Health Economics: partim
Beutels
PART 1
WHAT IS ECONOMICS ABOUT?
Economics is about how the decisions made by individuals, firms and the government affect the way
in which resources are distributed in the achievement of goals (set by individuals, firms or society).
It is about how we deal with the problem of scarcity. …in a nutshell: The study of
choice
THE PROBLEM OF SCARCITY
When you make decisions, you set out a purpose for available resources. These can then not be used
for other things: problem of scarcity! You can have many resources but the general abundance is not
large enough to do everything you want to: study of choice & how to achieve goals using the
resources you have & what will the consequences be of these choices on the distribution of the
resources.
Most important: how to spend time, but also other resource allocations. In HC the resources to make
decisions for health care provision are determined by availability of medical staff, medication… A
common goals is to achieve good health in a population. That itself can also be defined in various
ways.
What is the value of health? Economic evaluation
Determinants of health Equity
Supply of health care Planning & budgeting -> These are the
Market main topics of the
Demand for health care
classes
DETERMINANTS OF HEALTH AND HEALTH PRODUCTION
WHAT DETERMINES GOOD HEALTH?
Health can be measured as:
Reduced mortality rates (~1/Life expectancy)
, Reduced morbidity
Reduced disability
Improved self-reported health status
It’s been shown that what people state about their own health is a good indicator for
how healthy they really are. It’s used quite often as an outcome.
A BRIEF HISTORY
In history, 2 main indicators have changed:
1. Life expectancy at birth (vertical)
2. General indicator of welfare (horizontal: GDP per
capita (= income of countries)
In the year 1800: these countries are all together and almost
no exceeds the 40 years.
Not a whole lot has changed: a little bit more expensive (more
on horizontal axis: more differences in welfare creation than
increases in life expectancy). Still most countries don’t exceed
50 years, but richer countries clearly show a higher life
expectancy -> linear trend developing.
When you move through time there are shocks happening:
pandemic influenza decreases life expectancy but they all
reverted to their original position. The relationship bt welfare
and life expectancy becomes more clearly.
The countries are all lifted up. Almost no countries have a life
expectancy below 50 years anymore.
Main explanations:
- Vaccines
- AB
- Safe water & sanitation
Decreased mortality, esp. in early life: preventing infectious
diseases from killing young people
Rich countries still get higher
life expectancy, poorer
countries lower.
W/O log scale. Steep rise at
beginning then from a
certain basic level of welfare
,(+-20.000) it becomes more straight: differences in welfare not correlated very well anymore in life
expectancy. Basic level of welfare: basic vaccination, access to healthcare, AB, sanitation… Countries
with high levels of welfare still have a low position in life expectancy (eg UAE). This can be because
the welfare is not well distributed in the population: needs to be accessible to all.
HIV had an enormous impact on life-expectancy in Sub-Saharan Africa
Shocks of which you see the results in 1975 – 2000.
most African countries and esp southern Africa were
heavily affected by the HIV pandemic. SA had high
levels of welfare but lower levels of life expectancy
than you would expect. The life expectancy was
increasing in the 1980’s until HIV transmission
started to cause a lot of AIDS: big impact on life
expectancy & family income: life expectancy
decreases enormously up to a point where ART
became available to poor countries as well.
Demographic & epidemiological transition
Occasional shocks can bring the life expectancy down:
famines, wars, pandemics. After this, the countries
usually revert to their original growth path because of
the basic welfare & capacity of the health care systems
that are still intact.
This shows the demographic & epidemiological
transition. 75 years later: same population but virtually completely replaced.
- In 1891: most people are young people. Also a huge part of deaths occur under the age of 5.
- In 1966: mortality in younger ages decreased enormously & is pushed back to the end of life.
This is called the demographic transition: we went from high birth rates & high death rates to
both rates low. Completely different structure of the population: various ages represented
Epidemiological transition because in 1891 the deaths were due to short-lived, acute diseases, while
in 1966 it was more due to chronic diseases. Had also to do with safe practice of medicine. In 1890 a
lot of doctors did not wash their hands: impact on the amount of child births that went wrong.
DETERMINANTS OF HEALTH
WHICH FACTORS DETERMINE THAT SOME PEOPLE ARE HEALTHIER THAN OTHERS?
1. AGE AND GENDER
Age is an obvious determinant of health but also the difference
between genders declines as people get older. This is because at
around 85 the ratio of men to women is 1:7 or 1:8, which means the
men at this age are dying of the same causes as the women. Men die
sooner than women because of external causes and risky behaviour.
, Almost everywhere higher than 1,
meaning men have a larger risk of dying. Men between 21-25 are
about 3X more likely to die than women of this age. One aspect is
related to suicide.
Some other graphs
Suicide by age & gender (Flanders) Suicide: Flanders vs. Europe
Traffic deaths by age & gender (Be) Traffic deaths per million inhabitants
Smoking has a delayed effect at population level
Main causes of death by age (Be, 2015)
Gender specific mortality (OECD)
1. Men are more often suicidal than women
2. Flanders (VL) has more female suicides but also more male suicides
3. Also more traffic deaths for men than women: getting better over time -> bc risk perception
Beutels
PART 1
WHAT IS ECONOMICS ABOUT?
Economics is about how the decisions made by individuals, firms and the government affect the way
in which resources are distributed in the achievement of goals (set by individuals, firms or society).
It is about how we deal with the problem of scarcity. …in a nutshell: The study of
choice
THE PROBLEM OF SCARCITY
When you make decisions, you set out a purpose for available resources. These can then not be used
for other things: problem of scarcity! You can have many resources but the general abundance is not
large enough to do everything you want to: study of choice & how to achieve goals using the
resources you have & what will the consequences be of these choices on the distribution of the
resources.
Most important: how to spend time, but also other resource allocations. In HC the resources to make
decisions for health care provision are determined by availability of medical staff, medication… A
common goals is to achieve good health in a population. That itself can also be defined in various
ways.
What is the value of health? Economic evaluation
Determinants of health Equity
Supply of health care Planning & budgeting -> These are the
Market main topics of the
Demand for health care
classes
DETERMINANTS OF HEALTH AND HEALTH PRODUCTION
WHAT DETERMINES GOOD HEALTH?
Health can be measured as:
Reduced mortality rates (~1/Life expectancy)
, Reduced morbidity
Reduced disability
Improved self-reported health status
It’s been shown that what people state about their own health is a good indicator for
how healthy they really are. It’s used quite often as an outcome.
A BRIEF HISTORY
In history, 2 main indicators have changed:
1. Life expectancy at birth (vertical)
2. General indicator of welfare (horizontal: GDP per
capita (= income of countries)
In the year 1800: these countries are all together and almost
no exceeds the 40 years.
Not a whole lot has changed: a little bit more expensive (more
on horizontal axis: more differences in welfare creation than
increases in life expectancy). Still most countries don’t exceed
50 years, but richer countries clearly show a higher life
expectancy -> linear trend developing.
When you move through time there are shocks happening:
pandemic influenza decreases life expectancy but they all
reverted to their original position. The relationship bt welfare
and life expectancy becomes more clearly.
The countries are all lifted up. Almost no countries have a life
expectancy below 50 years anymore.
Main explanations:
- Vaccines
- AB
- Safe water & sanitation
Decreased mortality, esp. in early life: preventing infectious
diseases from killing young people
Rich countries still get higher
life expectancy, poorer
countries lower.
W/O log scale. Steep rise at
beginning then from a
certain basic level of welfare
,(+-20.000) it becomes more straight: differences in welfare not correlated very well anymore in life
expectancy. Basic level of welfare: basic vaccination, access to healthcare, AB, sanitation… Countries
with high levels of welfare still have a low position in life expectancy (eg UAE). This can be because
the welfare is not well distributed in the population: needs to be accessible to all.
HIV had an enormous impact on life-expectancy in Sub-Saharan Africa
Shocks of which you see the results in 1975 – 2000.
most African countries and esp southern Africa were
heavily affected by the HIV pandemic. SA had high
levels of welfare but lower levels of life expectancy
than you would expect. The life expectancy was
increasing in the 1980’s until HIV transmission
started to cause a lot of AIDS: big impact on life
expectancy & family income: life expectancy
decreases enormously up to a point where ART
became available to poor countries as well.
Demographic & epidemiological transition
Occasional shocks can bring the life expectancy down:
famines, wars, pandemics. After this, the countries
usually revert to their original growth path because of
the basic welfare & capacity of the health care systems
that are still intact.
This shows the demographic & epidemiological
transition. 75 years later: same population but virtually completely replaced.
- In 1891: most people are young people. Also a huge part of deaths occur under the age of 5.
- In 1966: mortality in younger ages decreased enormously & is pushed back to the end of life.
This is called the demographic transition: we went from high birth rates & high death rates to
both rates low. Completely different structure of the population: various ages represented
Epidemiological transition because in 1891 the deaths were due to short-lived, acute diseases, while
in 1966 it was more due to chronic diseases. Had also to do with safe practice of medicine. In 1890 a
lot of doctors did not wash their hands: impact on the amount of child births that went wrong.
DETERMINANTS OF HEALTH
WHICH FACTORS DETERMINE THAT SOME PEOPLE ARE HEALTHIER THAN OTHERS?
1. AGE AND GENDER
Age is an obvious determinant of health but also the difference
between genders declines as people get older. This is because at
around 85 the ratio of men to women is 1:7 or 1:8, which means the
men at this age are dying of the same causes as the women. Men die
sooner than women because of external causes and risky behaviour.
, Almost everywhere higher than 1,
meaning men have a larger risk of dying. Men between 21-25 are
about 3X more likely to die than women of this age. One aspect is
related to suicide.
Some other graphs
Suicide by age & gender (Flanders) Suicide: Flanders vs. Europe
Traffic deaths by age & gender (Be) Traffic deaths per million inhabitants
Smoking has a delayed effect at population level
Main causes of death by age (Be, 2015)
Gender specific mortality (OECD)
1. Men are more often suicidal than women
2. Flanders (VL) has more female suicides but also more male suicides
3. Also more traffic deaths for men than women: getting better over time -> bc risk perception
