Expenditure on healthcare in the UK: a review of the issues

This review examines the performance of the UK healthcare system. After presenting data on the level and distribution of resources, three topics are examined. The first is the lessons from international comparisons of evidence on expenditure, equity and healthcare outcomes. The second is the lessons from the recent internal market reforms. The third is the lessons from an analysis of the role for private finance in UK healthcare. The review concludes that economists and policymakers need to focus more attention on the relationship between healthcare inputs — expenditure — and health outcomes, and, within this, on the incentives facing suppliers and demanders of healthcare.

Why Economics is good for your health - 2004 Royal Economic Society Public Lecture

In this paper, I examine the contribution that economics can make to our understanding of key issues in health and health care. In the first part of the paper, I argue that economics can bring valuable insights into the world of over-eating and present recent economic theories that argue that the root cause of the increase in obesity lies in technological change. Technological change, in terms of the kind of work we do, the agricultural production revolution and the major cost reductions in food processing and distribution have all contributed to weight gain. This hypothesis is illustrated by data from the USA. In the second part, I argue that understanding incentives is the key to understanding the behaviour of suppliers of health care, explaining for example, why health staff 'fiddle the figures' to meet government targets and why doctors will respond to financial payments.health, economics, healthcare, obesity, incentives

An economic model of household income dynamics, with an application to poverty dynamics among American women

The rise in inequality and poverty is one of the most important economic and social issues in recent times. But in contrast to the literature on individual earnings inequality, there has been little work modelling (as opposed to documenting) household income dynamics. This is largely because of the difficulties created by the fact that on top of the human capital issues that arise in personal earnings, individuals are continually forming, dissolving and reforming household units. This paper proposes a framework for modelling household income dynamics. It emphasises the role of household formation and dissolution, and labour market participation. It allows standard economic theory to address the issues of household, as distinct from individual, income and poverty dynamics. We illustrate this framework with an application to poverty rates among young women in the US. We use this model to analyse differences in poverty experiences, particularly between black and white women

Early Health Related Behaviours and their Impact on Later Life Chances: Evidence from the US (OUT (publ. in Health Economics, 7(5), 1998)

This paper uses evidence from the US to examine the impact of adolescent illegal consumption and violent behaviour on later life chances. Specifically, we look at the effect of such behaviour by young men in late adolscence on productivity and household formation ten years on. We find that alcohol and soft drug consumption have no harmful effects on economic prospects in later life. In contrast, hard drug consumption and violent behaviour in adolescence are both associated with lower productivity even by the time the individuals are in their late twenties. These effects are substantial and affect earnings levels and earnings growth. These results are robust to the inclusion of a rich set of additional controls measuring aspects of the individuals' backgrounds. However, we find no evidence of any of these behaviours significantly affecting household formation.alcohol and drug consumption, anti-social behaviour, earnings, marriage

The Use and Usefulness of Performance Measures in the Public Sector

The paper focuses on the empirical evidence on the use and usefulness of performance measures in the public sector. It begins with consideration of the features of the public sector which make the use of performance measures complex: the issues of multiple principals and multiple tasks. It discusses the form that performance measures may take, the use made of these measures and the responses that individual may make to them. Empirical examples from the fields of education and health, with a focus on the US and UK, are examined. There is clear evidence of responses to such measures. Some of these responses improve efficiency, but others do not and fall into the category of ‘gaming’. Generally, there has been little assessment of whether performance measures bring about improvements in service. The paper ends with consideration of how such measures should be used and what measures are useful to collect.benchmarking, public sector, performance measures

Health supplier quality and the distribution of child health

There is emerging evidence to suggest that initial differentials between the health of poor and more affluent children in the UK do not widen over early childhood. One reason may be that through the universal public funded health care system all children have access to equally effective primary care providers. This paper examines this explanation. The analysis has two components. It first examines whether children from poorer families have access to general practitioners of a similar quality to children from richer families. It then examines whether the quality of primary care to which a child has access has an impact on their health at birth and on their health during early childhood. The results suggest that children from poor families do not have access to markedly worse quality primary care, and further, that the quality of primary care does not appear to have a large effect on differentials in child health in early childhood.primary care quality, child health

An Economic Model of Household Income Dynamics, with an Application to Poverty Dynamics among American Women

The rise in inequality and poverty is one of the most important economic and social issues in recent times. But in contrast to the literature on individual earnings inequality, there has been little work modelling (as opposed to documenting) household income dynamics. This is largely because of the difficulties created by the fact that on top of the human capital issues that arise in personal earnings, individuals are continually forming, dissolving and reforming household units. This paper proposes a framework for modelling household income dynamics. It emphasises the role of household formation and dissolution, and labour market participation. It allows standard economic theory to address the issues of household, as distinct from individual, income and poverty dynamics. We illustrate this framework with an application to poverty rates among young women in the US. We use this model to analyse differences in poverty experiences, particularly between black and white women.Poverty analysis, household income dynamics

Growing up: school, family and area influences on adolescents' later life chances

This paper explores the links between school, family and area background influences during adolescence and later adult economic outcomes. The empirical analysis is based on data covering the period 1979 to 1996, drawn from the 1979 US National Longitudinal Survey of Youth. For a sample of individuals aged 14 to 19 in 1979, estimates are produced of the impact of family, school and local area when growing up, on earnings capacity and poverty risk once they reach adulthood

Understanding socio-economic inequalities in childhood respiratory health

Asthma is the most common chronic disease of childhood. Recent evidence has shown a socio-economic gradient in its distribution. This paper examines whether a number of factors argued to have led to a rise in the incidence of asthma might also explain the social gradient. Several of these have been the object of policy intervention, though not necessarily with the aim of lowering childhood respiratory conditions. Using a large cohort study (the Avon Longitudinal Study of Parents and Children) we find significant inequalities in three respiratory conditions in middle childhood. We investigate eight potential mediating factors: exposure to other children in infancy, child's diet, poor housing conditions, maternal smoking, parental history of asthma, poor child health at birth, maternal age at child's birth and local deprivation. We find that each of these alone typically explains a relatively modest part of each respiratory inequality, with child's diet, local deprivation and maternal smoking generally the most important. But taken together, the mediating factors account for a substantial part of the respiratory inequalities. So the socio-economic gradient appears to operate through a number of inter-correlated pathways, some of which may be amenable to policy intervention.Asthma, wheeze, socio-economic inequalities, mediating

The Impact of Low-Income on Child Health: Evidence from a Birth Cohort Study

There is a growing literature that shows that higher family income is associated with better health for children. Wealthier parents may have more advantaged children because they have more income to buy health care or because parental wealth is associated with beneficial behaviours or because parental health is associated with both income and children's health. The policy implications of these transmission mechanisms are quite different. We attempt to unpick the correlation between income and health by examining routes by which parental disadvantage is transmitted into child disadvantage. Using a UK cohort study that has rich information on mother's early life events, her health, her behaviours that may affect child health, and her child's health, we examine the impact of being in low income compared to that of mother child health related behaviours and mother's own health on child health. We find children from poorer households have poorer health. But we find the direct impact of income is small. A larger role is played by mother's own health and events in her early life. No clear role is played by mother child health production behaviours.child health, income, maternal health, transmission mechanisms