HEALTH ECONOMICS Sponsored by a Grant TÁMOP-4.1.2-08/2/A/KMR-2009-0041 Course Material Developed by Department of Economics, Faculty of Social Sciences, Eötvös Loránd University Budapest (ELTE) Department of Economics, Eötvös Loránd University Budapest Institute of Economics, Hungarian Academy of Sciences Balassi Kiadó, Budapest Authors: Éva Orosz, Zoltán Kaló and Balázs Nagy Supervised by Éva Orosz June 2011
HEALTH ECONOMICS Syllabus Objectives The main purpose of this course is to introduce students to basic concepts of health economics and health policy needed to analyse: (i) performance of health systems; and (ii) health financing systems, as well as health policy options related to their reforms; principles and main types of economic evaluations, as well as the major steps and methods of conducting economic evaluations. The course intends to further develop analytical capacity of students in critical reading of technical literature and formulating options for issues debated from theoretical and health policy perspectives. The course enhances the methodological knowledge of students with an area of growing importance: health technology assessment. Part I: Economic analysis of the health system Week 1: Analysis of the health system: basic concepts. Introduction to health economics Health economics as a discipline Relationships of health, health care and economy 2
Health care as an economic good Need, demand and supply Components and functions of the health system Assessment of health system performance: criteria, methods and indicators Folland, S. et al. (2008) The Economics of Health and Health Care (Fourth Edition), Pearson Education, (passim) Murray, C. Frenk, J. (2000) A framework for assessing the performance of health systems. Bulletin of the World Health Organisation, 2000, 78(6) Smith, P.C. (ed.) (2009) Performance measurement for health system improvement: experiences, challenges and prospects, Cambridge University Press, 2009 (Chapter 6.1. Conclusions Week 2: Markets and market failure in health care and health insurance Characteristics of markets for health care Market failure in health insurance Market failure in health service provision Professional monopoly and information asymmetry Concepts of the role of the government and markets in health systems Barr, N.(2004) Economics of the Welfare State. Oxford Univesity Press, Oxford (Health and health care, részletek) 3
Donaldson, C. et al (2004) Economics of health care financing: the visible hand. 2nd edition, Basingstoke, UK, Palgrave Macmillan (passim) Preker, A. és Harding, A. (2005), Állami és magánszerepek gazdaságtana az egészségügyben az intézményi közgazdaságtan és szervezetelmélet szemszögéből. Kormányzás, Közpénzügyek, Szabályozás, I/1., 4 32. Week 3: Role of the state in health care Arguments for government intervention in health care: issues of equity and efficiency Goals, domains and tools of government intervention Theory of government failure Consequences of market and government failure for health policymaking Possible instruments for improving the efficiency of the government intervention in health service provision Hsiao, W. and Heller, P. (2007) What Should Macroeconomists Know About Health Policy? IMF Working Paper. WP/07613. International Monetary Fund. (passim) Roberts, M. J.(et.al) (2008) Getting Health Reform Right. Qxford University Press. (passim) Preker, A. és Harding, A. (2005), Állami és magánszerepek gazdaságtana az egészségügyben az intézményi közgazdaságtan és szervezetelmélet szemszögéből. Kormányzás, Közpénzügyek, Szabályozás, I/1, 4 32. 4
Week 4: Health care financing Components of health financing systems Performance goals of health financing systems Main types of health financing sub-systems Dominant mechanisms of revenue-raising and institutional forms of resource allocation in OECD and EU countries Gottret,P. and Schieber, G. (2006) Health Financing Revisited, World Bank, Washington. (passim) Mossialos, E. et. al. (2002) Funding health care: options for Europe. Policy brief. European Observatory on Health Care Systems Orosz É. (2010) Forrásteremtés és forrásallokáció. In: Kaló Z. et al.(2010): Egészség-gazdaságtani fogalomtár II. Professional Publishing Hungary, Medical Tribune Divízió Thomson, S. et al (2009), Financing Health Care in the European Union Challenges and policy responses. Observatory Studies Series No.17. WHO Regional Office for Europe, Copenhagen Week 5: Resource allocation in health systems Main issues in resource allocation Theory of purchasing Provider payment methods 5
Resource allocation mechanisms at macro-level Institutional frameworks of resource allocation Figueras, J., Robinson, R. and Jakubowski, E. (eds.)(2005), Purchasing to improve health system performance, European Observatory on Health Systems and Policies Series. Open University Press (passim) Orosz É. (2010) Forrásteremtés és forrásallokáció. In: Kaló Z. et al.(2010): Egészség-gazdaságtani fogalomtár II. Professional Publishing Hungary, Medical Tribune Divízió Week 6: Analysis of health expenditure Definition of health expenditure (based on OECD System of Health Accounts) Main indicators of health expenditure Interpreting key indicators Methodological issues in cross-country and over-time comparison Key driving forces of health spending growth Appleby, J. (ed.) Funding Health Care: 2008 and beyond. King s Fund, London (részletek) OECD (2009), Health at a Glance, OECD, Paris 6
Week 7: Health policies for sustainable financing and improving efficiency Driving forces behind increasing health expenditure 2000s: changing views on growth in health spending Cost-containment policies/instruments and their possible effects Policies/instruments aiming at improving efficiency and quality and their possible effects Main challenges OECD (2010) Value for Money in Health Spending (részletek) Thomson, S. et al (2009), Financing Health Care in the European Union. Observatory Studies Series No.17. WHO Regional Office for Europe, Copenhagen (részletek) PART II.: PRINCIPLES OF HEALTH ECONOMIC EVALUATIONS Week 8: Terminology. Types of economic evaluations Necessity of economic evaluation in the decision-making process Basic terms of health technology assessment Classification of economic evaluations. Cost-minimisation, cost-effectiveness and cost-utility analysis Drummond et al: Methods for the Economic Evaluation of Health Care Programs. Oxford University Press, 1999 (részletek) 7
Az egészség-gazdaságtani elemzések helye és szerepe 1/2. 1/3. In: Kaló Z, Inotai A, Nagyjánosi L (2009): Egészség-gazdaságtani fogalomtár I. Egészségügyi technológiák gazdasági elemzése. Professional Publishing Hungary, Medical Tribune Divízió A gazdasági elemzések elemzések orvosszakmai alapjai 5/1. In: Kaló Z, Inotai A, Nagyjánosi L (2009) A teljes körű gazdasági elemzés típusai 2/1. In: Kaló Z, Inotai A, Nagyjánosi L (2009) Week 9: Measurement of health gain in economic evaluations What health gain means? Calculation of health gain in economic evaluations Development and validation of qulaity of life instruments Quality Adjusted Life Years (QALY) Kaló Z., Péntek M.: Az életminőség mérése (7. fejezet) in Gulácsi L: Egészséggazdaságtan, Medicina, Budapest, 2005 A gazdasági elemzések orvosszakmai alapjai 5/6. 5/8. In: Kaló Z, Inotai A, Nagyjánosi L (2009) Week 10: Cost-effectiveness and cost-utility analyses Main approaches to measure cost-effectiveness Comparison of health gain in full economic evaluations 8
Applicability of cost-effectiveness and cost-utility analyses Drummond et al: Methods for the Economic Evaluation of Health Care Programs. Oxford University Press, 1999 (részletek) A teljes körű gazdasági elemzés típusai 2.3; 2.4. In: Kaló Z, Inotai A, Nagyjánosi L (2009) A gazdasági elemzések orvosszakmai alapjai 5/7. In: Kaló Z, Inotai A, Nagyjánosi L (2009) Torrance GW: Measurement of health state utilities for economic appraisal, J Health Econ, 1986 5. 1. 1-30. Week 11: Steps of economic evaluation Designing economic evaluations (program definition, selection of methodological approach and comparator) Information and data sources in economic evaluations Calculation of net costs and benefits Decision-making criteria Sensitivity analysis Szende Á: Az eljárások gazdasági értékelése. In: Vincze Z, Kaló Z, Bodrogi J. Bevezetés a farmakoökonómiába, Medicina, Budapest, 2001) 9
A gazdasági elemzések orvosszakmai alapjai 5/2 5/9. In: Kaló Z, Inotai A, Nagyjánosi L (2009) A gazdasági elemzések közgazdasági háttere 6/1 6/5. In: Kaló Z, Inotai A, Nagyjánosi L (2009) Week 12: Modeling approaches in health economic evaluations The role and necessity of modeling approaches in health technology assessment Principles of decision tree and Markov modeling Modeling exercises Szende Á: Az eljárások gazdasági értékelése. In: Vincze Zoltán - Kaló Zoltán -Bodrogi József: Bevezetés a farmakoökonómiába, Medicina, Budapest, 2001 Az egészség-gazdaságtani modellezés alapjai 3/3; 4/1-4/3. In: Kaló Z, Inotai A, Nagyjánosi L (2009) Week 13: Applicability of economic evaluation in the allocation of health care resources and health policy decisions Budget impact analysis Prerequites of fourth hurdle (mandatory health economic evidence) Inclusion of cost-effectiveness evidence in the reimbursement of new health technologies 10
Mauskopf JA, Sullivan SD, Annemans L, Caro J, Mullins CD, Nuijten M, Orlewska E, Watkins J, Trueman P. Principles of good practice for budget impact analysis: report of the ISPOR Task Force on good research practices - budget impact analysis. Value Health. 2007.10. 5. 336-47 Egészségügyi technológiák árképzése és finanszírozása 10/5.10/7. In: Kaló Z, Inotai A, Lukovics M: Egészség-gazdaságtani fogalomtár II. (2010) Kaló Z. Az egészség-gazdaságtani elemzések és az objektív támogatáspolitikai rendszer dilemmái Magyarországon, LAM, 2009. 19. 4 5. 329 333. Kaló Z, Vokó Z: A kockázatmegosztás szerepe a gyógyszerek finanszírozásában. LAM 2010. 20. 3 4. 237 241. 11