulting in a net increase in disposable income available for non-health purposes),
[b.2] for firms (due to reduced health benefit costs, resulting in increased opportunities for capital investment at higher or stable capital/output ratios or for job growth at stable or lower capital/output ratios), and
[b.3] for government (due to reduced health benefit costs and health system financing),
[c] Productivity can be increased for the general workforce due to improved protocol outcomes driven by protocol training and tracking under single-payor financing, resulting in
[c.1] reduced time lost by workers directly and by workplace team distraction and need-to-cover, and by family workforce time given to caretaking,
[c.2] better skills-occupations-requirements alignment due to expanded health portability enabling an increased ability to switch and optimize jobs,
[c.3] new capital investment, and
[c.4] higher training ROI due to reduced worry and diversion, i.e., a Hawthorne effect, especially as boosted by a reduced benefit burden that lets employers hire proportionately more workers with more education and more vocational or workforce training.
The productivity modeling needs to account for (a) capital and labor factor substitution due to the reduced benefit cost of labor, and (b) effects from improved capital stock, increased skills alignment and training ROI, and reduced direct and secondary sick leave usage.  The use of multi-regional sub-national analysis ensures domestic trade flow and commuter shed effects are captured together with regional differences in starting conditions and infrastructure.  The point in citing this detail is to demonstrate that healthcare economics includes a basis for macroeconomic multi-regional systemic analysis, not only or primarily microeconomic decision analysis. (71.192.212.228 (talk) 03:37, 3 September 2008 (UTC)
replies: text: Welcome to wikipedia. The ideas above (if I understand correctly) are fine, although you need above all a source. As an alternative, I'd paraphrase and simplify to something like "Externalities in health care, such as the benefit received by the population when others are vaccinated, can have effects of a macro scale on the economy. For example, there is evidence that better health care results in the workforce receiving more education overall, which increases skills and boosts overall productivity." Just a suggestion.--Gregalton (talk) 13:23, 24 April 2008 (UTC)
thread_title: Macro analysis

message: This article is full of original research. Could you please update unsourced claims accordingly of which there are many. Supposed (talk) 10:09, 12 November 2008 (UTC)
thread_title:  Original research. 

message: How are human and health capital related to each other? how do they differ from each other?  —Preceding unsigned comment added by Kapset 69 (talk • contribs) 17:02, 31 October 2009 (UTC)
thread_title:  human capital versus health capital 

message: In the text "Insured patients are naturally less concerned about health care costs than they would if they paid the full price of care. The resulting moral hazard drives up costs, as shown by the famous RAND Health Insurance Experiment. Insurers use several techniques to limit the costs of moral hazard, including imposing co-payments on patients and limiting physician incentives to provide costly care. Insurers often compete by their choice of service offerings, cost sharing requirements, and limitations on physicians." moral hazard is used when I can see no evidence of moral hazard.  A moral hazard is when I conceal information from you in order to strike a bargain that you would refuse if you knew the information.  The cited RAND article does not discuss or mention moral hazard.
Moral hazard is endemic in the US health care system.  For example, you can work as a contract worker while young and single without buying expensive individual insurance, expecting to be hired by a big employer with great health care if you get sick knowing that your pre-existing conditions will be covered at the low group rate.
But if you are told you should spend $1000 out of pocket for a colonoscopy because you have a 2% chance of requiring $100,000 in cancer treatment for which $95,000 will be paid by your catastrophic coverage, refusing the treatment is not a moral hazard. Both the insurer who doesn't set the price low enough for the colonoscopy under its rate schedule, and the patient, roll the dice hoping for the 98% chance it isn't needed.
Now I know that conservatives in particular have latched onto the term moral hazard as a vague allegation that any government involvement in health care is immoral like thou shalt not steal or commit adultery, but that is political rhetoric, not objective description of a term which has a fairly precise meaning in the insurance and securities underwriting field.  Mulp (talk) 20:41, 8 May 2009 (UTC)
thread_title: Moral hazard used contrary to meaning

message: IQWiG only conduct benefit assessments and do not consider costs - they therefore do not conduct economic evaluations. The section on Germany/UK should therefore have Germany removed.   — Preceding unsigned comment added by 95.152.232.127 (talk) 06:34, 12 July 2013 (UTC)
thread_title:  Economic Evaluation in Germany 

message: The content added here, pasted below, is maybe interesting but needs sourcing and the formatting fixed.
Economic evaluation is the comparison of two or more alternative courses of action in terms of both their costs and consequences (Drummond et al.). Economists usually distinguish several types of economic evaluation, differing in how consequences are measured:
* Cost-minimization analysis  Cost-minimization is a tool used in pharmacoeconomics to compare the cost per course of treatment when alternative therapies have demonstrably equivalent clinical effectiveness.  Therapeutic equivalence (including adverse reactions, complications and duration of therapy) must be referenced by the author conducting the study and should have been done prior to the cost-minimization work. Since equal efficacy and equal tolerability is already demonstrated, there is no requirement to find a common efficacy denominator as would be the case when conducting a cost-effectiveness study. The author is not precluded from doing so through the use of "cost/cure" or "cost/year of life gained". If efficacy and tolerability is demonstrated, however, then a simple comparison of "cost/course of treatment" can suffice for the purpose of comparing two or more therapeutically equivalent treatment alternatives. When conducting a cost-minimization study, the author needs to measure all costs (resource expenditures) inherent to the delivery of the therapeutic intervention and that are relevant to the pharmacoeconomic perspective. The optimal choice is that which can be provided for the lowest cost. {| class="wikitable" | {| class="wikitable" ! colspan="2" | |- | colspan="2" | |- !Concepts of quality |
* Evidence-based medicine
* Medical guideline
* Medical consensus |- | colspan="2" | |- !Health care evaluations |
* Clinical audit
* Health care ratings
* Health impact assessment
* Health services research
* Routine health outcomes measurement
* Independent medical review
* Medical peer review |- | colspan="2" | |- !Accreditation |
* Hospital accreditation
* International healthcare accreditation
* List of international healthcare accreditation organizations |- | colspan="2" | |- !Costs and benefits |
* Cost per procedure
* Cost-effectiveness analysis
* Cost-minimization analysis
* Incremental cost-effectiveness ratio |- | colspan="2" | |- !Tools |
* Incremental cost-effectiveness ratio
* Clinical Quality Management System
* Quality-adjusted life year |} |}
* Cost–benefit analysis
* Cost-effectiveness analysis
* Cost–utility analysis
* Cost consequence analysis
In cost minimization analysis (CMA), the effectiveness of the comparators in question must be proven to be equivalent. The 'cost-effective' comparator is simply the one which costs less (as it achieves the same outcome). In cost–benefit analysis (CBA), costs and benefits are both valued in cash terms. Cost effectiveness analysis (CEA) measures outcomes in 'natural units', such as mmHg, symptom free days, life years gained. Finally cost–utility analysis (CUA) measures outcomes in a composite metric of both length and quality of life, the Quality-adjusted life year (QALY).  (Note there is some international variation in the precise definitions of each type of analysis).
A final approach which is sometimes classed an economic evaluation is a cost of illness study. This is not a true economic evaluation as it does not compare the costs and outcomes of alternative courses of action. Instead, it attempts to measure all the costs associated with a particular disease or condition. These will include direct costs (where money actually changes hands, e.g. health service use, patient co-payments and out of pocket expenses), indirect costs (the value of lost productivity from time off work due to illness), and intangible costs (the 'disvalue' to an individual of pain and suffering). (Note specific definitions in health economics may vary slightly from other branches of economics.)
-- Jytdog (talk) 14:11, 14 April 2016 (UTC)
thread_title:  Table, sourcing 

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*Reference 1: Pedro Pita Barros & Xavier Martinez-Giralt, 2009. "Technological adoption in health care," UFAE and IAE Working Papers 790.09, Unitat de Fonaments de l'Analisi Economica (UAB) and Institut d'Analisi Economica (CSIC).
*Reference 2: Moreira S & Pita Barros P, 2009. "Double coverage and demand for health care: Evidence from quantile regression," Health, Econometrics and Data Group (HEDG) Working Papers 09/21, HEDG, c/o Department of Economics, University of York.
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*Reference : Paul V. Grootendorst & Lisa R. Dolovich & Anne M. Holbrook & Adrian R. Levy & Bernie J. O'Brien, 2002. "The Impact of Reference Pricing of Cardiovascular Drugs on Health Care Costs and Health Outcomes: Evidence from British Columbia--Volume I: Summary," Social and Economic Dimensions of an Aging Population Research Papers 70, McMaster University.
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*Reference 1: Philippe Chone & Ching-to Albert Ma, 2007. "Optimal Health Care Contracts under Physician Agency," Boston University - Department of Economics - Working Papers Series WP2007-041, Boston University - Department of Economics, revised Sep 2007.
*Reference 2: Godager, Geir & Iversen, Tor & Albert Ma, Ching-to, 2012. "Competition, Gatekeeping, and Health Care Access," HERO On line Working Paper Series 2012:2, Oslo University, Health Economics Research Programme.
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*Reference 1: Carbone, Jared C. & Kverndokk, Snorre, 2014. "Individual investments in education and health," HERO On line Working Paper Series 2014:1, Oslo University, Health Economics Research Programme.
*Reference 2: Kverndokk, Snorre, 2009. "Why do people demand health?," HERO On line Working Paper Series 2000:5, Oslo University, Health Economics Research Programme.
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*Reference 1: Grignon, Michel & Owusu, Yaw & Sweetman, Arthur, 2012. "The International Migration of Health Professionals," IZA Discussion Papers 6517, Institute for the Study of Labor (IZA).
*Reference 2: Michel Grignon & Bidenam Kambia-Chopin, 2009. "Income and the Demand for Complementary Health Insurance in France," Working Papers DT24, IRDES institut for research and information in health economics, revised Apr 2009.
*Reference 3: Christopher Longo & Michel Grignon, 2009. "The Value of Fixed-Reimbursement Healthcare Insurance- Evidence from Cancer Patients in Ontario, Canada," Centre for Health Economics and Policy Analysis Working Paper Series 2009-03, Centre for Health Economics and Policy Analysis (CHEPA), McMaster University, Hamilton, Canada.
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*Reference : Rocco, Lorenzo & Tanabe, Kimie & Suhrcke, Marc & Fumagalli, Elena, 2011. "Chronic diseases and labor market outcomes in Egypt," Policy Research Working Paper Series 5575, The World Bank.
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*Reference 1: Godager, Geir & Iversen, Tor & Albert Ma, Ching-to, 2012. "Competition, Gatekeeping, and Health Care Access," HERO On line Working Paper Series 2012:2, Oslo University, Health Economics Research Programme.
*Reference 2: Hoel, Michael & Iversen, Tor, 2009. "Impact of the public/private mix of health insurance on genetic testing," HERO On line Working Paper Series 1999:1, Oslo University, Health Economics Research Programme.
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*Reference 2: Birn, Erik & Godager, Geir, 2009. "Does quality influence choice of general practitioner? An analysis of matched doctor-patient panel data," HERO On line Working Paper Series 2008:3, Oslo University, Health Economics Research Programme.
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message: I have removed the section on Careers, which gave mention to a specific (not notable) person and was of little value. If somebody wishes to write a fuller section on careers it could be permissible, though I suspect not. Other Wikipedia articles on sub-disciplines of economics do not discuss careers and I see no reason why health economics should be different.
--ChrisSampson87 (talk) 11:56, 10 November 2016 (UTC)
thread_title:  Careers 

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thread_title:  External links modified 

message: I noticed that the link to Kenneth Arrow's 1963 paper was broken. I ended up editing the link and citation to now read: Arrow, Kenneth. (1963) Uncertainty and the Welfare Economics of Medical Care. The American Economic Review;53(5):941-973.  — Preceding unsigned comment added by Mbounthavong (talk • contribs) 21:37, 14 April 2019 (UTC)
thread_title:  Arrow 1963 link fixed