《健康经济学》课件Chapter4.ppt
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- 健康经济学 健康 经济学 课件 Chapter4
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1、IntroPreviouslyGrossman modelIndividuals make choices about their health based on time constraints,budget constraints,and utilityOptimal amount of health(H*)changes based on decisions about tradeoffsHow does socioeconomic status(SES)affect health and choices about health?Does health determine SES?Or
2、 does SES determine health?Use empirical evidence to explore these questionsThe pervasiveness of health disparitiesHealth disparities are everywhereHealth Disparity:(def)differences in health-incidence,prevalence,mortality,and burden of disease-between specific populationsex:death rates for all canc
3、er types for both men and women are highest among African Americans1Ubiquitous worldwide across races,educational attainments,employment grades,and incomesBroadly across all socioeconomic statuses(SES)Health disparities are everywhereBy education:College graduates are 25%more likely to survive to ag
4、e 68 than high school dropoutsBy race:Hispanics report better health status than black individualsWhite individuals report better health then both Hispanic and black individualsHealth deteriorates with age across all races,but disparities persistHealth disparities across incomeGenerally:high-income
5、individuals self-report a higher health status than those of lower incomesFor most conditions,the poor exhibit more incidences of diseaseSome exceptions like Bronchitis-no difference Hay fever-the rich appear to be diagnosed with hay fever more oftenMay be explainable if richer children visit the do
6、ctor more often and hence,are more likely to be diagnosed Disparities even with universal insuranceEven in countries with universal health insurance,health disparities persistCanada:Self-reported health status for children at high SES better than children of low SES(Currie and Stabile 2003)England:W
7、e discuss the Whitehall studies laterTheories to explain health disparitiesWhy do health disparities exist?Reasons/theoriesEarly life eventsIncome levelsStress of being poorWork capacityImpatienceAdherence to medical advicePolicy importance of understanding causes of disparities before addressing th
8、emWhat causes what?Does bad health cause low SES?Does low SES cause bad health?Are there other factors?Hypotheses for health disparitiesEfficient producerThrifty phenotypeDirect incomeAllostatic loadIncome inequalityAccess to careProductive timeTime preference(The Fuchs hypothesis)The Grossman model
9、 and health disparitiesRecall MEC indicates the return on each additional unit of health capitalDifferent SES groups may have different MECsWhy?Each hypothesis posits a different reasonThe efficient producer hypothesisHypothesis:better-educated individuals are more efficient producers of health than
10、 less well-educated individualsGrossman predicts that people who are more efficient health producers will have higher H*Lleras-Muney(2005)find that an additional year of schooling caused 1.7 year increase in life expectancy in 1920s USHence,education improves healthThe efficient producer hypothesisP
11、ossible causal mechanismsPossible reasons for positive correlation between health and education?Lessons in school help students to take better care of themselvesSchooling helps students be more patient when it comes to payoffs of investments(like health)Better-educated more likely to adhere to treat
12、ment regimensThe efficient producer hypothesisThrifty phenotype hypothesisGenetic reasons for being inefficient at producing healthDeprivation of resources(food)in utero and early childhood leads to activation of“thrifty”genes that are useful for sparse environmental conditionsThese“thrifty”genes go
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