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Assignment in Health Economics Final
Assignment in Health Economics Final
GRADUATE SCHOOL
Master of Science in Nursing
AY 2013-2014
MODULE
IN
ADVANCED HEALTH CARE ECONOMICS
Health economics can be defined as the application of Economic theories, tools and concepts
of economics as a to the topics of health and health care. Since health economics is concerned
with issues related to the allocation of scarce resources to improve health, this includes both
Health economics examines the problem of scarcity as it arises with respect to health and
health care.
It examines how we as individuals and societies confront the fact that while the resources
available to us are limited, the alternative uses for these resources are unlimited. Thus,
health economists are interested in some very important questions. How is health
produced? What role does health care play in its production? What is the value of health?
How do we go about measuring health status? What influences for health and health
care? What influences the supply of health care? How can equilibrium between demand
and supply be achieved? The discipline of health economic is the study of these questions
and the answers to them that individuals and societies have put forward.
1. The chapter begins by asserting that four preconditions are necessary for the
establishment of modern medical care: effective medical technology , sufficient wealth,
low risk of death, and insurance financing. Explain why each is necessary? How are they
interrelated?
To make effective for the establishment of modern medical care, the following are
necessary.
2. It is economic development that creates the foundation for modern medicine. Explain.
The connection between health and national development are complex. The interaction is a twoway phenomenon with health being both influenced by and influencing economic development.
Improved health has been considered solely a result of economic growth, a part of the product of
growth rather than one of its causes. Every country has their own programs in connection to the
health sector. Like for example the vaccines for pneumococcal. In the rich countries like the
Kingdom of Saudi Arabia. Any Saudi who would like to receive such vaccine would be given
freely because their government can afford the amount. In comparison to the Philippines where
such vaccines are limited. You can only have it unless you buy for the vaccine. One
manifestation is that a wealthy country would invest so much on researches for the benefits of its
constituents other than the country with low socio economic status.
3. Economic development, population growth and medical technology are linked. The growth of
humanity is divided into four periods.
The Stone Age is a broad prehistoric time period during which humans widely used stone for tool
making. Stone tools were made from a variety of different kinds of stone. For example, flint and
chert were shaped (or chipped) for use as cutting tools and weapons, while basalt and sandstone
were used for ground stone tools, such as quern-stones. Wood, bone, shell, antler and other
materials were widely used, as well. During the most recent part of the period, sediments (like
clay) were used to make pottery. A series of metal technology innovations characterize the later
Chalcolithic (Copper Age), Bronze Age and Iron Age. The period encompasses the
first widespread use of tools in human evolution and the spread of humanity from East Africa to
the rest of the world. It ends with the development of agriculture, the domestication of certain
animals, and the smelting of copper ore to produce metal. It is termed prehistoric since humanity
had not yet started writing the traditional start of recorded history. The date range of this
period is ambiguous, disputed, and variable according to the region in question. While it is
possible to speak of a general 'stone age' period for the whole of humanity, some groups never
developed metal-smelting technology, so remained in a 'stone age' until they encountered
technologically developed cultures. However, it is believed that this period began somewhere
around 2.5 million years ago with the first hominid tool makers in Africa. The transition out of
the Stone Age occurred between 6000 BC and 2500 BC for much of humanity living in North
Africa, Asia and Europe.
B. Agricultural Age
At the beginning of this age, the planet has warmed from the Ice Age to the temperatures of
today. In Alaska, the ice prison has broken up and the humans began migrating to the rest of the
continent. In northern Africa, the lush plains of the Sahara turned into the desert of today. To the
retreating peoples, the Nile River valley beckoned. Climate change caused large stands of wild
grain grew throughout the Middle East. Around 8000 people in northern Iraq began to
deliberately plant these grains. The nearby Tigris and Euphrates Rivers provided irrigation. After
harvest, the grains were ground into flour which kept for long periods of time. Historians call this
age "The New Stone Age" or in Latin the "Neolithic Age". I don't think that advances in
stonework was the determining factor in this era. It was warming of the planet and the
subsequent development of farming. Agriculture provided stability. It supported more people. It
allowed people to congregate into cities. City folk were able to perform specialized tasks.
Organization for defense and for commerce was needed. And people's imaginations were freed to
pursue academic pursuits. Agriculture is the foundation that allows workers of other skills to
prosper. Jericho (yes, the one of the Bible) may be the world's oldest city, dating back to 8000.
Possessing all of 10 acres and 2,500 people, it was the must-see metropolis of 7500. By
6000, pottery was developed. In the Far East, humans independently developed the farming of
rice. In the Sixth Millennium the Sumerians took over the Iraq region and established a network
C. Industrial Age
Industrial Revolution was a period from the 18th to the 19th century where major changes in
agriculture, manufacturing, mining, transport, and technology had a profound effect on the
socioeconomic and cultural conditions starting in the United Kingdom, then subsequently
spreading throughout Europe, North America, and eventually the world.
The Industrial Revolution marks a major turning point in human history; almost every aspect of
daily life was eventually influenced in some way. Most notably, average income and population
began to exhibit unprecedented sustained growth. In the two centuries following 1800, the
world's average per capita income increased over 10-fold, while the world's population increased
over 6-fold. In the words of Nobel Prize winning Robert E. Lucas, Jr., "For the first time in
history, the living standards of the masses of ordinary people have begun to undergo sustained
growth. ... Nothing remotely like this economic behavior has happened before." Starting in the
later part of the 18th century, there began a transition in parts of Great Britain's previously
manual labor and draft-animalbased economy towards machine-based manufacturing. It started
with the mechanization of the textile industries, the development of iron-making techniques and
the increased use of refined coal. Trade expansion was enabled by the introduction
of canals, improved roads and railways. The introduction of steam power fuelled primarily by
D. Information Age
Rate
809.9
722.5
707.6
476.5
448.8
134.1
51.5
42.3
36.3
23.6
5-Year Average
(2004-2008)
2009*
82,290
94.5
100,908 109.4
55,999
64.3
65,489
71.0
43,185
49.6
47,732
51.8
4. Pneumonia
35,756
41.1
42,642
46.2
5. Accidents**
34,704
39.9
35,990
39.0
25,376
29.2
25,470
27.6
20,830
24.0
22,755
24.7
8. Diabetes Mellitus
19,805
22.7
22,345
24.2
11,612
13.4
13,799
15.0
12,590
14.5
11,514
12.5
Health Status is the actual health status of an individual or a population. Health status can be
Measured by:
Morbidity- number of individuals who are ill
Mortality- number of individuals in a population who passed from one
State (alive) to the other (dead)
Health Outcome- net impact of health care on health status
Two activities can be measured: Cost of medical care and cost of illnessQUESTION 1: The economy as a whole is measured by the Gross National Product. From 2005
to 2012, what percentage of the GNP was allocated to Health? What is Gross National Product?
Gross National Product- It is a term denoting the total money value of the goods and services
produced by a nation during a given year. GNP is used for many purposes, but the most
YEAR
2005
2006
2007
2008
2009
2010
2011
2012
2013
GROSS NATIONAL
INCOME per capita
PPP or Purchasing
Power Parity (current
international $)
3030
3210
3480
3,670
3,670
3,950
4,120
4400
P34.983B as of 2nd
Quarter2013
GROSS
NATIONAL
PRODUCT
at current
price
$86.9B
$98.8B
$122.21B
$149.359B
$173.602B
$168.333B
$199.589B
$224.754B
9,725,318,000
9,457,285,000
11,398,771,000
18,912,010,000
23,666,655,000
24,649,765,000
31,828,616,000
42,155,963,000
$250.265B
51,269,491,000 3.5%
QUESTION 2: It is clear that national health expenditures rise with income per capita. Do health
outcomes improve in the same way? Explain
Per capita health spending varies widely among countries. In general, simple correlations
indicate that there is little or no connection between health spending and both life expectancy
and infant mortality, whether one is comparing developed nations. Multivariate analyses that
QUESTION 3: In terms of health care expenditure, how much had government and the
private sector spent for health care. From the public sector,
39%was spent for preventive research, teaching and training
61% for curative research, teaching and training
How does this compare to the private sector which spent
10% for preventive research, training and teaching
90% curative research, training and teaching
The price of health care is determined by the cost of accessing and utilizing health care. It is
important to know that seeking health care includes costs other than what people pay health
providers for health services rendered or goods assured. (Policarpio, 2006)
So, there are factors that can be considered that can cause high cost of health care.
QUESTION 4:
Discuss why and how these 11 factors identified have contributed to high cost of health care.
1. Increased use of health care agencies
Increase use of health care agencies being identified to contribute in high cost of health care
in a way that since health care is specifically an singularly consumed on the presumption of
investment benefits in the health care status it will turn out that the demand for healthcare
will take effect on the consumption of health . Health care being a commodity in the free
market and the doctor being the middle man to the people as consumer ,the doctors will offer
options of regimens that could help man in optimizing his health status and so given the
options man will try these options and so frequent use of this will contribute to high cost of
health care.
2. Inflation
Inflation means a reduction in the value of money; in other words, a rise in general price levels.
The literal meaning of the word inflation is to blow up or get bigger. If the amount of money in a
country - the money supply - grows faster than production in that country, the average price will
rise as a result of the increased demand for goods and services. Inflation can also be caused by
higher costs being charged on to the end-user. These might be raw material costs or production
costs which have risen, but could also be higher tax rates. These price rises cause the value of
money to fall. You can therefore buy less with the same amount of money. But this does not need
to have an immediate effect on purchasing power. Purchasing power only declines if wages rises
less rapidly than prices, limited inflation is good for the economy. But high inflation is less
Since 2009, the balance of the world's population now lives in urban areas, creating a series of
new challenges for governments and the healthcare sector. In Africa, Asia and Latin America,
urbanization has resulted in vast shantytowns and slums with little to no access to health
services, freshwater or sanitation services. And as urban populations swell, so too does the
incidence of illness such as hypertension, heart disease, obesity, diabetes and asthma.
Increasing affluence has also created a series of new challenges for the healthcare industry as the
gap widens between the rich and the poor, resulting in a disparity in the availability and quality
of care. And as more people move into the ranks of the middle class, the impact on the disease
profile has been dramatic as changing diets result in increasing levels of obesity and diabetes.
Responding to growing needs for healthcare services requires investment in those services and in
the infrastructure required to support it.
4.Demography
As we get older, we tend to need more medical care. The baby boom generation is heading into
retirement, with enrollment in Medicare set to grow by an average of 1.6 million people
8. Technology
Technology increases range of possible treatments. Newer technology, means more expensive.
In cases such as those with kidney problems that needs for kidney transplants. The emergence of
these transplants would mean expensive than the dialysis and so it can contribute to increase cost
of health care.
9. Indigent care
It is one of the rights of every citizen that health is accessible to them, regardless of their status
in life. Indigent care is a factor for the increasing of health care cost because of the reason that
since the indigent are exempted from paying taxes for revenues needed for the programs
implemented for indigent care therefore the tax payers will be paying more taxes thus increasing
health care cost.
10.Malpractice
Malpractice can be a factor for increase cost of health care. Just in the case of patients who
have undergone surgeries where strict aseptic technique is necessary, if not sustained it would
arise to further infection and so increase cost of healthcare will be the effect.
Cost Center
These are the smallest units of activity of area of responsibility for which costs are
documented. We can also refer to them as service sections of units. They are identified
based on this type of activities they provide as well as its geographical location within a
health facility. Each unit has its own set of activities to perform, a mission to fulfill and
Revenue Center
Summarizes the income management expected to generate during the planning period.
A. CONCEPT of COST:
Costs are expenses or assets having utility for future periods
1. Cost information in relation to time frame
2. Costs that change in relation to volume or time
3. Cost data utilized for product pricing
Cost Determination
The calculation of the unit cost of the activity by dividing the total cost of the function by
the measurement unit or base.
QUESTION 1.
Explain the 5 functions of cost management. You may use any journal on Health
Economics, on managing health care costs, quality and technology.
Activity forecasting
It is an activity to calculate or estimate in advance or foretell, it may be projected income
statement, projected or forecast balance sheet, financial forecasts for external users or
expenditures.
*In activity forecasting, Level I refers to product (demand) and Level II procedure (admissions,
meal, medical record processing, billing, housekeeping, IV therapy, laundry/linen, nursing care
by levels, EKG, X-ray and laboratory)
QUESTION 2:
Select a unit of your hospital (e.g. ICU, NICU, DR, OR, Ward, etc.) and answer the
following questions: In case of those who are working in Health Centers you may get
your own workplace and the same with those in the academe- the Skills Laboratory.
The selected unit is Emergency Room of Tuguegarao City Peoples General Hospital,
Tuguegarao City, Cagayan.
3. What are the diagnosis problems and how are they resolved?
The most common diagnosis problems are vehicular accidents, intoxication, wounds such
as gunshot wounds ,stabbing, concussion, contusion, difficulty of breathing or shortness
of breath, hypoglycemia,burns,cardiac arrest, and some trauma. They are resolved
through provision of quality nursing care and compliance of patients to its treatment
regimen.
2. COVERAGE
All citizens of the Philippines.
3. NATURE
Tax-exempt attached to the Department of Health for policy coordination and guidance.
Universality
The NHIP shall provide all citizens with the mechanism to gain financial access to health
services, in combination with other government health programs. The NHIP shall give the
highest priority to achieving coverage of the entire population with at least a basic minimum
package of health insurance benefits.
c. Equity
The NHIP shall provide for uniform basic benefits. Access to care must be a function of a
persons health needs rather than ability to pay.
d. Responsiveness
The NHIP shall provide for uniform basic benefits. Access to care must be a function of a
persons health needs rather than ability to pay.
Social Solidarity
Cost Sharing
The NHIP shall continuously evaluate its cost sharing schedule to ensure that costs borne by the
members are fair and equitable and that the charges by health care providers are reasonable.
Professional responsibility of health care providers
The NHIP shall assure that all participating health care providers are responsible and accountable
in all their dealings with the Corporation and its members.
The NHIP shall promote the improvement in the quality of health services provided through the
institutionalization of programs of quality assurance at all levels of the health service delivery
system. The satisfaction of the community, as well as individual beneficiaries shall be a
determinant of the quality of service delivery.
Cost containment
The NHIP shall incorporate features of cost containment in its designs and operations and
provided viable means of helping the people for health care services.
2. Budgetary Review
Re-examination, reconsideration and restudying the outputs or services provided by the program
on departmental area in determining the costs of these services.
3. Utilization Review
Refers to a formal evaluation of the necessity, cost appropriateness and efficiency of the use of
medical services, procedure and/ or facilities, on a prospective, concurrent or retrospective basis
including but not limited to examination of the clinical application of medical knowledge as
revealed by medical records.
Summary:
Health care providers should identify the inefficiencies that have developed in the industry,
largely because of the manner in which hospitals have been financed. Prospective Payment
(PhilHealth) is designed to encourage hospital administrators to manage the process in the most
cost-effective method possible while simultaneously assuring quality health care. Nurses have a
significant impact on quality assurance programs. Nurses are the only providers who directly
care for the patient 24 hours a day from admission through discharge. Therefore, they are in a
position to identify inefficiencies, redundancies, and omissions. Nurses must develop a formal
review mechanism that will trace the care of specific patients by specific nurses.
Resources:
http://www.philhealth.gov.ph/
http://www.ancient.eu.com/Stone_Age/
http://www.princeton.edu/~achaney/tmve/wiki100k/docs/Industrial_Revolution.html