L2 Flashcards
What other factors influence health levels other than HC?
income, workplace, education, health risk behaviours etc.
6 factors that affect demand for healthcare?
1) Price(cost) of HC
2) Price of other goods
3) Income
4) Tastes and trends
5) Patient expectations of care
6) Population size and composition
PP-IT-PP
3 cost types of HC/
Subsidised, charged, or free at point of use
Indirect costs of HC use? (3)
Time off work cost
Parking/travelling cost
Waiting time cost (non-financial cost)
Explain how the price of HC affects demand for HC?
Increase in price -> decrease in quantity demanded (not always but sometimes, eg. chemo cost increases D wont decrease necessarily (life-saving treatments))
Explain examples of where prices of other goods may affect D for HC? (2)
Subs.: paracetamol and aspirin
Complements: GP visits and prescription medicines
Explain 3 relationships that income may have with different HC goods?
1) Inferior good (eg. tooth extractions)
2) Normal necessity: toothpaste
3) Luxury: dental veneers
2 examples of how tastes and trends have affected D for HC:
1) Smoking seen as ‘cool’ in 50s tf high D, now not seen as cool tf low D
2) Cosmetic surgery now in fashion tf high D
2 ways patients expectations of care may affect the D?
1) Access: may want same dr each visit/7 day GP care
2) Treatment expectations: may expect to be treated with antibiotics for a minor illness, may want non-clinically indicated diagnostic treatments etc.
Explain how population size and composition may affect D?
1) Total size of pop. (larger tf more D)
2) Composition of pop: eg. baby booms, ageing population, rural vs. urban pop., migration, gender, ethnicity
What did the RAND health insurance experiment look at?
What the (quantifiable) impact health insurance has on demand for healthcare
Why is it difficult to assess how health insurance affects D for HC?
Is difficult to establish the connection when all other demand affecting variables are all changing and consequently so are prices
Draw diagram: impact of insurance on Demand? What does the diagram show?
The lower the coinsurance % (ie. the amount the client has to pay as % of total cost) the less elastic the demand (ie. less sensitive to a change in price) (check, not sure on this)
What did the RAND study do?
Randomised study on the impact of co-insurance rate on D for HC (largest HC study in US history)
3 additional objectives of the RAND study?
1) Is D response different for the poor?
2) Is D response different for diff. services?
3) Does increasing the % of ones own liability lead to people looking after themselves better?
Explain the method in the RAND study?
Families from 6 areas of the US are randomly assigned to 1 of 14 different health insurance plans, which differed ITO:
1) Coinsurance rate (from 0% to 95%)
2) Out-of-pocket expense ceiling (limited to 5%, 10% of 15% of annual family income)
5809 people, 5yr study
What were Manning et al.’s (1987) main findings using RAND data? (4)
1) 45% higher per capita expenditure on free vs. 95% coinsurance plan
2) Outpatient expenses of the free plan were 67% higher than the 95% coinsurance plan
3) Outpatient expenses of the free plan were 37% higher than the 25% coinsurance plan
4) PED for HC found to be approximately =-0.2 tf inelastic
What did Manning et al. (1987) want to find out?
Whether utilisation of HC depended on the amounts paid out-of-pocket
What did Lohr et. al (1986) find with RAND data? (2)
1) 54% lower probability that a low-income, cost-sharing adult obtains treatment for acute pharyngitis compared to a low-income, cost free adult
2) For 8 acute illnesses, the prop. children use services for HC on cost sharing plan: 33%, for free plan goes up to 68%
Other RAND findings? (2)
1) Risky behaviours and patient satisfaction did not vary between plans
2) Regardless of income, use of all types of services fell with cost-sharing
RAND evaluative finding?
Despite this evidence, no consistent findings have been found on the impact of user charges and HC demand
1 other RAND finding: low- vs. high-income patients?
Those with higher incomes use more HC when it is both FREE and when on cost-sharing plans; are other costs playing a role? (cost of transport/time off work etc.)
