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Scott Sams (15)
Lecture 9

HLTC43 Lecture 9.pdf

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Health Studies
Scott Sams

HLTC43 Lecture 9 Wednesday, July 10, 2013 10:00 AM Cue Column: Note-Taking Area: Markets for Health Purpose: To explore the role of market mechanisms and the private sector in the provision of health care. Lessons from today’s class: 1. Health care markets have implicationsfor access to care and for allocation of resources among members of society 2. Health care administration costs are lower in a single-payer system 3. Obamacare more successful at expandingcoverage than reducingcosts • Expandsto more ppl but didn'thelp to reduce costs Is health care a typical commodityand what are the implications of a market approachto it? (Bryant, 2009, pp. 205-229). Typical commodities provided by free mkts ○ ○ Create innovation  Compete by improving  If gov't controlled,it would be monochrome • Structuralpressures ○ Since 80s, concerned aboutdeficits ○ Pressure related to lower social and health spending ○ Econ restructurally driven by neo-lib (globalization)  More openingof mkts  Lookingtowards private sector □ HC becomes attractive investment for private sector  Why? To make some $ off it  Set of institutionsenabling exchangeof good/service btwn buyers & sellers  Distribution based on supply& demand □ High demand} higher price □ High supply} lower price • Markets 1) Systems of rules and regulations  Rules to what you can trade, and when □ Set by gov't or marketers 2) Complex  Don’t affect just internally, also externally □ Turn HC to mkt, diminish rolls of Drs? 3) Unstable  Competition is unstable  Always trying to increase mkt share  What if one companyis dominant,what power does it give them? □ Become monopoly?  Sometimes companies fail/break down □ Once break down, so does benefits • Rationalefor market competition 1) Sources of innovation  Improve products 2) Reduced role of the state  Believe in neo-lib  Mkts best allocate resources includingincomeand wealth □ We are capitalist society  Rely on mkt Believe in neo-lib  Mkts best allocate resources includingincomeand wealth □ We are capitalist society  Rely on mkt 3) Efficiencies  Mkts more efficient in providingservices rather thangov't • Marketization of health care o User fees  Show up, providedservice, part paid thrutaxes, other part we must pay o Contractingout  Service provided by private sector thrucontract o Private care  Operate private-for-profithospitals □ If have $ can use/access it o Public-privatepartnerships  Public sector provides in conjunctionw/ private □ Shared delivery  Best of both worlds • Impact of market forces and deregulation o Think of incentives  Mkts change how you behave □ Shapes way to providecare to patients □ One service more profitablethanother  Mkt distorts behaviour  No evidence private sector delivery saying it provides better care □ In fact, says opposite o Access  Charge per use/access □ User fees o Mortality  User fees is not incentive to use HC for ppl to use HC □ Found 2% higher death rate @ for profit hospitals  Due to less staff as well as poorly trained o Administration costs  Private is associated w/ higher admin costs • Commodificationand
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