1. Medical Care Costs: How Much Welfare Loss
Joseph P. Newhouse

2. Increase of Medical Expenditure
Growth in health care > Growth in GNP
The share of health care in GNP increases over time.

7. Now the health industry in U. S. is about two trillion…
$2,000,000,000,000

11. Increase of Medical Expenditure
Growth in health care > Growth in GNP
The share of health care in GNP increases over time.
The public is concerned about the growth of health care expenditure

12. Interview with Jonathan Gruber
What are the two or three most important questions that public finance economists have not answered but need to?
I like to say there are only two problems we have to worry about in America – healthcare spending and global warming because either one puts us underwater.

13. How we control healthcare costs is probably the number one problem for public finance economists and everyone in the world has to grapple with, because if we don’t control healthcare costs we’ll be bankrupt.

14. Factors accounting for Medical Exp Increase
Aging
Increased insurance
Increased income
Supplied induced demand
Factor productivity in a service industry

15. Aging Population mix changes over time
Aged over 65: 8% (1950) to 12% (1987)
Aged below 19: 33% (1950) to 28% (1987)

18. 人口急速老化，財務壓力遽增 =4.6倍 年輕人15,643 ≧65歲 ＜65歲以下 合計 每年增加人數(90~97年平均) 6萬人 12萬人
18萬人
人數成長率(90~97年平均)
2.84%
0.60%
0.81%
97年平均每人費用(點)
71,810
15,643
21,412
10年內人口將急遽老化，
解決健保財務刻不容緩
老人 71,810
=4.6倍 年度
≧65歲人口 98
10.60%
103
12.09%
108
15.44%
年輕人15,643 18

19. 人口老化
65歲以上人數及費用占率 19

20. 醫療費用成長原因-重大傷病
領證數占率
醫療費用占率 20

21. Aging Increase on Med Expenditure 15% increase
the actual increase is 500%

22. Increased Insurance
The spread of insurance reduces the price and increases the demand
Issue of moral hazard

36. Increased Insurance Rand experiment Increase on Med expenditure
Average coinsurance moves from 33% to 0% increases the spending by 40-50%
price elasticity is -0.1 to -0.2
Increase on Med expenditure
Average coinsurance rate: 67% (1950) to 27% (1980)
the increase in Med Exp is around 50%
No change on hospital co-payment but the increase in hospital expenditure is 50% in 1980s

38. Increased Income Income elasticity Increase on Med Exp in the world
Income elasticity in U. S. is
Income elasticity in the world is around 1.0
Increase on Med Exp in the world
Between , real GNP increases by 180%
Increase in health is 35-70% if elasticity is
Increase in health is 180% if elasticity is 1

39. Supplier Induced Demand
Physicians want more demand, even at the cost of patients
Number of physicians increases, increase the demand to protect their incomes
Number of physicians over time do not increase very much

41. Factor productivity in a service industry
Medical care is a service which is difficult to import or export
If the productivity gains for services are lower like the medical care than the rest of the economy, then relative medical prices would rise over time.
Demand is inelastic, so the expenditures would also rise.

42. Factor productivity in a service industry
The medical price inflation exceeds the CPI by 3.4% in 1980s, but 0.4% in 1970s, 2.0% in 1960s, and 1.9% in 1950s. No clear evidence indicating that medical price inflation is very different from CPI.
More importantly, price index for medical care is measured with strong bias, most notably is the problem of failing to make adjustments of quality change over time.

43. +15% 5倍 3.75% +50% 12.5% +180% 780% 23% minor - 項目 變化 對醫療支出的影響
同期醫療支出的上升程度
解釋程度
人口老化
(65以上）
8%(1950)
12%(1980)
+15% 5倍
3.75%
部分負擔率下降
(保險普及)
67%(1950)
27%(1980)
+50%
12.5%
所得成長
成長180%
+180%
780%
23%
醫師誘發需求
minor -
相對價格

44. About 50% is still unexplained…

50. Conclusions About 50% is still unexplained…
Technology innovation is considered the important factor that attributes to the growth of medical expenditure

51. Benefit of Medical Care