Learning goals
Inhoudsopgave
Week 1.......................................................................................................................................................... 4
Plenary meeting 1. Kick-off and Is health care really different?..........................................................................4
1- Explain the relevance of health economics.................................................................................................4
2- Analyze the causes and consequences of the expansion of the health care sector...................................4
3- Explain what makes Health care different and infer the implications there off.........................................4
Plenary meeting 2. Demand for health & health care.........................................................................................5
1- Recognize the relationship between the demand for health and health care...........................................5
2- Identify and interpret basic models of HC demand....................................................................................5
3- Identify the determinants of the demand of HC.........................................................................................6
4- Explain utility theory and its relevance for understanding health care demand........................................6
Plenary meeting 3. Asymmetric information, agency & supplier-induced demand............................................8
1- Interpret the lemons Principe in health insurance.....................................................................................8
2- Interpret supplier induced demand in health care.....................................................................................8
3- Evaluate the information issues in health care markets.............................................................................8
4- Analyze the principal agent problems in health care markets....................................................................9
5- How to prevent Moral Hazard in Health care markets...............................................................................9
Plenary meeting 4. Provider payment incentives...............................................................................................10
1- Explain the relevance and analyze the limits of provider payment incentives.........................................10
2- Explain the relevance of agency theory and interpret models of physician behavior..............................10
3- Explain the concept of ‘base payment’ and its rationale..........................................................................10
4- Interpret and apply the concept of ‘financial risk’ in relation to provider payment................................11
5- Analyze base-payment methods and interpret empirical research on their effects................................12
Week 2........................................................................................................................................................ 13
Plenary meeting 5. Value-based payment reform.............................................................................................13
1- What encompasses ‘value’ in health care?...............................................................................................13
2- To what extent does fee-for-service payment stimulate value creation?................................................13
3- To what extent does pay-for-performance stimulate value creation?.....................................................13
4- To what extent does bundled payment stimulate value creation?..........................................................13
5- Interpret the global interest in value-based health care and value-based provider payment.................13
6- Explain and apply the key components and design features of a theoretically optimal value-based
payment system............................................................................................................................................15
7- Critically assess recent payment reform initiatives and contrast them with a theoretically optimal
value-based payment system........................................................................................................................15
Plenary meeting 6. Guest lecture: Increasing value in health by changing the financial incentives: A health
insurer’s perspective...........................................................................................................................................15
No learning goals...........................................................................................................................................15
Plenary meeting 7. Cost-sharing & the demand for health care.......................................................................15
1- explain the concept and welfare effects of moral hazard.........................................................................15
2- formulate hypotheses on the demand response to consumer cost sharing............................................15
3- evaluate study designs for empirical measurement of demand response to consumer cost sharing.....16
4- interpret empirical findings on demand response to consumer cost sharing..........................................16
5- infer and judge implications of these empirical findings for health policy...............................................16
week 3......................................................................................................................................................... 17
Plenary meeting 8. Production of health & health care.....................................................................................17
1- how to maximize health with the available scare resources....................................................................17
2- which factors(inputs) contribute to our health (output)..........................................................................17
1
, 3- what is the marginal contribution of these inputs?..................................................................................17
4- What’s the optimal combination of these inputs in a given context?......................................................18
5- Explain the concept of the health production function............................................................................18
6- Identify and interpret various measures of health...................................................................................19
7- Reflect on changes in the marginal contribution of health care over the past centuries........................19
8- Explain the concepts of the cost function, technical and allocative efficiency, and economies of scale. 19
9- Reflect on the difficulties of assessing economies of scale in hospitals...................................................20
10- Reflect on the various methods of measuring relative efficiency of health care providers...................20
Plenary meeting 9. Non-profit firms in health care...........................................................................................22
1- Categorize and interpret the various types of ownership of health care organizations..........................22
2- Explain the reasons for the popularity of non-profit (NP) firms in health care........................................23
3- Explain the limited role of for-profit (FP) hospitals over time and across countries................................23
4- Evaluate the arguments pro and contra FP-providers in health care.......................................................23
5- Interpret differences in performance between NP- and FP-hospitals......................................................24
6- Reflect on the preconditions for allowing FP organizations in health care provision..............................24
Week 4........................................................................................................................................................ 24
Plenary meeting 10. Private health insurance & social health insurance..........................................................24
1- explain the concept of insurance..............................................................................................................24
2- explain the demand for and supply of insurance......................................................................................24
3- classify different types of insurance, e.g. private and social health insurance........................................25
4- demonstrate a good understanding of the major characteristics of the Bismarck, Semashko and
Beveridge model............................................................................................................................................25
5- explain the demand for and supply of private health insurance in low-income countries......................25
6- explain the (dis)advantages of community rating.....................................................................................25
7- explain the motives for making health insurance mandatory..................................................................26
Plenary meeting 11. Comparative health care systems & health system reform..............................................26
1- Explain the rationale for a third-party in health care....................................................................................26
4- Use a conceptual framework for comparing health system reforms in an international perspective.....26
5- classify contemporary health care systems..............................................................................................27
6- discern different waves of health care reforms........................................................................................27
7- demonstrate a good understanding of the key elements of the Dutch health care system....................28
Plenary meeting 12. Theory & practice of regulated competition.....................................................................29
1- write an essay on the goals of health policy in his/her country...............................................................29
2- critically interpret and apply the concepts equity and efficiency in the context of health policy............29
3- demonstrate a good understanding of ‘free market’- failure...................................................................29
4- demonstrate a good understanding of regulated/managed competition................................................30
5- recommend tools that regulators/sponsors can use to counteract ‘free market’- failure.......................31
6- demonstrate a good understanding of necessary preconditions for efficiency and affordability in
competitive healthcare markets, and argue why these preconditions are necessary.................................31
7- test whether these preconditions are fulfilled in practice........................................................................31
Plenary meeting 13. Competitive social health insurance markets...................................................................32
1- explain why a free, unregulated health insurance market may make health insurance unaffordable for
low-income, high-risk people........................................................................................................................32
2- design a regulatory framework to guarantee access to affordable coverage in a competitive health
insurance market...........................................................................................................................................32
3- design an effective system of risk equalization.........................................................................................33
4- explain which type of regulation induces incentives for risk selection.....................................................34
5- explain the disadvantages of risk selection in a regulated competitive health insurance market...........34
6- explain which trade-offs occur when reducing or preventing risk selection............................................35
Week 5........................................................................................................................................................ 35
Plenary meeting 14. Hospital competition & patient choice.............................................................................35
2
, 1- interpret the economic theory of hospital competition, including the Medical Arms Race (MAR).........35
2- evaluate the most important findings of the empirical literature on hospital competition, including the
importance of the institutional framework...................................................................................................36
3- explain the concept of patient hospital choice and its relevance for hospital competition.....................36
1- judge the main findings of the empirical literature on patient hospital choice, including the role of
quality information........................................................................................................................................37
Plenary meeting 15. Organization & financing of long-term care.....................................................................38
1- Identify the determinants of long-term care (LTC) utilization..................................................................38
2- Reflect on the relevance of Baumol’s disease for the public expenses for LTC........................................39
3- Understand and interpret differences in LTC provision and financing across countries..........................39
4- Understand and explain the challenges for the future financing and provision of LTC...........................39
5- Reflect on the pros and cons of increasing the role of informal care in the provision of LTC..................39
6- Evaluate the difference between saving and insuring for LTC..................................................................40
7- Reflect on potential explanations for the LTC insurance puzzle...............................................................40
3
, Week 1
Plenary meeting 1. Kick-off and Is health care really different?
1- Explain the relevance of health economics
1 The economic organization of healthcare systems has a significant impact on the
efficiency and equity of healthcare allocation.
2 Health care is a large and expanding sector of national economies. Total health
expenditure as % of GDP. Health sector has been consuming and increasing.
- Spending HC is growing faster than our economy
- VS is super high (high prices labor+ food)
3 Health care is not a regular economic commodity; its widely considered as a right,
not a privilege
4 Specific features of health care can easily result in market failure as well as in
government failure
2- Analyze the causes and consequences of the expansion of the health
care sector
Causes
1- Ageing of population
2- Advancing medical science & technology
3- Shift toward chronic diseases
4- Increasing welfare
5- Expanding health insurance coverage Moral hazard
6- Flawed (financial) incentives
7- Baumol’s cost disease productivity like in HC cannot be compared to other
industries. Increase in wages cannot be earned back by increases in productivity.
Consequences
Increasing health spending may significantly harm the economy
taxes/premiums get higher labor costs get higher competitiveness lower
Increasing public health spending may crowd out other public services
Financial sustainability: how to pay for spending growth
higher cross subsidies to guarantee universal access
Economic sustainability: ensuring value for money
important task for economist!
3- Explain what makes Health care different and infer the implications
there off
(wat de zorg anders maakt en de implicaties daar vanaf leiden) Of ook wel de kenmerkende
kenmerken van de zorg.
1- HC is not a regular (economic) commodity; its widely considered as a right not a
privilege
Privilege: special entitlement to only a restricted group.
Right: all citizens from the moment of birth(inherent entitlement)
4
Inhoudsopgave
Week 1.......................................................................................................................................................... 4
Plenary meeting 1. Kick-off and Is health care really different?..........................................................................4
1- Explain the relevance of health economics.................................................................................................4
2- Analyze the causes and consequences of the expansion of the health care sector...................................4
3- Explain what makes Health care different and infer the implications there off.........................................4
Plenary meeting 2. Demand for health & health care.........................................................................................5
1- Recognize the relationship between the demand for health and health care...........................................5
2- Identify and interpret basic models of HC demand....................................................................................5
3- Identify the determinants of the demand of HC.........................................................................................6
4- Explain utility theory and its relevance for understanding health care demand........................................6
Plenary meeting 3. Asymmetric information, agency & supplier-induced demand............................................8
1- Interpret the lemons Principe in health insurance.....................................................................................8
2- Interpret supplier induced demand in health care.....................................................................................8
3- Evaluate the information issues in health care markets.............................................................................8
4- Analyze the principal agent problems in health care markets....................................................................9
5- How to prevent Moral Hazard in Health care markets...............................................................................9
Plenary meeting 4. Provider payment incentives...............................................................................................10
1- Explain the relevance and analyze the limits of provider payment incentives.........................................10
2- Explain the relevance of agency theory and interpret models of physician behavior..............................10
3- Explain the concept of ‘base payment’ and its rationale..........................................................................10
4- Interpret and apply the concept of ‘financial risk’ in relation to provider payment................................11
5- Analyze base-payment methods and interpret empirical research on their effects................................12
Week 2........................................................................................................................................................ 13
Plenary meeting 5. Value-based payment reform.............................................................................................13
1- What encompasses ‘value’ in health care?...............................................................................................13
2- To what extent does fee-for-service payment stimulate value creation?................................................13
3- To what extent does pay-for-performance stimulate value creation?.....................................................13
4- To what extent does bundled payment stimulate value creation?..........................................................13
5- Interpret the global interest in value-based health care and value-based provider payment.................13
6- Explain and apply the key components and design features of a theoretically optimal value-based
payment system............................................................................................................................................15
7- Critically assess recent payment reform initiatives and contrast them with a theoretically optimal
value-based payment system........................................................................................................................15
Plenary meeting 6. Guest lecture: Increasing value in health by changing the financial incentives: A health
insurer’s perspective...........................................................................................................................................15
No learning goals...........................................................................................................................................15
Plenary meeting 7. Cost-sharing & the demand for health care.......................................................................15
1- explain the concept and welfare effects of moral hazard.........................................................................15
2- formulate hypotheses on the demand response to consumer cost sharing............................................15
3- evaluate study designs for empirical measurement of demand response to consumer cost sharing.....16
4- interpret empirical findings on demand response to consumer cost sharing..........................................16
5- infer and judge implications of these empirical findings for health policy...............................................16
week 3......................................................................................................................................................... 17
Plenary meeting 8. Production of health & health care.....................................................................................17
1- how to maximize health with the available scare resources....................................................................17
2- which factors(inputs) contribute to our health (output)..........................................................................17
1
, 3- what is the marginal contribution of these inputs?..................................................................................17
4- What’s the optimal combination of these inputs in a given context?......................................................18
5- Explain the concept of the health production function............................................................................18
6- Identify and interpret various measures of health...................................................................................19
7- Reflect on changes in the marginal contribution of health care over the past centuries........................19
8- Explain the concepts of the cost function, technical and allocative efficiency, and economies of scale. 19
9- Reflect on the difficulties of assessing economies of scale in hospitals...................................................20
10- Reflect on the various methods of measuring relative efficiency of health care providers...................20
Plenary meeting 9. Non-profit firms in health care...........................................................................................22
1- Categorize and interpret the various types of ownership of health care organizations..........................22
2- Explain the reasons for the popularity of non-profit (NP) firms in health care........................................23
3- Explain the limited role of for-profit (FP) hospitals over time and across countries................................23
4- Evaluate the arguments pro and contra FP-providers in health care.......................................................23
5- Interpret differences in performance between NP- and FP-hospitals......................................................24
6- Reflect on the preconditions for allowing FP organizations in health care provision..............................24
Week 4........................................................................................................................................................ 24
Plenary meeting 10. Private health insurance & social health insurance..........................................................24
1- explain the concept of insurance..............................................................................................................24
2- explain the demand for and supply of insurance......................................................................................24
3- classify different types of insurance, e.g. private and social health insurance........................................25
4- demonstrate a good understanding of the major characteristics of the Bismarck, Semashko and
Beveridge model............................................................................................................................................25
5- explain the demand for and supply of private health insurance in low-income countries......................25
6- explain the (dis)advantages of community rating.....................................................................................25
7- explain the motives for making health insurance mandatory..................................................................26
Plenary meeting 11. Comparative health care systems & health system reform..............................................26
1- Explain the rationale for a third-party in health care....................................................................................26
4- Use a conceptual framework for comparing health system reforms in an international perspective.....26
5- classify contemporary health care systems..............................................................................................27
6- discern different waves of health care reforms........................................................................................27
7- demonstrate a good understanding of the key elements of the Dutch health care system....................28
Plenary meeting 12. Theory & practice of regulated competition.....................................................................29
1- write an essay on the goals of health policy in his/her country...............................................................29
2- critically interpret and apply the concepts equity and efficiency in the context of health policy............29
3- demonstrate a good understanding of ‘free market’- failure...................................................................29
4- demonstrate a good understanding of regulated/managed competition................................................30
5- recommend tools that regulators/sponsors can use to counteract ‘free market’- failure.......................31
6- demonstrate a good understanding of necessary preconditions for efficiency and affordability in
competitive healthcare markets, and argue why these preconditions are necessary.................................31
7- test whether these preconditions are fulfilled in practice........................................................................31
Plenary meeting 13. Competitive social health insurance markets...................................................................32
1- explain why a free, unregulated health insurance market may make health insurance unaffordable for
low-income, high-risk people........................................................................................................................32
2- design a regulatory framework to guarantee access to affordable coverage in a competitive health
insurance market...........................................................................................................................................32
3- design an effective system of risk equalization.........................................................................................33
4- explain which type of regulation induces incentives for risk selection.....................................................34
5- explain the disadvantages of risk selection in a regulated competitive health insurance market...........34
6- explain which trade-offs occur when reducing or preventing risk selection............................................35
Week 5........................................................................................................................................................ 35
Plenary meeting 14. Hospital competition & patient choice.............................................................................35
2
, 1- interpret the economic theory of hospital competition, including the Medical Arms Race (MAR).........35
2- evaluate the most important findings of the empirical literature on hospital competition, including the
importance of the institutional framework...................................................................................................36
3- explain the concept of patient hospital choice and its relevance for hospital competition.....................36
1- judge the main findings of the empirical literature on patient hospital choice, including the role of
quality information........................................................................................................................................37
Plenary meeting 15. Organization & financing of long-term care.....................................................................38
1- Identify the determinants of long-term care (LTC) utilization..................................................................38
2- Reflect on the relevance of Baumol’s disease for the public expenses for LTC........................................39
3- Understand and interpret differences in LTC provision and financing across countries..........................39
4- Understand and explain the challenges for the future financing and provision of LTC...........................39
5- Reflect on the pros and cons of increasing the role of informal care in the provision of LTC..................39
6- Evaluate the difference between saving and insuring for LTC..................................................................40
7- Reflect on potential explanations for the LTC insurance puzzle...............................................................40
3
, Week 1
Plenary meeting 1. Kick-off and Is health care really different?
1- Explain the relevance of health economics
1 The economic organization of healthcare systems has a significant impact on the
efficiency and equity of healthcare allocation.
2 Health care is a large and expanding sector of national economies. Total health
expenditure as % of GDP. Health sector has been consuming and increasing.
- Spending HC is growing faster than our economy
- VS is super high (high prices labor+ food)
3 Health care is not a regular economic commodity; its widely considered as a right,
not a privilege
4 Specific features of health care can easily result in market failure as well as in
government failure
2- Analyze the causes and consequences of the expansion of the health
care sector
Causes
1- Ageing of population
2- Advancing medical science & technology
3- Shift toward chronic diseases
4- Increasing welfare
5- Expanding health insurance coverage Moral hazard
6- Flawed (financial) incentives
7- Baumol’s cost disease productivity like in HC cannot be compared to other
industries. Increase in wages cannot be earned back by increases in productivity.
Consequences
Increasing health spending may significantly harm the economy
taxes/premiums get higher labor costs get higher competitiveness lower
Increasing public health spending may crowd out other public services
Financial sustainability: how to pay for spending growth
higher cross subsidies to guarantee universal access
Economic sustainability: ensuring value for money
important task for economist!
3- Explain what makes Health care different and infer the implications
there off
(wat de zorg anders maakt en de implicaties daar vanaf leiden) Of ook wel de kenmerkende
kenmerken van de zorg.
1- HC is not a regular (economic) commodity; its widely considered as a right not a
privilege
Privilege: special entitlement to only a restricted group.
Right: all citizens from the moment of birth(inherent entitlement)
4
