A summary in english of all the lectures given in regards to the elective Rationing Health Care of ESHPM
Een samenvatting in het engels van alle colleges gegeven met betrekking tot het keuzevak Rationing Health Care aangeboden door ESHPM
Rationing Health Care - keuzevak
Lecture 1 – economic insights
Rationing health care – to limit the beneficial health care an individual desires by any means – price
or non-price, direct or indirect, explicit or implicit (Beyer, 2013).
- rationing takes place when an individual is deprived of care which is of benefit (in terms of
improving health status, or the length and quality of life) and which is desired by the patient
(Maynard, 1999) – evokes state of crisis
- something is out there that is beneficial, but we’re going to deny it; why/who/what are we
giving and by who
* When a country becomes more wealthy, more relatively/absolutely is spend on HC – we live
longer and healthier which means that HC works.
o Reasonable/ethical to ration HC? – we might be exaggerating considering how much
we spend on HC, we simply ration because of shortage (HC als een schaars goed.)
Scarcity – Human needs/wants are greater than our resources.
* Economists – limits to what you can do
o Everything comes with a sacrifice; time I invest in A, I can’t invest in B/ if I buy C I
can’t buy D. – opportunity costs, the costs you make directly and indirectly to
obtain/attain something.
Within health sector: price of health forgone
Outside health sector: other benefits forgone
o Because HC is scarce/limited, providing HC will come with a loss of something else –
economics are concerned with efficient allocation of scarce resources over
alternative uses and the equity implications.
Efficiency: relates to maximizing welfare
Equity: relates to notions of fair distribution (of welfare)
Because of scarcity there is a case of opportunity costs, thus rationing health care is inevitable.
Market/Government – price/non-price rationing
Leaving HC up to the market won’t lead to optimal outcomes, thus a government intervention is
needed to attain better results (in equity and efficiency).
- Uncertainty/consequences of insurance
- Information asymmetry between the consumer and suppliers
- Existence of externalities (think vaccination coverage)
- The relationship between equity and health can make efficient outcomes inequitable and
thus unacceptable.
So allocation and rationing is no longer up to the market, but based on ‘real need’ – what is need,
and how great must a need be in order to receive care?
- the market is a rationing device, the government here is a new rationing device
o ‘these methods can be divided into those that make use of the price mechanism
(“price rationing”) and those that do not (“non-price rationing”), the latter being
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