Behavioral Economics and Health Economics

The health sector is filled with institutions and decision-making circumstances that create friction in markets and cognitive errors by decision makers. This paper examines the potential contributions to health economics of the ideas of behavioral economics. The discussion presented here focuses on the economics of doctor-patient interactions and some aspects of quality of care. It also touches on issues related to insurance and the demand for health care. The paper argues that long standing research impasses may be aided by applying concepts from behavioral economics.

Pricing and Location of Physician Services in Mental Health

Puzzling results of a positive association between the number of physicians per capita and the level of fees for physician services have been reported in the literature. These results may be due to misspecification of econometric models and use of data aggre-gated across medical specialties. It is hypothesized that the unusual results would not persist with a carefully specified econometric model for a single medical specialty. A general model of pricing and location of physician's services is applied to the market for psychiatrist's services. The results imply that the market for psychiatrist's services operates in a manner consistent with the predictions of the competitive model.

Custom Made Versus Ready to Wear Treatments; Behavioral Propensities in Physician's Choices

To customize treatments to individual patients entails costs of coordination and cognition. Thus, providers sometimes choose treatments based on norms for broad classes of patients. We develop behavioral hypotheses explaining when and why doctors customize to the particular patient, and when instead they employ "ready-to-wear" treatments. Our empirical studies examining length of office visits and physician prescribing behavior find evidence of norm-following behavior. Some such behavior, from our studies and from the literature, proves sensible; but other behavior seems far from optimal.

Economics and Mental Health

This paper is concerned with the economics of mental health. We argue that mental health economics is like health economics only more so: uncertainty and variation in treatments are greater; the assumption of patient self-interested behavior is more dubious; response to financial incentives such as insurance is exacerbated; the social consequences and external costs of illness are formidable. We elaborate on these statements and consider their implications throughout the chapter. Special characteristics' of mental illness and persons with mental illness are identified and related to observations on institutions paying for and providing mental health services. We show that adverse selection and moral hazard appear to hit mental health markets with special force. We discuss the emergence of new institutions within managed care that address long-standing problems in the sector. Finally, we trace the shifting role of government in this sector of the health economy.

Pricing, Patent Loss and the Market For Pharmaceuticals

Empirical studies suggest that entry of generic competitors results in minimal decreases or even increases in brand-name drug prices as well as sharp declines in brand-name advertising. This paper examines circumstances under which this empirical pattern could be observed. The analysis focuses on models where the demand for brand-name pharmaceuticals is divided into two segments, only one of which is cross-price-sensitive. Brand-name firms are assumed to set price and advertising in a Stackelberg context; they allow for responses by generic producers but the latter take decisions by brand-name f inns as given. Brand-name price and advertising responses to entry are shown to depend upon the properties of the reduced-form brand-name demand function. Conditions for positive price responses and negative advertising responses are derived. We also examine the implications for brand-name price levels, and for the brand-name price response to entry, of health sector trends (such as increasing HMO enrollments) that may have the effect of expanding the size of the cross-price-sensitive segment of the market. The paper concludes with a review of recent empirical research and suggestions for future work on the effects of generic entry.

"Generic Entry and the Pricing of Pharmaceuticals"

During the 1980s the share of prescriptions sold by retail pharmacies that was accounted for by generic products roughly doubled. The price response to generic entry of brand-name products has been a source of controversy. In this paper we estimate models of price responses to generic entry in the market for brand-name and generic drugs. We study a sample of 32 drugs that lost patent protection during the early to mid-1980s. Our results provide strong evidence that brand-name prices increase after entry and are accompanied by large price decreases in the price of generic drugs.

The Effect of Mental Distress on Income: Results from a Community Survey

We employ a unique data set from a community based survey to assess the effect of mental distress on earnings. The main advantage of the data is that detailed measurements of mental health status were made on all subjects in the study. This means that our population-based measure of mental distress does not rely on a patient having had contact with the health care system and obtaining a diagnosis from a provider. The use of diagnosis-based measures may introduce measurement-error bias into the estimates. Our results show that the presence of mental distress reduces earnings by approximately 21% to 33%. To assess the magnitude of any measurement-error bias we present a estimates of models using measures of mental health both on a population-wide basis and on a diagnosis basis. The estimated impact of mental illness on earning is only 9% lower using the using the diagnosis-based measure. The conclusion drawn from this is that little bias is introduced by using the diagnosis-based measure.

Cost-Offsets of New Medications for Treatment of Schizophrenia

Broad claims are frequently made that new medications will offset all or part of their costs by reducing other areas of Medicaid spending. In this paper we examine the net impact on spending for new drugs used to treat schizophrenia. We extend research in this area by taking a new approach to identification of spending impacts of new drugs. We specify and estimate models of spending on treatment of schizophrenia using 7 years of Florida Medicaid data. The estimates indicate that use of the new drugs result in net spending increases. This may be due to increased adherence to treatment.

The Near Infrared Background: Interplanetary Dust or Primordial Stars?

The intensity of the diffuse ~ 1 - 4 micron sky emission from which solar system and Galactic foregrounds have been subtracted is in excess of that expected from energy released by galaxies and stars that formed during the z < 5 redshift interval (Arendt & Dwek 2003, Matsumoto et al. 2005). The spectral signature of this excess near-infrared background light (NIRBL) component is almost identical to that of reflected sunlight from the interplanetary dust cloud, and could therefore be the result of the incomplete subtraction of this foreground emission component from the diffuse sky maps. Alternatively, this emission component could be extragalactic. Its spectral signature is consistent with that of redshifted continuum and recombination line emission from HII regions formed by the first generation of very massive stars. In this paper we analyze the implications of this spectral component for the formation rate of these Population III stars, the redshift interval during which they formed, the reionization of the universe and evolution of collapsed halo masses. We find that to reproduce the intensity and spectral shape of the NIRBL requires a peak star formation rate that is higher by about a factor of 4 to 10 compared to those derived from hierarchical models. Furthermore, an extragalactic origin for the NIRBL leads to physically unrealistic absorption-corrected spectra of distant TeV blazars. All these results suggest that Pop III stars contribute only a fraction of the NIRBL intensity with zodiacal light, star forming galaxies, and/or non-nuclear sources giving rise to the remaining fraction.Comment: 28 pages including 7 embedded figures. Submitted to Ap

Price Indexes for Acute Phase Treatment of Depression

Although broad trends in medical spending in the U.S. over the last decade have received widespread attention from policymakers, very little attention has focused on the components of those changes. For many other industries, economists typically divide nominal expenditures by an official government price index to decompose these expenditures into price and quantity components. In this paper we construct a new price index for the treatment of one illness depression. Making use of results from the published clinical literature and from official treatment guideline standards, we identify therapeutically similar treatment bundles. These bundles can then be linked and weighted to construct price indexes for specific forms of major depression. In doing so, we construct CPI and PPI-like medical price indexes that deal with prices of treatment episodes rather than prices of discrete inputs, that are based on transaction rather than list prices, that take quality changes and expected outcomes into account employ current, time-varying expenditure weights in the aggregation computations. We find that regardless of which index number procedure is employed time period the treatment price index for the acute phase of major depression has hardly changed remaining at 1.00 or falling slightly to around 0.97. This index grows considerably less rapidly than the various official PPIs -- thus the price index for the treatment of the acute phase of major depression has fallen over the 1991-95 time period. A hedonic approach to price index measurement yields broadly similar results. These results imply that given a budget for treatment of depression accomplished in 1995 than in 1991. Our results suggest that at least in the case of acute phase major depression, aggregate spending increases are due to a larger number of effective treatments being provided.