International Health Care Management
Part 3b
Steffen Fleßa
Institute of Health Care Management University of Greifswald
1
1 International Public Health 2 Demand for Health Services 3 Supply of Health Services
4 Health Reforms
4.1 Costs
4.2 Options of Funding
4.3 Health Care Systems by International
Comparison
4.1 Costs
• Cost-of-Illness
– Content: all economically feasible negative results of disease and death
– Concept: Rice (1966); today standard – Examples: Cost-of-Illness studies
• Xie (1996): Alcohol and drugs in Ontario
• Henke (1997): Disease in Germany
• Welte, König, Leidl (2000): Consumption of cigarettes in Germany
3
Intangible Costs Tangible Costs
Health Services Costs Household Costs
Non-Core Costs Core Costs
Prevention
Curative Care Administration
Training
Research
Direct HH Costs Indirect HH Costs
Loss of harvest
Loss of labour Transport for patient
and relatives
Accomodation for relatives
Buildings, i.e. for disabled
Diet, i.e. special food
User Fees, drug bills etc.
Loss of salary
Loss of education
Personal suffering.
i.e. caused by grief, pain, longing, … Measurable only
indirectly in assessing quality of life
Directly or
indirectly resulting in consumption of
resources Usually
quantitatively measurable
5
Cost-of-Illness
Intangible Costs Tangible Costs
Health Services Costs Household Costs
Non-Core Costs Core Costs
Prevention
Curative Care Administration
Training
Research
Direct HH Costs Indirect HH Costs
Loss of harvest
Loss of labour Transport for patient
and relatives
Accomodation for relatives
Buildings, i.e. for disabled
Diet, i.e. special food
User Fees, drug bills etc.
Loss of salary
Loss of education
District Production Function:
Y=Y(K,L)
Direct Costs
Cost-of-Illness
Intangible Costs Tangible Costs
Costs of performing institutions, usually well documented
Costs of household consuming health services,
usually bad documentation
Intangible Costs Tangible Costs
Health Services Costs Household Costs
Non-Core Costs Core Costs
Prevention
Curative Care Administration
Training
Research
Direct HH Costs Indirect HH Costs
Loss of harvest
Loss of labour Transport for patient
and relatives
Accomodation for relatives
Buildings, i.e. for disabled
Diet, i.e. special food
User Fees, drug bills etc.
Loss of salary
Loss of education
Tangible Costs
Household Costs
Health Services Costs
Administration, Teaching,
Research
All Costs of Prevention and
Treatment
(programs,
dispensaries, hospitals
etc.) 7
Cost-of-Illness
Intangible Costs Tangible Costs
Health Services Costs Household Costs
Non-Core Costs Core Costs
Prevention
Curative Care Administration
Training
Research
Direct HH Costs Indirect HH Costs
Loss of harvest
Loss of labour Transport for patient
and relatives
Accomodation for relatives
Buildings, i.e. for disabled
Diet, i.e. special food
User Fees, drug bills etc.
Loss of salary
Loss of education
District Production Function:
Y=Y(K,L)
Direct Costs
Non-Core Costs Core Costs
Health Services Costs
Transport, Fees, Diet, Construction
Loss in Labor, Crops, Income,
Education,
Domestic Product
Intangible Costs Tangible Costs
Health Services Costs Household Costs
Non-Core Costs Core Costs
Prevention
Curative Care Administration
Training
Research
Direct HH Costs Indirect HH Costs
Loss of harvest
Loss of labour Transport for patient
and relatives
Accomodation for relatives
Buildings, i.e. for disabled
Diet, i.e. special food
User Fees, drug bills etc.
Loss of salary
Loss of education
Household Costs
Direct HH Costs Indirect HH Costs
Determining Household Costs
Direct Costs
Indirect Costs
- Human Capital Approach - Friction Costs Method
- Willingness-to-pay ≠ ability to pay
9
Intangible Costs Tangible Costs
Health Services Costs Household Costs
Non-Core Costs Core Costs
Prevention
Curative Care Administration
Training
Research
Direct HH Costs Indirect HH Costs
Loss of harvest
Loss of labour Transport for patient
and relatives
Accomodation for relatives
Buildings, i.e. for disabled
Diet, i.e. special food
User Fees, drug bills etc.
Loss of salary
Loss of education
4.2 Options of Funding
11
SOCIAL HEALTH INSURANCE
PRIVATE HEALTH INSURANCE GOVERNMENT
D ir ec t I np ut
HEALTH CARE FACILITIES
H E A L T H S E R V IC E S
POPULATION
DONORS
Risk of illness Age
Chronic illness Family illnesses Danger location Danger profession
Health Care Services Accessible
Quantity
Objective quality Subjective quality Distance
Risk of health care expenditure
Risk of catastrophic h.c. expenditure
Household income Wealth
Other sources (e.g.
HEF, family) Time preference
+ + + + +
- + + +
+ +
+
- - -
-
Demand for an Insurance
13
Risk of catastrophic h.c. expenditure Perception of risk of catastro. h.c.exp.
Time preference Risk aversion
Willingness to Pay
Household structure, e.g.
gender of
household head Other priorities
+
- + +
+
+
Willingness to Pay
Demand for Insurance
P re m iu m M od e of c ol le ct io n H ou se ho ld in co m e W ea lth O th er s ou rc es ( e. g. H E F , f am ily )
Accessibility of Insurance
D is ta nc e K no w le dg e F ri en dl in es s C ul tu ra lly a cc ep ta bl e
+ +
- - - -
+
Ability to Pay
- + + +
