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MSS > MSS28 Health And Wealth Opportunity Cost And Productivity In Low Back Pain > Flashcards

MSS28 Health And Wealth Opportunity Cost And Productivity In Low Back Pain Flashcards

1
Q

Characteristics of health care sector

A
  • complex, complicated structure
  • ***asymmetric information and uncertainties
  • unique institutional characteristics - adoption of competitive economic practices
  • ***barriers of entry, licensing and certification
  • ***manpower, costs of training
  • health policies and regulations
  • organization and practices of the health insurance industry
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2
Q

Health economics

A

Study of allocation of resources to and within health economy

  • Use of models, economic theories and assumptions in rational decision making
  • Valuation of health + health services
  • Scarcity of societal resources
  • Costs and benefits analysis
  • Resource allocation
  • Marginal analysis
  • Strategic planning
  • Health insurance
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3
Q

***Healthcare Financing

A

Sources of money:

  1. Tax revenue
  2. General revenues
  3. Capital investments
  4. Patient charges
  5. Voluntary health insurance
  6. Social insurance contribution
  7. Private insurance
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4
Q

Paying for healthcare

A

Households:

  1. General taxation
  2. Social insurance
  3. Private insurance
  4. User charges / copayments (out-of-pocket)

–> Healthcare budget –>

Providers:

  1. Capitation payments
  2. Salaries
  3. Fee per item of service
  4. DRG (diagnosis-related group: determine how much to pay the hospital for each “product” since patients within same group expected to use the same level of hospital resources)
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5
Q

***Basic ideological perspectives, political philosophies regarding health policy

A
  1. Libertarian (自由主義):
    - **Market forces (demand versus supply)
    - Individually oriented policies
    - User charges (extensive copayments and deductibles)
    - Efficiency benefits
    - Consumer directed
    - **    No welfare/health care rights
    - Charities assist the poor
  2. Collectivists (集體主義):
    - Health care is equity (**social responsibility)
    - Response to market failures in health care provision
    - Better **    regulation of providers
    - Robust ***consumer protection
  3. Utilitarians (效益主義):
    - **Social utility consideration
    - Preventing/curing disease/disability that contribute to aggregate welfare
    - Can enhance **    productivity of the workforce
  4. Liberal Egalitarians (平等主義):
    - Social justice - equalism
    - Rights to **equality of opportunity
    - Aim to keep people functioning as close to normal as possible
    - Use **    individual responsibility as a criterion for distribution of scarce resources
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6
Q

Organisation of care delivery

A 
Need for care:
Healthy (not seeking care)
--> Primary
--> Secondary
--> Tertiary
(↑ money for care)
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7
Q

Financing paradox

A

More health care expenditure on less need ecology

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8
Q

***Microeconomic tools for health economics

A
  1. Scarcity
  2. Opportunity costs
  3. Need-Demand-Supply
  4. Market mechanisms
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9
Q

Healthcare resources

A

2 types:

  • Tangible: hospitals, equipment, drugs
  • Intangible: staff expertise, time, doctor-patient relationship
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10
Q

Scarcity

A

Resources are valuable but scarce i.e. limited

–> use them for one purpose we cannot use the same resources for another purpose

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11
Q

Opportunity costs

A

When we use resources in one way we cannot use them in another way
–> Sacrificing some benefits

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12
Q

Need-Demand-Supply

A

Should overlap as much as possible
- some cases may not have demand / need / supply

e. g. Vaccination
- have need
- have supply
- but not desired due to SE

Plastic surgery

  • have demand
  • have supply
  • but no need
  • -> may then sacrifice some resources for something not needed

Spondylolisthesis (displacement of one vertebra compared to another)

  • Need: patient need less invasive treatment
  • Supply created: clinical researchers developed a new method
  • Demand: a lot from doctors, patients and families
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13
Q

Market mechanisms

A

Supply and demand analysis:

  • Economic model for ***price determination in a competitive market
  • Results in an ***economic equilibrium for price and quantity transacted
  • Demand-increasing / decreasing events tend to raise/lower equilibrium price
  • Supply-increasing / decreasing events tend to lower/raise equilibrium price
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14
Q

Variables affecting demand and supply

A
  • income
  • other prices
  • insurance
  • tastes
  • technological change
  • input change (supply)
  • prices of production
  • size of industry
  • regulations

Consumer theory:

  1. Utility (what consumer prefer)
  2. Budget constraints (what consumer can afford)

Price elasticity:
- Responsiveness in quantity demanded to changes in price

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15
Q

***Specificity of health care market in market mechanisms

A
  1. Uncertainty
  2. ***Expert knowledge
    - patient do not have as much knowledge as doctors
  3. ***Asymmetry of information
    - more information –> more advantages –> ∴ need to be regulated
  4. Provider’s moral hazard (even patient want provider do not give)
  5. Consumer’s moral hazard
  6. Government regulations
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16
Q

***Economic efficiency

A

Making optimal use of scarce resources to help satisfy changing needs and demands of patients/consumers

  • -> highest-valued use
  • -> Maximising the benefits from the use of resources
  • -> Important for evaluation of alternatives

5 methods:

  1. Cost-Benefit analysis
  2. Cost-Effectiveness analysis
  3. Cost-Utility analysis, QALYs and DALYs
  4. ICER (incremental cost-effectiveness ratio)
  5. Valuing human life (not always highest-valued use)
17
Q

Equity

A
  • Fairness
  • Hong Kong is committed to providing equitable healthcare
  • an efficient way of spending resources may not be equitable (vice-versa)
  • ***Balance between efficiency and equity: determined by decision-makers/society
18
Q

Inverse care law

A
  • Julian Tutor Hart
  • Availability of good medical care tends to vary inversely with the need of the population served
  • operates more completely where medical care is most exposed to market forces
  • Inverse laws are commonplace, and arise because of inequality + lack of social justice
19
Q

WHO on reaching universal health coverage through:

A
  1. ***Raising funds for health
  2. Reducing financial barriers to access through prepayment and subsequent ***pooling of funds over direct out-of-pocket payments
  3. Using funds in a way that ***promotes efficiency and equity
20
Q

Cost analysis

A

Economic evaluation technique that involves the systematic collection, categorization and analysis of

  1. ***Costs of Program intervention
  2. ***Costs of illness (COI)
  • -> Allow to identify the least costly method to obtain a certain level of output
  • -> Attempts to evaluate the opportunity cost of a program intervention
21
Q

Why is Cost Analysis important

A
  1. Provides a monetary estimate for the ***economic burden of disease
  2. Planning and cost ***projections (budget, funding)
  3. Provides information on health resources allocation
  4. Tracking expenses
  5. How health resources are distributed among various population (equity)
  6. Comparing cost from equally effective programs
22
Q

When can we use Cost Analysis

A

Stand-alone evaluation method:

  • for one program intervention only
  • for comparison of two or more interventions that are equally effective

Together with effectiveness assessment techniques in:

  • Cost-Effectiveness analysis
  • Cost-Utility analysis
  • ICER
23
Q

Low back pain cost

A
  1. Private:
    - hospital
    - specialists
    - GP
  2. Public:
    - tertiary hospital
    - specialist
    - GOPC
  3. Chinese practitioner
  4. A/E
  5. Products / service:
    - Imaging
    - Conservative treatment
    - Pain killers
    - Stretching exercises
    - Complementary and Alternative Medicine
    - Surgeries
24
Q

Cost of illness (low back pain)

A

Value of the resources that are expended or foregone as a result of health problem

  • Direct: consultation cost, physiotherapy
  • Indirect: cleaning staff, maintanence of theatre
  • Tangible: treatment
  • Intangible: expertise, patient-doctor relationship
25
Q

Burden of disease

A

Mortality - Morbidity - DALY - YLD

  • DALYs: the ***sum of years of healthy life lost to premature death and years lived with disability
  • YLDs (years living with disability): ***years lived in less than ideal health: includes conditions that may last for only a few days / a lifetime
26
Q

LBP cost

A

Globally:

  • Highest YLD
  • Health care utilisatio
  • Increasing trend (aging)
  • Increasing direct costs to medical system
  • Increased indirect costs to medical system and society:
  • -> Lower labor productivity
  • -> Increased economic burden: more than 100 million workdays lost

Hong Kong: LBP one of the leading causes for YLDs and DALYs

China: 2nd leading course of YLD

Peak age category: 35-49 (most years lived in less than ideal health)

27
Q

***Summary: Decide if a new intervention/diagnostic method for LBP should be subsidised by the public health resources

A

Principles and major economic concepts to consider:

  1. Healthcare financing, Scarcity, Healthcare resources, Healthcare policies
  2. Need-demand-supply, Opportunity cost, Equity, Efficiency
  3. Cost of illness
    - Chronic, non-fatal illnesses can have a very high cost
    - Complications / Ageing with unhealthy lifestyles will increase the cost
  4. Disease burden: YLDs, DALYs
  5. Ethical principles

MSS (32 decks)

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