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In the face of escalating health care expenditure, OECD countries are turning to a variety of cost-containment strategies. This thesis analyses three such mechanisms. In Part I, I consider the use of coinsurance to limit the demand for health care. Because coinsurance reduces the elasticity of demand with respect to the price of health care, consumers facing low coinsurance rates may be charged a higher price by doctors. Such discriminatory pricing enables the doctor to extract surplus created in the insurance market, and therefore reduces the effectiveness of coinsurance. I show that in equilibrium, some consumers remain uninsured. I also show how this problem is solved if the doctor and insurer enter into managed care style arrangements. Such arrangements improve insurer and doctor profitability, and restore complete insurance market coverage. In Part II, I consider the design of fundholding schemes which encourage doctors to restrict expensive treatment to severely ill patients. I show that such schemes may be undermined by a patient-doctor side contract. In the face of such patient-doctor collusion, the fundholding scheme may be made collusion-proof by increasing its "power". I show that the optimal collusion-proof scheme may pay the doctor more than his reservation wage. An alternative solution to patient-doctor collusion is to use a partial fundholding scheme that requires some additional co-payment from the patient. Part III analyses New Zealand's internal market reforms. Introduced in 1993, the reforms involved the separation of funding and provision of health care, and were intended to simulate a competitive market environment, thereby improving the incentives of government owned health care providers to be efficient. On the supply side, I look at the internal restructuring of hospitals into private-sector clones. I argue that this commercialisation failed to take account of informational issues within the hospital. On the demand-side, I examine the suitability of internal markets for eliciting optimal innovation from the hospital sector. Again, I find that a standard argument, namely that increased competition leads to innovation, is questionable in the context of the internal market. / Whole document restricted, but available by request, use the feedback form to request access.

In the face of escalating health care expenditure, OECD countries are turning to a variety of cost-containment strategies. This thesis analyses three such mechanisms. In Part I, I consider the use of coinsurance to limit the demand for health care. Because coinsurance reduces the elasticity of demand with respect to the price of health care, consumers facing low coinsurance rates may be charged a higher price by doctors. Such discriminatory pricing enables the doctor to extract surplus created in the insurance market, and therefore reduces the effectiveness of coinsurance. I show that in equilibrium, some consumers remain uninsured. I also show how this problem is solved if the doctor and insurer enter into managed care style arrangements. Such arrangements improve insurer and doctor profitability, and restore complete insurance market coverage. In Part II, I consider the design of fundholding schemes which encourage doctors to restrict expensive treatment to severely ill patients. I show that such schemes may be undermined by a patient-doctor side contract. In the face of such patient-doctor collusion, the fundholding scheme may be made collusion-proof by increasing its "power". I show that the optimal collusion-proof scheme may pay the doctor more than his reservation wage. An alternative solution to patient-doctor collusion is to use a partial fundholding scheme that requires some additional co-payment from the patient. Part III analyses New Zealand's internal market reforms. Introduced in 1993, the reforms involved the separation of funding and provision of health care, and were intended to simulate a competitive market environment, thereby improving the incentives of government owned health care providers to be efficient. On the supply side, I look at the internal restructuring of hospitals into private-sector clones. I argue that this commercialisation failed to take account of informational issues within the hospital. On the demand-side, I examine the suitability of internal markets for eliciting optimal innovation from the hospital sector. Again, I find that a standard argument, namely that increased competition leads to innovation, is questionable in the context of the internal market. / Whole document restricted, but available by request, use the feedback form to request access.

In the face of escalating health care expenditure, OECD countries are turning to a variety of cost-containment strategies. This thesis analyses three such mechanisms. In Part I, I consider the use of coinsurance to limit the demand for health care. Because coinsurance reduces the elasticity of demand with respect to the price of health care, consumers facing low coinsurance rates may be charged a higher price by doctors. Such discriminatory pricing enables the doctor to extract surplus created in the insurance market, and therefore reduces the effectiveness of coinsurance. I show that in equilibrium, some consumers remain uninsured. I also show how this problem is solved if the doctor and insurer enter into managed care style arrangements. Such arrangements improve insurer and doctor profitability, and restore complete insurance market coverage. In Part II, I consider the design of fundholding schemes which encourage doctors to restrict expensive treatment to severely ill patients. I show that such schemes may be undermined by a patient-doctor side contract. In the face of such patient-doctor collusion, the fundholding scheme may be made collusion-proof by increasing its "power". I show that the optimal collusion-proof scheme may pay the doctor more than his reservation wage. An alternative solution to patient-doctor collusion is to use a partial fundholding scheme that requires some additional co-payment from the patient. Part III analyses New Zealand's internal market reforms. Introduced in 1993, the reforms involved the separation of funding and provision of health care, and were intended to simulate a competitive market environment, thereby improving the incentives of government owned health care providers to be efficient. On the supply side, I look at the internal restructuring of hospitals into private-sector clones. I argue that this commercialisation failed to take account of informational issues within the hospital. On the demand-side, I examine the suitability of internal markets for eliciting optimal innovation from the hospital sector. Again, I find that a standard argument, namely that increased competition leads to innovation, is questionable in the context of the internal market. / Whole document restricted, but available by request, use the feedback form to request access.

In the face of escalating health care expenditure, OECD countries are turning to a variety of cost-containment strategies. This thesis analyses three such mechanisms. In Part I, I consider the use of coinsurance to limit the demand for health care. Because coinsurance reduces the elasticity of demand with respect to the price of health care, consumers facing low coinsurance rates may be charged a higher price by doctors. Such discriminatory pricing enables the doctor to extract surplus created in the insurance market, and therefore reduces the effectiveness of coinsurance. I show that in equilibrium, some consumers remain uninsured. I also show how this problem is solved if the doctor and insurer enter into managed care style arrangements. Such arrangements improve insurer and doctor profitability, and restore complete insurance market coverage. In Part II, I consider the design of fundholding schemes which encourage doctors to restrict expensive treatment to severely ill patients. I show that such schemes may be undermined by a patient-doctor side contract. In the face of such patient-doctor collusion, the fundholding scheme may be made collusion-proof by increasing its "power". I show that the optimal collusion-proof scheme may pay the doctor more than his reservation wage. An alternative solution to patient-doctor collusion is to use a partial fundholding scheme that requires some additional co-payment from the patient. Part III analyses New Zealand's internal market reforms. Introduced in 1993, the reforms involved the separation of funding and provision of health care, and were intended to simulate a competitive market environment, thereby improving the incentives of government owned health care providers to be efficient. On the supply side, I look at the internal restructuring of hospitals into private-sector clones. I argue that this commercialisation failed to take account of informational issues within the hospital. On the demand-side, I examine the suitability of internal markets for eliciting optimal innovation from the hospital sector. Again, I find that a standard argument, namely that increased competition leads to innovation, is questionable in the context of the internal market. / Whole document restricted, but available by request, use the feedback form to request access.

Diss. Uppsala : Univ., 2004.

In the face of escalating health care expenditure, OECD countries are turning to a variety of cost-containment strategies. This thesis analyses three such mechanisms. In Part I, I consider the use of coinsurance to limit the demand for health care. Because coinsurance reduces the elasticity of demand with respect to the price of health care, consumers facing low coinsurance rates may be charged a higher price by doctors. Such discriminatory pricing enables the doctor to extract surplus created in the insurance market, and therefore reduces the effectiveness of coinsurance. I show that in equilibrium, some consumers remain uninsured. I also show how this problem is solved if the doctor and insurer enter into managed care style arrangements. Such arrangements improve insurer and doctor profitability, and restore complete insurance market coverage. In Part II, I consider the design of fundholding schemes which encourage doctors to restrict expensive treatment to severely ill patients. I show that such schemes may be undermined by a patient-doctor side contract. In the face of such patient-doctor collusion, the fundholding scheme may be made collusion-proof by increasing its "power". I show that the optimal collusion-proof scheme may pay the doctor more than his reservation wage. An alternative solution to patient-doctor collusion is to use a partial fundholding scheme that requires some additional co-payment from the patient. Part III analyses New Zealand's internal market reforms. Introduced in 1993, the reforms involved the separation of funding and provision of health care, and were intended to simulate a competitive market environment, thereby improving the incentives of government owned health care providers to be efficient. On the supply side, I look at the internal restructuring of hospitals into private-sector clones. I argue that this commercialisation failed to take account of informational issues within the hospital. On the demand-side, I examine the suitability of internal markets for eliciting optimal innovation from the hospital sector. Again, I find that a standard argument, namely that increased competition leads to innovation, is questionable in the context of the internal market. / Whole document restricted, but available by request, use the feedback form to request access.

Obesity and overweight attributable deaths together are the second highest cause of death in the United States, according to the National Institute of Health. Obesity, diabetes, and heart disease also have an enormous economic cost to the American government and its citizens due to the rising cost of health care. The medical community agrees that preventive care, particularly diet, plays a crucial role in solving this health crisis. The Healthy, Hunger Free Kids Act of 2010 drastically changed the requirements of the National School Lunch Program in order to increase nutrition in school lunches. This thesis seeks to understand how improved health outcomes for children as well as adults. This paper analyzes previous research from the fields of Health and Behavioral Economics. It also conducts an empirical analysis of data from the California Health Interview Survey to understand the effects of the policy food on consumption of children and adults. Using theories from Behavioral Economics, the study hypothesizes that child and adult consumption of nutritious food increased following the implementation of this policy. The results of the empirical analysis do not entirely support the hypothesis that children’s and adult’s consumption of nutritious food increased. Food consumption is highly sensitive to a wide range of influences, and further empirical research accounting for these influences must be conducted to fully understand the potential benefits of public policy on health.

A blood transfusion is one of the most common hospital procedures, yet there is a lack of reliable information on the costs of administering blood. This thesis aims to fill this information gap, and considers the impact on total costs of alternative transfusion management strategies in the National Health Service (NHS) in the United Kingdom. A high user of blood transfusion, cardiac surgery, acts as a clinical exemplar. Comprehensive estimates of the costs of administering blood are first produced. The costs of administering blood add substantially to the costs of the blood products themselves, costs for red blood cells are 40% higher when the costs of administration are added to red blood cell costs. These cost estimates were used to more accurately cost blood products transfused (compared to the costs of blood products only) in two economic evaluations assessing firstly, the cost-effectiveness of a restrictive versus a liberal red blood cell transfusion threshold after cardiac surgery, and secondly, the cost-effectiveness of introducing bedside tests of haemostatic function in cardiac surgery. Both economic evaluations showed little difference in costs or outcomes between the groups and uncertainty around the cost-effectiveness results. While a restrictive threshold reduces costs associated with transfusion compared to a liberal threshold, there is no evidence based on detailed and comprehensive costings, to suggest that a restrictive threshold saves the NHS money overall. Reliable resource use data are vital for economic evaluations, and a subgroup of patients in both economic evaluations enabled resource use data collected from alternative sources to be compared. There was strong agreement between primary (clinical trial) data and routine datasets for data available from both sources, however, primary data captured post-operative complications more comprehensively than routine datasets. This thesis provides hospital managers and health economists with accurate information on the costs of administering blood for budget impact assessments and economic evaluations.

The prevalence of obesity in the United States is at the highest it has ever been. Adolescent and adult obesity rates have increased greatly over the past three decades, and those individuals who are already obese continue to gain weight. More recently, levels of obesity have stabilized but the number of obese individuals in the country is still very high. Efforts must be made at reducing these levels of obesity, as obesity is associated with the development of chronic diseases, significant reductions in quality of life, and insurmountable costs. The economic impact of obesity expands beyond direct healthcare costs into the workplace, reducing individual productivity levels and increasing the number of workdays missed as the severity of obesity increases. These realities provide incentives for both governmental and private sectors to take an interest in the prevention of obesity. The causes of obesity are many, and an appropriate treatment that will reduce obesity on a population level has not been identified. Current literature suggests the most effective population to target for obesity prevention is youth, especially around the ages of five to seven while lifestyle habits are being formed. This is mostly due to the relatively small changes needed to prevent childhood obesity as compared to the more difficult approach of reducing adult obesity. As opposed to the treatment of adult obesity, the prevention of childhood obesity requires a much smaller correction to daily calorie intake. Furthermore, obese youth tend to maintain their obesity into adulthood. The earlier in age that childhood obesity develops, the more difficult it is to prevent the development of adult obesity. Evidence currently shows that childhood obesity levels are related to the quality of meals and eating habits influenced by parents or caregivers and increased consumption of sugars and high-calorie foods strongly associated with aggressive food and beverage marketing. In addition, decreased levels of physical activity are associated with childhood obesity risk. In these ways, the current social and economic environment in the US strongly promotes childhood obesity. The most effective obesity prevention strategies involve a holistic modification of the surrounding environment. Studies show that addressing the school environment and thoroughly educating parents about the importance of nutritious eating and physical activity are important components of childhood obesity prevention efforts. While school and community interventions are moderately effective, a rise in BMI does tend to occur during summer months when children are typically on a less structured schedule and may not have encouragement from school programs to eat healthy foods and exercise. Schools also provide the opportunity for extracurricular activities, such as sports programs and other such supportive measures, which may prevent the development of childhood obesity. Suggested policy actions may modify the community and environment in such a way that obesity reduction is economically favorable. A tax on sugar-sweetened beverages is estimated to be highly effective in reducing childhood consumption of sugar, and subsequently lowering obesity rates. Other policy interventions that would be effective for reducing childhood obesity include imposing limits on the types of foods sold in school to children, and restricting marketing efforts aimed at children. Implementing a sugared-beverage tax and reducing tax subsidies from advertisements of food and beverage companies would produce positive return-on-investments and raise additional funds for additional adolescent obesity prevention efforts. Policymakers, local governments, parents, schools, and the community will need to invest time and finances into these modifications for obesity prevention to be effective. Policy changes, specifically sugared-beverage taxes, have recently been enacted in Mexico and in Berkeley, California. Evaluation research will provide additional evidence for the efficacy of these policy actions in obesity prevention. Current projects that will contribute to the gaps in preventive community modification research are in progress in California, Massachusetts and Texas. Additionally, research into the prevention of summer-month BMI increases in children may be beneficial for maintaining appropriate lifestyle modifications when school is not in session.