Pub Date : 2019-05-23DOI: 10.1093/acrefore/9780190625979.013.23
J. Ours
There are three main topics in research on the effects of work on health. The first topic is workplace accidents where the main issues are reporting behavior and workplace safety policies. A worker seems to be less inclined to report a workplace accident for fear of job loss when unemployment is high or when the worker has a temporary contract that may not be renewed. Workplace safety legislation has intended to reduce the incidence and severity of workplace accidents but empirical evidence on this result is unclear. The second topic is employment and health where the focus is on how job characteristics and job loss affect health, in particular mental health. Physically demanding jobs have negative health effects. The effects of working hours vary and the effects of job loss on physical and mental health are not uniform. Job loss seems to increase mortality. The third topic concerns retirement and health. Retirement seems to have a negative effect on cognitive skills and short-term positive effects on overall health. Other than that, the effects are very inconsistent, that is, even with as clear a measure as mortality, it is not clear whether life expectancy goes up, goes down, or remains constant due to retirement.
{"title":"Health Economics of the Workplace: Workplace Accidents and Effects of Job Loss and Retirement","authors":"J. Ours","doi":"10.1093/acrefore/9780190625979.013.23","DOIUrl":"https://doi.org/10.1093/acrefore/9780190625979.013.23","url":null,"abstract":"There are three main topics in research on the effects of work on health.\u0000 The first topic is workplace accidents where the main issues are reporting behavior and workplace safety policies. A worker seems to be less inclined to report a workplace accident for fear of job loss when unemployment is high or when the worker has a temporary contract that may not be renewed. Workplace safety legislation has intended to reduce the incidence and severity of workplace accidents but empirical evidence on this result is unclear.\u0000 The second topic is employment and health where the focus is on how job characteristics and job loss affect health, in particular mental health. Physically demanding jobs have negative health effects. The effects of working hours vary and the effects of job loss on physical and mental health are not uniform. Job loss seems to increase mortality.\u0000 The third topic concerns retirement and health. Retirement seems to have a negative effect on cognitive skills and short-term positive effects on overall health. Other than that, the effects are very inconsistent, that is, even with as clear a measure as mortality, it is not clear whether life expectancy goes up, goes down, or remains constant due to retirement.","PeriodicalId":211658,"journal":{"name":"Oxford Research Encyclopedia of Economics and Finance","volume":"3 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116845130","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-05-23DOI: 10.1093/ACREFORE/9780190625979.013.85
J. Pinto-Prades, A. Attema, F. Sánchez-Martínez
Quality-adjusted life years (QALYs) are one of the main health outcomes measures used to make health policy decisions. It is assumed that the objective of policymakers is to maximize QALYs. Since the QALY weighs life years according to their health-related quality of life, it is necessary to calculate those weights (also called utilities) in order to estimate the number of QALYs produced by a medical treatment. The methodology most commonly used to estimate utilities is to present standard gamble (SG) or time trade-off (TTO) questions to a representative sample of the general population. It is assumed that, in this way, utilities reflect public preferences. Two different assumptions should hold for utilities to be a valid representation of public preferences. One is that the standard (linear) QALY model has to be a good model of how subjects value health. The second is that subjects should have consistent preferences over health states. Based on the main assumptions of the popular linear QALY model, most of those assumptions do not hold. A modification of the linear model can be a tractable improvement. This suggests that utilities elicited under the assumption that the linear QALY model holds may be biased. In addition, the second assumption, namely that subjects have consistent preferences that are estimated by asking SG or TTO questions, does not seem to hold. Subjects are sensitive to features of the elicitation process (like the order of questions or the type of task) that should not matter in order to estimate utilities. The evidence suggests that questions (TTO, SG) that researchers ask members of the general population produce response patterns that do not agree with the assumption that subjects have well-defined preferences when researchers ask them to estimate the value of health states. Two approaches can deal with this problem. One is based on the assumption that subjects have true but biased preferences. True preferences can be recovered from biased ones. This approach is valid as long as the theory used to debias is correct. The second approach is based on the idea that preferences are imprecise. In practice, national bodies use utilities elicited using TTO or SG under the assumptions that the linear QALY model is a good enough representation of public preferences and that subjects’ responses to preference elicitation methods are coherent.
{"title":"Measuring Health Utility in Economics","authors":"J. Pinto-Prades, A. Attema, F. Sánchez-Martínez","doi":"10.1093/ACREFORE/9780190625979.013.85","DOIUrl":"https://doi.org/10.1093/ACREFORE/9780190625979.013.85","url":null,"abstract":"Quality-adjusted life years (QALYs) are one of the main health outcomes measures used to make health policy decisions. It is assumed that the objective of policymakers is to maximize QALYs. Since the QALY weighs life years according to their health-related quality of life, it is necessary to calculate those weights (also called utilities) in order to estimate the number of QALYs produced by a medical treatment. The methodology most commonly used to estimate utilities is to present standard gamble (SG) or time trade-off (TTO) questions to a representative sample of the general population. It is assumed that, in this way, utilities reflect public preferences. Two different assumptions should hold for utilities to be a valid representation of public preferences. One is that the standard (linear) QALY model has to be a good model of how subjects value health. The second is that subjects should have consistent preferences over health states. Based on the main assumptions of the popular linear QALY model, most of those assumptions do not hold. A modification of the linear model can be a tractable improvement. This suggests that utilities elicited under the assumption that the linear QALY model holds may be biased. In addition, the second assumption, namely that subjects have consistent preferences that are estimated by asking SG or TTO questions, does not seem to hold. Subjects are sensitive to features of the elicitation process (like the order of questions or the type of task) that should not matter in order to estimate utilities. The evidence suggests that questions (TTO, SG) that researchers ask members of the general population produce response patterns that do not agree with the assumption that subjects have well-defined preferences when researchers ask them to estimate the value of health states. Two approaches can deal with this problem. One is based on the assumption that subjects have true but biased preferences. True preferences can be recovered from biased ones. This approach is valid as long as the theory used to debias is correct. The second approach is based on the idea that preferences are imprecise. In practice, national bodies use utilities elicited using TTO or SG under the assumptions that the linear QALY model is a good enough representation of public preferences and that subjects’ responses to preference elicitation methods are coherent.","PeriodicalId":211658,"journal":{"name":"Oxford Research Encyclopedia of Economics and Finance","volume":"7 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115723711","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-05-23DOI: 10.1093/ACREFORE/9780190625979.013.356
E. L. Yeyati
While traditional economic literature often sees nominal variables as irrelevant for the real economy, there is a vast body of analytical and empirical economic work that recognizes that, to the extent they exert a critical influence on the macroeconomic environment through a multiplicity of channels, exchange rate policies (ERP) have important consequences for development. ERP influences economic development in various ways: through its incidence on real variables such as investment and growth (and growth volatility) and on nominal aspects such relative prices or financial depth that, in turn, affect output growth or income distribution, among other development goals. Additionally, ERP, through the expected distribution of the real exchange rate indirectly, influences dimensions such as trade or financial fragility and explains, at least partially, the adoption of the euro—an extreme case of a fixed exchange rate arrangement—or the preference for floating exchange rates in the absence of financial dollarization. Importantly, exchange rate pegs have been (and, in many countries, still are) widely used as a nominal anchor to contain inflation in economies where nominal volatility induces agents to use the exchange rate as an implicit unit of account. All of these channels have been reflected to varying degrees in the choice of exchange rate regimes in recent history. The empirical literature on the consequences of ERP has been plagued by definitional and measurement problems. Whereas few economists would contest the textbook definition of canonical exchange rate regimes (fixed regimes involve a commitment to keep the nominal exchange rate at a given level; floating regimes imply no market intervention by the monetary authorities), reality is more nuanced: Pure floats are hard to find, and the empirical distinction between alternative flexible regimes is not always clear. Moreover, there are many different degrees of exchange rate commitments as well as many alternative anchors, sometimes undisclosed. Finally, it is not unusual that a country that officially declares to peg its currency realigns its parity if it finds the constraints on monetary policy or economic activity too taxing. By the same token, a country that commits to a float may choose to intervene in the foreign exchange market to dampen exchange rate fluctuations. The regime of choice depends critically on the situation of each country at a given point in time as much as on the evolution of the global environment. Because both the ERP debate and real-life choices incorporate national and time-specific aspects that tend to evolve over time, so does the changing focus of the debate. In the post-World War II years, under the Bretton Woods agreement, most countries pegged their currencies to the U.S. dollar, which in turn was kept convertible to gold. In the post-Bretton Woods years, after August 1971 when the United States abandoned unilaterally the convertibility of the dollar, thus
{"title":"Exchange Rate Policies and Economic Development","authors":"E. L. Yeyati","doi":"10.1093/ACREFORE/9780190625979.013.356","DOIUrl":"https://doi.org/10.1093/ACREFORE/9780190625979.013.356","url":null,"abstract":"While traditional economic literature often sees nominal variables as irrelevant for the real economy, there is a vast body of analytical and empirical economic work that recognizes that, to the extent they exert a critical influence on the macroeconomic environment through a multiplicity of channels, exchange rate policies (ERP) have important consequences for development.\u0000 ERP influences economic development in various ways: through its incidence on real variables such as investment and growth (and growth volatility) and on nominal aspects such relative prices or financial depth that, in turn, affect output growth or income distribution, among other development goals. Additionally, ERP, through the expected distribution of the real exchange rate indirectly, influences dimensions such as trade or financial fragility and explains, at least partially, the adoption of the euro—an extreme case of a fixed exchange rate arrangement—or the preference for floating exchange rates in the absence of financial dollarization. Importantly, exchange rate pegs have been (and, in many countries, still are) widely used as a nominal anchor to contain inflation in economies where nominal volatility induces agents to use the exchange rate as an implicit unit of account. All of these channels have been reflected to varying degrees in the choice of exchange rate regimes in recent history.\u0000 The empirical literature on the consequences of ERP has been plagued by definitional and measurement problems. Whereas few economists would contest the textbook definition of canonical exchange rate regimes (fixed regimes involve a commitment to keep the nominal exchange rate at a given level; floating regimes imply no market intervention by the monetary authorities), reality is more nuanced: Pure floats are hard to find, and the empirical distinction between alternative flexible regimes is not always clear. Moreover, there are many different degrees of exchange rate commitments as well as many alternative anchors, sometimes undisclosed. Finally, it is not unusual that a country that officially declares to peg its currency realigns its parity if it finds the constraints on monetary policy or economic activity too taxing. By the same token, a country that commits to a float may choose to intervene in the foreign exchange market to dampen exchange rate fluctuations.\u0000 The regime of choice depends critically on the situation of each country at a given point in time as much as on the evolution of the global environment. Because both the ERP debate and real-life choices incorporate national and time-specific aspects that tend to evolve over time, so does the changing focus of the debate. In the post-World War II years, under the Bretton Woods agreement, most countries pegged their currencies to the U.S. dollar, which in turn was kept convertible to gold. In the post-Bretton Woods years, after August 1971 when the United States abandoned unilaterally the convertibility of the dollar, thus ","PeriodicalId":211658,"journal":{"name":"Oxford Research Encyclopedia of Economics and Finance","volume":"85 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127460307","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-05-23DOI: 10.1093/ACREFORE/9780190625979.013.446
Chaocheng Gu, Han-Soo Han, Randall Wright
The effects of news (i.e., information innovations) are studied in dynamic general equilibrium models where liquidity matters. As a leading example, news can be announcements about monetary policy directions. In three standard theoretical environments—an overlapping generations model of fiat currency, a new monetarist model accommodating multiple payment methods, and a model of unsecured credit—transition paths are constructed between an announcement and the date at which events are realized. Although the economics is different, in each case, news about monetary policy can induce volatility in financial and other markets, with transitions displaying booms, crashes, and cycles in prices, quantities, and welfare. This is not the same as volatility based on self-fulfilling prophecies (e.g., cyclic or sunspot equilibria) studied elsewhere. Instead, the focus is on the unique equilibrium that is stationary when parameters are constant but still delivers complicated dynamics in simple environments due to information and liquidity effects. This is true even for classically-neutral policy changes. The induced volatility can be bad or good for welfare, but using policy to exploit this in practice seems difficult because outcomes are very sensitive to timing and parameters. The approach can be extended to include news of real factors, as seen in examples.
{"title":"The Effects of Monetary Policy Announcements","authors":"Chaocheng Gu, Han-Soo Han, Randall Wright","doi":"10.1093/ACREFORE/9780190625979.013.446","DOIUrl":"https://doi.org/10.1093/ACREFORE/9780190625979.013.446","url":null,"abstract":"The effects of news (i.e., information innovations) are studied in dynamic general equilibrium models where liquidity matters. As a leading example, news can be announcements about monetary policy directions. In three standard theoretical environments—an overlapping generations model of fiat currency, a new monetarist model accommodating multiple payment methods, and a model of unsecured credit—transition paths are constructed between an announcement and the date at which events are realized. Although the economics is different, in each case, news about monetary policy can induce volatility in financial and other markets, with transitions displaying booms, crashes, and cycles in prices, quantities, and welfare. This is not the same as volatility based on self-fulfilling prophecies (e.g., cyclic or sunspot equilibria) studied elsewhere. Instead, the focus is on the unique equilibrium that is stationary when parameters are constant but still delivers complicated dynamics in simple environments due to information and liquidity effects. This is true even for classically-neutral policy changes. The induced volatility can be bad or good for welfare, but using policy to exploit this in practice seems difficult because outcomes are very sensitive to timing and parameters. The approach can be extended to include news of real factors, as seen in examples.","PeriodicalId":211658,"journal":{"name":"Oxford Research Encyclopedia of Economics and Finance","volume":"23 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130499177","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-05-23DOI: 10.1093/ACREFORE/9780190625979.013.275
Pieter H.M. Baal, H. Boshuizen
In most countries, non-communicable diseases have taken over infectious diseases as the most important causes of death. Many non-communicable diseases that were previously lethal diseases have become chronic, and this has changed the healthcare landscape in terms of treatment and prevention options. Currently, a large part of healthcare spending is targeted at curing and caring for the elderly, who have multiple chronic diseases. In this context prevention plays an important role, as there are many risk factors amenable to prevention policies that are related to multiple chronic diseases. This article discusses the use of simulation modeling to better understand the relations between chronic diseases and their risk factors with the aim to inform health policy. Simulation modeling sheds light on important policy questions related to population aging and priority setting. The focus is on the modeling of multiple chronic diseases in the general population and how to consistently model the relations between chronic diseases and their risk factors by combining various data sources. Methodological issues in chronic disease modeling and how these relate to the availability of data are discussed. Here, a distinction is made between (a) issues related to the construction of the epidemiological simulation model and (b) issues related to linking outcomes of the epidemiological simulation model to economic relevant outcomes such as quality of life, healthcare spending and labor market participation. Based on this distinction, several simulation models are discussed that link risk factors to multiple chronic diseases in order to explore how these issues are handled in practice. Recommendations for future research are provided.
{"title":"Modeling Chronic Diseases in Relation to Risk Factors","authors":"Pieter H.M. Baal, H. Boshuizen","doi":"10.1093/ACREFORE/9780190625979.013.275","DOIUrl":"https://doi.org/10.1093/ACREFORE/9780190625979.013.275","url":null,"abstract":"In most countries, non-communicable diseases have taken over infectious diseases as the most important causes of death. Many non-communicable diseases that were previously lethal diseases have become chronic, and this has changed the healthcare landscape in terms of treatment and prevention options. Currently, a large part of healthcare spending is targeted at curing and caring for the elderly, who have multiple chronic diseases. In this context prevention plays an important role, as there are many risk factors amenable to prevention policies that are related to multiple chronic diseases.\u0000 This article discusses the use of simulation modeling to better understand the relations between chronic diseases and their risk factors with the aim to inform health policy. Simulation modeling sheds light on important policy questions related to population aging and priority setting. The focus is on the modeling of multiple chronic diseases in the general population and how to consistently model the relations between chronic diseases and their risk factors by combining various data sources. Methodological issues in chronic disease modeling and how these relate to the availability of data are discussed. Here, a distinction is made between (a) issues related to the construction of the epidemiological simulation model and (b) issues related to linking outcomes of the epidemiological simulation model to economic relevant outcomes such as quality of life, healthcare spending and labor market participation. Based on this distinction, several simulation models are discussed that link risk factors to multiple chronic diseases in order to explore how these issues are handled in practice. Recommendations for future research are provided.","PeriodicalId":211658,"journal":{"name":"Oxford Research Encyclopedia of Economics and Finance","volume":"4 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133376075","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-05-23DOI: 10.1093/ACREFORE/9780190625979.013.308
Sushant Acharya, Paolo A. Pesenti
Global policy spillovers can be defined as the effect of policy changes in one country on economic outcomes in other countries. The literature has mainly focused on monetary policy interdependencies and has identified three channels through which policy spillovers can materialize. The first is the expenditure-shifting channel—a monetary expansion in one country depreciates its currency, making its goods cheaper relative to those in other countries and shifting global demand toward domestic tradable goods. The second is the expenditure-changing channel—expansionary monetary policy in one country raises both domestic and foreign expenditure. The third is the financial spillovers channel—expansionary monetary policy in one country eases financial conditions in other economies. The literature generally finds that the net transmission effect is positive but small. However, estimated spillovers vary widely across countries and over time. In the aftermath of the Great Recession, the policy debate has devoted special attention to the possibility that the magnitude and sign of international spillovers might have changed in an environment of low interest rates worldwide, as the expenditure-shifting channel becomes more relevant when the effective lower bound reduces the effectiveness of conventional monetary policies.
{"title":"Global Spillovers in a Low Interest Rate Environment","authors":"Sushant Acharya, Paolo A. Pesenti","doi":"10.1093/ACREFORE/9780190625979.013.308","DOIUrl":"https://doi.org/10.1093/ACREFORE/9780190625979.013.308","url":null,"abstract":"Global policy spillovers can be defined as the effect of policy changes in one country on economic outcomes in other countries. The literature has mainly focused on monetary policy interdependencies and has identified three channels through which policy spillovers can materialize. The first is the expenditure-shifting channel—a monetary expansion in one country depreciates its currency, making its goods cheaper relative to those in other countries and shifting global demand toward domestic tradable goods. The second is the expenditure-changing channel—expansionary monetary policy in one country raises both domestic and foreign expenditure. The third is the financial spillovers channel—expansionary monetary policy in one country eases financial conditions in other economies. The literature generally finds that the net transmission effect is positive but small. However, estimated spillovers vary widely across countries and over time. In the aftermath of the Great Recession, the policy debate has devoted special attention to the possibility that the magnitude and sign of international spillovers might have changed in an environment of low interest rates worldwide, as the expenditure-shifting channel becomes more relevant when the effective lower bound reduces the effectiveness of conventional monetary policies.","PeriodicalId":211658,"journal":{"name":"Oxford Research Encyclopedia of Economics and Finance","volume":"40 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126196914","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-05-23DOI: 10.1093/ACREFORE/9780190625979.013.74
H. Hayes, M. Sutton
Contracts and working conditions are important influences on the medical workforce that must be carefully constructed and considered by policymakers. Contracts involve an enforceable agreement of the rights and responsibilities of both employer and employee. The principal–agent relationship and presence of asymmetric information in healthcare means that contracts must be incentive compatible and create sufficient incentive for doctors to act in the payer’s best interests. Within medicine, there are special characteristics that are believed to be particularly pertinent to doctors, who act as agents to both the patient and the payer. These include intrinsic motivation, professionalism, altruism, and multitasking, and they influence the success of these contracts. The three most popular methods of payment are fee-for-service, capitation, and salaries. In most contexts a blend of each of these three payment methods is used; however, guidance on the most appropriate blend is unclear and the evidence on the special nature of doctors is insubstantial. The role of skill mix and teamwork in a healthcare setting is an important consideration as it impacts the success of incentives and payment systems and the efficiency of workers. Additionally, with increasing demand for healthcare, changing skill mix is one response to problems with recruitment and retention in health services. Health systems in many settings depend on a large proportion of foreign-born workers and so migration is a key consideration in retention and recruitment of health workers. Finally, forms of external regulation such as accreditation, inspection, and revalidation are widely used in healthcare systems; however, robust evidence of their effectiveness is lacking.
{"title":"Contracts and Working Conditions in Medicine","authors":"H. Hayes, M. Sutton","doi":"10.1093/ACREFORE/9780190625979.013.74","DOIUrl":"https://doi.org/10.1093/ACREFORE/9780190625979.013.74","url":null,"abstract":"Contracts and working conditions are important influences on the medical workforce that must be carefully constructed and considered by policymakers. Contracts involve an enforceable agreement of the rights and responsibilities of both employer and employee. The principal–agent relationship and presence of asymmetric information in healthcare means that contracts must be incentive compatible and create sufficient incentive for doctors to act in the payer’s best interests. Within medicine, there are special characteristics that are believed to be particularly pertinent to doctors, who act as agents to both the patient and the payer. These include intrinsic motivation, professionalism, altruism, and multitasking, and they influence the success of these contracts. The three most popular methods of payment are fee-for-service, capitation, and salaries. In most contexts a blend of each of these three payment methods is used; however, guidance on the most appropriate blend is unclear and the evidence on the special nature of doctors is insubstantial. The role of skill mix and teamwork in a healthcare setting is an important consideration as it impacts the success of incentives and payment systems and the efficiency of workers. Additionally, with increasing demand for healthcare, changing skill mix is one response to problems with recruitment and retention in health services. Health systems in many settings depend on a large proportion of foreign-born workers and so migration is a key consideration in retention and recruitment of health workers. Finally, forms of external regulation such as accreditation, inspection, and revalidation are widely used in healthcare systems; however, robust evidence of their effectiveness is lacking.","PeriodicalId":211658,"journal":{"name":"Oxford Research Encyclopedia of Economics and Finance","volume":"17 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122524259","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-04-26DOI: 10.1093/ACREFORE/9780190625979.013.246
A. Medici, Maureen Lewis
Latin American and Caribbean (LAC) countries have experienced a long-term process of improvement in populational health conditions, shifting their health priorities from child–mother care and transmissible diseases to non-communicable diseases (NCDs). However, persistent socioeconomic inequalities create barriers to achieve universal health coverage (UHC). Despite a high level of governmental commitment to UHC, and rising coverage, approximately 25% of the population does not have access to healthcare, particularly in rural and outlying areas. Health system quality issues have been largely ignored, and inefficiency, from health financing to health delivery, is not on the policy agenda. The use of incentives to improve performance are rare in LAC health systems and there are political barriers to introduce reforms in payment systems in the public sector, though the private sector has opportunity to adapt change. Fragmentation in the financing of healthcare is a common theme in the region. Most systems retain social health insurance (SHI) schemes, mostly for the formal sector, and in some cases have more than one; and parallel National Health System (NHS)-type arrangements for the poor and those in the informal labor market. The cost and inefficiency in delivery and financing is considerable. Regional health economics literature stresses inadequate funding—despite the fact that the region has the highest inequality in access and spends the most on healthcare across the regions—and analyzes multiple aspects of health equity. The agenda needs to move from these debates to designing and leveraging delivery and payment systems that target performance and efficiency. The absence of research on payment arrangements and performance is a symptom of a health management culture based on processes rather than results. Indeed, health services in the region remain rooted in a culture of fee-for-service and supply-driven models, where expenditures are independent of outcomes. Health policy reforms in LAC need to address efficiency rather than equity, integrate healthcare delivery, and tackle provider payment reforms. The integration of medical records, adherence to protocols and clinical pathways, establishment of health networks built around primary healthcare, along with harmonized incentives and payment systems, offer a direction for reforms that allow adapting to existing circumstances and institutions. This offers the best path for sustainable UHC in the region.
{"title":"Health Policy and Finance Challenges in Latin America and the Caribbean: An Economic Perspective","authors":"A. Medici, Maureen Lewis","doi":"10.1093/ACREFORE/9780190625979.013.246","DOIUrl":"https://doi.org/10.1093/ACREFORE/9780190625979.013.246","url":null,"abstract":"Latin American and Caribbean (LAC) countries have experienced a long-term process of improvement in populational health conditions, shifting their health priorities from child–mother care and transmissible diseases to non-communicable diseases (NCDs). However, persistent socioeconomic inequalities create barriers to achieve universal health coverage (UHC). Despite a high level of governmental commitment to UHC, and rising coverage, approximately 25% of the population does not have access to healthcare, particularly in rural and outlying areas.\u0000 Health system quality issues have been largely ignored, and inefficiency, from health financing to health delivery, is not on the policy agenda. The use of incentives to improve performance are rare in LAC health systems and there are political barriers to introduce reforms in payment systems in the public sector, though the private sector has opportunity to adapt change.\u0000 Fragmentation in the financing of healthcare is a common theme in the region. Most systems retain social health insurance (SHI) schemes, mostly for the formal sector, and in some cases have more than one; and parallel National Health System (NHS)-type arrangements for the poor and those in the informal labor market. The cost and inefficiency in delivery and financing is considerable.\u0000 Regional health economics literature stresses inadequate funding—despite the fact that the region has the highest inequality in access and spends the most on healthcare across the regions—and analyzes multiple aspects of health equity. The agenda needs to move from these debates to designing and leveraging delivery and payment systems that target performance and efficiency.\u0000 The absence of research on payment arrangements and performance is a symptom of a health management culture based on processes rather than results. Indeed, health services in the region remain rooted in a culture of fee-for-service and supply-driven models, where expenditures are independent of outcomes.\u0000 Health policy reforms in LAC need to address efficiency rather than equity, integrate healthcare delivery, and tackle provider payment reforms. The integration of medical records, adherence to protocols and clinical pathways, establishment of health networks built around primary healthcare, along with harmonized incentives and payment systems, offer a direction for reforms that allow adapting to existing circumstances and institutions. This offers the best path for sustainable UHC in the region.","PeriodicalId":211658,"journal":{"name":"Oxford Research Encyclopedia of Economics and Finance","volume":"53 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-04-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129033754","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-04-26DOI: 10.1093/acrefore/9780190625979.013.436
S. A. Hamid
Health microinsurance (HMI) has been used around the globe since the early 1990s for financial risk protection against health shocks in poverty-stricken rural populations in low-income countries. However, there is much debate in the literature on its impact on financial risk protection. There is also no clear answer to the critical policy question about whether HMI is a viable route to provide healthcare to the people of the informal economy, especially in the rural areas. Findings show that HMI schemes are concentrated widely in the low-income countries, especially in South Asia (about 43%) and East Africa (about 25.4%). India accounts for 30% of HMI schemes. Bangladesh and Kenya also possess a good number of schemes. There is some evidence that HMI increases access to healthcare or utilization of healthcare. One set of the literature shows that HMI provides financial protection against the costs of illness to its enrollees by reducing out-of-pocket payments and/or catastrophic spending. On the contrary, a large body of literature with strong methodological rigor shows that HMI fails to provide financial protection against health shocks to its clients. Some of the studies in the latter group rather find that HMI contributes to the decline of financial risk protection. These findings seem to be logical as there is a high copayment and a lack of continuum of care in most cases. The findings also show that scale and dependence on subsidy are the major concerns. Low enrollment and low renewal are common concerns of the voluntary HMI schemes in South Asian countries. In addition, the declining trend of donor subsidies makes the HMI schemes supported by external donors more vulnerable. These challenges and constraints restrict the scale and profitability of HMI initiatives, especially those that are voluntary. Consequently, the existing organizations may cease HMI activities. Overall, although HMI can increase access to healthcare, it fails to provide financial risk protection against health shocks. The existing HMI practices in South Asia, especially in the HMIs owned by nongovernmental organizations and microfinance institutions, are not a viable route to provide healthcare to the rural population of the informal economy. However, HMI schemes may play some supportive role in implementation of a nationalized scheme, if there is one. There is also concern about the institutional viability of the HMI organizations (e.g., ownership and management efficiency). Future research may address this issue.
{"title":"Microinsurance and Rural Health","authors":"S. A. Hamid","doi":"10.1093/acrefore/9780190625979.013.436","DOIUrl":"https://doi.org/10.1093/acrefore/9780190625979.013.436","url":null,"abstract":"Health microinsurance (HMI) has been used around the globe since the early 1990s for financial risk protection against health shocks in poverty-stricken rural populations in low-income countries. However, there is much debate in the literature on its impact on financial risk protection. There is also no clear answer to the critical policy question about whether HMI is a viable route to provide healthcare to the people of the informal economy, especially in the rural areas. Findings show that HMI schemes are concentrated widely in the low-income countries, especially in South Asia (about 43%) and East Africa (about 25.4%). India accounts for 30% of HMI schemes. Bangladesh and Kenya also possess a good number of schemes. There is some evidence that HMI increases access to healthcare or utilization of healthcare. One set of the literature shows that HMI provides financial protection against the costs of illness to its enrollees by reducing out-of-pocket payments and/or catastrophic spending. On the contrary, a large body of literature with strong methodological rigor shows that HMI fails to provide financial protection against health shocks to its clients. Some of the studies in the latter group rather find that HMI contributes to the decline of financial risk protection. These findings seem to be logical as there is a high copayment and a lack of continuum of care in most cases. The findings also show that scale and dependence on subsidy are the major concerns. Low enrollment and low renewal are common concerns of the voluntary HMI schemes in South Asian countries. In addition, the declining trend of donor subsidies makes the HMI schemes supported by external donors more vulnerable. These challenges and constraints restrict the scale and profitability of HMI initiatives, especially those that are voluntary. Consequently, the existing organizations may cease HMI activities.\u0000 Overall, although HMI can increase access to healthcare, it fails to provide financial risk protection against health shocks. The existing HMI practices in South Asia, especially in the HMIs owned by nongovernmental organizations and microfinance institutions, are not a viable route to provide healthcare to the rural population of the informal economy. However, HMI schemes may play some supportive role in implementation of a nationalized scheme, if there is one. There is also concern about the institutional viability of the HMI organizations (e.g., ownership and management efficiency). Future research may address this issue.","PeriodicalId":211658,"journal":{"name":"Oxford Research Encyclopedia of Economics and Finance","volume":"43 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-04-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128191098","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-04-26DOI: 10.1093/ACREFORE/9780190625979.013.56
Olena Stavrunova
In many countries of the world, consumers choose their health insurance coverage from a large menu of often complex options supplied by private insurance companies. Economic benefits of the wide choice of health insurance options depend on the extent to which the consumers are active, well informed, and sophisticated decision makers capable of choosing plans that are well-suited to their individual circumstances. There are many possible ways how consumers’ actual decision making in the health insurance domain can depart from the standard model of health insurance demand of a rational risk-averse consumer. For example, consumers can have inaccurate subjective beliefs about characteristics of alternative plans in their choice set or about the distribution of health expenditure risk because of cognitive or informational constraints; or they can prefer to rely on heuristics when the plan choice problem features a large number of options with complex cost-sharing design. The second decade of the 21st century has seen a burgeoning number of studies assessing the quality of consumer choices of health insurance, both in the lab and in the field, and financial and welfare consequences of poor choices in this context. These studies demonstrate that consumers often find it difficult to make efficient choices of private health insurance due to reasons such as inertia, misinformation, and the lack of basic insurance literacy. These findings challenge the conventional rationality assumptions of the standard economic model of insurance choice and call for policies that can enhance the quality of consumer choices in the health insurance domain.
{"title":"Choice Inconsistencies in the Demand for Private Health Insurance","authors":"Olena Stavrunova","doi":"10.1093/ACREFORE/9780190625979.013.56","DOIUrl":"https://doi.org/10.1093/ACREFORE/9780190625979.013.56","url":null,"abstract":"In many countries of the world, consumers choose their health insurance coverage from a large menu of often complex options supplied by private insurance companies. Economic benefits of the wide choice of health insurance options depend on the extent to which the consumers are active, well informed, and sophisticated decision makers capable of choosing plans that are well-suited to their individual circumstances.\u0000 There are many possible ways how consumers’ actual decision making in the health insurance domain can depart from the standard model of health insurance demand of a rational risk-averse consumer. For example, consumers can have inaccurate subjective beliefs about characteristics of alternative plans in their choice set or about the distribution of health expenditure risk because of cognitive or informational constraints; or they can prefer to rely on heuristics when the plan choice problem features a large number of options with complex cost-sharing design.\u0000 The second decade of the 21st century has seen a burgeoning number of studies assessing the quality of consumer choices of health insurance, both in the lab and in the field, and financial and welfare consequences of poor choices in this context. These studies demonstrate that consumers often find it difficult to make efficient choices of private health insurance due to reasons such as inertia, misinformation, and the lack of basic insurance literacy. These findings challenge the conventional rationality assumptions of the standard economic model of insurance choice and call for policies that can enhance the quality of consumer choices in the health insurance domain.","PeriodicalId":211658,"journal":{"name":"Oxford Research Encyclopedia of Economics and Finance","volume":"103 3 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-04-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134418404","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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