2. Production of Health FGS - Chapter 4

3. General Formulation HS = f (Health Care, Environment, Human Biology, Life Style) HS = f (HC, Env, HB, LS) If we’re concentrating on health care, Total Product: HS = f (HC, Env, HB, LS) Marginal Product: MP =  HS/  HC Average Product: AP = HS/HC (Excel Spreadsheet - Ch 4.xls)

5. Measures of Health Status Death rates (easiest to measure) Healthy days Morbidity rates It may be critical to distinguish between total and marginal contributions, since low marginals may accompany high totals.

6. Total v. Marginal It is critical to distinguish between total and marginal contributions. It may turn out that although the total contribution may be substantial, the marginal contribution may be very small. Why do we care? Because many decisions are made at the margin. Additions to the amount spent, may not be “worth it.”

7. Marginal Products Under most conditions, marginal products are always going to be non-negative. Why? Can  H/  x (where x = health care) be negative? Yes! 2 Possibilities

8. Iatrogenic (physician caused) disease Iatrogenic (physician caused) disease. All procedures have their risks. For example, in anesthesia, you kill someone a little bit -- You may do it too much. Suppose, that the more we do the higher the risk. More care gives lower marginal product, higher risk

9. Iatrogenic Picture Impacts of care –mgl product (+) –mgl risk (-) Net impact –mgl product - mgl risk. Health care, x Marginal impacts Mgl. Prod. Mgl. Risk Net impact. Here, it’s positive.

10. Iatrogenic Picture Health care, x Marginal impacts Mgl. Prod. Mgl. Risk Net impact. Here, it’s negative. Why?

11. Examples of Iatrogenic (physician caused) disease Examples: smallpox vaccine is a prime example; flu shots, for many, are another. Medical malpractice may be a third (i.e. the more done, the more possible mistakes).

12. Medicalization of Health Care Ivan Illich has argued that the medicalization (substituting medical for home care) of health care could effectively lead to less personal consumer effort to produce health. How would this work?

13. On the Historical Role of Medicine and Health Care McKeown focused on dramatic rise in population in England and Wales since 1750. It seems that world population rose and fell without any upward trend, up until that time. How does population increase? (Discuss) Increased births Decreased deaths Increased inmigration

14. KEY !!! Decreased deaths due to: 1. airborne causes -- tuberculosis, bronchitis, pneumonia, and influenza 2. waterborne causes [Table 4.1].

16. McKinlay and McKinlay Figure 4.2 shows that availability of effective medical intervention occurred well after the largest mortality decline.

17. MeaslesScarlet Fever

18. Public Health If not medical care, than what? McKeown argues that it’s public health Immunization of populations Quarantines Sanitary standards for water and sewage Sanitary standards for food handling and treatment Key point, though is increased nutrition

19. Increased Nutrition “Infectious disease creates a relationship between host and parasite. While control of the parasite is directly helpful in reducing disease incidence, the condition of the host helps to determine its resistance to disease. A person who is better housed, better rested, and... better fed, will be more resistant and less likely to die subsequent to exposure.” [FGS, Ch. 4]