Handbook of Health Economics 

About: Handbook of Health Economics is an academic journal. The journal publishes majorly in the area(s): Health care & Incentive. Over the lifetime, 53 publications have been published receiving 7203 citations.

The Human Capital Model

Abstract: This chapter contains a detailed treatment of the human capital model of the demand for health which was originally developed in 1972. Theoretical predictions are discussed, and theoretical extensions of the model are reviewed. Empirical research that tests the predictions of the model or studies causality between years of formal schooling completed and good health is surveyed. The model views health as a durable capital stock that yields an output of healthy time. Individuals inherit an initial amount of this stock that depreciates with age and can be increased by investment. The household production function model of consumer behavior is employed to account for the gap between health as an output and medical care as one of many inputs into its production. In this framework the “shadow price” of health depends on many variables besides the price of medical care. It is shown that the shadow price rises with age if the rate of depreciation on the stock of health rises over the life cycle and falls with education (years of formal schooling completed) if more educated people are more efficient producers of health. An important result is that, under certain conditions, an increase in the shadow price may simultaneously reduce the quantity of health demanded and increase the quantities of health inputs demanded.

The Anatomy of Health Insurance

Abstract: This article describes the anatomy of health insurance. It begins by considering the optimal design of health insurance policies. Such policies must make tradeoffs appropriately between risk sharing on the one hand and agency problems such as moral hazard (the incentive of people to seek more care when they are insured) and supplier-induced demand (the incentive of physicians to provide more care when they are well reimbursed) on the other. Optimal coinsurance arrangements make patients pay for care up to the point where the marginal gains from less risk sharing are just offset by the marginal benefits from reduced provision of low valued care. Empirical evidence shows that both moral hazard and demand-inducement are quantitatively important. Coinsurance based on expenditure is a crude control mechanism. Moreover, it places no direct incentives on physicians, who are responsible for most expenditure decisions. To place such incentives on physicians is the goal of supply-side cost containment measures, such as utilization review and capitation. This goal motivates the surge in managed care in the United States, which unites the functions of insurance and provision, and allows for active management of the care that is delivered. The analysis then turns to the operation of health insurance markets. Economists generally favor choice in health insurance for the same reasons they favor choice in other markets: choice allows people to opt for the plan that is best for them and encourages plans to provide services efficiently. But choice in health insurance is a mixed blessing because of adverse selection – the tendency of the sick to choose more generous insurance than the healthy. When sick and healthy enroll in different plans, plans disproportionately composed of poor risks have to charge more than they would if they insured an average mix of people. The resulting high premiums create two adverse effects: they discourage those who are healthier but would prefer generous care from enrolling in those plans (because the premiums are so high), and they encourage plans to adopt measures that deter the sick from enrolling (to reduce their overall costs). The welfare losses from adverse selection are large in practice. Added to them are further losses from premiums that vary with observable health status. Because insurance is contracted for annually, people are denied a valuable form of intertemporal insurance – the right to buy health coverage at average rates in the future should they get sick today. As the ability to predict future health status increases, the lack of intertemporal insurance will become more problematic. The article concludes by relating health insurance to the central goal of medical care expenditures – better health. Studies to date are not clear on which approaches to health insurance promote health in the most cost-efficient manner. Resolving this question is the central policy concern in health economics.

Risk Adjustment in Competitive Health Plan Markets

Abstract: In the 1990s many countries have chosen to use prospective payment arrangements for health plans (e.g., health insurers, sickness funds or HMOs) together with health plan competition, as a means of creating incentives to be cost conscious, while preserving quality, innovation and responsiveness to consumer preferences. Risk adjustment is an important mechanism for attenuating problems that threaten the effectiveness of this strategy for resource allocation in health care. Without adequate risk adjustment, competing health plans have incentives to avoid individuals with predictable losses and to select predictably profitable members. This selection and the resulting risk segmentation can have adverse effects in terms of access to care, quality of care and efficiency in the production of care. This chapter first provides a conceptual framework for thinking about risk adjustment. Second, it gives an overview of the progress developing risk adjustment models in recent years. Third, several forms of risk sharing are discussed, which can be used as a tool for reducing selection in case of imperfect risk adjustment. Fourth, an overview is given of the current practice of risk adjustment and risk sharing in 11 countries. Finally some directions for future research are discussed.

Moral Hazard and Consumer Incentives in Health Care

Abstract: Consumer incentives are reflected in a wide range of choices, many of which occur in both insurance- and tax-financed health care systems. However, health insurance and sick leave pay cause consumer incentives to be reflected in moral hazard effects of several types. Theoretically, ex ante moral hazard (a reduction of preventive effort in response to insurance coverage) is not unambiguously predicted, and there is very limited empirical evidence about it. The case for static ex post moral hazard (an increase in the demand for medical care of a given technology) is stronger. The empirical evidence reported comes from three sources, natural experiments, observational comparisons of individuals, and the Health Insurance Experiment (HIE). The distinguishing feature of the HIE is that participants were assigned to insurance plans, which forestalls the possibility of good risks self-selecting plans with substantial cost sharing, resulting in an overestimate of the effects of plan design on health care expenditure. While the values of estimated price elasticities vary widely among the three sources and less markedly according to the type of care (outpatient, hospital, dental, mental), the responsiveness of the demand for medical care to net price is beyond doubt. The pure price elasticity for medical care in excess of a deductible (i.e. where the marginal price is constant) was estimated by HIE at −0.2 overall. Finally, there may be a dynamic moral hazard effect (choice biased in favor of new, usually more expensive medical technology). Here, the empirical evidence is very scanty again. Another promising field for future research is the interplay between consumer incentives and rationing by the physician in managed care.

Chapter 34 Equity in health care finance and delivery

Abstract: The paper surveys the economics literature on equity in health care financing and delivery. The focus is, for the most part, on empirical work, especially that involving international and temporal comparisons. There is, however, some discussion of the concept and definition of equity. The empirical sections cover the literature on equity in health care financing (progressivity and horizontal equity of health care financing arrangements), equity in health care delivery (horizontal equity in the sense of treating persons in equal need similarly), and equality of health.