HEALTH ECONOMICS                                                                           

Econ., PHS, PA 548

Fall 2004; Tuesday 1-3:40

Professors:

John Mullahy   jmullahy@wisc.edu

Barbara Wolfe  bwolfe@wisc.edu

 

Office Hours: By appointment

 

 

Course Web Page: http://www.pophealth.wisc.edu/phs548/index.htm

 

Course Description: This is primarily a lecture course that provides a survey of leading issues in the microeconomics of health.  Health is conceptualized as a commodity that: is produced in a multivariate production setting (in which medical care is one among many determinants); is demanded by individuals as one contributor to welfare; and constrains individuals' consumption and labor supply behaviors.

 

Topics to be addressed include: measurement and production of health; demand for health insurances and health services; health care provider behavior; health care cost  containment; public sector health programs; health disparities; evaluation of health care; health technologies and regulations; disabilities; unhealthy behaviors and labor market considerations.

 

Prerequisites: Intermediate microeconomics (Econ 301, PA 880, PHS 877, etc.), or consent of instructor.

 

Requirements: Students are expected to read assigned materials, participate in and lead class discussions, participate in a small group project and successfully complete a final exam.

 

Grading:  10% general classroom participation; 10% weekly policy discussion leadership; 30% group project; 50% final exam.

 

Classroom Participation and Policy Discussion: Students are expected to participate in classroom discussions and also to lead once during the semester a policy-in-the-news discussion (to be described in detail at the first class meeting on Sept. 7).  Irregular class attendance will be counted against the classroom participation grade.

 

Group Project: Students will be assigned by the professors to a small group that will undertake a research project on a topic area chosen by the group from a set of topics provided by the professors.  Oral presentations of these research projects will take place during the last two sessions of the semester.  ALL members of the group will make oral presentations at this time.  The student's grade on this component is determined by their own presentation as well as on the overall quality of the group's presentation and materials -- presentation materials such as Powerpoint or related materials should be submitted as part of this component.

 

Group Project: Detailed Information

 

Final Exam: A comprehensive final exam

                   Sample Final Exam Questions from 2002

 


Semester Schedule

 

1.         Sept. 7              (Mullahy and Wolfe) Organizational; Measuring Health

 

2.         Sept. 14            (Mullahy) The Production of Health and Health Capital

 

3.         Sept. 21            (Mullahy) The Demand for Health Care

 

4.         Sept. 28            (Wolfe) The Demand for Health Insurance

 

5.         Oct. 5               (Wolfe) The Behavior of Health Care Providers

 

6.         Oct. 12             (Wolfe) Public Sector Programs for Health

 

7.         Oct. 19             (Mullahy and Wolfe) Strategies to Reduce Health Care Costs  combined cost containment lecture

 

8.         Oct. 26             (Mullahy and Wolfe) Strategies to Increase Insurance Coverage

 

9.         Nov. 2               (Mullahy) Health Care Technology and Regulation

 

10.        Nov. 9               (Mullahy) Evaluating Health Interventions and Programs

 

11.        Nov. 16             (Wolfe) Health Disparities

 

12.        Nov. 23             (Mullahy) Unhealthy Behaviors; Health and Labor Market Issues

 

13.        Nov. 30             (Wolfe) The Economics of Disabilities

 

14.        Dec. 7               Group project presentations

 

15.        Dec. 14             Group project presentations (continued)

 

 

 

BIBLIOGRAPHY (bold numbers in brackets correspond to above lecture sequence numbers)

 

 

JSTOR:                         www.jstor.org

UW Library:                   www.library.wisc.edu/journals/

NBER:                           www.nber.org


 

 

Arrow, K., "Uncertainty and the Welfare Economics of Medical Care," American Economic Review, December 1963, 53(5), pp. 941-973. [1] (good background reading.)

 

Baicker, Katherine and Douglas Staiger 2004. Fiscal Shenanigans, Targeted Federal Health Care Funds, And Patient Mortality. NBER Working Paper 10440. [6]

 

Baker, Michael, Mark Stabile, Catherine Deri. 2001. What do Self-Reported, Objective, Measures of Health Measure? NBER Working Paper No.w8419 (NBER) (Journal of Human Resources, forthcoming). [1]

 

Balsa, Ana L.  and Thomas G. McGuire. 2001  Statistical discrimination in health care, Journal of Health Economics Volume 20, Issue 6, (November) Pages 881-907. [8]

 

Bhattacharya, et al 2002. Disability Forecasts and Future Medicare Costs. Mimeo. [13].

 

Bitler, Marianne, Jonah Gelb, and Hilary Hoynes 2004. "Welfare Reform And Health" NBER Working Paper 10549. [6]

 

 

Blumberg, L.J., L.M. Nichols, and J.S. Banthin. 2001. "Worker Decisions to Purchase Health Insurance." International Journal of Health Care Finance and Economics 1: 305-325. [4]

 

Bound, John and Timothy Waidmann, "Disability Transfers and the Labor Force Attachment of Older Men: Evidence from the Historical Record," Quarterly Journal of Economics, 107(4),   November 1992, 1393-1419.  (JSTOR) [13]

 

Bound, John, "The Health and Earnings of Rejected Disability Insurance Applicants," American Economic Review, 79(3), June 1989, 482-503. (JSTOR) [13]

 

Brook, R.H., et al, "Does Free Care Improve Adults' Health? Results from a Controlled Trial of Cost Sharing in Health Insurance," N Engl J Med, December 8, 1983, 309, pp. 1426-1434. [3,4]

 

CMS. 2002. Program Information. [6]

 

Currie, J. and Gruber, J., Public health insurance and medical treatment: the equalizing impact of the Medicaid expansions  Journal of Public Economics, Oct 2001, 63-89. [6]

 

Cutler, D.M., E.L. Glaeser, and J.M. Shapiro. 2003. "Why Have Americans Become More Obese?" Journal of Economic Perspectives 17: 93-118 [2,12]

 

Cutler, DM Robert S. Huckman, and Mary Beth Landrum  2004 The Role of Information in Medical Markets: An Analysis of Publicly Reported Outcomes in Cardiac Surgery NBER working Paper #10489. [5]

 

Cutler D.M. and M. McClellan. 2001. "Is technological change in medicine worth it?" Health Affairs 20: 11-29. [6,7,9,10]

 

Cutler, D. and Reber, S. “Paying for Health Insurance: The Tradeoff Between Competition and Adverse Selection,” Quarterly Journal of Economics, May 1998. [4]

 

Cutler, D 2002. Employee Costs And The Decline In Health Insurance Coverage Harvard University and National Bureau of Economic Research.  [4]

 

Cutler, D. M. and E. Richardson. 1997. "Measuring the Health of the United States Population." Brookings Papers on Economic Activity: Microeconomics: 217-282. (JSTOR) [1]

 

Danzon, P.M. and L.-W. Chao. 2000. "Does Regulation Drive out Competition in Pharmaceutical Markets?" Journal of Law and Economics 43: 311-357. [9]

 

Deaton, Angus, and Darren Lubotsky. 2002. “Mortality, Inequality and Race in American Cities and States.” Center for Health and Well-Being. Princeton University. [11]

Deaton, Angus. 2002. Policy Implications Of The Gradient Of Health And Wealth. Health Affairs March/April. [11]

 

P. DeCicca, D. Kenkel, and A. Mathios. 2002. "Putting Out the Fires: Will Higher Taxes Reduce the Onset of Youth Smoking?" Journal of Political Economy 110:144-169. [12] 

 

De Jaegher, K.and Jegers, M., 2000 A model of physician behaviour with demand inducement. Journal of Health Economics, Mar 2000 231-258. [5]

 

de Jong, Philip, Robert Haveman, and Barbara Wolfe. 1991. Disability Transfers and the Work Decision of Older Men” Quarterly Journal of Economics, 939–949. August, 1991.(JSTOR) [13]

 

Dranove, D. and D. Meltzer. 1994. "Do Important Drugs Reach the Market Sooner?" Rand Journal of Economics 25: 402-423. (JSTOR) [9]

 


Dranove, D., Daniel Kessler, Mark McClellan, Mark Satterthwaite. 2002. Is More Information Better? The Effects of 'Report Cards' on Health Care Providers. Journal of Political Economy 111: 555-588. [5]

 

Dranove D., Spier K.E., and Baker L.  2000.  ‘Competition’ Among Employers Offering Health Insurance.  Journal of Health Economics 19(1):121-140. [4]

 

Duckett, S. 2004 Drug Policy Down Under: Australia’s Pharmaceutical Benefits Scheme. Health Care Financing Review/Spring 2004/Volume 25, Number 3. [7]

 

Ellis, R.P. 1989. "Employee Choice of Health Insurance." Review of Economics and Statistics 71: 215-23. (JSTOR) [4]

 

Ellis, R.P. 1998. "Creaming, Skimping and Dumping: Provider Competition on the Intensive and extensive Margins." Journal of Health Economics 17(5): 537-555. [5]

 

Ellis, R.P. and T.G. McGuire. 1996. "Hospital Response to Prospective Payment: Moral Hazard, Selection, and Practice-Style Effects," Journal of Health Economics 15: 257-77. [5]

 

Ettner, Susan L. 1996. "New Evidence on the Relationship between Income and Health." Journal of Health Economics 15: 67–86. [11]

 

Farrell, P. and V.R. Fuchs. 1982. "Schooling and Health: The Cigarette Connection," Journal of Health Economics: 217-230. [2,12]

 

Fryback, D.G. 1998. Methodological Issues in Measuring Health Status and Health-Related Quality of Life. in M.J. Field and M.R. Gold, Eds. Summarizing Population Health: Directions for the Development and Application of Population Metrics.  Washington: IOM.[1]

 

Garber, Alan. 2004. Cost-Effectiveness And Evidence Evaluation As Criteria For Coverage Policy. Health Affairs. 19 May 2004. [7,10]

 

Garrett, B. 2004. Employer-Sponsored Health Insurance Coverage: Sponsorship, Eligibility, and Participation Patterns in 2001. Kaiser Commission.[4,8]

 

Glazer, J. and T.G. McGuire. 2000. "Optimal Risk Adjustment in Markets with Adverse Selection: An Application to Managed Care." American Economic Review 90: 1055-1071. [6]

 

Glied, S. and J.G. Zivin. 2002. "How Do Doctors Behave When Some (but Not All) of Their Patients Are in Managed Care?" Journal of Health Economics 21: 337-353. [5]

 

Glied, S. 1999. "Managed Care." NBER Working Paper 7205. (NBER) [5]

 

Groenveld, P.W. et al. 2001. Cost-effectiveness of Automated External Defibrillators on Airlines. JAMA. 2001;286:1482-1489. [10]

 

Grossman, M.  1972. "On the Concept of Health Capital and the Demand for Health," Journal of Political Economy 80: 223-55. [2]

 

Gruber, J. 2002. "Taxes and Health Insurance." in J.M. Poterba, ed. Tax Policy and the Economy, Vol. 16. Cambridge, MA: MIT Press (Working paper version is NBER w.p. 8657, 2001). (NBER). [4]

 

Gruber J, and Owings M 1996. Physician financial incentives and cesarean section delivery. Rand J Econ Spring 27:99-123. [5]

 

Gruber J., and Poterba J.  1994.  Tax Incentives and the Decision to Purchase Health Insurance: Evidence from the Self-Employed.  Quarterly Journal of Economics, August, 701-733. (JSTOR) [4]

 

Hadley, J. and Holohan, J.  2004. The Cost Of Care For The Uninsured: What Do We Spend, Who Pays, And What Would Full Coverage Add To Medical Spending? Prepared for the Kaiser Commission on Medicaid and the Uninsured May 10, 2004. [8]

 

Hadley, J. and J.M. Mitchell. 2002. "The Growth of Managed Care and Changes in Physicians' Incomes, Autonomy, and Satisfaction, 1991–1997." International Journal of Health Care Finance and Economics 2: 37-50. [5]

 

Harris, J. 1977.  "The Internal Organization of Hospitals: Some Economic Implications" Bell Journal of Economics 8: 467-482. (JSTOR) [5]

 


Haveman R. and B. Wolfe 2001. The Economics of Disability and Disability Policy IRP RPT 816 Handbook of Health Economics, Volume 1A, ed. A. Culyer and J. Newhouse [Amsterdam: North-Holland, pp. 995–1051. [13]

 

Haveman R., P. De Jong and B. Wolfe. 1991. "Disability Transfers and the Work Decisions of Older Men" Quarterly Journal of Economics 106: 3. 939-949. [13]

 

Heffler, S. et al Health Spending Projections Through 2013. Health Affairs. Web Exclusive W4-79. [1,7,8]

 

Hill, S.C.and Wolfe, B.L. 1997. "Testing the HMO competitive strategy: An analysis of its impact on medical care resources." Journal of Health Economics, Jun 1997. [5]

 

Himmelstein, D.U., Woolhandler, S., Hellander, I., Wolfe, S.M., "Quality of Care in Investor-Owned vs Not-for-Profit HMOs," JAMA.July 14, 1999, 282:159-163. [5]

 

Johannesson, M. et al. 1996. "Outcome Measurement in Economic Evaluation." Health Economics 5: 279-296. [1]

 

Kessler, Daniel and Mark McClellan 2002. Malpractice law and health care reform: optimal liability policy in an era of managed care. Journal of Public Economics. Volume 84, Issue 2. May Pages 175-197. [5]

 

Kenkel, D. 1990. "Consumer Health Information and the Demand for Medical Care." Review of Economics and Statistics 72: 587-595. [2,3]

 

Kenkel, D. and J.V. Terza. 2001. "The Effect of Physician Advice on Alcohol Consumption: Count Regression with an Endogenous Treatment."  Journal of Applied Econometrics 16: 165-184. [2,3]

 

Kessler, D. and M. McClellan.  1996.  "Do Doctors Practice Defensive  Medicine?" Quarterly Journal of Economics 111(2): 353-90.(JSTOR) [5]

 

K. G. Manton and X. Gu From the Cover: Changes in the prevalence of chronic disability in the United States black and nonblack population above age 65 from 1982 to 1999 PNAS, May 22, 2001; 98(11): 6354 - 6359. [PDF]

 

Lakdawalla, D. and T. Philipson. 2002. "The Growth of Obesity and Technological Change: A Theoretical and Empirical Examination." NBER Working Paper w8946. (NBER) [12]

 

Lichtenberg, F.R. 2002. "Sources of U.S. Longevity Increase, 1960-1997" NBER Working Paper No.w8755 (NBER) [2] 

 

Manning, W.G., et al, "Health Insurance and the Demand for Medical Care," American Economic Review, June 1987, 77:251-277. [3,4]

 

May, Jessica H And Peter J. Cunningham 2004. Tough Trade-Offs: Medical Bills, Family Finances And Access To Care.  Issue Brief, Findings From Health Systems Change. June. [11]

 

Mayer, T.R., and Mayer, G.G., "HMOs: Origins and Development" N Engl J Med, February 28, 1985, 312, pp. 590-594. [6] (history of beginnings of managed care)

 

McClellan, M., B.J. McNeil, and J.P. Newhouse. 1994. "Does More Intensive Treatment of Acute Myocardial Infarction in the Elderly Reduce Mortality? Analysis Using Instrumental Variables. JAMA 272: 859-66, 1994. [10]

 

Meara, Ellen. Chapin White, and David M. Cutler 2004.  Trends In Medical Spending By Age, 1963–2000. Health Affairs. July/August. [1]

 

Meltzer, D. 1997. "Accounting for Future Costs in Medical Cost-Effectiveness Analysis." Journal  of Health Economics 16: 33-64. [10]

 

Meltzer, D. 2001. "Addressing Uncertainty in Medical Cost-Effectiveness Analysis: Implications of Expected Utility Maximization for Methods to Perform Sensitivity Analysis and the Use of Cost-Effectiveness Analysis to Set Priorities for Medical Research." Journal of Health Economics 20: 109-29. [10]

 

Milliman. 2004 Health Savings Accounts, Health FSAs, and HRAs. [7]

 

Mills, Robert. 2001 Health Insurance Coverage: 2000 Current Population Reports. P60-215. US Bureau of the Census.  [4]

 

Mitchell, J.M.and Sass, T.R., Physician ownership of ancillary services: Indirect demand inducement or quality assurance? Journal of Health Economics, Aug 1995, vol 14.  Pages 263-289. [5]

 

Mullahy, J. 2004. "Introduction to Symposium on the Demand for Health and Health Capital" (including papers by M. Grossman, R. Michael, V. Fuchs, A. Leibowitz, T.P. Schultz). Journal of Health Economics (forthcoming). [2]

 


Mullahy, J. and J.L. Sindelar. 1993. "Alcoholism, Work, and Income." Journal of Labor Economics 11: 494-520. [12]

 

Mullahy, J. S. Robert, and B. Wolfe. 2004. "Health, Income, and Inequality." Ch. 13 in K. Neckerman, ed. Social Inequality. New York: Russell Sage Foundation. [11]

 

Mullahy J. and B. Wolfe. 2002. “Health Policies for the Nonelderly Poor.”in Understanding Poverty. Edited by S.Danziger and R. Haveman. Cambridge MA: Harvard University Press. [6]

 

Murray C.J.L. and A.K. Acharya. 1997. "Understanding DALYs." Journal of Health Economics.  1997  16(6): 703-730.  [1]

 

Newhouse J.P. and C.E. Phelps. "New Estimates of Price and Income Elasticities of Medical Care Services" in Richard Rosett, ed., The Role of Health Insurance in the Health Services Sector, New York: Neal Watson, 1976 [4] (classic)

 

Newhouse, J.P. 1998. "Risk Adjustment: Where Are We Now?" Inquiry 35: 122-31. [6,7]

 

Newhouse, JP 2001. Medicare Policy in the 1990s. NBER Working Paper 8531 (NBER) [6]

 

Nicholson, Sean and David Song. 2001. "The incentive effects of the Medicare indirect medical education policy." Journal of Health Economics, Nov 2001. [5]

 

Nyman, John A. 1999. "The Economics of Moral Hazard Revisited." Journal of Health Economics 18(6): 811-824. [4]

 

Nyman, J.A., 2001. The income transfer effect, the access value of insurance and the Rand health insurance experiment. Journal of Health Economics 20, 295–298.[4]

 

Pattison, R.V., and Katz, H.M., "Investor-Owned and Not-for-Profit Hospitals:  A Comparison Based on California Data," N Engl J Med, August 11, 1983, 309, pp. 347-353. [5]

 

Pauly, M.V. 1986. "Taxation, Health Insurance, and Market Failure in the Medical Economy," Journal of Economic Literature 24: 629-75. (JSTOR)  [4]

 

Pauly, M.V. and Herring, B.J., "An efficient employer strategy for dealing with adverse selection in multiple-plan offerings: an MSA example." Journal of Health Economics, Jul 2000. [7]

 

Peltzman, S. 1973. "An Evaluation of Consumer Protection Legislation: The 1962 Drug Amendments," Journal of Political Economy  81: 1049-91. [9]

 

Peltzman, S. 1975. "The Effects of Automobile Safety Regulation."Journal of Political Economy 83: 677-726. [9]

 

Phelps, C.E. 1997. "Good Technologies Gone Bad: How and Why the Cost-Effectiveness of a Medical Intervention Changes for Different Populations." Medical Decision Making 17: 107-117. [10]

 

Philipson, T. 1995. "The Welfare Loss of Disease and the Theory of Taxation," Journal of Health Economics 14: 387-95. [10]

 

Pohlmeier, W. and V. Ulrich. 1995. "An Econometric Model of the Two-Part Decisionmaking Process in the Demand for Health Care." Journal of Human Resources 30: 339-361. [3]

Richard G. Frank,  and Thomas G. McGuire  1999. Economics and Mental Health. NBER Working Paper No. w7052 March 1999

 

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Santos Silva, João M.C., and Frank Windmeijer, "Two-part multiple spell models for health care demand." Journal of Econometrics. Volume 104, Issue 1. August 2001, Pages 67-89. [3]

 

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Sheils, John and Randall Haught. 2004. The Cost Of Tax-Exempt Health Benefits In 2004. Health Affairs. [4]

 

Short, A. Glen Mays and Jessica Mittler. 2004. Disease Management: Issue Brief Findings from HSC. [7]

 

Smith, J.P. 1999. "Healthy Bodies and Thick Wallets: The Dual Relation between Health and Economic Status." Journal of Economic Perspectives 13: 145-166. [8,10]

 

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Sturm, R. 2002. "The effects of obesity, smoking, and drinking on medical problems and costs." Health Affairs 21: 245ff. [10,12]

 

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Swartz K, Garnick DW Adverse selection and price sensitivity when low-income people have subsidies to purchase health insurance in the private market. Inquiry 2000 Spring 37:45-60. [4]

 

Vanness, D. and B. Wolfe “Government Mandates and Employer-Sponsored Health Insurance: Who Is Still Not Covered?” International Journal of Health Care Finance and Economics, 2 (2) 99_135 June, 2002. [4]

 

Vistnes, J., P. Cooper and Vistnes. 2001. “Employer Contribution Methods and Health Insurance Premiums” International Journal of Health Care Finance and Economics [7]

 

Wagstaff, Adam, and Eddy van Doorslaer. 2000. “Income Inequality and Health: What Does the Literature Tell Us? Annual Review of Public Health 21: 543–67. [11]

Ware, J.E., Bayliss, M.S., Rogers, W.H., Kosinski, M., Tarlov, A.R., "Differences in 4-Year Health Outcomes for elderly and Poor, Chronically Ill Patients treated in HMO and Fee-for-Service Systems," JAMA, October 2, 1996, 276(13), pp. 1037-1047. [2,4]