4.2.

Consumer Choice and

Demand
보건의료시장과 정부
• Consumer choice
– Consumers value ‘health’ and ‘home good’
• Made by consumer
• allocate income and time
– Figure 9-1
• Production possibilities frontier
• Rate of time preference
– How to allocate income to purchase ‘health
care’ and ‘other goods’.
 Applying Standard Budget
Constraint Model
• Decision making on allocation of income among ‘health
care’ and ‘other goods’
– Relative price: elasticity: Figure 9-3
– Income: income elasticity: figure 9-4
– Taste
– Health status: Figure 9-5
– Time price
• Transportation cost, waiting time
• 의료서비스의 full price = money price + time price
– Money price elasticity < full price elasticity
• 소득수준과 time price
• 저소득층의 무상의료의 실제 가격(time price 포함)
– Medicaid, 영국의 NHS
– Coinsurance: Figure 9-7
• Market effects: Coinsurance rate ↓ → market price ↑ quantity
demanded ↑
 Issues in Measuring Health Care
Demand
• Individual and Market Demand Functions
– Individual demand function
V=f(P, r, t, P0, Y, HS, AGE, ED, …)
V: number of visits,
P: price per visit
t: time price
P0: price of other goods
Y: income
HS: health status
AGE
ED: education
– Market demand function
• How to define ‘dependent variable’?
– Visit per capita? Problem in interpolation (from individual to market) of results
– Alternative measures
• Dollar expenditure
– Combination of price of care, quantity of case, quality of care
• Quantity of visits, Patient days, case treated
– Ignore intensity of care
– Definition and measurement of price?
• Insurance
• Deductible, Coinsurance, Limits
– Difference in the study populations
• Difference among groups
• Difference overtime in the same population
– 미국의 경우, 소득탄력성이 낮아지고 있는 추세
» Medicare, Medicaid의 영향
• Difference among types of care
– Data sources:
• Insurance claims
– Limited to services covered
– Lack detail on individuals’ characteristics
• Interview survey
– Accuracy?
– Experimental vs. Non-experimental Data
• Non-experimental data
– Control the environment, extraneous variables?
• Natural experiment data
• Experiments
 Empirical Measurement of
Demand Elasticities
• Price elasticities
– Estimates by type of care, Table 9-2
– Firm (physician)-specific demand, Table 9-3
• 탄력성이 더 높음.
– 소비자의 physician에 대한 일반적인 선택과 상이
– 만일 각 의사(physician)의 의료의 질과 가격에 대한 정보
가 있다면, 동일한 질을 소비함에 있어 가장 낮은 가격 선
택할 것임.
– Few substitutes for physician care,
Many substitutes among individual physicians
• 시장 경쟁의 측도
– 탄력성이 높을 수록 경쟁적
• Individual Income Elasticities
– Table 9-4
• Income Elasticities across countries
– Cross-national data를 사용할 경우 소득탄력성이
개인 데이터 사용할 때보다 높게 나오는 경향
– 이유는?
• 공공정책
– 예: 두 국가(rich, poor) 소득수준에 상관없이 모든 국민에게
낮은 가격으로 의료서비스 제공
» 국가내 소득탄력성은 낮지만
» Rich country는 많은 의료서비스 양, 높은 기술수준의
의료서비스 제공 가능
• 개인과 국가의 의료서비스 지출에 대한 의사결정
– 개인: 질병 증상과 고통의 정도
– 국가: 이용 가능한 health care resource, 의료기술
• Insurance Elasticities
– Price elasticities vs. Coinsurance elasticities
• Deductible, Maximum Dollar Expenditure (MDE)
• Adverse Selection
– Non-experimental data used
– 개인의 특성에 따라 보험가입에 대한 상이한 의사결정
– RAND experiment:
• Table 9-5
– Hurd and McGarry (1997):
• 노인이 fully insured 되면, 더 많은 의료서비스 소
비
• 이유는?
– 높은 발병률
– Adverse selection
• Other determinants of demand
– 인종
• Black, Hispanics,
• 인종간 특징 집병 발병률 차이
• 문화의 차이
• 지역별 차이: 서부, 북중부 지역
– 성별:
• 가임 기간 여성
• 성별 발병 질병의 차이
• 기대수명의 차이
– Urban vs. Rural
• 문화의 차이
– Taste, Relative reluctance to seek out physicians
• Health status,
• Travel time price
– Education
• Demand for health capital model
• More efficient user of health
• Less likely to smoke
• More likely to eat healthful diet
• With long-term goal
• Proper care of yourself
• Higher income
– Age, Health Status, Uncertainty
• Grossman’s theory
– Health depreciation rate increase as you age
• Wedig (1998):
– Lower price elasticity for the elderly
• Uncertainty
– Precautionary demand
– Elderly patients may smooth their utility over time by spending now
to avoid sharp drops in well-being and morbidity in the future
» Health advice,
» preventive care,
» health insurance purchase
– Role of health system
• Role of ‘Gatekeeper’
• Physicians are capitated, salaried, or paid on a fee-for-service?
– Market-based strategies
• Cost-conciousness?
• Consumer-directed health plans (CDHPs)
• High-deductible health plans (HDHPs)
• Health Savings Accounts (HSA)