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Health Economics

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How to Reverse the Trend of Declining Birth Rates

In 2050, world population growth is predicted to come almost to a halt. Shortly thereafter it may well start to shrink. A major reason behind this shift is the fertility decline that has taken place in many developed countries. In this book, experts discuss the appropriateness and effectiveness of using public policy to influence fertility decisions. Contributors discuss the general feasibility of public interventions in the area of fertility, analyze fertility patterns and policy design in such countries as Japan, South Korea, China, Sweden, and France, and offer theoretical analyses of parental fertility choices that provide an overview of a broad array of child-related policy instruments in a number of OECD and EU countries. The chapters show that it is difficult to gauge the effectiveness of such policy interventions as child-care subsidies, support for women’s labor-force participation, and tax incentives. Data are often incomplete, causal relations unproved, and the role of social norms and culture difficult to account for. Investigating reasons for the decline in fertility more closely will require further study. This volume offers the latest work on this increasingly important subject.

Most experts would agree that the current medical malpractice system in the United States does not work effectively either to compensate victims fairly or prevent injuries caused by medical errors. Policy responses to a series of medical malpractice crises have not resulted in effective reform and have not altered the fundamental incentives of the stakeholders. In Medical Malpractice, economist Frank Sloan and lawyer Lindsey Chepke examine the U.S. medical malpractice process from legal, medical, economic, and insurance perspectives, analyze past efforts at reform, and offer realistic, achievable policy recommendations. They review the considerable empirical evidence in a balanced fashion and assess objectively what works in the current system and what does not. Sloan and Chepke argue that the complexity of medical malpractice stems largely from the interaction of the four discrete markets that determine outcomes--legal, medical malpractice insurance, medical care, and government activity. After describing what the evidence shows about the functioning of medical malpractice, types of defensive medicine, and the effects of past reforms, they examine such topics as scheduling damages as an alternative to flat caps, jury behavior, health courts, incentives to prevent medical errors, insurance regulation, reinsurance, no-fault insurance, and suggestions for future reforms. Medical Malpractice is the most comprehensive treatment of malpractice available, integrating findings from several different areas of research and describing them accessibly in nontechnical language. It will be an essential reference for anyone interested in medical malpractice.Frank A. Sloan is J. Alexander McMahon Professor of Health Policy and Management and Professor of Economics at Duke University. He is the coauthor of The Price of Smoking (MIT Press, 2004) and author or editor of many other books on health economics. Lindsey M. Chepke, an attorney, is a Research Associate at the Center for Health Policy at Duke University.

An Integrated Assessment Modeling Approach

The impact of climate change is widespread, affecting rich and poor countries and economies both large and small. Similarly, the study of climate change spans many disciplines, in both natural and social sciences. In environmental economics, leading methodologies include integrated assessment (IA) and game-theoretic modeling, which, despite their common premises, seldom intersect. In Strategic Bargaining and Cooperation in Greenhouse Gas Mitigations, Zili Yang connects these two important approaches by incorporating various game-theoretic solution concepts into a well-known integrated assessment model of climate change. This framework allows a more comprehensive analysis of cooperation and strategic interaction that can inform policy choices in greenhouse gas (GHG) mitigation.

Yang draws on a wide range of findings from IA and game theory to offer an analysis that is accessible to scholars in both fields. Yang constructs a cooperative game of stock externality provision—the economic abstraction of climate change—within the IA framework of the influential RICE model (developed by William D. Nordhaus and Zili Yang in 1996). The game connects the solution of an optimal control problem of stock externality provision with the bargaining of GHG mitigation quotas among the regions in the RICE model. Yang then compares the results of both game-theoretic and conventional solutions of the RICE model from incentive and strategic perspectives and, through numerical analysis of the simulation results, demonstrates the superiority of game- theoretic solutions. Yang also applies the game-theoretic solutions of RICE to such policy-related concerns as unexpected shocks in economic/climate systems and redistribution and transfer issues in GHG mitigation policies. Yang's innovative approach sheds new light on the behavioral aspects of IA modeling and provides game-theoretic modeling of climate change with a richer economic substance.

A vast body of empirical evidence has accumulated demonstrating that incentives affect health care choices made by both consumers and suppliers of health care services. Decisions in health care are affected by many types of incentives, such as the rate of return pharmaceutical manufacturers expect on their investments in research and development, or disincentives, such as increases in the copayments patients must make when they visit physicians or are admitted to hospitals.

In this volume, leading scholars in health economics review these new and important results and describe their own recent research assessing the role of incentives in health care markets and decisions people make that affect their personal health. The contexts include demand decisions—choices made by individuals about health care services they consume and the health insurance policies they purchase—and supply decisions made by medical students, practicing physicians, hospitals, and pharmaceutical manufacturers.

Researchers and students of health economics and policy makers will find this book a valuable resource, both for learning economic concepts, particularly as they apply to health care, and for reading up-to-date summaries of the empirical evidence. General readers will find the book's chapters accessible, interesting, and useful for gaining an understanding of the likely effects of alternative health care policies.

Henry J. Aaron, Ernst R. Berndt, John Cawley, Julie M. Donohue, Donna Gilleskie, Brian R. Golden, Gautam Gowrisankaran, Chee-Ruey Hsieh, Hirschel Kasper, Thomas G. McGuire, Joseph P. Newhouse, Sean Nicholson, Mark V. Pauly, Anna D. Sinaiko, Frank Sloan

Reclaiming the Environmental Agenda

The past twenty-five years have seen a significant evolution in environmental policy, with new environmental legislation and substantive amendments to earlier laws, significant advances in environmental science, and changes in the treatment of science (and scientific uncertainty) by the courts. This book offers a detailed discussion of the important issues in environmental law, policy, and economics, tracing their development over the past few decades through an examination of environmental law cases and commentaries by leading scholars. The authors focus on pollution, addressing both pollution control and prevention, but also emphasize the evaluation, design, and use of the law to stimulate technical change and industrial transformation, arguing that there is a need to address broader issues of sustainable development.

Environmental Law, Policy, and Economics, which grew out of courses taught by the authors at MIT, treats the traditional topics covered in most classes in environmental law and policy, including common law and administrative law concepts and the primary federal legislation. But it goes beyond these to address topics not often found in a single volume: the information-based obligations of industry, enforcement of environmental law, market-based and voluntary alternatives to traditional regulation, risk assessment, environmental economics, and technological innovation and diffusion. Countering arguments found in other texts that government should play a reduced role in environmental protection, this book argues that clear, stringent legal requirements--coupled with flexible means for meeting them--and meaningful stakeholder participation are necessary for bringing about environmental improvements and technologicial transformations.

This book is regularly updated online at

Findings and Policy Implications

While human capital is a clear determinant of economic growth, only recently has health's role in this process become a focus of serious academic inquiry. By marrying the separate fields of health economics and growth theory, this groundbreaking book explores the explicit mechanisms by which a population's individual and collective health status affects a nation's economic development and performance. International leaders from both fields have contributed original essays that employ theoretical and empirical perspectives on the relationship between health and economic growth, including the relevant interconnections with investment in education, family planning, and productivity.Each of the book's five sections deals with a different aspect of this dynamic. These include the channels through which health human capital generates both higher income and individual well-being; the impact of health on long-run development, economic growth, and poverty reduction; the link between human capital levels and fertility and mortality rates, with models that analyze demographic and epidemiological transitions; the quantitative effect of better health on labor productivity and wages; and, finally, the devastating effects of AIDS -- in underdeveloped countries the most deadly, most economically adverse, and the surest barrier to growth -- on individual well-being and populations, and the prospects for incentives for developing new treatments. A concluding chapter integrates the different microeconomic and macrodynamic analyses and draws some policy conclusions for future study.

The Health and Economic Damages of Air Pollution in China

China's historic economic expansion is driven by fossil fuels, which increase its emissions of both local air pollutants and greenhouse gases dramatically. Clearing the Air is an innovative, quantitative examination of the national damage caused by China's degraded air quality, conducted in a pathbreaking, interdisciplinary U.S.-China collaboration. Its damage estimates are allocated by sector, making it possible for the first time to judge whether, for instance, power generation, transportation, or an unexpected source such as cement production causes the greatest environmental harm. Such objective analyses can reset policy priorities.Clearing the Air uses this information to show how appropriate "green" taxes might not only reduce emissions and health damages but even enhance China’s economic growth. It also shows to what extent these same policies could limit greenhouse gases, suggesting that wealthier nations have a responsibility to help China build environmental protection into its growth.Clearing the Air is written for diverse readers, providing a bridge from underlying research to policy implications, with easily accessible overviews of issues and summaries of the findings for nonspecialists and policymakers followed by more specialized, interlinked studies of primary interest to scholars. Taken together, these analyses offer a uniquely integrated assessment that supports the book's economic and policy recommendations.

What does a pack of cigarettes cost a smoker, the smoker's family, and society? This longitudinal study on the private and social costs of smoking calculates that the cost of smoking to a 24-year-old woman smoker is $86,000 over a lifetime; for a 24-year-old male smoker the cost is $183,000. The total social cost of smoking over a lifetime -- including both private costs to the smoker and costs imposed on others (including second-hand smoke and costs of Medicare, Medicaid, and Social Security) -- comes to $106,000 for a woman and $220,000 for a man. The cost per pack over a lifetime of smoking: almost $40.00. The first study to quantify the cost of smoking in this way, or in such depth, this accessible book not only adds a weapon to the arsenal of antismoking messages but also provides a framework for assessment that can be applied to other health behaviors. The findings on the effects of smoking on Medicare and Medicaid will be surprising and perhaps controversial, for the authors estimate the costs to be much lower than the damage awards being paid to 46 states as a result of the 1998 Master Settlement Agreement.

A Health Care Conundrum

The health care industry differs from most other industries in that medical pricing is primarily administered by the government and private insurers and in that it uses several types of contracts. Providers may receive a fixed sum for all necessary services within a given period of time, for the necessary services to treat a given condition, or for each specific service. The industry is changing dramatically, offering many natural experiments to aid understanding of the economics of pricing for health care.

In Pricing the Priceless, Joseph Newhouse explains the different pricing systems and how they affect resource allocation and efficiency, focusing on the efficiency of pricing. He also discusses larger issues of equity, fair distribution of burden, and social justice. Although most of the examples are American-based, the same issues arise in all medical care financing and delivery systems, and the theories and models are general enough to apply to many institutional contexts. The topics include Medicare, managed care, the contemporary integration of health insurance and medical care, the management of moral hazard and stinting, uncertainty and risk aversion, the demand for health insurance, agency relationships, information disparities, regulation, and supply-side and demand-side selection.

This series from the NBER presents new research by leading economists on current health care policy issues. The papers in this seventh volume, originally presented at the annual Frontiers in Health Policy Research conference held in Washington D.C. in the summer of 2003, reflect the economic challenges faced by policymakers and health care professionals in an age of budget deficits. Topics discussed include prescription drug benefits as a stand-alone component of Medicare, disability rates and Medicare costs, and conversion to for-profit health plans.

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