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From Health Care USA - eight edition book - chapter 10 question -

"In contrast to widely held assumptions, mental disorders can now be diagnosed and treated as effectively as physical disorders." Discuss factors that have contributed to the persistence of erroneous assumptions about mental illness treatment.

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Chika Ilonah
Chika IlonahLv10
29 Sep 2019

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Case Study: Mental Health Parity

Presenting to the board, Chris spoke with passion. Our insurance plan should provide the same coverage for mental health services as for other medical services. It's the right thing to do, and it's good business. If our employees or their dependents have untreated mental health problems, the employees become less productive and waste money getting treated for other stuff. Thank you, Chris,€ said Kerry, the company's CEO. This is an important question for us, and the Benefits Committee will carefully consider it. After Chris left the room, Kerry turned to Jordan, the director of human resources, and said, Jordan, what's your take on this? There are actually two questions here, said Jordan. First, how elastic is the demand for ambulatory mental health services? How much will the use of mental health services increase if coverage improves? Second, how effective is mental health care? This second question is the more important one because good mental health care can have such powerful effects. Now, a number of studies have concluded that the use of mental health services is more price-sensitive than the use of other ambulatory care. Analyses of ambulatory mental health services have found elasticities ranging from 0.44 to 1.00. These results could be statistical flukes. Consumers who expect to use mental health services may choose insurance plans that offer generous coverage for those services. However, the RAND Corporation researchers Keeler, Manning, and Wells in 1988 used data from the RAND Health Insurance Experiment, which randomly assigned respondents to insurance plans, to resolve this issue. The RAND analysis generally confirmed that the demand for mental health services is more price-sensitive than the demand for general ambulatory medical services. Demand for each is inelastic, but the elasticity for mental health services is 0.8 and the elasticity for other outpatient services is 0.3. Most consumers will not use any mental health services, but plans that offer generous mental health benefits will cost more. We can't ignore this. I'm confused,€ said Addison, an internist on the board. In 2012 McConnell and colleagues published a study showing that Oregon's law requiring mental health parity in commercial insurance plans had little effect on spending. How could that be? Real-life appears to be contradicting the RAND study. I'm sure the plans for federal employees used managed care techniques to control spending,€ Jordan jumped in. And mental health spending isn't the issue. The issues are what happens to other healthcare spending and what happens to our workers. I'm pretty sure there's good evidence showing that effective mental health treatment can reduce other costs and improve productivity.

Discussion questions:

Why does it matter whether demand for mental health services is more elastic than demand for other services?

The price elasticity of demand for ambulatory mental health services appears to be about 0.8, and the price elasticity for general ambulatory medical services appears to be about 0.3. How much would spending increase for each type of care if copayments were cut from $40 to $25?

What managed care techniques do insurers use to control spending?

Is there evidence that better treatment of mental health problems reduces other spending?

Is there evidence that better treatment of mental health problems improves productivity?

What is your recommendation to the Benefits Committee?

Hyflux dips toes into wellness, beauty market /
Hyflux banks on oxygenated water for consumer market
In City Square Mall, a new store offering bath facilities has opened its doors to shoppers.
This marks Hyflux, the company better known for its desalination plants, first foray into the
brick-and-motar retail sector with its budding consumer business. The Singapore-listed
company will open Elo Lab officially on 8 September 2016. This retail outlet is a physical
representation of Hyflux’s bet on the consumer water business – in particular, on a special
oxygenated water termed Elo Water.
Said to contain three times more oxygen than tap water, Elo Water was the reason
behind Hyflux's US$8 million investment in European firm Kaqun Europe in November
2015. It also forms the basis for the group's new bath facilities, as well as bottled
drinking water and skincare gels that it sells online. "Oxygen can increase the cell's ability to
generate more energy," Hyflux group chief financial officer Lim Suat Wah explained in an
interview with The Business Times. "A cell with sufficient oxygen can actually generate 15
times more energy than a cell without sufficient oxygen. So this Elo Water puts the two
together, the water element as well as the oxygen."
The venture into the consumer business came as Hyflux sought to see how water, besides
being used for daily needs, could also be used to improve health. It conducted a research and
uncovered a company which produced similar oxygenated water in the US a few years ago,
but the oxygen level in the water produced with their technology wasn't stable. On the other
hand, Kaqun was able to produce oxygenated water that contains stable oxygen levels which
can be easily absorbed into the body. This has been shown to reduce mental and physical
tiredness, according to Kaqun's website.
The oxygenated water is said to have been developed from more than 10 years of research
work by a group of doctors. Hyflux holds the exclusive rights to manufacture, sell and market
Elo Water in the Asia-Pacific, Middle East and Africa. It holds a 70 per cent stake in
Elo Water Pte Ltd with Kaqun Europe owning the rest.
"We're quite excited about this business," said Ms Lim. The group hopes to add its
proprietary membrane expertise to purify the water and also use its know-how to scale up
production of Elo Water while ensuring consistency in quality. For a start, Hyflux has
commenced clinical trials to test the properties of Elo Water. The first of these have just been
concluded, with observations of improved skin condition after the use of Elo Gel.
The clinical study, conducted by Seoul-based clinical trial institute, involved 22 women aged
49 to 52 years old who applied Elo Gel every morning and night on half their face for eight
straight weeks. During this period, skin wrinkles, colour elasticity, hydration and radiance
were observed to be "significantly improved" on the side of their faces treated with Elo Gel.
The study validated some of the observations that they have been hearing from people who
have already used it.
But even before conclusive trial results on the drinking water and bath come in – expected to
be only in 2017 – news of the products and their effects have travelled by word of mouth.
Bottles of Elo Water and Elo Gel have been snapped up, causing the company to run out of
stock of the products on occasions. A pack of six 1.5-litre bottles of Elo Water costs S$63.80
and a single tube of Elo Gel, S$68, according to its website. Still, Hyflux will not actively
market the products until it has more substantial trial results. Currently, the business in Elo
Water still remains small, as Hyflux only sells them in Singapore via an online channel.
The firm is hoping that Elo Water might bring a new breath of life to its business and
broaden Hyflux's reach to a new group of customers – consumers. How large the business
could grow into would depend on the number of cities Hyflux moves into. More investment
will also be needed in marketing, IT systems and building up a logistics network.
Singapore will be the starting point for sales, and a valuable one given its credibility and
governance. "If it can be established in Singapore, then other cities and countries will look at
(Elo Water) with more trust." In 2017, the group plans to expand sales to other Asian
countries such as Malaysia and Indonesia. China, too, is on the radar, said Ms Lim. The Elo
Water is also generating interest from consumers in countries like Australia, Hong Kong,
Thailand and China. The firm has already received enquiries on when its Elo products will be
marketed there.
Hyflux is also hoping for positive clinical trial results to give the products more credibility,
especially within the medical field. Anecdotally, users have said that Elo Water helps to
improve certain medical conditions, and some medical clinics are already ordering the gel
and drinking water through the Elo Water website. Said Ms Lim: "Some heard from their
patients who tried it and went back to them, so they know that there's some effect there. But
they can't actively promote it at this time (without the clinical trial results)."When the resul ts
come out, "hopefully, at that point in time, it will take off on a larger scale", she said. In the
coming months, Hyflux will be conducting clinical trials to determine if the water can help
benefit those with diabetes and prediabetes (blood glucose levels that are higher than normal,
but not yet high enough to be diagnosed as diabetes).
For individuals such as homemaker Audrey Koh, however, personal experience alone
suffices. The 49-year-old has been drinking Elo Water for the last six months and also
finished a cycle of soaking sessions for 14 straight days. "People who have not seen me for a
year or even six months and saw me recently remark that I look as though I have lost weight,"
she said, adding her complexion has improved, and body more toned.
Asked whether the price tag would deter her from continuing on another cycle of soaking
sessions or drinking Elo Water, she said the opportunity cost of being ill is higher than the
cost of water. Ms Koh added: "How do you place a price on health?
(Adapted for academic purposes: “Hyflux dips toes into wellness, beauty market / Hyflux banks on
oxygenated water for consumer market,” by Andrea Soh, The Business Times, 6 September 2016.)

Analyse three (3) possible social and personal factors that can have an impact on a
consumer’s decision to purchase the Elo brand of oxygenated water for personal
consumption.
(30 marks)

What is the best way to prevent and reduce smoking? Briefly discuss.

Please read the article below to have a general idea about the topic.

Case Study: Deterring Young Smokers

As the U.S. Surgeon General warns on each pack of cigarettes, smoking can be hazardous to your health. Researchers estimate that smoking kills 440,000 Americans a year, 10 times the fatalities from traffic accidents. Smoking is the overwhelming cause of lung cancer, which is the top cancer killer among women. Four of five people with lung cancer die within three years. Smoking is also the leading cause of heart disease, emphysema, and stroke.

Thus, smoking imposes major health and economic costs. Policymakers try to reduce these costs by discouraging smoking, especially among young people. About one in four U.S. high school students were smokers in 2005, the same rate as in 2003. Each day, about 3,000 U.S. teens under 18 become regular smokers. Worldwide, an estimated 100,000 teens become regular smokers each day.

One way to reduce youth smoking is to prohibit the sale of cigarettes to minors. A second way is to raise the price through higher cigarette taxes. The amount by which a given price hike reduces teen smoking depends on the price elasticity of demand. This elasticity is higher for teens than for adults. Why are teenagers more sensitive to price changes than adults?

First, recall that one factor affecting elasticity is the importance of the item in the consumer's budget. Because teen income is relatively low, the share spent on cigarettes usually exceeds the share spent by adult smokers.

Second, peer pressure shapes a young person's decision to smoke more than an adult's decision to continue smoking (if anything, adults face negative peer pressure for smoking). Thus, the effect of a higher price gets magnified among young smokers because that higher price also reduces smoking by peers. With fewer peers smoking, teens face less pressure to smoke.

And, third, young people not yet addicted to nicotine are more sensitive to price increases than are adult smokers, who are more likely to be already hooked.

The experience from other countries supports the effectiveness of higher cigarette taxes in reducing teen smoking. For example, a large tax increase on cigarettes in Canada cut youth smoking by two-thirds. Another way to reduce smoking is to change consumer tastes through health warnings on packages. In Canada, these warnings include photos showing how smoking can affect the brain, teeth, and gums, and a wilted cigarette depicts male impotence.

In Australia, labels show gangrenous limbs, underweight babies, cancerous mouths, and blind eyes. Belgium adds corpses to the picture.

In California, a combination of higher cigarette taxes and an ambitious awareness program contributed to a 5 percent decline in lung cancer among women, even as it rose 13 percent in the rest of the country. (As of 2007, state taxes varied from a low of 7 cents per pack in South Carolina to a high of $2.58 in New Jersey.)

More generally, the message about the dangers of smoking along with the higher cost of cigarettes has had an effect over time. Only about 20 percent of American adults now smoke, down from more than half in the 1960s.

According to the U.S. Centers for Disease Control and Prevention, each pack of cigarettes sold in the United States costs society $7.18 in higher health care costs and in lost worker productivity. The added cost exceeds $150 billion a year, which works out to be about $3,400 per smoker per year.

SOURCES

Hutchinson, œSmoke Signals: Adolescent Smoking and School Continuation, NBER Working Paper 12462, (August 2006); and Hana Ross and Frank Chaloupka, œThe Effects of Public Policies and Prices on Youth Smoking, : John Tauras, œAn Empirical Analysis of Adult Cigarette Demand, Eastern Economic Journal, Vol. 31, No. 3 (Summer 2005): pp. 361“375

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