HSSP 104: Health Economics
HellerSchool for Social Policy and Management
BrandeisUniversity
Spring 2016
SYLLABUS
Instructor: Dominic HodgkinTeaching Assistant: Ye Zhang
Office: Heller 264Email:
Email:
Telephone: 6-8551
Description: This course will teach students to apply economic analytical approaches to the health sector, in areas where this adds insights. Relevant tools include cost-benefit and cost-effectiveness analysis, theories of demand, supply, adverse selection, moral hazard and price discrimination.
Learning goals: After taking this class, students should be able to use the tools of economic analysis to evaluate issues in health care policy and research.
Prerequisite: Econ 2a or Econ 10a.
Evaluation: The course grade will be determined by a midterm (25%), a final exam (30%), a research paper (15%), homework assignments (20%), responses to readings (5%), and attendance/punctuality/participation (5%).
The requirements for the responses to readings are outlined in a separate document posted on Latte. The schedule of due dates for assignments is posted on Latte too.
Laptops are allowed in class for note-taking purposes, but use for non-class related purposes is not allowed, and will affect your participation grade negatively.
Academic integrity: You are expected to be familiar with and to follow the University’s policies on academic integrity (see ). Any suspected instances of alleged dishonesty may be referred to the Office of Student Development and Conduct. Instances of academic dishonesty may result in sanctions including but not limited to, failing grades being issued, educational programs, and other consequences.
Disabilities: If you are a student with a documented disability on record at BrandeisUniversity and wish to have a reasonable accommodation made for you in this class, please see me immediately.
Textbook:Bhattacharya J, Hyde T and Hu T, Health Economics. Palgrave Macmillan, 2013.
We will also read portions of two other textbooks:
The Economics of Health Care Reconsidered, 4rd edition, by Rice T. and Unruh L, and The Economics of Health and Health care, by Folland S., Goodman A. and Stano M. These portions are on the course website.
CLASS SCHEDULE AND READINGS
1. Introduction1/15
Bhattacharya et al., chapter 1.
Folland et al, chapters 2-3. This is a review of relevant microeconomics and statistics tools. If you have not had much exposure to this material, you are strongly recommended to review it now.
Martin, A. B., Hartman, M., Benson, J., Catlin, A., & National Health Expenditure Accounts Team. (2016). National Health Spending In 2014: Faster Growth Driven By Coverage Expansion And Prescription Drug Spending. Health Affairs, 35(1), 150-160.
2. Demand for health care1/19
Bhattacharya et al., chapter 2.
Rice and Unruh, chapter 4, pp. 92-109.
Waters, T. M., Chang, C. F., Cecil, W. T., Kasteridis, P., & Mirvis, D. (2011). Impact of High‐Deductible Health Plans on Health Care Utilization and Costs. Health services research, 46(1p1), 155-172.
3. Demand for health1/22
Bhattacharya et al., chapter 3
Kaestner, R., Darden, M., & Lakdawalla, D. (2014). Are investments in disease prevention complements? The case of statins and health behaviors. Journal of health economics, 36, 151-163.
4. Socioeconomic disparities in health1/26
Bhattacharya et al., chapter 4.
Adler, N. E., & Rehkopf, D. H. (2008). US disparities in health: descriptions, causes, and mechanisms. Annu. Rev. Public Health, 29, 235-252.
Hebert, P. L., Sisk, J. E., & Howell, E. A. (2008). When does a difference become a disparity? Conceptualizing racial and ethnic disparities in health. Health Affairs, 27(2), 374-382.
5. Production/cost of health care1/29
Folland et al, chapter 6.
Schneider J.E., Miller T.R., Ohsfeldt R.L. et al (2008). The economics of specialty hospitals. Medical Care Research & Review 65(5): 531-53.
Carey, K., Burgess, J. F., & Young, G. J. (2015). Economies of Scale and Scope: The Case of Specialty Hospitals. Contemporary Economic Policy, 33(1), 104-117.
Background:Guterman S. (2006).Specialty hospitals: a problem or a symptom? Health Affairs: 25(1):95-105.
6. Provider reimbursement2/2
Werner R.M., Dudley R.A. (2009). Making The ‘Pay’ Matter In Pay-For-Performance: Implications For Payment Strategies. Health Affairs 28(5): 1498-1508.
Conrad, D. A. (2015). The Theory of Value‐Based Payment Incentives and Their Application to Health Care. Health services research, 50(S2), 2057-2089.
Song, Z., Rose, S., Safran, D. G., Landon, B. E., Day, M. P., & Chernew, M. E. (2014). Changes in health care spending and quality 4 years into global payment. New England Journal of Medicine, 371(18), 1704-1714.
Background: Chernew, M.E., et al. "Private-payer innovation in Massachusetts: the ‘alternative quality contract’." Health Affairs 30.1 (2011): 51-61.
7. Hospitals2/5
Bhattacharya et al., chapter 6.
Rice & Unruh, pp. 231-248.
Frakt, A. B. (2011). How much do hospitals cost shift? A review of the evidence. Milbank Quarterly, 89(1), 90-130.
Background: Schlesinger M., Gray B.H. (2006). How nonprofits matter in American medicine, and what to do about it. Health Affairs. 2006 Jul-Aug;25(4):W287-303.
8. Insurance game2/9
[no readings]
9. Demand for health insurance2/12
Bhattacharya et al., chapter 7.
Rice and Unruh, pp. 86-92.
Baicker, K., Congdon, W. J., & Mullainathan, S. (2012). Health Insurance Coverage and Take‐Up: Lessons from Behavioral Economics. Milbank Quarterly, 90(1), 107-134.
[no class on 2/16, 2/19:February break]
10. Adverse Selection: Akerlof's Market for Lemons2/23
Bhattacharya et al., chapter 8.
11. Adverse Selection: The Rothschild-Stiglitz Model2/26
Bhattacharya et al., chapter 9.
12. Adverse Selection in Real Markets3/1
Bhattacharya et al., chapter 10.
Kaiser Family Foundation (2015). The Uninsured: A Primer. Key Facts about Health Insurance and the Uninsured in the Era of Health Reform.
Newhouse, J. P., Price, M., Huang, J., McWilliams, J. M., & Hsu, J. (2012). Steps to reduce favorable risk selection in Medicare Advantage largely succeeded, boding well for health insurance exchanges. Health Affairs, 31(12), 2618-2628.
MIDTERM EXAM3/4
13. Moral hazard3/8
Bhattacharya et al., chapter 11.
Rice & Unruh, pp.109-128.
Thomson, S., Schang, L., & Chernew, M. E. (2013). Value-based cost sharing in the United States and elsewhere can increase patients’ use of high-value goods and services. Health Affairs, 32(4), 704-712.
Background: Nyman J.A. (2004). Is 'moral hazard' inefficient? The policy implications of a new theory. Health Affairs 23(5):194-199.
14. Pharmaceuticals3/11
Bhattacharya et al., chapter 12.
Berndt, E. R., McGuire, T., & Newhouse, J. P. A Primer on the Economics of Prescription Pharmaceutical Pricing in Health Insurance Markets. In Forum for Health Economics & Policy (Vol. 14, No. 2, p. 10).
Outterson, K., Powers, J. H., Daniel, G. W., & McClellan, M. B. (2015). Repairing the broken market for antibiotic innovation. Health Affairs, 34(2), 277-285.
Berndt E.R., Donohue J.M. (2008). Direct to consumer advertising in health care: an overview of economic issues. In: Sloan FA, Kasper H; Incentives and choice in health care. MIT Press.
Background: Wood, A. J. (2006). A proposal for radical changes in the drug-approval process. New England Journal of Medicine, 355(6), 618-623.
15. Technology and the Price of Health Care3/15
Bhattacharya et al., chapter 13.
Rice and Unruh, chapter 10.2.
Chen, A., & Goldman, D. (2015). Health Care Spending: Historical Trends and New Directions (No. w21501). National Bureau of Economic Research.
Martin et al (2016) - see topic 1.
16. Cost-effectiveness analysis3/18
Bhattacharya et al., chapter 14.
Shepard D.S., Thompson A.S. (1979). First principles of cost-effectiveness analysis in health. Public Health Reports 94(6): 535-543.
Canning D. (2006). The economics of HIV/AIDS in low-income countries: the case for prevention.J Econ Perspectives 20(3):121-42.
Boelaert M., Van Damme W., Meessen B., Van der Stuyft P. (2002). The AIDS crisis, cost-effectiveness and academic activism. Trop Med Int Health 7(12):1001-2.
Kahn, J.G.., et al. "Cost-effectiveness of antiretroviral therapy for prevention." Current HIV research 9.6 (2011): 405.
Collier, P., Sterck, O., & Manning, R. (2015). The Moral and Fiscal Implications of Anti-Retroviral Therapies for HIV in Africa (No. WPS/2015-05). NBER.
17. Equity, efficiency and need3/22
Rice and Unruh, chapter 9: Equity and redistribution.
Folland et al., chapter 18.
Ubel P.A., Loewenstein G. (1996). Public perceptions of the importance of prognosis in allocating transplantable livers to children.Med Decis Making 16(3):234-41.
Macklin, R., & Cowan, E. (2012). Given financial constraints, it would be unethical to divert antiretroviral drugs from treatment to prevention. Health Affairs, 31(7), 1537-1544.
[No class on 3/25 –school vacation]
18. Health policy framework3/29
Bhattacharya et al., chapter 15.
Rice & Unruh, chapter 12.2.
Garber A.M., Skinner J. (2008). Is American Health Care Uniquely Inefficient? J Econ Perspectives 22(4): 27–50.
19. The Beveridge Model: Nationalized Health Care4/1
Bhattacharya et al., chapter 16..
Reynolds, L., Gerada, C., & McKee, M. (2012). Ditching the single-payer system in the national health service: how the English Department of Health is learning the wrong lessons from the United States. International Journal of Health Services, 42(3), 539-547.
Propper, C. (2012). Competition, incentives and the English NHS. Health economics, 21(1), 33-40.
Stabile, M., & Thomson, S. (2014). The changing role of government in financing health care: an international perspective. Journal of Economic Literature, 52(2), 480-518.
Background: Ellis, R. P., Chen, T., & Luscombe, C. E. (2013). Comparisons of Health Insurance Systems in Developed Countries. Encyclopedia of Health Economics; Culyer, AJ, Ed.; Elsevier: Amsterdam, The Netherlands.
20. The Bismarck Model: Social Health Insurance4/5
Bhattacharya et al., chapter 17.
Rice and Unruh chapter 12.1, 12.3.
Chernichovsky, D. (2013). Reforms are needed to increase public funding and curb demand for private care in Israel’s health system. Health Affairs, 32(4), 724-733.
van Ginneken, E., Swartz, K., & Van der Wees, P. (2013). Health insurance exchanges in Switzerland and the Netherlands offer five key lessons for the operations of US exchanges. Health Affairs, 32(4), 744-752.
21. The American Model4/8
Bhattacharya et al., chapter 18.
Brecher, C., & Rose, S. (2013). Medicaid's Next Metamorphosis. Public Administration Review, 73(s1), S60-S68.
Buchmueller, T., Carey, C., & Levy, H. G. (2013). Will employers drop health insurance coverage because of the affordable care act?. Health Affairs, 32(9), 1522-1530.
22. International comparison: Developing countries4/12
Mills A. health systems in low- and middle-income countries. In: Glied S, Smith PC (2011): The Oxford Handbook of Health Economics.
Bitrán R., Muñoz R., and Prieto L. "Health insurance and access to health services, health services use and health status in Peru." The Impact of Health Insurance in Low and Middle Income Countries (2011): 106-21.
Damrongplasit, K., & Melnick, G. (2015). Funding, Coverage, and Access Under Thailand’s Universal Health Insurance Program: An Update After Ten Years. Applied health economics and health policy, 13(2), 157-166.
23. The Economics of Health Externalities4/15
Bhattacharya et al., chapter 20.
Fogarty, J. J. (2012). Optimal alcohol taxes for Australia. In Forum for Health Economics & Policy (Vol. 15, No. 2).
24. Prospect Theory4/19
Bhattacharya et al., chapter 23.
Volpp, K., Loewenstein, G., & Asch, D. (2015). Behavioral economics and health. In: Glanz K, Rimer BK, Viswanath K (editors):Health Behavior: Theory, Research, and Practice, 5th Edition.
Review session4/21 (Thurs)
Final exam5/5 (Thurs)
1
10/6/2018