SEMINAR IN HEALTH ECONOMICS AND POLICY ECON 4490/7300 January 1, 2017

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1 SEMINAR IN HEALTH ECONOMICS AND POLICY ECON 4490/7300 January 1, 2017 Location TBA Time Fridays 8:30 11:15, starting January 20 Instructor Greg Mason Office Hours Fridays 11:30 12:30 Telephone Contact (only use this address for communicate) Course website UMLearn Since this course requires active participation by all, I do not permit students to audit the course Objectives of the course This course provides students with an understanding of current problems and policies in promoting health and well-being among all sectors of society. It draws from recent developments in economics such as the limits to decision-making from behavioural economics, the impact of disruptive innovation in health care technologies, how market imperfection and rent-seeking drive costs, the role of insurance in uncertainty/risk mitigation, and socio-economic determinants of health. Throughout the course we will examine the optimal balance of public and private provision of health care by examining systems across a range of countries. In addition to gaining a deeper understand of health economics and policy, this course offers students training in the preparation of high quality reports. The major deliverable for the course is a paper that meets academic, government and industry standards and which will serve students in their career and academic advancement (see Assessment below) Course overview Heath economics presents unique challenges for analysis and policy. As an applied field, the focus of this seminar will be to gain understanding and rigorously examining the problems faced in promoting health for all members of society. Applying economic theories of consumer, producer and social choice, we will work to understand the behavior and decision-making of individuals, health care providers, and government. The emphasis will be on crafting economic policies that promote health using recent developments in behavioral economics, equity is income/wealth distribution, socio-economic determinants of both health status and access to health services, institutional constraints in producing and allocating health services, limits to decision-making, and how externalities condition outcomes. This course follows the form of graduate lecture/seminar. Each will comprise an overview of key issues by the instructor, followed by a seminar on the assigned readings. The coal of each class will be to learn important economic principles that should be reflected in the paper. Text/Readings Mastering these two texts will equip you with modern tools for the economc evaluation of health and health care. Barer, Morris L. et. al (2016) An undisciplined economist: Robert G Evans, McGill Queens University Press Drummond et. al. (2015) Methods for the Economic Evaluation of Health Care Programmes., 4 th edition, Oxford University Press I also recommend creating an account (free) for the New England Journal of Medicine (NEJM) ( and you will receive a weekly update of the journal. The Perspectives section has many pertinent articles that are interesting which are free to download and in the main sections there are academic articles of interest as well. The NEJM is accessible through U of M Libraries e-journals where you may download articles.

2 Assessment The assessment will be based on contributions to class and a major paper using economic analysis of a substantive health issue. a. Contribution in class (30%) is an assessment of leadership and participation in class discussions based on readings supporting the lectures. Each class will be divided into lecture followed by discussion and debate. Each student will take the responsibility for leading the discussion on a rotating basis based on assigned readings and relevant aspects of the texts. The issues to developed in each session are posted on UMLearn. While everyone will be expected to have reviewed the material, discussion leaders will be expected to pose key questions and go beyond the questions posed on line. Deep thinking is encouraged. Discussion leaders can review issues with me prior each class via or during my office hours. I will direct you to additional material. b. The paper (70%)comprises three deliverables: (see below for more information) i. References (5%): This is the preliminary bibliography of the literature you intend to use. ii. Literature review (25%): This document will use current techniques of on-line investigation. This starts with the list of references and culminates in the review. iii. Final paper (Analysis and discussion) (40%): The final paper featuring analysis and policy conclusion.(the final paper must integrate the literature review and analysis into a single coherent paper). Some of the seminar time will feature support to assist students in the preparation of the paper. This paper is intended to offer students training and experience in the preparation of reports that are common to industry, government and graduate level work. Re-drafts of the literature review may be resubmitted to support grade improvement. A topic in which you are interested may require you to read ahead Please feel free to discuss these with me. The final paper should include relevant elements of the economic theory and practice presented in this and other courses. Academic integrity (The not so fine print) Each student must read and understand university regulations regarding academic integrity as described in the General Calendar. Claims that these regulations were not understood will not be accepted. Please do not plagiarize it is a tedious experience for everyone, and the consequence for a course at this level is automatic F (undergraduates) and program withdrawal (graduate students).

3 Lecture Outline Lecture/Date Topic Jan 20 Jan 27 Feb 3 Feb 10 Feb 17 Feb 24 Mar 3 Health and healthcare as economic commodities Reading: UMLearn Notes and Barer (Chapter 1 and 2 include the Forward by Culyer) Discussion questions Externality and Behavioural economics and health policy Reading; Notes on UMLearn and Barer Chapters 4 and 5 Paper preparation aids: Effective on-line searching Supply of health care: practitioners and hospitals UMLearn Notes and Barer Chapter 9 Paper presentation aids: Using bibliographic aids (Zotero and other reference managers) References Due Healthcare Evaluation economic evaluation defined Readings: UMLearn Notes and Drummond, Chapters 1 3) Introduction to decision analytic approaches to economic evaluation Readings: UMLearn Notes and Drummond, Chapter 9) BREAK Guest lecture decision modelling of diabetes management Reading: UMLearn Mar Mar Mar Mar Apr Apr Apr 21 Apr 28 Cost-effectiveness and cost-benefit analysis Reading: UMLearn notes and Drummond, Chapters 4, 6 Lit Review Due Cost-utility and measuring healthcare gain Reading: UMLearn notes and Drummond Chapter 5 Supply of health care labour Reading: UMLearn notes and readings and Barer Chapters 10 Revised Lit Review Due Socio-economics of health Readings: UMLearn notes and readings and Barer Chapters 13 Public versus private supply of health care Readings: UMLearn notes and readings and Barer Chapters 6 and 7 Health Policy Comparison of US and Canadian health care systems Readings: UMLearn notes and readings Class presentation Students will give a 15 minute presentation Final paper due (Midnight)

4 Key dates 1. References due February 3 (which means you need to decide on your paper topic ASAP 2. Literature Review Draft March Revised Literature Review March Final Paper Due April 28 Paper This paper is intended to offer students training and experience in the preparation of reports that are common to industry, government and graduate level work. General instructions All submissions must be in WORD and formatted according to APA, Chicago, or similar style. This is important: Please submit all written material via following titles for the files: ECON4490_References_lastname_firstname.doc ECON4490_Lit Review_lastname_firstname.doc ECON4490_Lit Review_Revised_lastname_firstname.doc ECON4490_Final Paper_lastname_firstname.doc Example ECON4140_Lit Review_Mason_Greg.doc I will offer comments on the literature review; students who receive lower than an Amay revise and resubmit to increase their mark Potential paper topics (students are free to define their own topic, but consult with me first). Topics will be selected by students on a first come first serve basis. (One topic per student) 1. In addition to mortality and morbidity, a variety of subjective health outcomes are commonly used, such as QALY, DALY, and HRQOL. Review the basis of defining and measuring these alternatives, starting with the psychological basis for these measures. What is the basis for the common valuation of a quality life year as being equivalent to $55,000 (US) and suggest alternatives? 2. The supply of medical services is typically uneven between rural and urban areas. Review economic incentives and policies that can increase the supply of medical services (labour and capital) to rural areas. Undertake this in the framework of the costs and benefit of each policy you propose. You may wish to place this in the context of a specific country if you wish. 3. Select a specific treatment (surgical approach, pharmaceutical therapy, etc.) and undertake a critical review of the cost effectiveness methods used to establish the value of that treatment. You may also select treatments in alternative medicine, but there must be a credible and sufficiently large scientific and economic literature testimonials from Hollywood actors will not work. You should read the Chapter 8 in Drummond. (Note that there can be hundreds of trials published in PubMed, so this paper will require you to sort through a range of evidence). An example, might be an economic evaluation of laparoscopic surgery, in general or for a specific condition.

5 4. Alternative medicine has grown in popularity. What is the source of this growth, especially in a country such as Canada, where much of medical services are free and funded through the tax system? Pay attention to the marketing techniques used by alternative health suppliers to create demand. You may also wish to examine the role of Health Canada in regulating natural medicines. 5. Develop a cost-benefit framework for subsidized shingle vaccination promotion using incentives and penalties. Comment on the efficacy of incentives and penalties (what would these be/) in the context of a target population of seniors in Manitoba. 6. We grant a temporary monopoly in the form of a patent to allow pharmaceutical companies to recoup research and develop. Critically evaluate this policy and offer an alternative approach, weighing the benefits and costs in terms of brings the right drug to the right patient as fast as possible. Use a specific case study of pharmaceuticals coming off patent and the techniques used by the patent holder to maintain market share after the patent expires. 7. Examine the information on providers and hospitals patients available to patients in the US compared to Canada. What are the important dimensions for provider and hospital performance? What role does increased information on provider and hospital quality have in patient welfare and economic efficiency of the health system? What options exist to increase the flow of information or provider and hospital quality to Canadians? Focus on one aspect of health supply such as physicians (surgeons), hospitals, etc. How useful are informal on-line sites such as rate your doctor compared to work of mouth, and more formal assessment processes? 8. The expansion of scope of practice for medical professionals is one method for overcoming the shortage of physicians. Examine the impacts with terms of one of the following professions; a. Pharmacy (increase fees for diagnosis, advice and administration of routine (flu) vaccines. b. Nurse practitioners operating in a primary care setting c. Allowing midwives to bill for services under provincial health care d. The role of Physician Assistants in primary care clinics. Ensure that your analysis includes a discussion of the benefits and costs associated with such expansion of practices. In particular, do your think that medical costs overall will rise or fall as a result of such expanded scope of practice? 9. Compare the health systems of Canada to one of UK, France, Sweden, or Israel, identifying differences in how healthcare is financed, health outcomes indicators, equity of access, efficiency, wait-times, and value for money (outcomes per unit of national income devoted to health services (privately and publicly). Based on your findings, develop the optimal system for funding and delivering healthcare in Canada. 10. Examine how the Canadian health care system encourages rent-seeking among health providers. Please feel free to propose your own topics. Deliverable 1: References: You should have at least 10 and preferably closer to 20 relevant references (books, articles, reports) upon which you will be building your paper. You will likely change and expands this list as your research evolves. Deliverable 2: Literature Review The literature review provides the context for your paper and a summary is often the first part (5-20%) of any journal article or technical report. Some papers are entirely a literature review. The literature review has two functions: 1. It establishes the relevance of the topic 2. It presents a summary of the work done to date and the work done in the specific aspect you are examining. I expect the literature review to be about pages double-spaced (2500 words). I will offer feed back and students have the option of revising for a higher mark (those who receive an A or A+ will be exempted from this). I expect more advanced work from graduate students

6 Deliverable 3: Final Paper The final paper will include the literature review (suitably adjusted to integrate it with the main paper). The paper should be an in-depth discussion of the specific topic you have selected to study, applying relevant economic principles and if possible, coming to a conclusion with recommendation. Top papers are typically 20 pages (undergraduate) and 30 pages (graduate). Conclusion Sample papers from past courses that illustrate the expectations are on the UMLearn site.