a healthy economy

8/17/2019 A Healthy Economy

1/44

>I I UA J>O EOV, >FJH 16 >HO AFFJI < EI (N.>J) (L.

1.0).

>I I I KH CHJL CI O--I 3.0 (>JJF://HJLI.H/II/O--I/

3.0/) I. J> I J IO I OK I>H J>I I I OKHJ J> KJ>H (KJ I M), 'J O

I JHI.

>I JJ MI II I < DH 29, 2012, J MI M J> O AO >JP

(>JJF://HKJ.H) I .

HO, J> KJ>H FKI>H MK HJ >H. MLH, J> FKI>H >I I KIJHO

CHJL CI JJHKJ J J> H FKI>H, KJ>HI, JJ, +# J HL. AJO,

FH J> FKI>H'I HGKIJ, J>H >I HL I FIII. H I

FHJ'I JJHKJ F (>JJF://2012I.HKJ.H/JJHKJ.>J?KJIKH=>H).

H H IKH < J>I , H M>O J I L

2/44

Chapter 16

A Healthy Economy

The Cost of Health Care

>J OK M> OK H ? K >J

I>LI J, -KJH J J>J OK J> M OK

< FHKJ K I, K

FIJ NFH, J> L < FI LHJIJ OK IM

JLI.

#< J> JHF J J> HKIJH IXJ IL J> FH, LIJ J JH KIKO

I NJ. > IJ, JHF J J> JH I F. H I J KIKO JH J KI M O J> NFH JI< KJ KI <

FH T IH J >J>O.

A JHF J J> JH JOFO I MJ> , FHIHFJ, FH>FI I

MJ> UI OK I.V (>J IJ J, < KHI, I J GKJ M>J OK

MJ J >H.) > OK J J> F>HO J FHIHFJ. #< OK JJ> F < FFH J> JH L OK, OK >J J KF < J>I. HIJ,

J> JHXI >MHJ I F I LJO J >> J>

IJ < JFI JK>J J I>. , L < OK H M>J I

MHJJ, J FHO I J> J OK. > >I H J>J J FHO I

I J OK >L LH >H L >H < J, OK

FHO >L M>J J> J I H >M J MHI.

# J>H MHI, J>K> OK H J> FKH>IH J> FJJ, OKH JHJJ I

HO KJ < OKH >I. J>-H FKH>II J HJO HI J> MO IJ J>H IF II . K J >I J I, OK J >I OKH JHJJ J>H.

IO, OKH !* >J H J>J OK LIJ J>H JH,

IFIJ. KH !* >J JHO J NF J> II < J>I HJ, KJ OK

FHO J> NFHJI J> M J LKJ J> I. ,

OK KIJ JHKIJ OKH JH J I I J LIJ J>

699

3/44

IFIJ I HO OKH JHXI HJ>H J> OKH M. K JOFO

JHXI L JH J II OKH

IJ JHIJ, (2) < OK >L IKH, OK J >L J FO IJ IJI.

>L IH J>I I J>K> OK >L JH J LH OKH M >J>

H JHJJ. >I I NHJ. #< OK H IM>J J I MH MJ> OK, J> OK IKII J #JHJ. K I KJ I J>H FI L IHKI JHJJI, IK>

I IKH FHKH, OK M >L J I JHJJ.

>H I JH J>I OI H M >J>. J, KII OK >L JH

OKHIL J HO J I H, FHO LHO H H,

J> L < OKH JHI.

#< OK H IHKIO , OK O >L J J J> >IFJ. >H OK >L II J

O H IFIJI I M I J < IFP GKFJ. >JLH KJO

OK > KJ OKH JHJJ HO IFFHI OK JH J> >IFJ. AJ

J>I FJTJ IJ < OK H L J> J JJITOK HJO I>K >F

OK >L IKH LH. IFJ IJI IJK.

#< OK >IJHO, >J> H MI J MOI FHL J> MO J I JO.

. >O MK

JHJO HHL MJ> I J J>H I JI. (>I JOF J JJI.) H J> IJ FHJ, J>J MI M>H OKH

JHJJ .

# FHJ, J>I H IJJ < M J J> J. #J I >H J

FH> >M K> I >I L J> IJ JKHO.

>KH OHI , KH M KJ J> MHI < J> >K O MI

HKJHO. >H MH J OJ

ILH, M>> J J>J J> IFIJ KHOTL IHJ>TK

HMH >O L

( NFIL) JH. >L II J L IJ JI, IK> I

J HI (+#) II, JIJI J>J J I

C>FJH 16 A J>O EO

700

4/44

O OII HJ J>HFO. *H>FI IJ IJHO, M >L II J

H < F>HKJ FHKJI J>J >L LFTIJI J HJ

NFITO IJIJI HIH>HI. >I FHKJI JHJ

JI J F J .

J> J>I LIJI J JHI J>I JI, M IF HJ

>J> H. F I

JJ KJFKJ < J> O) >I HI I 1960 (KH 16.1 "

J>-CH ENFII I *HJ < !D*"). KH 16.2 "! J>-CH

F" I>MI JJ IF >J> IHLI FH FHI HK J>

MH.H J> HPJ, UJ ENFJKH J> FH CFJ, 2007 (

$),V II H> 1, 2011, >JJF://MMM.M>.J/>/KI/J>F2007.F. >

I> HI J J> L < IF >J>-H IHLI. > J

JJI IFI J> IJ >J> H FH FHI, MJ> HMO MJPH

I >>-IF KJHI. J>H H> KJHI, IK> I F, AKIJH,

M , KJ> %H, KJHI IJH EKHF, MI IFHJLO H KJI >J> H. > FHH KJHI J> MH, J

IKHFHIO, IF K> II FH FHI >J> H. AHII KJHI J>

MH, I MJ> KJHO, >J>-H FKH>II H HJ J .

Figure 16.1 US Health-Care Expenses as a Percentage of GDP

C>FJH 16 A J>O EO

701

5/44

Figure 16.2 Global Health-Care Spending

HI J>J M IF I K> >J> H J> J JJI I J>J >>-

GKJO H, IK> I I L H> KJHI, I J IJ FHJ KNKHO

TJ>J I, IJ> J>J M IF HJLO H I KH HII.

J L HII HJLO H JI LHO 14, 2011, >JJF://MMM.JNJ.H/#C#B/#C39/CFH.>J .

CFH, J JJI C. C >I IOIJ M>>

J> LHJ FOI J> H. > FHH I FOJ LHJ. DJHIX LHJ, M>> JI

FJJ MJ> J> >J> KIJHO. KHJ>HH, J>H LF KJHI

IF K> II >J> H J> J> J JJI KJ >L >J> KJI

J>J H I H L JJH.

D GKJO IJ < >J> H J>J, FH>FI

IKHFHIO, >J> H I JH HII J KHI. # I II, FF

JHL HII J> J J H J>H KJHI. JI, FF JHL

J J JHJJI J>J H KL J>H > KJHI. H NF,

HIJI IJI JHL J J>H KJHI J J IJ- JHJJI J>J

H J> J JJI. H FF O I >J> H J>H KJHI

IFO KI J I >FH: FF MH JHL J >, F H JIJHO IHLI. >H H L JKH

C>FJH 16 A J>O EO

702

6/44

FHJHI J>J HH IK> U>J> JKHIV JHFI.J *K + >

H> 18, 2008, IJHO < >KI M - K>JH (>JJF://MMM.FH.H/JFJI/

IJHO/IJHO.F>F?IJHO#=88123868). >H I I FO J>J HPI JHFI J

C (>JJF://MMM.F). !L J>I H IJI HK J> MH, MHII J> I >FJH:

>J JHI J> IJ < >J> H?

Road Map

BKI M MJ J J KJ J> FH < >J> H, IKFFO I

JKH IJHJ FJ. AI M KI J>I K>, J M HFO

H J>J J>H H O J>I J>J H KGK KJ J> HJ J>

H. J < J>I I J>J J>H I M> IKJ> I.V >H I IKJ H I,V UJN

L I,V H U>JK I.V ELJO, J>H I IJ>

H. AJ>H J I J> J LHJI

HK J> MH FO HKI KJ < JJJ J J>I HJ.

!LHJI JHL NJILO J>I HJ J>HK> JNI, J>HK>

IKII, IJI O J> HJ FHLH < >J>-H IHLI.

J> H O >KI>I. > M J J>IKFFO < >J> H, > M JKH J J> JHJ < FHI. AI M

FH, M M I J>J >J> H KI IHJI < H H O HII M>O J I H MJ> IF IKFFO-- O >J> H I IK> FJ JF >I J MJ> J>

J, H KHILI. +J>H, M (H KH

FOHI) FKH>I >J> IKH, J> J> IKH FO FOI

J> >J>-H FHLHI. J>HJ> IKH I

J. > >FJH I MJ> IKII < J> LHJXI H J>>J> IJH, M>> M J KJ HJ FJH 16 A J>O EO

703

7/44

16.1 Supply and Demand in Health-Care Markets

LEARNING OBJECTIVES

1. >J FH GKJJO < >J> H?

2. # M>J II I IF >J> LIJJ?

3. >J J>-H IHLI?

4. >J I J> FHKJ ?

KFFI M MJ J NF M>O >J> H I H NFIL J> J JJI

J> EKHF. > IKFFO II JKH IJHJ FJ. #< M

HJ J> H HM J> KIK MO, MJ> J> GKJJO

J> >HPJ NI J> FH J> LHJ NI, J> J>GKIJ I, U>O I J> FH < >J> H >>H J> J JJI J>

EKHF?V

KFFO

FHI >> KI I >>. H NF, < J> KHL I

H J J> H>J J> J JJI FH J EKHF (FHJ I FIT I GKT>>H FHI J> J

JJI. > J>H HI > FHI I KI IKFFO I J. #< J> IKFFOKHL J> J JJI I H J J> J> IKFFO KHL EKHF

(FHJ J>I I MK FOT I

GKT>>H FHI J> H J> J JJI. J>H HKJ II

J>J F, M>> JKHO I KI J MH < J> IKFFO--

IJ H. # H H

HII J J> J>J J> IKFFO-- IJ

FFH> J J>I HJ.

C>FJH 16 A J>O EO

704

8/44

Figure 16.3 Two Explanations for Why Health Care in the United States Is More Expensive Than in Europe

Supply and demand offers two possible explanations of high health-care costs in the United States: demand in the

United States is high (a), or supply in the United States is limited (b). Neither is a very compelling explanation.

J KI J> KJ J> I J I I

J> J>J > LK M IK H IHL KF J J> FJ

M>H J> marginal valuation1 FH < J>J

J KJ.C>FJH 4 "ELHOO DII" NFI J>I H J.

>J>-H IKH I LHO JJ < J> LKTJ

J> H LKJT< J> FHJKH JHJJ HL. >

IKH I LHO IJ

I H, J>I J>J KHJHJ FFH> J I J MH LHO M J>-H IHLI.

> IKFFO I I I FHJ. HIJ < , I >J>-H IKFFHI >L

II I J J>J M J I>JI FH < >J> H

HII KJHI KI M >L J IH J>-H IKFFHI, IK> I >IFJI, H J>H

LHJ-JH H J- FHIKI J>J FHJ>-H FHI H J IIHO JH O IKFFO

. A, J> LHJ >I I NK KJ LK MK M JFO J J NJH KJ J .

2. A J >I MMH-IF KHL.

C>FJH 16 A J>O EO

16.1 KFFO D J>-CH HJI 705

9/44

JM, IO, >IFJI HK FI HJ>H J> O IKFFO .

KHJ>HH, < FF >J>-H IHLI, J> J>H I O J

LHO IJ (J> GKJJO I J HIF K> J FH >I).

#IJ I J, < JI GKHK FH K LHO >>. BKJ < M KF IJ

MJ> IKHI M> JJHI H FJ. *H>FI OK HO >L

II < M>O: M >L H HKF < IKHI MJ> LHO IJ M>

H HJLO KI IKI IKFFH.

>L I IIK < M>J NJO I JH J>I HJ.

UJ>-H IHLIV O LHO I, F>HIJI, O J>HI

Q *HKHI JIJ, IK> I J HI (+#)

II HJHO OII < IFI

Q IFJ KHI H IHLI

Q EHO IHLI IK> I KI

Q *>HKJ FHKJI (M>> JI< LHI >K H, J>HFO HKI)

K FHO J> < J>H FJI I M. J I H J> JJ

I J JHJ >J> H I IJ> >KI J>J I K>J I

I HJ.

>F J>J O M M >L FJO K OKH LM < J> >J>-H

HJ. KH FJ I J>J J> IF H H ILH HII M>O M >J NFJ FHI < HJ FMH. AJ>H I J> LHKI L J. A J>H I J>J I IFJI < >J> H >L J>

>HJHIJI < public good3.

The Demand for Health Care

M J KI JJ FH J J> I < >J> H.

3. A J>J I J> HL NK: J FHL J O KIHIMJ>KJ NK O.

C>FJH 16 A J>O EO

10/44

Response to Price

> M < FFI J >J> H I J>H HJI: I J> FH < >J>

H HII, OK II < J. BKJ M KIJ HJ JJHI I J>

FH < >J> H J you. #< OK >L >J> IKH, J>I FH O K>

MH J> J> JK IJ < FHL OK MJ> H. H IJ >J>-IKHJHJI, J> marginal private cost < H J >KI> I II J> J> marginal

social cost < FHL J>J H. > >KI> >I JL J FKH>I J

< >J>-H IHLI KI JI FKH>II H, J> IKH JH J>I >FJH.

J: J 31.19 "ENJHJI *K !I"

K HLM J> IJJ JM H FHLJ IJ HI IJ J> JJ.

AJ>H O >HJHIJ < >J> H I J>J I HJLO IJ. #I >J>-H IHLI J IJ O

FH. < KHI, OKH JO J FKH>I >J> H I KJJO J O OKH

, KJ OK H O J JH H FHKJI J

FKH>I J> H OK . >I I M>O M KJ IKH HKFJ O NFII.

Health as Investment

ELHO FHJ>O J I. > J> H I FHJ

NFHII < J>I FH J>J I >J> H , I J>J J I IKJKIO LIJJ.

O OK IF >J>O JO M I H

H ILH IF >J> H HFHIJI

LIJJ.

Mortality. H FJ < KH >J>-H >I I JHI M O M H J J J JJI HJJO HJ I LH J>

< 85 MI 13,823 KJ < 100,000, H 13.8 FHJ.HJJO HJI

J CJH JJIJI, J J JJIJI OIJ, UHJJO

I,V II H> 14, 2011, >JJF://MMM..L/>I/LII/

C>FJH 16 A J>O EO

11/44

HJJOJI.>J. # J>H MHI, J> JOF OK FHI >I KJ 1

10,000 > < O L OH, M>HI J> JOF FHI >I H

J> 1 10 > < O.

#J I J IKHFHI J>J J> HJJO HJ HII MJ> TJ>J I, J>J OKFF >L MH FHJO < O J> H FF. (#- > I H O J J> 18-J>- >

KI LHO OK >H H FHJKHO IKIFJ J HJ III.) BKJ

J>I LH HJJO HJI IKI J < LHJ, K> < M>> I KH KH

JH. >H H O >LHI J>J >L FHJ L >>H FHJO < O J> IHI. >I M> H

I >L >>H FHJO < O J> J>I M> H J. DJ, NHI,

HIO >LHI (M>> KI LHOJ> I IH J> J>H

IH, J> J> HJJO HJ I I>H IH. >I I

J J>J J> IH M IIHO IH. #J I J>J

I J> I, I HII J> probability4 < J>. + < KI I JIJ < FHJKH I LJ >IJH LI J>J FI

-JH HI < >HJ II, > O J KIJ >I J, FH>FI IK

II H J. #< >JO-OH- HI J> I MI, > O J J> J>

-JH L KF >I IJI J>O I I J>J OK MH H MI. IJI < FH >J> I IJ OI J MH. >I I IJ J O J J> LK

KJ I J IJO I M>: J> OXI FFKJ I FHK II KJFKJ. #J>, J> OK HI I MI OI M> OK J J MH. O FOHI FHL IKH I IJ MI J>HK> J>

FHLI H I

IJO IKH I FHJ < J> I IKHJO IOIJ J> J JJI.>

LHJ FHH I IKHP J >JJF://MMM.II.L/IJO. *HLJ

FOHI IJI I FHJ > J>J KJ M KH.

C>FJH 16 A J>O EO

12/44

FI, OK I FKH>I IKH HJO H I NF < > J> JOF LK I K J

JH J> GKJO < M>J I FKH>I. K J> < J>H NFI,

IK> I IHLI KI HI. # IK> IJKJI, >M M

II? !HO M I O HO J> L < NFHJI. # J> I J>, J>I H J> JHI, JIJI, J>H >J> FH H

JH J OP KH >J> IJKJ IKIJI J KI. IJ, JHO J

KHIJ, , KI J>H L, .

KFFI OK J F> O M < IJ,

JH JHJ, J>J M K FH J> J

LHO IFJ, IKIFJ J>J J>O >L J>H HII I J LHIJ MJ> NFHJ. !HO OK H J

L J>J J> NFHJ I J OKH IJ JHIJI. AJ>K> OK >J J

I (H J>H) F, OK I KI >J> FHI H FN J>

L II IJ>, J KI OK H JH I

I OK HH J FH H J> J> FHLH < IJ JFI? HO I KI

M JHKIJ J>J J>H JLI H MJ> KH I; J>J I, M >F J>J J>O

H JLJ J J KH IJ JHIJI.

The Supply of Health Care

M JKH J J> IKFFO I < >J> H. EIJI J KII H, FJ, JHJ

FKJI. >J I J> FHKJ IFJ?

Q > H >IFJ KI JHI, IKHI, HHI,

J>I, KHII, IJHJL IJ >IFJ KI H FHJ < J> >IFJXI FJ IJ. #

J, >IFJI J I GKJJO < J>H FJ I,

IK> I >IFJ I IJ JITLHOJ> IFI J N-HO >I.

Q #JHJ FKJI >IFJ K HIII HKJ FHKJI, IK> I IJ>JI KI H IJHI < J> >J>-H KIJHO MI FO H, FJ,

JHJ FKJI.

C>FJH 16 A J>O EO

13/44

J: J 31.17 "*HKJ KJ"

K HLM J> M OKH JHXI .

AI I JHI>F J> OK L I J FHJ . >I

I II: OK MK J MJ O J LHJI I JH HHII < J>H

I L. IJ < KI MK K J J M>J>H FHJKH LK MI

GK GKJO H J> IHL J>O H FKH>I, J I KIL NJH LJI

< GKJO.

I FHLI H J> KHJ < GKJO, >MLH. #J I JI JHO

J J> FHJ I HKF < OIJI OKH

>JM MJ I IJJ MHI J I J> I MO I F>OII.

K MK GKJ H>JO IKIFJ J>J J>H MI J J KHJ >>-GKJO

I. H O, J>O MK JHO J J J> KH H HJ FMH. KH IKIFI MK J O < J>I OIJI

HK J>J I MI FJJO LHO >H

IHI < I, J>O MH FHJJ J> KJO. # J> I < JHI, J>

KHO HI I

IJJI.

DJHI H L FHI FHIKFJ J>J MI KI J LF KH J>HO < IKFFO. DJHI JO J> KJ FH < ,

M>> I I >H, AIFKI, O, *, # J J MJII

J> I, J> III, J F H J O JO O KJ, J>

HJ:

5. A IJ O EO

14/44

R

# M FHIH HI < O FJJI H J O JO O

KJ LH >H J OR

# M J L J> HK J O < # I,RWikipedia, I.L.

UFFHJJ>,V II H> 14, 2011, >JJF://.MF.H/M/

FFHJJ>.

>I J> I IJH J HO LHO J H.

Other Health-Care Workers

# J J JHI IFIJI, J>H H O J>H I < MHHI J>

>J> H KIJHO, K KHII, J >OIJI, IJHJL IJI, O

J>HI. > >J>-H KIJHO FOI IJ 10 FHJ < L MHHI

J> J JJI.

16.1 "EFOJ J> HLI ( I)" I>MI J> HM J>-IHL IJ H OHI: 2000, 2003, 2006. IJ

I (J ) < J> JOFI < >J> IJI. H J> J, M I J>J J> KH I KIJHO >I HI I HI I JOF < O IHL KIJHI JHIJI

MJ> KH J> KH < MHHI FO I .

16.1 EFOJ J> HLI ( I)

Type of Health Service Site 2000 2003 2006

*>OII (I/J/>KI/>KI07.FFJH 16 A J>O EO

15/44

IFJI H J> IJ FHJJ JOF < FOJ IJ J>-H MHHI.

# 2006, 40 FHJ < >J>-H MHHI MH FO >IFJI. AKJ J>H-

I < J> MHHI J> >J>-H IJH H M. H

FHJKHO FHLJ KHI H 1.6 MHHI

KHI H H I M LHJO < KFJI MJ> >J> H: HI, FHHIJI, J.), IHL KFJI (IIIJJI, I,

HI, J.), IJH KI < J>

M < MHHI

KHI >I.

Health-Care Capital

> M J KIJHO IK> I >J> H, MO < IH J I O

KJ J> KH < JHIX J> IHLI. IFJI H O

NF; J>HI K JHIX BKHK < H JJIJI (>JJF://MMM.I.L///

I035.>J), 2008, J>H MH 595,800 IJI>JI J> >J>-H IJH

J> J JJI. < J>I, JHIX 14, 2011,>JJF://MMM.I.L///I035.>J. AJ>H MO J IH J> KIJHO I O

J J> KH < MHHI FO H, J>I IJJIJI FJ JHIJ FJKH. IFJI H I

JJ >J>-H IJI>JI KJ FO 35 FHJ < J>

MHHI. >I JI KI J>J J>H H HJLO IFJI (FH J JHIX

IFJI FO H J> 1,000

MHHI. K> FJJH I J FKH J J> >J>-H IJH. #

K HJO < IJI>JI H I, JI FO J> HJO < MHHI.>I I IH JL . DLI,

> C. JMH, JJ >K>, Job Creation and Destruction (BIJ, A: #

*HII, 1998). IKII J>I F> H J C>FJH 9 "!HM

I".

C>FJH 16 A J>O EO

16/44

> MHI>F < >IFJI I I FJ. H FHLJ, M> J>HI H

FK, J>J . #

J, J FHLJ >IFJI H KIII IFJI >L J> < FJJ IJO LH

KJ 5.5 OI.

16.2 IFJ AJLJO, 2005

Type of Hospital Admissions (Thousands) Average Length of Stay (Days)

A 37,006 6.5

H 952 11.6

H FJ I J>J JH J> FHKJ J>IJH. H NF, F>HKJ FHKJ I FJ

IJ. J I J> FJ IJ < FI J>J FHK J> >I, IK> I

+#I, KI JHIX LI >J> H H JHKO IJH. > FHHII

J>I IJH, I J>H IJHI, FHII J> FHKJ FHII LJI.

BO FHKJ LJI, M HII J> JOFI KI>I JHI. A NF I J> LIJ HHO < HKIM L J> HJ, M>> I J> KJHMJ> J> < HIH>

LFJ J F>HKJ FI < FKO .

AJ>H NF I J> L >HO KI H >J>-H I, J>H

FI < J>O J>J MK >L KJ> OKH HFHJIX O.

+# >I H J>H NF: J>I H IGKI IK> I -HOI, KJ J>O H NFILT M +# > M

C>FJH 16 A J>O EO

17/44

JOFO IJ >IFJ H J> $1 .A HJ IHI J>I J>GK J

A, U> *JKH BI CH 15, 2011, >JJF://MMM.I.H.K/L/062/062O.>J.

*HII LJI HM J>GKI H FJ. H NF,IKHI JO FHJ IKHI < FHLKI HJI K

J L . > M I FHKHI MI HJ O JK>J J J>HI I> J>H JH FHHI.

*HII FHKJ LJI JJ>H M> OK FH >M HJ

FHKHI H FHH. > H (>J) IKHHO J F HK 1919, J> FHKH

MI HIO FI LL

>IFJ IJOI, O OI IJ IJHO < >J >H IKHHO, I >I JOFKI

DL . +JJH, U> IJHO < J H KHHO: H BMJ> J

FHIFO,V Annals of Surgery 241, . 1 (2005): 185S193, II H> 14, 2011,

>JJF://MMM.FKJH.>.L/HJHH.

J>

>J J>J MI IKH J I I FJJXI LJO. >, KI

J>H IJHKJ, IHJ J>HK> I I, J> IKH HFH

J> >H. +HO, J>I I KJFJJ FHKH. > FJJ HI >IFJ MJ> FJH MH IJ J>HI J>I , M MK M JKH J

IKII < >M IKFFO JHJ FJJL HJ J

JH J> FH. H, HP J>J HJ FMH IJ FHI, M

>J KI J> J J>J H HLK GKI H IJ J J KJ

FH JHJ. J I J KHIJ J> HJ J> H, J>I JI H J I KIO, OK MJ J >J H M H CJO. K

KF O >J FH < H. H OK J> #JHJ > FHI J>H J J> >JXI MIJ H J O KH < J>H IJI J>J

FHL IHLI. K J , H

HLMI J IJ JF> J

FH J> >JXI JI.

C>FJH 16 A J>O EO

18/44

M FH J>I J >IFJ. #J I K> >HH J J I FHJ. K

. H NF,

J>H I MIJ J>J MI OK J HI O O J K J> IJI < JHI J>H

FKJI. #< OK >L IKH LH, M>, OK J J

FHJ < O M LH O OKH IKH. KH KJ J> FH <

FHKH I GKJ FJ.

M, J>, H FHI JH? A, FHJJO, M>J FH H M J

KJ: J> FH OK FO H J> O HL O J> >IFJ? O < J> IJ

FHJJ FHI H JH O J> JHJ < LHJ, IKH FI, F>HKJ FI. KH 16.4

"*OJI J IFJI DJHI" LI II < J> IKHI < IFJI JHI. IFJI JHI J F O IKH FI,

>KI>I, J> LHJ.

Q H (>JJF://MMM.H.L/ IHLI J HO (LH 65)

I FF. #J LHI HO 40 FF. H J>I

FHH, J> LHJ IJI I HK> J> J> K

HLI MIJ. CJHI 14, 2011, >JJF://MMM.I.L/FFI/F>OI-K/LHLM.IFN. A IH> J J>J IJ

MI OK J OII >IFJI I IHLI.

Q Medicaid (>JJF://MMM.I.L/!#

LHJ KJ MJ> IJJ LHJI.> IJJI I

J> FHHI IKJ J FFHL O J> KI

J>H H LH FH

FHI J>J IJJ. >I FHH FHLI >J> H J M-

>KI>I J>HK> FOJI HJO J >J>-H IHL

FHLH, IK> I >IFJ.

C>FJH 16 A J>O EO

19/44

Figure 16.4 Payments to Hospitals and Doctors

BKI < J>I FHHI, J> LHJ I FOH J> >J>-H

HJ. !LHJ II JH J> J>-H IHLI.

!LHJI J J FHI I L. # I II, J> LHJ IJI HJI

J>-H FHLHI HIF. # J>H II, J>

LHJ I LL JJITMJ> F>HKJ FI, >IFJ

JH. #< OK H FO>H H JJ J >IFJ, OKH IKH

FO M HKHI J> >IFJ IJ < OKH H. #J I

HKHII OKH JH HJO. M K> < J>J IJ I HKHI FI

OKH IKH FO. #< OK JH >IFJ, IO, KJ IKH FO M FO J> >IFJ I IJ O NIJ HJ.AI HIKJ, >IFJ IJHJHI KI.

+KHIJ HJI I KO J> IHL, I

J> J H

FOI KJ 50 FHJ < M>J H IKH HHH BK CHII/

BK > FOI. H NF, < HKHI $500 H HHH $1,000 I

C>FJH 16 A J>O EO

20/44

FHKH.V>I GKJ I IFJ F, %II. BI,

UH: CH LHIKI CIJ, cjonline.com, JH 23, 2007, II HKHO 1,

2011, >JJF://MMM../IJHI/102307/IJ211162036.I>J. BKI I I HJ JI J>J

JHI IJI JKH M FJJI KI < J>I M HJI.

A M>J M OK FO < OK M J >IFJ MJ>KJ >J> IKH? A

AFH 28, 2008, HJ J> Wall Street Journal IHI J> F>J < H

FJJ MJ>KJ GKJ IKH. > FJJ MI KIJHO.

IFJI H FJ FO J FHL J>H L FF O

HL H. BKJ M, FJ J J>H KH -J >HJO-H IJI,

>IFJI H I FJJI O >L JKH J J> FHJ KI < IF FJJI M>

XJ FO J>H I. FIJ H IJ J> >IFJ KIJHO $31.2

2006, KF 44 FHJ AH IFJ

AIIJ.BHH HJP, UCI> : IFJI !J K>. Wall Street

Journal, AFH 28, 2008, A1.

KEY TAKEAWAYS

Q DK J I, HJ FMH O

IKFFHI, LHJ JHLJ, J> HJ J> H

J OP O KI IJH IKFFO-- KHLI.

Q F >J> H JO >I IJJKI J>

J II, J>I IF I LIJJ.

Q > J> IHLI, J>H I, FI OKH

J> FH < J> IHLI. OKH H I, OKH J> IHLI I IJI

< >J> IKH. AI, K J> I H I,IKHI M> >J> IHLI H HJLO K IHL J>O H KO.

Q > FHKJ JI FKJI, IK> I JHI, KHII,

>I, FHKI >J>-H IHLI.

C>FJH 16 A J>O EO

21/44

CHECKING YOUR UNDERSTANDING

1. IJ J>H HII M>O J> LJ IKFFO-- O

J HJ J> IHLI M.

2. M I J> J> IHLI FHLI < >J>-

H IHLI.

C>FJH 16 A J>O EO

22/44

16.2 Health Insurance

LEARNING OBJECTIVES

1. >J H J> JL IIKI IIJ MJ> J> J>

IKH?

2. >O I >J> IKH J FOJ J> J JJI?

3. M I J> M < FFO J J> J> IHLI

M> J>H I >J> IKH?

#IKH I IJ> J>J >K I >L LF J >F KI MJ> J>

HII M J H FHFHJO M IJ.

Q K M I I < OKH FIIIII K J I IJ. MOI >L J MHHO KJ J>I

>FF. IJ I J>J, HII IJ, OK J IKH.

>I I J>J M FO FHK) J IKHH; HJKH, M HL

FOJ IKHH < J> J> >FFI.

#IKH I I J> < J> diversification6 < HI.C>FJH 5 "

23/44

#IKH FI H J HHO KJ IK> LHIH H HKFI < FF. #IKH FI IJ FHK GK

J J> expected value < J> II ( J> NF, 15,000

Y $10,000 = $2), FKI IKH FO I FH KJ < NFJ LK J> JJ.

#IKH, J>H IHLI, I JH HJ. K >I J KO J H HI < J> JOF < IKH OK

FKH>I. > I IKH FO IIKI OKH HI J FH OK H

M J FO. BKI FF J>HI J. #< OK H LHO

KJKI (H FHIO, LHO HI-LHI), J> OK H H O J KO

IKH.

What Makes Health Insurance Different?

J> IKH >I J> I I IJHKJKH I O J>H IKH: OK FO

FHK J IKH FO J>J J> FOI OKH I < J>

HII. J>H JOFI < IKH, J>H H I I>H < HI.

MLH, >J> IKH F .. J> #IKH,V American Economic Review 93, . 4 (2003): 1373S1384.

I J> HJ IKII < J> >IJHO < >J> IKH: II

>II, UJ> #IKH J> J JJI,V EH.net , HKHO 1, 2010,

II HKHO 1, 2011, >JJF://>.J/OF/HJ/

J>II.IKH.>J>.KI. (1) >J> IKH I HO FHL O

FOHI, (2) J> IKH I HO FHL O J>

LHJ. # I II, J> LHJ I I FHLH < >J> IHLI. #

J> J JJI, J> LHJ FHLI I >J> IKHTJ J> LHO

FH, J> , JHO LJHI. BKJ IJ FHJ, J> FHLI < >J>

C>FJH 16 A J>O EO

16.2 J> #IKH 720

24/44

IKH J> J JJI I LHO MI J> JOFI < >J> IKH J>J

>KI>I J J> J JJI. > UJV K JI J>

KI>I MJ> IKH. 1999, J>I >I LH KJ 85

FHJ KJ >I J. J> H>J I, J>I JI KI J>J IJ

FF H LH O IKH. #J I JI KI J>J KJ 50 FF J>J JJI >L >J> IKH. > J HLI J J>J O

IJ FHJJ IKH < >J> IKH I J>HK> FOHI: KJ 60 FHJ

< LKI >L IKH FHL J>HK> J>H J> LHJ (KJ 30 FHJ) HJ FKH>I

(KJ 9 FHJ). >I KHI J H J> 85 FHJ KI O

LKI >L IKH IKH.

16.3 KHI < J> #IKH J> J JJI

Year Total (%) Government (%) Employment (%) Direct (%)

2009 83.3 30.6 55.8 8.9

2007 84.7 27.8 59.3 8.9

2005 84.7 27.3 60.2 9.2

2003 84.9 26.6 61.0 9.3

2001 85.9 25.3 63.2 9.3

1999 86.0 24.5 63.9 10.0

KH: CIKI BKHK, UJ> #IKH IJH I,V II H> 14,

2011, >JJF://MMM.IKI.L/>>I/MMM/>J>I/J/>IJH/>IJJ1.NI

#J >J I J>J OKH >J> IKH I O J J OKH . AI JI HJI J> JPJ AJ < 1942,

M>> MI I J M O *HIJ H +ILJ. > < J>

IJ MI J IJP MI FHI KH H H ##. AJ>K>

*HIJ HHO HK HF IJ < J> FHLII < J> J 1946, I < J> J O *HIJ HHO HK IKJ J J> AH *HIO *HJ, UENKJL HH 9801: +L

HO CJHI AFJ *KHIKJ J J> JPJ AJ < 1942,V

II H> 14, 2011, >JJF://MMM.FHIO.KI.K/MI/

N.F>F?F=60709.

C>FJH 16 A J>O EO

16.2 J> #IKH 721

25/44

A O FHLI < J> J IJI> M FH JHI. >I J J>J

MI MH H JH O HJ LHJ. BKJ M> J> LHJ FI HIJHJI J> MO FF

JH, J>O M I I J J>

>HJ FJH 12 "BHHHI J H J> HHK EO". >

F> J> JPJ AJ MI J>J J NFJ FII IKH KJ < MI. >I J J>J LH FIJ

J>O J> FHLI < FII >J> IKH. EL

J>K> M FH JHI H H F, J> FHJ < IKH I FHJ < FIJ F FHIIJ.

A FOJ-I >J> IKH IOIJ MI H O JN JI, IK>

I J> 1954 #JH +LK C, M>> FOH JHKJI J

FO >J> IKH JN. #LKI MH I M J KJ

NFII IKH, OK H JN J>$1,000 < . BKJ < J> IKH OK J FO JN

J> $1,000 MHJ> FH OK FO HJI OK M GKJ J> IKH H

K> >>H J> J> HJ (J> FO J>HK> OKH . NFJ I I J>J J I >FH J MHJ

IKH FO H J> LKO. A I

NFJ, M>> M NF H J JH, I J>J, LH, FO

FF H O J MH HI J> J>I J MH. A J>H J HKF < FOI I HO FHJO LHI HKF I II HIO J>

I LK.

IM 16.3 "KHI < J> #IKH J> J JJI" J>J KJ

15 FHJ < LKI J> J JJI J FIIII >J> IKH. BKJ

M> H J>I LKI, M>O H J>O KIKH? > UM>V I IH J

IMH J> J> UM>OV KI M >L IJJIJI J> KIKH. 16.4 ">

IKH ( I)" HLI J> I J I 14, 2011, >JJF://MMM.IKI.L/FH/2010FKI/

F60-238.F KIKH H FH. < J> HO 45 KIKH

2005, KJ 14.5 > I II J> $25,000. (AI

>H, H J J> CIKI BKHK, J> 2006 FLHJO L

O EO

16.2 J> #IKH 722

26/44

KIKH > I NII < $75,000. # 2009, < J> 50.7

KIKH, KJ 15.5 > II J> $25,000.

◦ O < J> KIKH H OK. # 2005, J>H MH 8.0

KIKH FF KH J> < 18. >I KH MI 7.5

2009.◦ O < J> KIKH H OK and FH. AKJ 2.5 < J>

8.5 >L FLHJO . AH

J J> CIKI BKHK, 65.5 FHJ < J> >H FLHJO

MH LH O J> LHJ FHH.

(>JJF://MMM.I.>>I.L/!# KIKH H MH. >H MH LH 20

LKI 2005 M> MH MH L

>J> IKH. # 2009, J> KH < KJ>J> IKH MI MHT14.6 TM> J> KH < FHJ-

J MHHI MJ>KJ >J> IKH MI >>H. J M

I J M>J>H J>O MH IKH J MH

H > I J>J J 14, 2011, >JJF://MMM.IKI.L/FH/

2010FKI/F60-238.FFJH 16 A J>O EO

16.2 J> #IKH 723

27/44

Adverse Selection

FJ < >J> IKH HJI I J>J J>I M> IKH

H J> I M> H H O J IKH. >I JI< >J J

FH, NFJ J>J LKI I M H KJ J>H M >J> J>

J> FI J>J H IKH J>.

KFFI J>J >< J> FFKJ HHI J>J LI J> 1 FHJ HI

> OH < JHJ FHJKH < H. > J>H >I >I O 0.1 FHJ HI < J>I H. #< LK I

I, IKFFI J>J J> IJ < JHJJ FKI IJ MH J I $100,000. 16.5

"*HJI ENFJ III" IKHPI J> IJKJ. !HKF A >I 0.1

FHJ > < JHJ J> H, I J> NFJ II I $100 (=

0.001 Y $100,000). !HKF B >I 1 FHJ > < JHJ J> H, I J>H

NFJ II I $1,000 (= 0.01 Y $100,000).

16.5 *HJI ENFJ III

Group Probability of Cancer (%) Expected Loss ($)

A 0.1 100

B 1 1,000

M J KI J> KJ IKH FO J>J MJI J O O I

IKH FI IJ J>I II. KFFI J>I FI FJO LH III J> LJ J>J J> LK JHJI J> II. #< J> IKH

FO MH J IJ J> FH < FO LHO >> (IO, $5,000), J> O LHO

HI-LHI FF MK KO J> FO. #< J MH J IJ J> FH LHO MTIO,

$50TJ> LHO J> FFKJ MK MJ J>I FO, KJ J> IKH

FO MK II LHO LK.

MLH, IKFFI J>J J> IKH FO MH J H H GK KHI < J> HKFI J>FFKJ, M I>K NFJ J FHH

H 2,000 JOF LKI (1,000 < > JOF), J> LH HKF A

FHI M I (KI J>H > I 1 1,000) 10 HKF B

LKI M I. # JJ (HII J> L J FO

KJ I FH, KH NFJ HLKI

C>FJH 16 A J>O EO

16.2 J> #IKH 724

28/44

IJI H J> I. #< M MH J >H I>JO >>H FHK, J> M K

FH LKI J> FFKJ J M J>H M JOF, J>I MHI

J KO J>I JHJ. >FH I < LKI KII I J M>> HKF J>O H

TFH>FI KI J>O M J> >IJHO < J>I H J>H M J> IKH FO >J . !HKF B FF MK

JHJ. > FHK I II J> J>H NFJ II.

BKJ HKF A FF >J HI J>J J>O H LHO KO J J J>I II

>J J>J IKH FO J>J IJI $550 I K> J NFIL, L

J>J J>H NFJ II I O $100. >I I J>J HKF A FFTKII J>O

H LHO HI-LHIT>I J J KO J> JHJ. M J> IKH FO

M O I 1,000 JHJI, H HLK < $550,000, KJ J M >L J FO

KJ $1 (= 10 Y $100,000).

#< J> IKH FO K IJKI> HI < HKF A J I FHJ I

J J> HKF B FF O, MJ> FHK < $1,000. !HKF A FF H > < KO IKH J H KO FO J>J I LIJOLHFH L J>H JK HI < JHJ J> II.

>I I NF < M>J IJI adverse selection8: IJKJ M>>

LKI < H H J J KO IKH (J>I I

J> IJ). MH-HI LKI FJ KJ < J> IKH HJ, L O

>>-HI LKI J> HJ (J>I I J> II M>> J> IJ I

LHI). ALHI IJ I J I IKH < HJ

J

HI FH.

M IKH FI MJ> J>H

J>O I H IKHI < J>O, HIFI LKI FKJ I J J OK MH O FHJ> HI. >I I < J> HII M>O J I8. A HJ FHII M>> M-

HI LKI L HJ,M> >>-HI LKIH.

C>FJH 16 A J>O EO

16.2 J> #IKH 725

29/44

KIKO >FH J J IKH J>HK> OKH HJO J> H I FHNIJ JI,

I II H IJO OK HO FIIII M> OK FFO >I FHLKIO IK IKH FO

MI J>J J>I FHI I J HJH HI < J>H JJ.

#< OK FFO L FHNIJ J, J> J> JHI < J>

IKH M H > J>J J> J M HKH. >I I HI

K>: IKH I J J FHL FHJJ IJ J>I J>J >J >FF

J OK J> I J>J >FF J> FIJ. BKJ J HII FH

MJ> FOH-FHL >J> IKH. KFFI LK >I >J>-H

LH J> J> IK

KI J> >HJ JJ MI J FHNIJ J M> > J

IKH. BKJ < > MI>I J > I, >I >HJ JJ I FHNIJ

J I M IKHH. >I J LHO IJO J > IT JKH

J> O J,I IKH, LKI O >L HIH MOI. H NF,

J> KJ OKH > < H J. > FHJO J>J OK M

>L J FI O J>I: H JI, J> JI < J>H

HLHI, K, O J>HI. #J I FI J> JI OK J I HLH <

J> H. >H H O J>I M J>J < >L

J, K (KJ J J J) J> H

Q *O JJJ M> HL

Q DHL M> JHQ DHL

>I JI H J M . > J IKH I

J>J, < M H IKH, M O J < KH

H, J> MO M HL, KH F>OI IJJ M> M HL. > KI

MJ> >J> IKH I J>J M O >I J L II >J>O JHII M> J> FHLI I.

C>FJH 16 A J>O EO

16.2 J> #IKH 726

30/44

HIH >LH < M M J>J M >L >J> IKH J LH KH NFII

< M I H KH.

#IKH FI KHIJ LHO M J>J J>H FI >I

J>J FF . >H HIFI I J I IKH JHJI J>J FHLIKH MJ>KJ I KJ < II OK >L J LH > I J> I>H < J> II > OK

H HIFI. > I FFI J IKH. # J> LJ OK H ,

>J> IKH M JOFO LH M LHJO < IJI, KJ J>H M

KIKO KJ FHFHJO H

KJ IKH, J> KJ FHLI JL J OK II O J IJ J> FO.

>H H JM H >PH IIKI MJ> >J> H. HIJ, >J> H I

LK LIJJ. AJ>K> MJI J J I, J> H OK FO H O OK M LIJ OKH M >J>. C>I

FHJ J NHI, J, FHLJL H F J> IKH

FOJI M JFJ < M >J> H. > H IKH M >L, J>

II JL M >L J J H < KHILI. A J> II M J H, J> H

O M H J FHIJ J> IKH FO MJ> IP >J> .

, J> IP < J> >J> I FI OKH >I KJ JHJJ.

> OK H , OK M J MJ> OKH JH J JO JHJJI.AJ>K> OKH JH M FHO J J OK KJ LHKI JHJJ FJI,

J>H FH M J J> IKII. ELJKO OK M J MJ>

I I J> M LH O OKH IKH. # J> , OK >L

K < JHJJI K < FHI J>J OK >L J FO. K M J>

> I K J>J I OKH IJ JHIJ.

> IKH FO FOI I < OKH , I J> KJ OK FO I MH J>

J> JK FH < JHJJ. BO J> M < , OK FKH>I H J> OK

MK < OK > J FO J> J K> H J J I J>H FI < OK XJ >L J FO J> I JLI O

C>FJH 16 A J>O EO

16.2 J> #IKH 727

31/44

K >KFI LH KH J> FO. XJ KFI LHO

J> KI IK> LIJI H J LH O IJ FI. > IKH FO

HJO II J> JLI I OK H O J M> J

I FHLJL H.

Health Insurance and the Law of Demand

M J>J M >L JJH KHIJ < >J> IKH JHJI, M IO

H KJ J> J> H. IJHJ MJ> J> IJ < >J> H J KI

I >KI>I. >L KIJ I J>J < OK >L >J> IKH, J> IJ J OK

< JHF J J> JH I JH O OKH >J> IKH JHJ. O I JHJI >L FOJ FHLIT H

LIJ, KJ OK XJ FO J>J IJ. OK, JHF J J> JH IJI $20.

> FFH> J LK > IJ FFI. KH JH I H LKJ < J>I LIJI IJ J>I

IJ < $20. > M < MHI J> KIK MO: < OKH IKH FO

HI JI FOJ J, IO, $50, OK MK JH. >

NJJ J M>> J> GKJJO HIFI J J> FH FI, < KHI,

M>J NJO I MH MJ> OK. #< OK H IHKIO , OKH I O J

IJ. #< OK >L O IH J>HJ, OK >J MJ OK H.

>H I J>H J < J> >J> IKH JHJ J>J >I HJ I I, OK OKH JIJ H HIF J

J> JLI < J> J JHJ.

C>FJH 16 A J>O EO

16.2 J> #IKH 728

32/44

KEY TAKEAWAYS

Q #JL FHI < LHI IJ (J> >J> IKH FHLH

J M OKH HI II) H >PH (JI OK J J

J> H) H FHLIL J>FHLI < >J> IKH. >I JL FHI H FHIJ

M> J> IKH I FHL O FHLJ FI J>

LHJ.

Q J> IKH J> J JJI I J OKH I

IGK < IJ 1942 J>J NFJ J> FHLI L >J> IKH, OKH J> IHLI M

H H IJ J OK < J> IHL. >I I KIKO J>HK>

J> FOJ.


1. KFFI J> FHLI < >J> IKH J OKH I NF < H >PH H LHI

IJ?

2. #< J> FOJ HII OKH J IKH, M>J M J>I

J J> JIJ J> J OK LJ J

J H < OKH JJ>?

3. >J I J> O EO

16.2 J> #IKH 729

33/44

16.3 Government Policy

LEARNING OBJECTIVES

1. >J I J> II HJ J>-

H IHLI?

2. >J I JHLJ J?

# J> J JJI HK J> MH, LHJI H LL J>

FHLI < >J> H. J> IKH I F

EKHF C. # J> J JJI, I FHJ J >J> H

KLHI >J> IKH >L J MHXI 1954 JJ < AHII: U#

IPJ < . > HJ IFJ

IHLI IJ J O J> JJL < FHLJ FI. BKJ J I

KHI>FI O H !LHJ O >FI

IJ H IPJ < .VADC: DKJI

JKO < AH IJHO, UDM>J EI>MH, WJJ < J> , 1954,X"

II H> 14, 2011, >JJF://MMM.L.KI/I/JNJI/1954.>J.

AI M J HH, J> FO O IMH JM GKIJI: (1) M>O LHJI

JHL? (2) >M J>O JHL?

Why Do Governments Intervene?

AI KIK, M OP LHJ LLJ J> O J>HK> J> I J> H, J>H H ILH HJ H I J> FHI

J> > J>J J>HI HK

J>J FHI J I HII. #LKI JOFO II KJ J>H

>J> H MJ>KJ J> K> KJ J>

MHI. K O J J MH L J>K> OK H IKO EO

730

34/44

J> O, OK O J J> LHO K> KJ OKH

> < HI. >I I II NF < NJHJO.

Commitment. IFJI H HIKHI J FO J H. >HK> IJ FII 1986, >IFJI H HGKH J JHJ FJJI HO IJKJI, JJH

M>J J>H IKH LH.> HKJ I EAA

(>JJF://MMM.J./>IJHO.>J). #J JHO FFI O J J>I >IFJI

J>J FJ H, KJ J>I I IJ KLHI. # O II, J>I I

KIKH

>L JL J I H H >IFJ HO HI, L J>K>

J>I I NFIL F J FHL H.

#< >IFJI K J J J IHL FF KII J>O > >J> IKH,

J> I < J> KIKH >J K J FKH>I >J> IKH, IJ

< HO HO MHI. BKJ >IFJI H J J IK>

JJ; J>K> J>I >J H .

Adverse selection and moral hazard. NF HH J>J M> IKH

FI H K J IHL J> FHJO < III, I LKI M

J IKH M> J>HI J. AJ>K> J>I >I O FJ IJFJ < LK, J> HJ KJ I J J>-H HJ I FI H JHI J I J> HK FI JIJ J>H M FHKJI, J> LHJ

>I H IIII J>I I-H HJ I J>

JO < FJJ J FHFHO LKJ J> GKJO < JH. K I FJJ

J I JI < OKH JHXI JO, IK> I OHI < FHJ,

I> < HKJ, KH < FF J> MJ H. BKJ J I J

FII J LHJ FOI H O HGKH J>J JHI J IFP JH

FII I NJ O H M J FHJ.

Patents. > HIH> LFJ J HJ M HK I

IKIJJ. I IKII J>I C>FJH 15 "BKIJ F FI". H I LIJJ, J> FJJ IOIJ NIJI J FHL J>

C>FJH 16 A J>O EO

16.3 !LHJ *O 731

35/44

FHJJ H I FHKJ I J J MH

FH. AJ>K> J>I JOF < FJJ O LK given that a product exists, J

IJHOI J> J JLI J>J I J KHJ HIH>

LFJ. !LHJI FHL FJJ FHJJ J K IIHO HIH> LFJ.

Market power. HJ KJI H J H H HJLO I O KH LHKI >J>-H HJI KI J>H

O HJLO HH,

F>HKJ FI >L HJ FMH I NKIL M H IFHK> FJJI. O, J>H H HJLO

J> IKH FHLHI, I H LHO H.

Equity and fairness. EL < >J>-H HJI MH > J>O H J), J>O O J GKJ.

HKJ J O AHI

>J> IKH GKJ >J> H I I II LHI DHJ < K +>JI KI J> H>J J >J>

H: UELHO >I J> H>J J IJH < L GKJ >J>

M- < >I< < >I KI

H IIHO I IHLI, J> H>J J IKHJO J> LJ , H J>H < L>

HKIJI O >I JHV (>JJF://MMM.K.H//KJI/K>H/N.I>J).J JI, ULHI DHJ < K +>JI,V II

H> 14, 2011, >JJF://MMM.K.H//KJI/K>H/N.I>J. J>

NJJ J>J I >J> H I LM I I >K H>J, J> J> LHJ

K>J J KHJ II J J IJ L < H.

#, < J> I J L JMH GKJO < M-, J>H I L

IJHH GKJO HKJ J> H. # J FF K

>M J J >J> H J>H HIKHI O M OJ>

KJ J>H M >J> H M-. (>K>J NFHJI < J>I H

IIJ MJ> J> F>IF>H > +MI.# C>FJH 13 "KFHIJHI", M IKIIJ>I < J>K>J NFHJ H J.) *F >J M H J>J J>I

M> I H I I>K L extra resources J FIJ J> H >J>.

C>FJH 16 A J>O EO

16.3 !LHJ *O 732

36/44

How Do Governments Intervene?

M J>J M >L I KHIJ < J> IKHI < HJ

>J>-H HJ, M JKH J IKII < LHJ FO.

Taxes and Subsidies

>L HO J < J> O MOI M>> J> LHJ

IKIPI >J> HTO M FOI JN-J> IKH I MO, J> LHJ HKI J> IJ < J> H. #J I M J

JJI J K FHLI J> H.

< J> IIKI IKHHK FOH-FHL >J> IKH I J>

FIIJO OK > I (IJI J>

UFHJJO FHV). # KH O, I> HJ < M I O I

IJHKJ H (FH>FI II FHJ> IKH, J> GKJJ OKH J H O

IJO FH

< IH>. , J J>J MI LH O IKH O OKH NIJ

OK GKH IKH J

M I >L LHI I FKHOKI < J> FJI J> IKH.

J> H I I IKIP J>HK> JNI. #< OK HJ> KIJHO. >I HKJI IKFFO J>I HJ.

J> I, >KI>I H HGKH J J HJ IHLI.

LJI H JHO, L, J>H I

H KJ J> IFH < JI. UJI CFKI,V

American College Health Association, AFH 27, 2005, II HKHO 1, 2011,

C>FJH 16 A J>O EO

16.3 !LHJ *O 733

37/44

>JJF://MMM.>.H/FHJIFHHI/JI/N. HI

J>I , J I I HKJ JHLJI I J>J J>H H NJHJI J> J J> >J> < J>HI.

> LHJ II O < J> JHI J> IKFFO I < J> >J>-H

HJ. >I I J>H FHJ IJJ

KIJ FII NI HI. IFJI H HJJJF://MMM.I>I.IJJ.JN.KI/*/>IFJ.I>J. J>H FHLHI < >J> H H

I I. H NF, KHI > KIJ HJ HJ JHLJI IJI

NJIL >J>-H HJ. AI IKHI H

K J KHJO IIII J> GKJO < H FHL O JHI >IFJI,J> LHJ FHLI IHL J KI O HKJ >J>-H FHLHI.

Provision of Insurance

> LHJ, J>HK> JI H FHHI, FHLI IKH

J J> M- HO >KI>I. >H I JK J KJ

NF J> LJO < >J> IKH J J> H FFKJ. H>

23, 2010, *HIJ I >J>-H H

>J KI MJ> J> +H M J> CH,V >>J KI, II H> 14, 2011, >JJF://MMM.M>J>KI.L/>J>-H-

J/FHFI. > < J> I J HK J> KH < LKI

MJ>KJ >J> IKH J> J JJI. >I II J >L J>I O

HGKH J>J LHO FKH>I >J> IKH, J>H J>HK> FOH H

LKO. > IJ FHLI FFHJKJI KI>I J J

IKH J>H M J>HK> IKII UHJF HKJI IKH FI ILH MOI. H NF, J FI JI

J> JO < IKH FI J NK FF J> JI H J>H >J> HII. #J I HIJHJI J> JO HJI IKH FI.

> M FO M J J>-H KJI, >J>-

H IJI, J> I>HJ IKHO JHHO < CHII, UB KHO & JJKI: 111J> CHII (2009S2010),

C>FJH 16 A J>O EO

16.3 !LHJ *O 734

38/44

.+.3590, C+ KHO,V II H> 14, 2011, >JJF://J>I..L/-/

GKHO/P?111:+03590:@@@D&IK2=&.I J IO H.) BO J>

J < JI FJJ, JI J> M M O HH. # FHJKH,

NJO >M IKH HJI M HP HKJ M H

FHI. KHJ>H, M> J> MI FII, IJJI MH < J> IJ ILI

IKH. LH J, M M JJH J IF JNJ FJI < J> >KI> M I < J>I IJ FHLI J> J>-H

HJ.

A H J>H J> LHJ I>K L J>

KIII < FHL >J> IKH. IJ < HKJI LHKI HJ J M >L JI

>FJH. J> H I FJ, J>H H O MOI M>> >J>-H

HJI FHJ FJJL . #J I IJI HK J>J IF

>J> IHLI J> J JJI I LHO >> KI J> HJ I LHOL J> LHJ >H < J>I IJH

< J> O >J HK J> JJHI. >I I LHJO H FJJO >H MHI

H NF < LHJ FHLI < IKH I FHKJI MJI J M J> FJ >J>. !J>H IK> H HK JIJ. > DHK

AIJHJ (DA; >JJF://MMM. DA I IKFFI FK O EO

16.3 !LHJ *O 735

39/44

KEY TAKEAWAYS

Q !LHJ JHLJ J>I HJ HJ> IKH, J> HJ FHLI < >J>-H

IHLI, J> HKJ < HK FI.


1. >J I J> JJ FH < >IFJ?

2. +J HI KJ J> 11 LHKI J> LHJI O

KJHI J JHL. M MK OK NF J> II I

JHLJ KI J> IJ < HJ I IJ?3. !L HJ NF M>H J> LHJ FHL >J>

MH.

C>FJH 16 A J>O EO

16.3 !LHJ *O 736


40/44

16.4 End-of-Chapter Material

C>FJH 16 A J>O EO

737

41/44

In Conclusion

> JI J>J M >L JHK J>I >FJH H J>-H FO I

J>J I J O J GKO HIL J> J JJI H IM>H J> MH. AJ J> J, M IO >J> H I FHL J> J JJI J MJ> J> FHL FH < KIKH

>KI>I. AI M >L I, J>I I O J < J> >J>-H J>J MI I J M 2010. #

J, J>H H KIL FHI IIJ MJ> H . >I LHJ FHHI H

< H J> IJ IJI < H. AH J J> !H AKJ HII IJ FHKJ (!D*). #H H >I KHHJ FHHI, J>I I

HMI J> IKII < J> KJ J>HK> 2075: UA 125-H *JKH < J> H !LHJXI >H EO, 1950 J 2075,V Congressional Budget Office, KO 3, 2002, II HKHO 1, 2011,>JJF://MMM..L/ III J HM I >FJH.

1. Incentives matter. >JLH FHHI H J IH >J>-H

FHI, M J IKH J J J KJ J> JLI J>J J>I FI M HJ.2. People are different. J>-H FHLHI, IKH FI, J> LHJ J

IHL O < J>I J HJI I IKH < J> KHO FH < >J> H.

> JKH < LHI IJ I >LO O. +JO, J> CHII >I

IH IJ, + 493,!LJH.KI, UNJ < .+. 493 110J>: !J # 14, 2011, >JJF://MMM.LJH.KI/HII/JNJ.NF?=>110-493&I>M-

>I=0&F-=FHJ. M>> JI J> JO < IKH FI J KI J HII, J> J>O I H JHJIKH JHJI. H J> FHIFJL < J I J J> KI J JI

I LHI IJ FHI. # J>J J>O MH J H> FJ M>H OKH H >J>

HII K J KHJJO LH OKH >J> MK

IFFH, J>H MK IJ H J> IKH. (>H K, < KHI, IJ IKH FJH 16 A J>O EO

16.4 E-FJH JH 738

42/44

J HI.) AJ>K> J>I MH >J H

J FHIFIJI J HJ III MK >J>O FF MK J.

# J>I MH FF MK MJ IKH O MH H, M> J>H MI IJ KHJJO KJ J>HJ KF, M>> JI KI J J> +MI J>K>J NFHJ J>J M IKII HH. #J >J

J>J, FHNO, < J> IJ F HKJI J> H M

JKH KJ J J> HK elimination < HJ JJF://MMM.M>.J/>/Q DFHJJ < J> K HLI:

>JJF://MMM.>>I.L

Q CIKI BKHK, U#, *LHJO J> #IKH

CLH J> J JJI: 2009V >JJF://MMM.IKI.L/

FH/2010FKI/F60-238.FJJF://MMM.I.L/F/FJ

C>FJH 16 A J>O EO

16.4 E-FJH JH 739

43/44

EXERCISES

1. #I >J> IKH FJ H IKIJJKJ J>-H IHLI?

2. #< JHI H I J FHJ I J>J J>H MI FHLI < J>J IHL, M>J MK >FF J J> FH

GKJJO < >J>-H IHLI? >J MK >FF J J> GKJO?

3. !L NF < J> LJ J> >J>-H KIJHO.

4. #< LHI IJ I FH, I M IKH FO J

M OKH JH >J> >IJHO FHL HJ O XJ HIJKHJI >L J>I I FH?

6. LHJ JHLJ >J> H I FKIHO LJI

H IJ LHKI O

LHJI >J J IK> FI? (J: H J>H O

NJHJI LL?)7. # I KJHI I HI, J>H H I>HJI < JHI. >O

I J>I FH J GKO HIL O J> H MHI < IKFFO

J> H HJ?

8. AI J> J JJI >I H>H, HI FHFHJ < !D*

I IFJ >J> H. DI J>I J>

H KNKHO I?)

9. FJ FHJ < J> J> H I J>J IKHI

H J GKJ IKH < J> GKJO < J> FHKJ J>O H KO. C OK

J> < J>H I H IHLI J>J >L J>I I FHFHJO? AH J>H

IKHI J FHJJ IKHI? >O XJ IHI I O M-GKJOI J IKHI M> H J J K GKJO?

10. # J> >J>-H HJ, FHLJ FK >IFJI NIJ. C OK

J> < J>H HJ M>> J> FK FHLJ FHLHI

NIJ? >J H J> FK

FHLJ J H J> JLI J> H H

>H?

12. > NJ J OK LIJ JH, I J

>FFI.

13. > LHJ FHLI FIJ IKH I J>J I KJ < KIII. >J H J>

H >PH FJI < FHL FIJ IKH?

14. >J I J> < >J>-H LH J FOJ J J>

JLI FJH 16 A J>O EO

16.4 E-FJH JH 740

44/44

EI DJJL

1. 16.4 "> IKH ( I)" J I J> KHHJ KH < KIKH? >J 18S24 HKF?

2. KJ KJ J> >J>-H IOIJ H, M, H C.M I J FH MJ> J> IOIJ? M >J> KJI

J> KJHO OK >L >I FH MJ> J>I J> J JJI?

3. > J HIKJI LH 2010 H >J>-H I J M H> 2010. >J MH J>

HI IKII J> J F MJ> HH J J> ?

C>FJH 16 A J>O EO

a healthy economy

Documents