Gezondheidseconomie
Inhoud
Hoofdstuk 1: introductie.........................................................................................................................5
Economie............................................................................................................................................5
Scarcity...........................................................................................................................................5
Opportunity cost.................................................................................................................................5
The production process......................................................................................................................6
Productivity growth over time........................................................................................................6
Economic growth over time............................................................................................................7
The living standard of people around the worl...............................................................................7
Life satisfaction and income............................................................................................................7
Positive vs. Normative economics...................................................................................................8
Gezondheidseconomie.......................................................................................................................8
Wat is gezondheid?.........................................................................................................................9
Waarom is gezondheid belangrijk?.................................................................................................9
Determinanten van ill-health........................................................................................................10
Levensverwachting.......................................................................................................................10
Healthy life expectancy (HALE).........................................................................................................11
Hoeveel geld spenderen we aan gezondheidszorg...........................................................................12
Wat is gezondheidszorg?..................................................................................................................12
Gezondheidszorg altijd een vorm van ‘preventie’?.......................................................................13
Wrm zijn gezondheidszorgkosten aan het stijgen?.......................................................................13
Hoofdstuk 2: markets...........................................................................................................................15
Supply, demand & ‘the market’........................................................................................................15
Utility functions................................................................................................................................16
Hoe gedragen consumenten zich?................................................................................................16
Relatie tussen units consumed and utility....................................................................................16
Indifference curves...........................................................................................................................17
Substituting consumption.............................................................................................................17
Vraagcurve........................................................................................................................................17
Consumer surplus.........................................................................................................................18
Prijselasticiteit en vraag....................................................................................................................18
Prijselasticiteit en vraag om alcohol.............................................................................................19
Productiefuncties..............................................................................................................................20
Hoe gedragen producenten zich?.................................................................................................20
1
, Relatie tussen input factor en output...........................................................................................20
Isoquants..........................................................................................................................................20
Substituting production factors....................................................................................................20
Aanbodscurve...................................................................................................................................21
Producer surplus...........................................................................................................................21
Prijselasticiteit van aanbod...............................................................................................................21
Vraag en aanbod in actie: de market equilibrium.............................................................................22
Welvaart analyse..........................................................................................................................23
Maximum price.............................................................................................................................24
Minimum price.............................................................................................................................24
Een taks........................................................................................................................................25
Een subsidie..................................................................................................................................25
De 'eerste fundamentele stelling van de welvaartseconomie..........................................................25
Voorwaarden voor een ‘perfecte’ markt...........................................................................................26
Probleem 1: Asymmetrische informatie en de relatie tussen het agentschap..............................26
Probleem 2: ‘externalities’............................................................................................................28
Rol van ‘de markt’ in gezondheidszorg..............................................................................................28
Ethiek en bilijkheid...........................................................................................................................28
The efficiency-equity trade-off......................................................................................................29
Ethisch probleem 1: ‘rule of rescue’.............................................................................................29
Ethisch probleem 2: health equity................................................................................................30
Recht tot gezondheid....................................................................................................................30
Equity................................................................................................................................................31
Samengevat......................................................................................................................................31
Hoofdstuk 3: financing healthcare........................................................................................................32
Gezondheidsdriehoek.......................................................................................................................32
Privé en publiek provision en financiering........................................................................................32
Bronnen van gezondheidszorg financiering..................................................................................33
Gebruikersbijdrage...........................................................................................................................33
Directe gebruikersbijdrage............................................................................................................33
Indirecte gebruikersbijdrage.........................................................................................................35
Protectie schema’s........................................................................................................................35
4 goede redenen om gebruiksrechten in te voeren......................................................................35
The RAND health insurance experiment...........................................................................................36
Resultaten: impact op gezondheidszorg vraag..............................................................................36
Resultaten: impact op de kosten...................................................................................................37
2
, Kernpunten mbt het gebruik van gebruiksrechten...........................................................................37
Rol voor op waarde gebaseerde gebruikskosten..........................................................................37
Informele betalingen........................................................................................................................38
In EU.............................................................................................................................................38
Medische spaarrekeningen...............................................................................................................39
Verdeling van de zorguitgaven......................................................................................................40
Gezondheidsverzekering...................................................................................................................40
Risico aversie en rationele keuze..................................................................................................41
Zou je een gezondheidsverzekering betalen?...............................................................................41
De ‘welvaartswinst’ van verzekeringen.............................................................................................42
Verzekeringsprobleem 1: ‘moral hazard’......................................................................................42
Verzekeringsprobleem 2: adverse selection..................................................................................44
Bismarck vs beveridge......................................................................................................................46
Verzekeringsdekking.........................................................................................................................47
Les samengevat................................................................................................................................47
Hoofstuk 4: paying providers................................................................................................................48
Informatie-asymmetrie: het probleem van de duale agentschappen...............................................48
..........................................................................................................................................................48
2 extreme modellen.........................................................................................................................49
A. Individual caregivers.....................................................................................................................50
Fee for service..............................................................................................................................50
Capitation.....................................................................................................................................52
B. Institutional providers...................................................................................................................54
P4P................................................................................................................................................55
Conclusie P4P...............................................................................................................................60
Stimulerende aanbieders..............................................................................................................60
Hoofdstuk 5: priority-setting and cost-effectiveness.............................................................................61
View 1: the sanctity of human life................................................................................................61
View 2: opportunity cost...............................................................................................................62
Definiëren van een (economische) evaluatie................................................................................63
Wat zijn kosten?............................................................................................................................64
Perspectieven bepalen welke kost telt..........................................................................................64
Relevante kostcategorieën............................................................................................................65
Het meten van productiviteitskosten: 2 componenten van betaalde arbeid................................66
Waardering van onbetaalde arbeid..............................................................................................67
Gezondheidsuitkomsten...................................................................................................................69
3
, Cost-effectiveness analysis................................................................................................................69
Natuurlijke eenheden: niet-monetair, niet-preferentie.................................................................69
Cost-effectiveness analyse (CEA)...................................................................................................69
Cost-utility analysis...........................................................................................................................70
QALY’s: niet-monetair, op basis van voorkeuren...........................................................................70
Quality-adjusted life-years............................................................................................................70
EQ-5D vragenlijst..........................................................................................................................70
Cost-benefit analysis.........................................................................................................................71
Monetary preference-based outcomes........................................................................................71
‘revealed’ preferences..................................................................................................................72
Stated preferences........................................................................................................................72
Calculeren en interpreteren van ratio’s............................................................................................72
Thresholds....................................................................................................................................73
ICER thresholds used in some countries.......................................................................................73
Supply-side thresholds..................................................................................................................73
Supply-side thresholds: estimates for the NHs.............................................................................75
Ethische principes voor de toewijzing van middelen........................................................................75
Probleem 1: priority tot he worst-off............................................................................................75
Probleem 2: prioriteit aan de ziekten...........................................................................................75
Probleem 3: persoonlijke verantwoordelijkheid...........................................................................76
Probleem 4: ‘ageism’ en gelijke kansen........................................................................................76
4
Inhoud
Hoofdstuk 1: introductie.........................................................................................................................5
Economie............................................................................................................................................5
Scarcity...........................................................................................................................................5
Opportunity cost.................................................................................................................................5
The production process......................................................................................................................6
Productivity growth over time........................................................................................................6
Economic growth over time............................................................................................................7
The living standard of people around the worl...............................................................................7
Life satisfaction and income............................................................................................................7
Positive vs. Normative economics...................................................................................................8
Gezondheidseconomie.......................................................................................................................8
Wat is gezondheid?.........................................................................................................................9
Waarom is gezondheid belangrijk?.................................................................................................9
Determinanten van ill-health........................................................................................................10
Levensverwachting.......................................................................................................................10
Healthy life expectancy (HALE).........................................................................................................11
Hoeveel geld spenderen we aan gezondheidszorg...........................................................................12
Wat is gezondheidszorg?..................................................................................................................12
Gezondheidszorg altijd een vorm van ‘preventie’?.......................................................................13
Wrm zijn gezondheidszorgkosten aan het stijgen?.......................................................................13
Hoofdstuk 2: markets...........................................................................................................................15
Supply, demand & ‘the market’........................................................................................................15
Utility functions................................................................................................................................16
Hoe gedragen consumenten zich?................................................................................................16
Relatie tussen units consumed and utility....................................................................................16
Indifference curves...........................................................................................................................17
Substituting consumption.............................................................................................................17
Vraagcurve........................................................................................................................................17
Consumer surplus.........................................................................................................................18
Prijselasticiteit en vraag....................................................................................................................18
Prijselasticiteit en vraag om alcohol.............................................................................................19
Productiefuncties..............................................................................................................................20
Hoe gedragen producenten zich?.................................................................................................20
1
, Relatie tussen input factor en output...........................................................................................20
Isoquants..........................................................................................................................................20
Substituting production factors....................................................................................................20
Aanbodscurve...................................................................................................................................21
Producer surplus...........................................................................................................................21
Prijselasticiteit van aanbod...............................................................................................................21
Vraag en aanbod in actie: de market equilibrium.............................................................................22
Welvaart analyse..........................................................................................................................23
Maximum price.............................................................................................................................24
Minimum price.............................................................................................................................24
Een taks........................................................................................................................................25
Een subsidie..................................................................................................................................25
De 'eerste fundamentele stelling van de welvaartseconomie..........................................................25
Voorwaarden voor een ‘perfecte’ markt...........................................................................................26
Probleem 1: Asymmetrische informatie en de relatie tussen het agentschap..............................26
Probleem 2: ‘externalities’............................................................................................................28
Rol van ‘de markt’ in gezondheidszorg..............................................................................................28
Ethiek en bilijkheid...........................................................................................................................28
The efficiency-equity trade-off......................................................................................................29
Ethisch probleem 1: ‘rule of rescue’.............................................................................................29
Ethisch probleem 2: health equity................................................................................................30
Recht tot gezondheid....................................................................................................................30
Equity................................................................................................................................................31
Samengevat......................................................................................................................................31
Hoofdstuk 3: financing healthcare........................................................................................................32
Gezondheidsdriehoek.......................................................................................................................32
Privé en publiek provision en financiering........................................................................................32
Bronnen van gezondheidszorg financiering..................................................................................33
Gebruikersbijdrage...........................................................................................................................33
Directe gebruikersbijdrage............................................................................................................33
Indirecte gebruikersbijdrage.........................................................................................................35
Protectie schema’s........................................................................................................................35
4 goede redenen om gebruiksrechten in te voeren......................................................................35
The RAND health insurance experiment...........................................................................................36
Resultaten: impact op gezondheidszorg vraag..............................................................................36
Resultaten: impact op de kosten...................................................................................................37
2
, Kernpunten mbt het gebruik van gebruiksrechten...........................................................................37
Rol voor op waarde gebaseerde gebruikskosten..........................................................................37
Informele betalingen........................................................................................................................38
In EU.............................................................................................................................................38
Medische spaarrekeningen...............................................................................................................39
Verdeling van de zorguitgaven......................................................................................................40
Gezondheidsverzekering...................................................................................................................40
Risico aversie en rationele keuze..................................................................................................41
Zou je een gezondheidsverzekering betalen?...............................................................................41
De ‘welvaartswinst’ van verzekeringen.............................................................................................42
Verzekeringsprobleem 1: ‘moral hazard’......................................................................................42
Verzekeringsprobleem 2: adverse selection..................................................................................44
Bismarck vs beveridge......................................................................................................................46
Verzekeringsdekking.........................................................................................................................47
Les samengevat................................................................................................................................47
Hoofstuk 4: paying providers................................................................................................................48
Informatie-asymmetrie: het probleem van de duale agentschappen...............................................48
..........................................................................................................................................................48
2 extreme modellen.........................................................................................................................49
A. Individual caregivers.....................................................................................................................50
Fee for service..............................................................................................................................50
Capitation.....................................................................................................................................52
B. Institutional providers...................................................................................................................54
P4P................................................................................................................................................55
Conclusie P4P...............................................................................................................................60
Stimulerende aanbieders..............................................................................................................60
Hoofdstuk 5: priority-setting and cost-effectiveness.............................................................................61
View 1: the sanctity of human life................................................................................................61
View 2: opportunity cost...............................................................................................................62
Definiëren van een (economische) evaluatie................................................................................63
Wat zijn kosten?............................................................................................................................64
Perspectieven bepalen welke kost telt..........................................................................................64
Relevante kostcategorieën............................................................................................................65
Het meten van productiviteitskosten: 2 componenten van betaalde arbeid................................66
Waardering van onbetaalde arbeid..............................................................................................67
Gezondheidsuitkomsten...................................................................................................................69
3
, Cost-effectiveness analysis................................................................................................................69
Natuurlijke eenheden: niet-monetair, niet-preferentie.................................................................69
Cost-effectiveness analyse (CEA)...................................................................................................69
Cost-utility analysis...........................................................................................................................70
QALY’s: niet-monetair, op basis van voorkeuren...........................................................................70
Quality-adjusted life-years............................................................................................................70
EQ-5D vragenlijst..........................................................................................................................70
Cost-benefit analysis.........................................................................................................................71
Monetary preference-based outcomes........................................................................................71
‘revealed’ preferences..................................................................................................................72
Stated preferences........................................................................................................................72
Calculeren en interpreteren van ratio’s............................................................................................72
Thresholds....................................................................................................................................73
ICER thresholds used in some countries.......................................................................................73
Supply-side thresholds..................................................................................................................73
Supply-side thresholds: estimates for the NHs.............................................................................75
Ethische principes voor de toewijzing van middelen........................................................................75
Probleem 1: priority tot he worst-off............................................................................................75
Probleem 2: prioriteit aan de ziekten...........................................................................................75
Probleem 3: persoonlijke verantwoordelijkheid...........................................................................76
Probleem 4: ‘ageism’ en gelijke kansen........................................................................................76
4
