Shifting public-health-sector waiting lists to the private sector (original) (raw)
Related papers
Public health care with waiting time: the role of supplementary private health care
Journal of Health Economics, 2003
We consider an economy where most of the health care is publicly provided, and where there is waiting time for several types of treatments. Private health care without waiting time is an option for the patients in the public health queue. We show that although patients with low waiting costs will choose public treatment, they may be better off with waiting time than without. The reason is that waiting time induces patients with high waiting costs to choose private treatment, thus reducing the cost of public health care that everyone pays for. Even if higher quality (i.e. zero waiting time) can be achieved at no cost, the self-selection induced redistribution may imply that it is socially optimal to provide health care publicly and at an inferior quality level. We give a detailed discussion of the circumstances in which it is optimal to have waiting time for public health treatment. Moreover, we study the interaction between this quality decision and the optimal tax/subsidy on private health care.
Private care and public waiting
Australian Health Review, 2005
Waiting time for public hospital care is a regular matter for political debate One political response has been to suggest that expanding private sector activity will reduce public waiting times. This paper tests the hypothesis that increased private activity in the health system is associated with reduced waiting times using secondary analysis of hospital activity data for 2001-02.
Private health care as a supplement to a public health system with waiting time for treatment
2009
In this article the authors Michael Hoel and Erik Magnus Sæther consider an economy where most of the health care is publicly provided, and where there is waiting time for several types of treatments. Private health care without waiting time is an option for the patients in the public health queue. This article shows the effects of a tax (positive or negative) on private health care, and derives the socially optimal tax/subsidy. Finally, a discussion of how the size of the tax might affect the political support for a high quality public health system is provided.
Pricing and Waiting Time Decisions in a Health Care Market with Private and Public Provision
Journal of Applied Economics, 2019
This paper describes a duopoly market for healthcare where one of the two providers is publicly owned and charges a price of zero, while the other sets a price so as to maximize its profit. Both providers are subject to congestion in the form of an M/M/1 queue, and they serve patient-consumers who have randomly distributed unit costs of time. Consumer demand (as market share) for both providers is obtained and described. The private provider’s pricing decision is explored, equilibrium existence is proven, and conditions for uniqueness presented. Comparative statics for demand are presented. Social welfare functions are described and the welfare maximizing condition obtained. More detailed results are then obtained for cases when costs follow uniform and Kumaraswamy distributions. Numerical simulations are then performed for these distributions, employing several parameter values, demonstrating the private provider’s pricing decision and its relationship with social welfare.
Public health care and private insurance demand: the waiting time as a link
Health care management science, 2000
This paper analyzes the effect of waiting times in the Spanish public health system on the demand for private health insurance. Expected utility maximization determines whether or not individuals buy a private health insurance. The decision depends not only on consumer's covariates such as income, socio-demographic characteristics and health status, but also on the quality of the treatment by the public provider. We interpret waiting time as a qualitative attribute of the health care provision. The empirical analysis uses the Spanish Health Survey of 1993. We cope with the absence of income data by using the Spanish Family Budget Survey of 1990-91 as a complementary data set, following the Arellano-Meghir method [4]. Results indicate that a reduction in the waiting time lowers the probability of buying private health insurance. This suggests the existence of a crowd-out in the health care provision market.
2011
Cost sharing represents a well-established tool for the control of health care demand in many Oecd countries. However, it is used with caution and in combination with other instruments in order to avoid potential negative impacts on access to essential health care services. Waiting lists and waiting times represent an alternative (and implicit) way to control demand in public health care systems, even though in terms of welfare rationing by waiting may be an inferior solution to cost sharing. This paper focuses on the use of waiting times, cost sharing, and other tools (in particular, priority and appropriateness criteria) in order to control demand for a public outpatient health service in presence of a fully paid out-of-pocket private alternative. We develop an agent-based model where heterogeneous agents maximise their individual utility based on income and health status. On this basis, we develop some computational experiments based on micro-simulations to offer some useful insights for health care policy. In particular, we show that: i) the presence of a private alternative to a public treatment can improve social welfare and health equity in a NHS, when public supply is constrained by a fixed budget and longer waiting times than the private one; ii) using prioritisation of waiting lists without any copayment to control the demand for public treatment may produce high performances in terms of social welfare, health equality and policy efficiency; iii) applying a moderate copayment rate as a tool to control public demand could determine the same policy efficiency of using only priority lists, if the copayment revenues are used to fund the public provision.
Cost sharing represents a well-established tool for the control of health care demand in many Oecd countries. However, it is used with caution and in combination with other instruments in order to avoid potential negative impacts on access to essential health care services. Waiting lists and waiting times represent an alternative (and implicit) way to control demand in public health care systems, even though in terms of welfare rationing by waiting may be an inferior solution to cost sharing. This paper focuses on the use of waiting times, cost sharing, and other tools (in particular, priority and appropriateness criteria) in order to control demand for a public outpatient health service in presence of a fully paid out-of-pocket private alternative. We develop an agent-based model where heterogeneous agents maximise their individual utility based on income and health status. On this basis, we develop some computational experiments based on micro-simulations to offer some useful insights for health care policy. In particular, we show that: i) the presence of a private alternative to a public treatment can improve social welfare and health equity in a NHS, when public supply is constrained by a fixed budget and longer waiting times than the private one; ii) using prioritisation of waiting lists without any copayment to control the demand for public treatment may produce high performances in terms of social welfare, health equality and policy efficiency; iii) applying a moderate copayment rate as a tool to control public demand could determine the same policy efficiency of using only priority lists, if the copayment revenues are used to fund the public provision.
Waiting Lists and Patient Selection
Journal of Economics & Management Strategy, 2005
We develop a model of waiting lists for public hospitals when physicians deliver both private and public treatment. Public treatment is free but rationed, i.e., only cases meeting some medical criteria area admitted for treatment. Private treatment has no waiting time but entails payment of a fee. Both physicians and patients take into account that each patient treated in the private practice schedule reduces the waiting list for public treatment. We show that physicians do not necessarily select the mildest cases from the waiting list. We provide sufficient conditions on the rationing policy under which cream skimming is always partial. We show that, to a large extent, one can bypass the analysis of doctors' behavior in the characterization of patient selection.
Production and Operations Management, 2014
T his study develops a theoretical model and then, using Canadian joint replacement surgery data, empirically tests the relationship between government policies that promote privately funded health care and patients' waiting time in the public health care system. Two policies are tested: one policy allows opt-out physicians to extra-bill private patients, and the other provides public subsidies to private patients. We find that both policies are associated with shorter public waiting time, and that the subsidy policy appears to be more effective in waiting time reduction than the extra-billing policy. Our findings are consistent with a dominant demand-side effect in that these policies would provide patients an option, and some incentive, to opt out of the public health system, shifting the demand from the public health system to the private care market.
Illness severity and the use of public health care by the privately insured. Is there a link?
2000
We study the link between illness severity and the use of public health care services by the privately insured under a National Health System. Our theoretical model shows that this relationship will depend on the prioritization established by the public authorities, the cost of waiting and the private doctors' strategic behavior. In our empiri- cal exercise, we find the consistent