The Health Economy. Victor R. Fuchs
In: Journal of political economy, Band 95, Heft 6, S. 1337-1340
ISSN: 1537-534X
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In: Journal of political economy, Band 95, Heft 6, S. 1337-1340
ISSN: 1537-534X
In: Journal of political economy, Band 95, Heft 6, S. 1337
ISSN: 0022-3808
In: Journal of political economy, Band 84, Heft 1, S. 143-152
ISSN: 1537-534X
In: Journal of political economy, Band 83, Heft 1, S. 209-213
ISSN: 1537-534X
In: Public choice, Band 14-14, Heft 1, S. 143-154
ISSN: 1573-7101
In: The American economist: journal of the International Honor Society in Economics, Omicron Delta Epsilon, Band 14, Heft 2, S. 57-58
ISSN: 2328-1235
In: Comparative economic studies, Band 59, Heft 3, S. 405-427
ISSN: 1478-3320
In: The Australian economic review, Band 37, Heft 3, S. 243-256
ISSN: 1467-8462
AbstractWhat are the economic rationales for the public subsidy of private health insurance? Inducing more people to purchase private cover has the potential to create a positive fiscal externality, as it frees up the limited public beds and other public resources for people who cannot afford private health insurance. Investigating this quantitatively, based on short‐run demand estimates, we find that the subsidy cannot be justified on the basis of this externality effect alone. We estimate that the optimal subsidy is actually negative, that is, a tax on private health insurance premiums. On the other hand, the externality does finance some of the costs. We then consider a long‐run dynamic version, consistent with the government's stated rationales for the reforms. In this context, the subsidy might be justified, or at least largely offset, by the fiscal externality. We then discuss other rationales for a subsidy and implementation issues.
In: Journal of benefit-cost analysis: JBCA, Band 13, Heft 2, S. 166-181
ISSN: 2152-2812
AbstractThe relationship between costs and health benefits of branded pharmaceuticals remains controversial. This paper examines the incremental costs incurred for incremental health benefits gained from the largest available sample of cost-effectiveness studies of branded drugs in the USA, the 1994–2015 Tufts Registry of Cost-Effectiveness Analyses. Earlier studies used small, specialized samples of drugs. We use linear regression analysis to estimate the association in those studies between additional quality-adjusted life years (QALYs) and incremental pharmaceutical costs. The preferred sample uses 476 studies involving branded pharmaceuticals with both higher costs and increased effectiveness compared to the previous standard of care. Regressions of costs on QALYs imply that an additional QALY is associated, on average, with a $28,561 increase in cost (95 % CI, $18,853–$38,270). This regression explains 20 % of the variation in sample costs. In this analytical sample, a share of the variation in the cost of pharmaceuticals is, therefore, not random but rather associated with variation in QALYs; prices are to some extent "value-based." Our results are robust to varying sample inclusion criteria and to the funding source. In subgroup analyses, the highest cost per QALY was $44,367 (95 % CI, $35,373–$53,361). Costs of pharmaceuticals in this data set are, on average, lower than common estimates of the monetary value of a QALY to American consumers. As in other studies, we find that sellers of patent-protected beneficial new technology appear to capture only a fraction of the benefits provided.