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Hoorcolleges Healthcare Management and Organisation
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Samenvatting alle hoorcolleges (gecombineerd Engels en Nederlands, afhankelijk van de docent).
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Healthcare Management and Organization | HoorcollegesIntroductie
The value of what you are doing!
• Hospitals close to universities that o er both medicine and management programs have better
management practices.
• Hospitals with better management practices deliver better care outcomes.
• E ects strongest when universities o er combined medicine/management courses.
Artsen zijn ‘ook maar’ mensen
• Decision making in health care: left-digit bias.
- Why product cost 4,99 and not 5,00.
- Also cost lives.
- How frequently inpatient coronary-artery bypass grafting was performed in patients who
were admitted with acute myocardial infarction in the 2 weeks before their 80th birthday as
compared with those who were admitted in the 2 weeks after their 80th birthday.
Waarom interdisciplinair leren?
• Interdisciplinair onderwijs geeft de kans om eens een andere ‘bril’ op te zetten.
• Het maakt assumpties in een ‘academische cultuur’ expliciet, en alleen dan is er de
mogelijkheid het perspectief van de ander in te nemen.
• Communicatie en samenwerking kunnen worden bevorderd door het expliciet maken van de
verschillen tussen disciplines.
Boundary crossing
De grenzen tussen de medische studenten en de managementstudenten zijn verlaagd.
• Epistemisch.
• Professioneel: inter- en intraprofessioneel.
• Organisatorisch.
Interdisciplinary understanding
Een eigenschap die de student opdoet in het onderwijs. Je bent in staat om het perspectief van
de ander in te nemen en op basis hiervan te komen tot een betere oplossing van het probleem.
Gedurende dit vak word je uitgedaagd om het perspectief van medische studenten in te nemen.
Diversiteitsparadox
Er bestaat altijd een bepaalde paradox (je wilt niemand discrimineren, maar toch ga je om met
dezelfde soort). Wij kiezen altijd de weg van de minste weerstand (en komen hierdoor in
homogene groepen terecht).
Perspectieven
Interdisciplinair leren veronderstelt dat je (tijdelijk) accepteert dat je de waarheid niet kent. Je moet
tijdelijk accepteren dat je andere meningen zult tegenkomen over bepaalde zaken. Je moet jezelf
uitdagen om daarvoor open te staan.
Interdisciplinair leren en stereotypering
• Stereotypen zijn alledaags.
• Stereotypen werken op impliciet niveau.
• Stereotypen zijn dus niet te sturen met bewuste gedachten!
• Stereotypen zijn aangeleerd.
• Samenwerken kan dit verminderen.
(Impliciete) vooroordelen
• Wees je bewust van de eventuele impliciete vooroordelen je hebt.
• Impliciete vooroordelen kunnen de samenwerking beïnvloeden.
• Impliciete gedachten kunnen veranderen door onder andere samenwerking in disciplinair
onderwijs.
• Na a oop van het vak nogmaals IAT.
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, Module 1 Decision-making in healthcare
Hoorcollege 1 Harmonic initiative: decision-making in healthcare
Health economics - who cares?
• Health care costs a ect government budgets by a lot (US especially). We have a lot of elderly
and less people working in health care and working to cover these costs.
• People can get resistant to antibiotics, so a new drug has to be developed (less alternatives).
After 23 years you reach breakeven as a company. This is not rewarding enough.
• Diseases may have global (economic) impact.
• (Some) treatments are getting more and more expensive. While others (of high importance) are
getting cheaper and cheaper.
- The drug companies have a very bad name (expensive drugs, not giving about health).
- For example antibiotics get cheaper en companies won’t invest in it, but in the drugs where
the pro ts are.
• People may not always behave rationally when confronted with health economic problems.
• Ethical considerations play a big role.
• Emotions play a role.
• Almost everyone likes to be healthy (and live long). But this is costly.
Basic concepts in health economics
• Scarcity: occurs when the resources available to use are less than the resources required for
everything we would like to do.
• Choices: must be made about how to use available resources.
• Opportunity cost: bene t that a person could have received, but gave up in order to take
another course of action.
- This is the same in health care: is the bene t of a treatment for a person bigger than the
costs of a treatment? If we treat everyone with very expensive treatment, will the costs for
the whole society rise? Is the quality of life much lower than without the treatment?
E ciency and equity
• E ciency: maximize the health outcome (population average) given the available resources.
• Equity: reduce social disparities in health and health care.
This are the target points in health economics (sometimes there is a trade-o between the two).
For example
Everybody gets a new hip (a youth and an elderly). This is equity. But we have one hip, then it is
more e cient to give the hip to the youth.
Principles of markets: demand
Assumptions
• Consumers act rationally.
• Consumers have perfect information about
the quality of services and product.
• Scarcity: consumers have to choose
between various goods (budget restriction).
Decision criterion: preference (relative
valuation) for one good.
Comparison of cost and utility of all goods.
This is a decreasing slope.
Principles of markets: supply
Assumptions
• Firms act rationally.
• Firms have perfect information.
• Firms maximise pro t.
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,Principes of markets: supply
Firms maximize production function:
• Function of input and output:
- Inputs: labor time, materials.
- Output: product, services.
Decreasing marginal productivity
Increasing one variable, while keeping others
constant, may initially increase output, but
eventually adding more of that one input leads
to a diminishing rate of return.
The more input, but maybe the factory is too
small or people are standing in each other
ways, the output decreases after a while.
Principles of markets: market equilibrium
• Demand and supply (in a simpli ed
healthcare market):
• Assume a supply price (for a treatment): Ps
= 3q + 10.
• Assume a demand price (for a treatment):
Pd = -2q + 30.
• What is the equilibrium price for the
treatment?
• How many units of treatment will be
supplied in equilibrium?
• In equilibrium: supply = demand.
• 3q + 10 = -2q + 30. So q = 4 (this is the
quantity for which is supplied and asked for
in equilibrium).
• We can plug in q in Ps or Pd in order to get
the equilibrium price. This is p = 22.
Health care markets
• Third parties (insurers, governments, and
unwitting bystanders) often have an interest
in healthcare outcomes.
• Patients often don’t know what they need and cannot evaluate the treatment they are getting.
• Healthcare providers are often paid not by the patients but by private or government health
insurance.
• The rules established by these insurers, more than market prices, determine the allocation of
resources.
• The invisible hand can’t work its magic, and so the allocation of resources in the healthcare
market can end up highly ine cient.
Thus: assumptions from standard theory do not apply to healthcare markets.
• Externalities.
• Uncertainties.
• Information asymmetrie.
• This results in market failure … and requires regulation.
Externalities
An economic actor engages in behavior that a ects the utility of another actor (bystander) who
neither receives payment from that actor nor compensates him or her. There are two sort of
externalities:
• Positive externalities: vaccination (you are protecting others, because you can’t transmit it).
• Negative externalities.
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, Uncertainties
Healthcare spending is unpredictable since people (most of them at least) do not know when and
whether they get sick and what kind of treatment they might need (and what the cost of such
treatment are). Therefore, people like to take insurance (especially if they are risk averse and
dislike uncertainty). Imagine (option A) a certain income of 100.000 and (option B) a 50-50 chance
or receiving either 150.000 or 50.000. Which option will you choose?
Insurance
Insurance cover part (or all of the risk) for a premium. Suppose there is a 5% chance of getting a
rare disease. Treatment cost 50.000. Thus, the expected cost of healthcare is 5% of 50.000 and
this is 2.500. If people are risk averse, they prefer to pay 2.500 with certainty over 5% of having to
pay 50.000. An insurance can charge 2.500 (or slightly more to make a pro t).
Information asymmetrie
Two problems arise in healthcare markets (with insurance)
1. Adverse selection: before agreeing on some transaction, one of the two parties has some
relevant information that is not known to the other party.
2. Moral hazard: after agreeing on some transaction, one party can take an action to its own
bene t that is not observed by the other party.
Both may arise because of asymmetric information.
Adverse selection | 1
• All people have an income of 50.000 a year.
• When they get hit by a health shock - they lose 20.000 (for treatment etcetera).
• Two groups (people know which group they belong to):
- Group 1: probability loss of 10%.
- Group 2: probability loss of 70%.
• Expected income: (30.000 is het verschil tussen 50.000 en 20.000).
- E1 = 0,9 (50.000) + 0,1 (30.000) = 48.000.
- E2 = 0,3 (50.000) + 0,7 (30.000) = 36.000.
Adverse selection | 2
• Suppose that the utility (the value) of a person is:
• Easy to show that:
- E1 = 0,9 (50.000)0,5 + 0,1 (30.000)0,5 = 218,6.
- E2 = 0,3 (50.000)0,5 + 0,7 (30.000)0,5 = 188,3.
• Assume that there is an insurance which will leave them with the same income in both states of
the world.
• What are these groups willing to pay for insurance?
Adverse selection | 3
• In the good state, they have income Y, pay the premium (P), U = (Y - P)0,5.
• In the bad state, they have income Y, pay the premium P, then experience a loss (L), then receive
check from insurance for L.
• U_withinsure =
Adverse selection | 4
• Insurance needs to be such that it leaves people equally well o
(in expectation) as without insurance.
• Group 1: certain income that leaves them as well o as if they
had no insurance (utility of 218 without insurance).
• Group 2: certain income that leaves them as well o as if they
had no insurance (utility of 188 without insurance).
Adverse selection | 5
• Note that group 1 has 2000 in expected loss, but they are willing to pay 2.229 or an addition
229 to shed risk (0,1 x 20.000).
• Group 2 has 14.000 in expected loss, they are willing to pay 14.533 or an extra 533.
• Now let’s look at the other side of the trade: the insurance company.
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