Is ‘Moral Hazard’ Inefficient? The Policy Implications Of A New Theory. By John A. Nyman
ABSTRACT: “Moral hazard” refers to the additional health care that is purchased when persons become insured. Under conventional theory, health economists regard these additional health care purchases as inefficient because they represent care that is worth less to consumers than it costs to produce. A new theory, however, suggests that much of moral hazard is actually efficient. When the care that was deemed to be welfare-decreasing is reclassified as welfare-increasing, health insurance becomes much more valuable to consumers than health economists have hitherto thought it was. As a result, there is a new argument for national health insurance: efficiency. Download full article »»»
Inequalities in access to medical care by income in developed countries. By Eddy van Doorslaer
Background: Most of the member countries of the Organization
for Economic Cooperation and Development (OECD)
aim to ensure equitable access to health care. This is often
interpreted as requiring that care be available on the basis of
need and not willingness or ability to pay. We sought to examine
equity in physician utilization in 21 OECD countries
for the year 2000.
Methods: Using data from national surveys or from the European Community Household Panel, we extracted the number of visits to a general practitioner or medical specialist over the previous 12 months. Visits were standardized for need differences using age, sex and reported health levels as proxies. We measured inequity in doctor utilization by income using concentration indices of the need-standardized use.
Results: We found inequity in physician utilization favouring patients who are better off in about half of the OECD countries studied. The degree of pro-rich inequity in doctor use is highest in the United States and Mexico, followed by Finland, Portugal and Sweden. In most countries, we found no evidence of inequity in the distribution of general practitioner visits across income groups, and where it does occur, it often indicates a pro-poor distribution. However, in all countries for which data are available, after controlling for need differences, people with higher incomes are significantly more likely to see a specialist than people with lower incomes and, in most countries, also more frequently. Pro-rich inequity is especially large in Portugal, Finland and Ireland.
Interpretation: Although in most OECD countries general practitioner care is distributed fairly equally and is often even pro-poor, the very pro-rich distribution of specialist care tends to make total doctor utilization somewhat pro-rich. This phenomenon appears to be universal, but it is reinforced when private insurance or private care options are offered...Download full article »»»
for Economic Cooperation and Development (OECD)
aim to ensure equitable access to health care. This is often
interpreted as requiring that care be available on the basis of
need and not willingness or ability to pay. We sought to examine
equity in physician utilization in 21 OECD countries
for the year 2000.
Methods: Using data from national surveys or from the European Community Household Panel, we extracted the number of visits to a general practitioner or medical specialist over the previous 12 months. Visits were standardized for need differences using age, sex and reported health levels as proxies. We measured inequity in doctor utilization by income using concentration indices of the need-standardized use.
Results: We found inequity in physician utilization favouring patients who are better off in about half of the OECD countries studied. The degree of pro-rich inequity in doctor use is highest in the United States and Mexico, followed by Finland, Portugal and Sweden. In most countries, we found no evidence of inequity in the distribution of general practitioner visits across income groups, and where it does occur, it often indicates a pro-poor distribution. However, in all countries for which data are available, after controlling for need differences, people with higher incomes are significantly more likely to see a specialist than people with lower incomes and, in most countries, also more frequently. Pro-rich inequity is especially large in Portugal, Finland and Ireland.
Interpretation: Although in most OECD countries general practitioner care is distributed fairly equally and is often even pro-poor, the very pro-rich distribution of specialist care tends to make total doctor utilization somewhat pro-rich. This phenomenon appears to be universal, but it is reinforced when private insurance or private care options are offered...Download full article »»»
Reflections on the Meaning of Efficiency: Can Efficiency Be Separated from Equity? By Uwe E. Reinhardt*
The word efficiency has taken on a powerful role in the current debate on health policy and, indeed, in public policy in general. It is widely taken for granted that an efficient approach is ispo facto superior to an inefficient one. The fastest way to eliminate a rival policy from the field is simply to brand it inefficient Usually, the involvement of government in the implementation of a policy is taken as prima facie evidence of inherent inefficiency. Read more »»»
Make-Work and the G.D.P. By UWE E. REINHARDT
Uwe E. Reinhardt is an economics professor at Princeton. He has some financial interests in
the health care field.
Suppose some evening a group of bored and mischievous teenagers slash tires on a number of
cars in the parking lot of a shopping center. Distraught car owners call sundry nearby garages to
send someone to fix the damage on the spot or tow the cars in for repairs. That work is speedily
done, and the cars are ready for use again. The car owners pay the garage owners sizable repair
bills.
This fictitious event leads to a number of questions:
1. Did the garages deliver value to the car owners?
2. Was gross domestic product increased or decreased?
3. Were the car owners better off, after paying the repair bill?
Today’s Economist
Perspectives from expert contributors.
My answer to the first question is yes and to the second yes, as well, unless the garages had to
give up other jobs with revenue equal to or greater than what they earn coming to the car
owners’ rescue. To the third question, my answer is, it depends.
If we take as the baseline the position of the car owners after the tires had been slashed, they
would be better off, unless for some the repair bill turned out to be so high that, in retrospect,
these owners would have preferred to abandon their cars. If we take as the baseline the situation
before the tires were slashed, the entire affair left the car owners worse off. It reduced what
economists would call social welfare.
Why is this vignette in so serious a blog as Economix? Because it illuminates a phenomenon not
always fully appreciated when we talk about value added or G.D.P.
In many instances, Person (or Enterprise) A delivers great value to Person (or Enterprise) B to
extract the latter from a situation into which B should not have been put in the first place. We
count in G.D.P. the value added by the extrication but...Read more »»»
the health care field.
Suppose some evening a group of bored and mischievous teenagers slash tires on a number of
cars in the parking lot of a shopping center. Distraught car owners call sundry nearby garages to
send someone to fix the damage on the spot or tow the cars in for repairs. That work is speedily
done, and the cars are ready for use again. The car owners pay the garage owners sizable repair
bills.
This fictitious event leads to a number of questions:
1. Did the garages deliver value to the car owners?
2. Was gross domestic product increased or decreased?
3. Were the car owners better off, after paying the repair bill?
Today’s Economist
Perspectives from expert contributors.
My answer to the first question is yes and to the second yes, as well, unless the garages had to
give up other jobs with revenue equal to or greater than what they earn coming to the car
owners’ rescue. To the third question, my answer is, it depends.
If we take as the baseline the position of the car owners after the tires had been slashed, they
would be better off, unless for some the repair bill turned out to be so high that, in retrospect,
these owners would have preferred to abandon their cars. If we take as the baseline the situation
before the tires were slashed, the entire affair left the car owners worse off. It reduced what
economists would call social welfare.
Why is this vignette in so serious a blog as Economix? Because it illuminates a phenomenon not
always fully appreciated when we talk about value added or G.D.P.
In many instances, Person (or Enterprise) A delivers great value to Person (or Enterprise) B to
extract the latter from a situation into which B should not have been put in the first place. We
count in G.D.P. the value added by the extrication but...Read more »»»
Uncertainty and the welfare economics of medical care. By Kenneth Arrow 1963
Download this article here
Next Great Depression? MIT researchers predict ‘global economic collapse’ by 2030
By Eric Pfeiffer | The Sideshow
April 4, 2012
A new study from researchers at MIT and produced for an international think tank, says that the world could suffer from "global economic collapse" and "precipitous population decline" if people continue to consume the world's resources at the current pace.
Smithsonian Magazine writes that Australian physicist Graham Turner says "the world is on track for disaster" and that current evidence coincides with a famous, and in some quarters, infamous, academic report from 1972 entitled, "The Limits to Growth."
Produced for a group called The Club of Rome, the study's researchers created a computing model to forecast different scenarios based on the current models of population growth and global resource consumption. The study also took into account different levels of agricultural productivity, birth control and environmental protection efforts. Twelve million copies of the report were produced and distributed in 37 different languages.
Most of the computer scenarios found population and economic growth continuing at a steady rate until about 2030. But without "drastic measures for environmental protection," the scenarios predict the likelihood of a population and economic crash.
However, the study said "unlimited economic growth" is still possible if world governments enact policies and invest in green technologies that help limit the expansion of our ecological footprint.
The Smithsonian notes that several experts strongly objected to "The Limit of Growth's" findings, including the late Yale economist Henry Wallich, who for 12 years served as a governor of the Federal Research Board and was its chief international economics expert. At the time, Wallich said attempting to regulate economic growth would be equal to "consigning billions to permanent poverty."
Turner says that perhaps the most startling find from the study is that the results of the computer scenarios were nearly identical to those predicted in similar computer scenarios used as the basis for "The Limits to Growth."
"There is a very clear warning bell being rung here," Turner said. "We are not on a sustainable trajectory."
April 4, 2012
A new study from researchers at MIT and produced for an international think tank, says that the world could suffer from "global economic collapse" and "precipitous population decline" if people continue to consume the world's resources at the current pace.
Smithsonian Magazine writes that Australian physicist Graham Turner says "the world is on track for disaster" and that current evidence coincides with a famous, and in some quarters, infamous, academic report from 1972 entitled, "The Limits to Growth."
Produced for a group called The Club of Rome, the study's researchers created a computing model to forecast different scenarios based on the current models of population growth and global resource consumption. The study also took into account different levels of agricultural productivity, birth control and environmental protection efforts. Twelve million copies of the report were produced and distributed in 37 different languages.
Most of the computer scenarios found population and economic growth continuing at a steady rate until about 2030. But without "drastic measures for environmental protection," the scenarios predict the likelihood of a population and economic crash.
However, the study said "unlimited economic growth" is still possible if world governments enact policies and invest in green technologies that help limit the expansion of our ecological footprint.
The Smithsonian notes that several experts strongly objected to "The Limit of Growth's" findings, including the late Yale economist Henry Wallich, who for 12 years served as a governor of the Federal Research Board and was its chief international economics expert. At the time, Wallich said attempting to regulate economic growth would be equal to "consigning billions to permanent poverty."
Turner says that perhaps the most startling find from the study is that the results of the computer scenarios were nearly identical to those predicted in similar computer scenarios used as the basis for "The Limits to Growth."
"There is a very clear warning bell being rung here," Turner said. "We are not on a sustainable trajectory."
1 in 2 Americans are poor
Census shows 1 in 2 people are poor or low-income
Nearly half of Americans are low-income as rising expenses, unemployment shrink middle class
By Hope Yen, Associated Press | AP – 15 December 2011
WASHINGTON (AP) -- Squeezed by rising living costs, a record number of Americans — nearly 1 in 2 — have fallen into poverty or are scraping by on earnings that classify them as low income.
The latest census data depict a middle class that's shrinking as unemployment stays high and the government's safety net frays. The new numbers follow years of stagnating wages for the middle class that have hurt millions of workers and families.
"Safety net programs such as food stamps and tax credits kept poverty from rising even higher in 2010, but for many low-income families with work-related and medical expenses, they are considered too 'rich' to qualify," said Sheldon Danziger, a University of Michigan public policy professor who specializes in poverty.
"The reality is that prospects for the poor and the near poor are dismal," he said. "If Congress and the states make further cuts, we can expect the number of poor and low-income families to rise for the next several years."
Congressional Republicans and Democrats are sparring over legislation that would renew a Social Security payroll tax cut, part of a year-end political showdown over economic priorities that could also trim unemployment benefits, freeze federal pay and reduce entitlement spending.
Robert Rector, a senior research fellow at the conservative Heritage Foundation, questioned whether some people classified as poor or low-income actually suffer material hardship. He said that while safety-net programs have helped many Americans, they have gone too far, citing poor people who live in decent-size homes, drive cars and own wide-screen TVs.
"There's no doubt the recession has thrown a lot of people out of work and incomes have fallen," Rector said. "As we come out of recession, it will be important that these programs promote self-sufficiency rather than dependence and encourage people to look for work."
Mayors in 29 cities say more than 1 in 4 people needing emergency food assistance did not receive it. Many middle-class Americans are dropping below the low-income threshold — roughly $45,000 for a family of four — because of pay cuts, a forced reduction of work hours or a spouse losing a job. Housing and child-care costs are consuming up to half of a family's income.
States in the South and West had the highest shares of low-income families, including Arizona, New Mexico and South Carolina, which have scaled back or eliminated aid programs for the needy. By raw numbers, such families were most numerous in California and Texas, each with more than 1 million.
The struggling Americans include Zenobia Bechtol, 18, in Austin, Texas, who earns minimum wage as a part-time pizza delivery driver. Bechtol and her 7-month-old baby were recently evicted from their bedbug-infested apartment after her boyfriend, an electrician, lost his job in the sluggish economy.
After an 18-month job search, Bechtol's boyfriend now works as a waiter and the family of three is temporarily living with her mother.
"We're paying my mom $200 a month for rent, and after diapers and formula and gas for work, we barely have enough money to spend," said Bechtol, a high school graduate who wants to go to college. "If it weren't for food stamps and other government money for families who need help, we wouldn't have been able to survive."
About 97.3 million Americans fall into a low-income category, commonly defined as those earning between 100 and 199 percent of the poverty level, based on a new supplemental measure by the Census Bureau that is designed to provide a fuller picture of poverty. Together with the 49.1 million who fall below the poverty line and are counted as poor, they number 146.4 million, or 48 percent of the U.S. population. That's up by 4 million from 2009, the earliest numbers for the newly developed poverty measure.
The new measure of poverty takes into account medical, commuting and other living costs. Doing that helped push the number of people below 200 percent of the poverty level up from 104 million, or 1 in 3 Americans, that was officially reported in September.
Broken down by age, children were most likely to be poor or low-income — about 57 percent — followed by seniors over 65. By race and ethnicity, Hispanics topped the list at 73 percent, followed by blacks, Asians and non-Hispanic whites.
Even by traditional measures, many working families are hurting.
Following the recession that began in late 2007, the share of working families who are low income has risen for three straight years to 31.2 percent, or 10.2 million. That proportion is the highest in at least a decade, up from 27 percent in 2002, according to a new analysis by the Working Poor Families Project and the Population Reference Bureau, a nonprofit research group based in Washington.
Among low-income families, about one-third were considered poor while the remainder — 6.9 million — earned income just above the poverty line. Many states phase out eligibility for food stamps, Medicaid, tax credit and other government aid programs for low-income Americans as they approach 200 percent of the poverty level.
The majority of low-income families — 62 percent — spent more than one-third of their earnings on housing, surpassing a common guideline for what is considered affordable. By some census surveys, child-care costs consume close to another one-fifth.
Paychecks for low-income families are shrinking. The inflation-adjusted average earnings for the bottom 20 percent of families have fallen from $16,788 in 1979 to just under $15,000, and earnings for the next 20 percent have remained flat at $37,000. In contrast, higher-income brackets had significant wage growth since 1979, with earnings for the top 5 percent of families climbing 64 percent to more than $313,000.
A survey of 29 cities conducted by the U.S. Conference of Mayors being released Thursday points to a gloomy outlook for those on the lower end of the income scale.
Many mayors cited the challenges of meeting increased demands for food assistance, expressing particular concern about possible cuts to federal programs such as food stamps and WIC, which assists low-income pregnant women and mothers. Unemployment led the list of causes of hunger in cities, followed by poverty, low wages and high housing costs.
Across the 29 cities, about 27 percent of people needing emergency food aid did not receive it. Kansas City, Mo., Nashville, Tenn., Sacramento, Calif., and Trenton, N.J., were among the cities that pointed to increases in the cost of food and declining food donations, while Mayor Michael McGinn in Seattle cited an unexpected spike in food requests from immigrants and refugees, particularly from Somalia, Burma and Bhutan.
Among those requesting emergency food assistance, 51 percent were in families, 26 percent were employed, 19 percent were elderly and 11 percent were homeless.
"People who never thought they would need food are in need of help," said Mayor Sly James of Kansas City, Mo., who co-chairs a mayors' task force on hunger and homelessness.
Nearly half of Americans are low-income as rising expenses, unemployment shrink middle class
By Hope Yen, Associated Press | AP – 15 December 2011
WASHINGTON (AP) -- Squeezed by rising living costs, a record number of Americans — nearly 1 in 2 — have fallen into poverty or are scraping by on earnings that classify them as low income.
The latest census data depict a middle class that's shrinking as unemployment stays high and the government's safety net frays. The new numbers follow years of stagnating wages for the middle class that have hurt millions of workers and families.
"Safety net programs such as food stamps and tax credits kept poverty from rising even higher in 2010, but for many low-income families with work-related and medical expenses, they are considered too 'rich' to qualify," said Sheldon Danziger, a University of Michigan public policy professor who specializes in poverty.
"The reality is that prospects for the poor and the near poor are dismal," he said. "If Congress and the states make further cuts, we can expect the number of poor and low-income families to rise for the next several years."
Congressional Republicans and Democrats are sparring over legislation that would renew a Social Security payroll tax cut, part of a year-end political showdown over economic priorities that could also trim unemployment benefits, freeze federal pay and reduce entitlement spending.
Robert Rector, a senior research fellow at the conservative Heritage Foundation, questioned whether some people classified as poor or low-income actually suffer material hardship. He said that while safety-net programs have helped many Americans, they have gone too far, citing poor people who live in decent-size homes, drive cars and own wide-screen TVs.
"There's no doubt the recession has thrown a lot of people out of work and incomes have fallen," Rector said. "As we come out of recession, it will be important that these programs promote self-sufficiency rather than dependence and encourage people to look for work."
Mayors in 29 cities say more than 1 in 4 people needing emergency food assistance did not receive it. Many middle-class Americans are dropping below the low-income threshold — roughly $45,000 for a family of four — because of pay cuts, a forced reduction of work hours or a spouse losing a job. Housing and child-care costs are consuming up to half of a family's income.
States in the South and West had the highest shares of low-income families, including Arizona, New Mexico and South Carolina, which have scaled back or eliminated aid programs for the needy. By raw numbers, such families were most numerous in California and Texas, each with more than 1 million.
The struggling Americans include Zenobia Bechtol, 18, in Austin, Texas, who earns minimum wage as a part-time pizza delivery driver. Bechtol and her 7-month-old baby were recently evicted from their bedbug-infested apartment after her boyfriend, an electrician, lost his job in the sluggish economy.
After an 18-month job search, Bechtol's boyfriend now works as a waiter and the family of three is temporarily living with her mother.
"We're paying my mom $200 a month for rent, and after diapers and formula and gas for work, we barely have enough money to spend," said Bechtol, a high school graduate who wants to go to college. "If it weren't for food stamps and other government money for families who need help, we wouldn't have been able to survive."
About 97.3 million Americans fall into a low-income category, commonly defined as those earning between 100 and 199 percent of the poverty level, based on a new supplemental measure by the Census Bureau that is designed to provide a fuller picture of poverty. Together with the 49.1 million who fall below the poverty line and are counted as poor, they number 146.4 million, or 48 percent of the U.S. population. That's up by 4 million from 2009, the earliest numbers for the newly developed poverty measure.
The new measure of poverty takes into account medical, commuting and other living costs. Doing that helped push the number of people below 200 percent of the poverty level up from 104 million, or 1 in 3 Americans, that was officially reported in September.
Broken down by age, children were most likely to be poor or low-income — about 57 percent — followed by seniors over 65. By race and ethnicity, Hispanics topped the list at 73 percent, followed by blacks, Asians and non-Hispanic whites.
Even by traditional measures, many working families are hurting.
Following the recession that began in late 2007, the share of working families who are low income has risen for three straight years to 31.2 percent, or 10.2 million. That proportion is the highest in at least a decade, up from 27 percent in 2002, according to a new analysis by the Working Poor Families Project and the Population Reference Bureau, a nonprofit research group based in Washington.
Among low-income families, about one-third were considered poor while the remainder — 6.9 million — earned income just above the poverty line. Many states phase out eligibility for food stamps, Medicaid, tax credit and other government aid programs for low-income Americans as they approach 200 percent of the poverty level.
The majority of low-income families — 62 percent — spent more than one-third of their earnings on housing, surpassing a common guideline for what is considered affordable. By some census surveys, child-care costs consume close to another one-fifth.
Paychecks for low-income families are shrinking. The inflation-adjusted average earnings for the bottom 20 percent of families have fallen from $16,788 in 1979 to just under $15,000, and earnings for the next 20 percent have remained flat at $37,000. In contrast, higher-income brackets had significant wage growth since 1979, with earnings for the top 5 percent of families climbing 64 percent to more than $313,000.
A survey of 29 cities conducted by the U.S. Conference of Mayors being released Thursday points to a gloomy outlook for those on the lower end of the income scale.
Many mayors cited the challenges of meeting increased demands for food assistance, expressing particular concern about possible cuts to federal programs such as food stamps and WIC, which assists low-income pregnant women and mothers. Unemployment led the list of causes of hunger in cities, followed by poverty, low wages and high housing costs.
Across the 29 cities, about 27 percent of people needing emergency food aid did not receive it. Kansas City, Mo., Nashville, Tenn., Sacramento, Calif., and Trenton, N.J., were among the cities that pointed to increases in the cost of food and declining food donations, while Mayor Michael McGinn in Seattle cited an unexpected spike in food requests from immigrants and refugees, particularly from Somalia, Burma and Bhutan.
Among those requesting emergency food assistance, 51 percent were in families, 26 percent were employed, 19 percent were elderly and 11 percent were homeless.
"People who never thought they would need food are in need of help," said Mayor Sly James of Kansas City, Mo., who co-chairs a mayors' task force on hunger and homelessness.
Subscribe to:
Posts (Atom)