งานนำเสนอเรื่อง: "Health economic Chavanant Sumanasrethakul MD. M.Sc. Department of Preventive and Social Medicine BMA Medical College and Vajira Hospital."— ใบสำเนางานนำเสนอ:
Health economic Chavanant Sumanasrethakul MD. M.Sc. Department of Preventive and Social Medicine BMA Medical College and Vajira Hospital
What is health? WHO (1978) “a state of complete physical, mental and social well-being and not merely the absence of disease of infirmity”
Definition of economics The study of how and society end up CHOOSING, with or without the use of money, to employ SCARCE productive RESOURCES that could have ALTERNATIVE uses, to produce various commodities and DISTRIBUTE them for consumption, now or in the future, among various people and groups in society It analyses the cost and benefits of improving patterns of resource allocation. Paul Samuelson
Economics Macro-economics Micro-economics Demand laws of demand Supply laws of supply Market
Demand-supply relatioinship Number/amount of product Price of product Demand Supply PEPE HEHE Equilibrium point (E)
The role of health economic To provide: a way of thinking a set of techniques To assist decision making, usually in the health care sector, to promote: efficiency equity
Why health economics? Rapid growth in health expenditure: demographic changes technological advance changing expectations Resources available to health care are scarce Choices must be made as to what health care should be provided, how it should be provided, in what quantities and how it might be distributed
What is a market? Any process of exchange between buyers and sellers…. a mechanism which permits the transfer of goods and services between consumers and producers without the need for Government intervention Markets “work” by information to consumers and producers being conveyed by ‘market signals’. Market signals are “prices” and quantities” of goods and services provided
Market Interaction of demand and supply Price competition and market forces Demand = supply (market equilibrium) Demand > supply (excess demand) Supply > demand (excess supply)
Leave it to the market? Do we really need make explicit choices as how to allocate resources in the health care sector? Can’t we just leave it to the market to sort this out? So can’t we just buy and sell health care in the same way as for example televisions and CDs ? It works for cosmetic surgery so why not for other health care services? Why is there such extensive government intervention? What is different about health (care)?
"The first question of health economics has always been simple: why not leave health care alone? Some say that it is too complex for buyers to understand, so that they would be ripped off by sellers in a free market. Perhaps they would - but so are buyers of time shares, hot dogs and jewellery. In any case, the complexity is hugely exaggerated. And even where it is not, a similar complexity does not stop a market operating in the servicing and repair of car engines" Economist 1991
Conditions perfect market When does a market work? Certainty Perfect knowledge Consumers act free of self-interested advice from suppliers No externalities Freedom of exit and entry for producers
Uncertainty in health care services Uncertainty about: when you want health care what you want how much it will cost where you can get health care Cannot plan future consumption People take out health care insurance premium = expected health care expenditure plus admin costs and profits
Perfect knowledge? consumer wants health cannot buy health buys health care in expectation it will contribute to health Market fails to provide information on the effect of health care on health status
Asymmetry of information Imbalance of information about: alternative health care treatments effects of each treatment on health status and utility costs, outcomes and probabilities of ‘success’ Frequency of transactions and information
Asymmetry of information (2) doctors act as ‘agents’ for patients agency relationship potential for supplier-induced demand (SID) “the amount of care the patient would have demanded if they had the same information and knowledge as the doctor” doctor’s own interests versus patients’ interests depends on remuneration system
Perfect agent The doctor is there to give the patient all the information the patient need in order that the patient can make a decision, and the doctor should then implement that decision once the patient has made it.
Perhaps not so perfect The patient is there to give the doctor all the information the doctor need in order that the doctor can make a decision, and the patient should then implement that decision once the doctor has made it.
Externalities Externalities are spillovers from other people’s production or consumption of commodities which affect an individual in either a negative or a positive way but which are out of the individual’s locus of control
Externalities (2) Positive externalities: knowing that others consume a public health intervention, such as vaccination, which has direct effects on risks to one’s own health knowing that someone is receiving needed health care
Externalities (3) Negative externalities communicable diseases iatrogenic illness (hospital acquired infections) relative status Not accounted for in unregulated markets - market may under provide health care Leads to government subsidization of health care
Market failure Assumptions of the perfect market do not hold in health care Leads to extensive government intervention in health care But how should a government allocate health care resources? What principles/criteria should it use to set priorities?
WHO CARES ? Perspective of societyPerspective of society, patient & provider Planners & Policy makers CLINICIANS -Develop programs -Allocate resources among programs -Consider alternative diagnostic tests -Consider alternative treatment ECONOMICS FOR SYSTEM MANAGEMENT ECONOMICS FOR PATIENT MANAGEMENT