0 penilaian0% menganggap dokumen ini bermanfaat (0 suara)
23 tayangan19 halaman
Osteopathy, like most goods, is a no7mal good - an increase in income leads to an increase in demand and vice versa. The more expensive it is to buy osteopathy, all other Iactors remaining constant, the less we will buy.
Osteopathy, like most goods, is a no7mal good - an increase in income leads to an increase in demand and vice versa. The more expensive it is to buy osteopathy, all other Iactors remaining constant, the less we will buy.
Hak Cipta:
Attribution Non-Commercial (BY-NC)
Format Tersedia
Unduh sebagai DOCX, PDF, TXT atau baca online dari Scribd
Osteopathy, like most goods, is a no7mal good - an increase in income leads to an increase in demand and vice versa. The more expensive it is to buy osteopathy, all other Iactors remaining constant, the less we will buy.
Hak Cipta:
Attribution Non-Commercial (BY-NC)
Format Tersedia
Unduh sebagai DOCX, PDF, TXT atau baca online dari Scribd
Osteopaths manipulate and massage bones, muscles and ligaments that have been twisted or strained.
What will inIluence how much osteopathy people are prepared to buy at any particular time?
Substitution and income effects Perhaps the most important Iactor will be the price oI the treatment. The more expensive it is to buy osteopathy, all other Iactors remaining constant, the less we will buy. Why?
When osteopathy becomes more expensive two things happen: 1. 7elative p7ices change; and 2. our 7eal income changes. When we react to the price rise, we are taking both oI these changes into account. The change in relative price means that osteopathy is now more expensive compared to other goods and services. How do we respond to this? Economists assume that people are satisIaction maximisers. This means that we all try to gain as much satisIaction as possible Irom our consumption oI goods and services. So we react to the Iact that osteopathy is now relatively more expensive by choosing to buy less oI it and more oI something else instead (substitution eIIect).
The increase in the price oI osteopathy has also reduced our 7eal income - we can now buy less than beIore with our money income. The way which we react to this change in real income depends on the kind oI good or service. Osteopathy, like most goods, is a no7mal good - an increase in income leads to an increase in demand and vice versa. So a Iall in real income will Iurther reduce the amount oI treatment bought (income eIIect).
%e demand curve This predictable relationship between price and quantity demanded allows us to deIine demand Iormally as the quantity oI a good or service that buyers are willing and able to buy at every conceivable price. The demand curve (see Figure 6 on the leIt) shows this relationship graphically.
DD shows the quantity oI osteopathy treatments that consume7s are prepared to buy at every conceivable price. A change in price leads to a movement along the demand curve.When the price is P consumers will -uy Q. II the price Ialls to P' then the quantity demanded will 7ise to Q'. A change in price has led to a movement along the demand curve. What else will inIluence how much osteopathy we buy? The answer is our income, our preIerences and the prices oI other goods. Osteopathy is a no7mal good so iI our income rises we will buy more treatment at each price, and iI it Ialls we will buy less. II our preIerences change, we will buy more or less osteopathy at each price. II we decide we are keen on osteopathy, then we will buy more oI it. II we go oII the idea oI osteopathy, then the amount we buy will drop. Our demand Ior osteopathy will also be aIIected by the prices oI related services. An obvious example is the price oI physiotherapy, which is an alternative (or substitute) treatment Ior many oI the conditions treated by osteopaths. II the price oI physiotherapy Ialls then some people are likely to switch Irom osteopathy to physiotherapy, so the demand Ior osteopathy would Iall.
Our demand Ior goods and services is also aIIected by changes in prices oI complementa7y goods. These are goods and services which tend to be bought together. For instance, iI the price oI eye tests rose signiIicantly, then many people would not bother to get their eyes checked regularly. This would lead to a Iall in the demand Ior spectacles. Whenever income, preIerences or the price oI a related good or service changes, the demand curve shiIts. You can try out the eIIects oI changes in the graph on the leIt.
ow Iook at tese (ceck te status bar for information)
b. Supply - analysing the sellers' behaviour
Further questions
"uestion nswer Is this statement true or false? "If the price of osteopathy falls, the demand curve will shift."
Reset
igure 6 The demand for osteopathy treatments o to
The Economics of Health Care
Unit 2. The free market approach
Page 15
i
b. Supply - analysing the sellers behaviour
igure 7. The supply curve for osteopathy treatments
The sellers in this market are the osteopaths we described earlier. We assume that these osteopaths want to maximise their proIits. What are proIits and how can they be maximised? Osteopaths earn money (7evenue) by selling their services e.g. by massaging away muscular strains. Out oI this revenue they need to pay Ior the Iactors they use to produce the treatment (costs) e.g. pay their receptionist, pay the rent or pay Ior a new ultrasound machine. ProIit is the excess oI revenue over costs.
aximising profits Seeking to maximise proIits leads each osteopath to want to sell more care at higher prices. There is a reliable and predictable positive relationship between price and quantity supplied. Formally, supply is deIined as the quantity oI a good or service that a population oI sellers is willing and able to sell at every conceivable price. This positive relationship is shown graphically by the supply curve on the leIt - SS. II the price changes there is a movement along the supply curve (see Figure 7). At price P the osteopath population is prepared to sell Q t7eatments. When the price rises to P' the osteopath population is prepared to sell Q' t7eatments - this might be because more people become osteopaths when it becomes a more lucrative job.
ange in costs II the level oI Iactor costs changes then the supply curve will shift. For example nurses' wages could go up or the rent could Iall. Let's look at the eIIects oI these. In Figure 8, SS is the initial supply curve Ior treatments. Imagine that nurses' wages rise, pushing up osteopaths' costs. The osteopaths react by being prepared to supply Iewer treatments at each price (this may be because there are Iewer osteopaths). At a price such as P' osteopaths are now only prepared to sell Q" treatments rather than Q'. The supply curve shiIts inwards to S'S'.
Now imagine that rents Iall. The proIit oI osteopaths will increase Ior each treatment. The osteopath population will react by being prepared to supply more treatments at each price. At the price P' osteopaths are now prepared to sell Q"' treatments rather than Q'. The supply curve shiIts outwards. ow Iook at tese check the status bar for information)
c. The market
Further questions
"uestion nswer urses' wages rise. Which one of these describes the behaviour of osteopaths? A. They will be prepared to sell more treatments B. They will be prepared to sell the same number of treatments C. They will be prepared to sell fewer treatments
Fall Nurses' pay Rise Fall Rent Rise
igure 8. Reset Co Lo
1he Lconomlcs of PealLh Care
unlL 2 1he free markeL approach
age 16
l
c 1he markeL
llgure 9
We can now puL Lhe demand and supply curves LogeLher 1hls wlll glve us a plcLure of Lhe markeL for osLeopaLhy 1hls ls shown by llgure 9 noLlce LhaL Lhere ls only one prlce aL whlch Lhe quanLlLy of LreaLmenLs people wanL Lo buy ls Lhe same as Lhe quanLlLy Lhe osLeopaLhs wanL Lo sell 1hls ls called Lhe equlllbrlum prlce e 1he correspondlng quanLlLy ls Lhe equlllbrlum quanLlLy C e 1he equlllbrlum ls a sLaLe of resL where Lhere ls no pressure for change
AL any oLher prlce elLher buyers or sellers are dlssaLlsfled and acL Lo change Lhe quanLlLy demanded or supplled Excess demand II there is excess demand, consumers bid up the price. At price P' consumers demand Q'. The price is low so a lot oI people are willing and able to buy treatments. However, the low price means that there aren't enough osteopaths prepared to provide this amount oI treatment. They are only prepared to provide Q". The excess demand (Q' - Q") causes the consumers to bid the price up to the equilibrium price P e . Excess supply At P" the price is too high. Consumers only demand Q"' treatments. However,the osteopaths want to sell more treatment: Q"". So there is an excess oI supply (Q"" - Q"'). This will lead to osteopaths having to cut their prices (to encourage more consumers to buy treatment). As sellers, they will have to reduce their prices until they reach the equilibrium price P e .
So Lhe free lnLeracLlon of buyers and sellers ln Lhe markeL auLomaLlcally leads Lo a slngle prlce aL whlch Lhe quanLlLy Lraded clears Lhe markeL le Lhe quanLlLy supplled equals Lhe quanLlLy demanded
now look aL Lhese (check Lhe sLaLus bar for lnformaLlon)
d Pow a markeL allocaLes resources
lurLher quesLlons
CuesLlon Answer lmaglne LhaL Lhe prlce ln a markeL ls seL below Lhe equlllbrlum ls Lhere A. excess supply? . excess demand? C. neither?
o to
The Economics of Health Care
Unit 2. The free market approach
Page 17
i
d. How a market allocates resources
We have shown how supply and demand combine to give a single stable price and output - the equili-7ium. ut what happens when something comes along and upsets this equilibrium?
Economists call anything which moves a market out oI equilibrium a shock. Shocks could come Irom shifts in demand caused by such things as changes in income or Irom shiIts in supply caused by such things as a change in costs. In each case the shock upsets the market equilibrium. How will the ma7et respond?
ow te market responds to a sock
Let's analyse the reaction by looking at a demand shock caused by a rise in people's incomes. How will the osteopathy market react? The graph on the leIt, Iigure 10, shows the initial supply and demand curves - SS and DD. The initial market equili-7ium is at a price P' and quantity Q'.
igure 10.
Now imagine that there is an increase in people's income. The demand curve will shiIt outwa7ds to D'D' because people are willing to buy more osteopathy treatments at the same price (osteopathy is a no7mal good). This shiIt in demand throws the market out oI equilibrium. Now people want to buy Q"' treatments at price P' but the osteopaths are still only prepared to sell Q' at that price. The result is excess demand and unsatisIied buyers who react by '-idding up' the price. The rise in price simultaneously 7educes the demand and increases the supply until the market regains equili-7ium at a new price and quantity. The rise in people's incomes has led to a new equilibrium at a highe7 p7ice P" and a higher quantity Q" than beIore.
This process will occur whenever there is shock leading to either a shiIt in demand or supply. The market will move out oI equilibrium with either excess demand or excess supply appearing. The price will then adjust until equilibrium is regained.
%e 'invisibIe and'
We have just demonstrated that our Iree market will automatically produce an equilibrium price and quantity. It is this which makes it a very powerIul allocation system. (See page 6 in Unit 1). This is what Adam Smith (the Iounding Iather oI economics) reIerred to as the "invisible hand".
Who decides how much osteopathy is to be produced? The answer in a Iree market is consumers. They go out and buy osteopathy treatments and the price they are prepared to pay sends signals to the osteopaths. The osteopaths respond by producing either more or less treatment. The market not only allocates resources automatically, it does so eIIiciently. Providing certain conditions are met, the Iree market will achieve a Pa7eto efficient allocation. (See page 5 in Unit 1).
rom price mecanism to a Pareto efficient aIIocation
For the consumer, the price they are willing to pay measures the beneIit or utility that the consumers expect to receive Irom consuming the last unit. To be precise, the demand curve reIlects the marginal utility (extra beneIit) that consumers receive Irom consuming the last unit. Consumers only buy something iI it is worth as much as or more than the other things that the same money could buy. So iI the price oI something is greater than the beneIit they get Irom consuming it, they will not buy it.
For the p7oduce7 or seller, the price they are willing to accept measures the cost oI the resources involved in the production including the supplier's own time and eIIort. Again to be precise, the supply curve reIlects the seller's marginal costs (the cost oI producing an extra unit). Thus when a market is in equilibrium, marginal beneIit equals marginal cost equals price. The beneIit received Irom the last unit consumed will exactly equal the resource cost oI producing that unit. This IulIils the condition Ior allocative efficiency. Competing producers chasing maximum proIits will always choose the least cost combination oI Iactors to produce a given output. Consequently, the Iree market will also be productively eIIicient.
ow Iook at tese (ceck te status bar for information)
e. Case study - cosmetic surgery
Further questions
"uestion nswer Who decides how much osteopathy is to be produced? A. The osteopaths B. The government C. Consumers
o to
The Economics of Health Care
Unit 2. The free market approach
Page 18
i
e. Case study - cosmetic surgery
How well does our theoretical model oI a market explain what has been going on with cosmetic surgery? Look at this newspaper report on the growth oI cosmetic dentistry.
More durable and lifelike dental porcelains and resins, developed recently, have given rise to specialists in cosmetic dentistry selling off-the-peg designer smiles. The Guardian.
Putting your money were your mout is Maggie Smith is a publisher in her late 40s who has just splashed out on a 1,400 "tooth liIt". "I saw the treatment as an investment. Compared with the cost oI a couple oI outIits, it's not that expensive and it lasts much longer". Smith purchased her cosmetic dentistry Irom Dentics on London's Kings Road. Dentics opened its Iirst "tooth boutique" Iour years ago and now has three London branches. Customers can walk into the shop-Ironted surgeries without an appointment and browse through albums oI photos showing wayward canines tamed into piano keyboards by bleaching, Iiling down, building with resins or covering with porcelain veneers. Each treatment costs around 200. Primary school teacher Elizabeth Eccose-Westley regarded the treatment as an aIIordable luxury. "I'm not rich and I'm not vain, but at 42 I started to Ieel I was getting long in the tooth. I spent 1,000 on porcelain veneers, instead oI a summer holiday, and it's really boosted my conIidence. Give it another couple oI years and people won't think twice about it. Everybody will be having it done "
Emma rooker Guardian 16.9.93
Clearly there is a demand Ior cosmetic dentistry - people are willing and able to pay Ior it. oth the women in the article viewed the cosmetic treatment as something which gave them 'utility' , i.e. satisIaction, and they consciously compared the satisIaction gained with that Irom other purchases.
The article also provides evidence that the market is growing. Why is this happening?
igure 11.
conomic anaIysis The initial supply and demand curves are shown in Figure 11 - the system is in equili-7ium. The Iirst change is that technology has reduced the costs oI such treatment - shiIting the supply cu7ve outwa7ds. Demand also seems to be growing; why is this? According to a recent national survey, one in Iour people dislikes their appearance suggesting that they would consider buying this kind oI treatment iI they could aIIord it. So consume7s are likely to respond to the lower prices brought about by the shift in supply - a movement down the market demand curve. This sets up a new equili-7ium at P" and Q". The next change is an increase in consumers' 7eal income leading to an outwa7d shift in the demand curve Irom DD to D'D'. So there's a new equilibrium at P'" and Q'".
Suppliers have reacted to the growth oI consumer demand in exactly the way our theory predicts. Dentics has expanded its operations by opening more shops and providing more t7eatments. There is a new equili-7ium. Reduced costs and ext7a consume7 demand have both led to the allocation oI mo7e 7esou7ces to cosmetic dental treatment. So our model has perIormed Iairly well. ut we can develop it Iurther by introducing the concept oI elasticity.
ow Iook at tese (ceck te status bar for information)
f. Elasticity
Further questions
"uestion nswer Why have more dentists opened offering cosmetic surgery?
lasticity
Elasticity provides a way oI measuring how sensitive demand or supply is to Iactors such as a change in price. Take the relationship between price and quantity demanded. We know that iI price rises then people will buy less but we do not know how much less. Price elasticity oI demand allows us to calculate this.
Price eIasticity of demand (P) The Iormula Ior price elasticity oI demand (PED) is change in quantity demanded
change in price oI the good
So iI the price oI osteopathy rose by 10 and the quantity bought Iell by 5 then the PED would be 5/10 - 0.5. This tells us that demand Ior osteopathy is not particularly sensitive to changes in price. It is what economists call p7ice inelastic. Take another example, iI the price oI eye tests Iell by 20 and the quantity oI eye tests bought rose by 30 then the value oI PED would be 30/-20 -1.5. In this case the demand Ior eye tests is p7ice elastic, i.e. sensitive to changes in price.
Notice several things about PED. First, the value oI PED is always negative reIlecting the inverse relationship between price and quantity demanded. Second, PED is just a number, it is not expressed in terms oI any particular units.
How do we know whether demand is elastic or inelastic? The rule is:
Demand is price inelastic whenever the change in price leads to a smaller change in quantity demanded. This gives PED values between 0 and 1.
Demand is price elastic whenever the change in price leads to a larger change in quantity demanded. This gives PED values between 1 and inIinity.
Price elasticity oI demand allows us to predict what will happen to spending when price changes. Take the example oI the increase in the price oI osteopathy used above. As the price oI osteopathy rises, people will buy Iewer treatments but will they spend less? Suppose the price oI a treatment rose Irom 20 an hour to 22 (a price increase oI 10). At 20 an hour, consumers were buying 1,000 treatments per week and spending 20,000. AIter the price rise, they bought 950 a week (a Iall oI 5) but their spending had risen to 20,900 ( 950 x 22). So the answer in this case is no. People spend more on osteopathy aIter the price rise because the percentage increase in price is greater than the percentage Iall in sales volume. So although osteopaths sell Iewer treatments, the higher price oI each treatment more than oIIsets the lost quantity oI treatments sold. This gives us a general rule: II PED is inelastic, a rise in price will lead to people spending more while a Iall in price will lead to people spending less; II PED is elastic, a rise in price will lead to people spending less while a Iall in price will lead to people spending more.
Price elasticity oI demand allows economists to analyse and predict the eIIect oI changes in prices on diIIerent markets. We can see an example oI this by looking at the debate over cost sharing in health care.
ost saring in eaIt care Cost sharing is the term used to describe diIIerent Iorms oI direct charging Ior health care services. Increasingly, direct charging is seen as a way oI reducing demand but also as a way oI raising revenue. How eIIective is this policy? For instance, in the UK, many people have to pay prescription charges, that is they have to pay a certain amount every time they want to have a prescription dispensed. What has been the eIIect oI this charging? Estimates made by Hughes and McGuire have indicated that demand Ior prescriptions is rather price inelastic with a mean value oI -0.32. This would suggest that prescription charges would be an eIIective way oI raising revenue but not have a great eIIect on the level oI demand. Hughes and McGuire calculated, Ior instance, that the rise in prescription charges Irom 3.75 in 1992 to 4.25 in 1993 would have resulted in the generation oI an estimated 17.3 million in extra revenue but led to a Iall oI 2.3 million in the number oI prescriptions dispensed. However, their research also suggests that demand Ior prescriptions is becoming more price elastic as time passes. They Iound that PED was 0.125 in 1969, - 0.22 in 1980, -0.68 in 1985 and 0.94 in 1991. This suggests that raising prescription charges is now likely to raise less revenue but lead to greater reductions in use oI prescribed medicines than it did in the past.
ter forms of eIasticity The concept oI elasticity can be applied to the impact oI both income and changes in the prices oI other goods on quantity demanded. ncome elasticity of demand (YED) measures how demand reacts to changes in income. The Iormula Ior income elasticity of demand is: change in quantity demanded
change in income
II the result is positive then the goods are normal, iI it is negative then they are inIerior. All the evidence suggest that health care is not only a normal good but that it is income elastic, i.e. rising income leads to a greater rise in demand Ior health care.
C7oss p7ice elasticity of demand (XED) measures how demand reacts to changes in the price oI other goods. The Iormula Ior c7oss p7ice elasticity of demand is: change in quantity demanded oI main good
change in price oI other good
II cross price elasticity oI demand is positive then this indicates that the goods are substitutes. II it is negative then the goods are complements.
Finally, the concept oI elasticity can be applied to supply. P7ice elasticity of supply (PES) measures how sensitive quantity supplied is to a change in the price oI the good. The Iormula Ior p7ice elasticity of supply is: change in quantity supplied
change in price oI the good
Price elasticity oI supply is always positive, reIlecting the positive relationship between price and quantity supplied. PES becomes more elastic over time. This reIlects the time it takes to switch resources into a market. For instance, in health care the PES is likely to be Iairly inelastic in the short run but much more elastic in the long run. Even iI price rises signiIicantly it will take time Ior Iirms to react and to produce more health care. For instance, to deliver more health care new hospitals will need to be built or existing hospitals extended and extra doctors and nurses will need to be trained. All oI this takes time.
The concept oI elasticity has helped to make our market theory more sophisticated. However, the model still suIIers Irom being rather static.
ow Iook at tese (ceck te status bar for information)
g. Markets as dynamic systems
Further questions
"uestion nswer The $ only pays a part of the cost of adult dental treatment; the remainder has to be paid by the patient. What would be the effects of raising dental charges by 10% if the PED for dental treatment was estimated to be -0.6?
In an earlier book "Challenge to the NHS", IEA 1986, Green looked at the perIormance oI the health care ma7et in the US and came to the conclusion that the introduction oI a more eIIective Iree market in the early 1980s resulted in the emergence oI a Ilexible, cost eIIective system. He claimed that problems oIten associated with the American health care system, such as rapidly rising costs and doctors providing patients with unnecessary surgery, were the result oI a Iailure oI the Iree market to operate.
octors' monopoIy Green argued that the problems oI US health care in the 1960s and 1970s were the result oI the doctors' monopoly power over supply. The doctors achieved this partly by restricting entry to the medical proIession through limits on entry to medical schools and partly by keeping consume7s in ignorance. The doctors' association, the American Medical Association (AMA), "was able to keep a tight grip on the number oI doctors trained and hence to limit the supply oI doctors in active practice." They also maintained the monopoly by preventing doctors Irom advertising which prevented consumers Irom gaining the inIormation they needed to make a rational market choice.
This monopoly power was Iatally undermined in 1982 when the US Supreme Court outlawed the AMA's ban on advertising. The Federal Trade Commission had already enIorced a number oI other pro-competition policies on the doctors such as making price Iixing by the Michigan State Medical Society illegal. Combined with a signiIicant expansion in the number oI doctors, this led to the eIIective emergence oI competition between them. Green argues that the emergence oI this eIIective competition in the health care market has led to exactly the results predicted by the Iree market model.
Since Green wrote this paper, new types oI health care purchaser have grown up in the US, called Health Maintenance Organisations (HMOs). These have more bargaining power over doctors on behalI oI the patients who are insured with them. This is seen by many commentators as a Iurther example oI the Iree market working, although others have argued that HMOs restrict patients' access to doctors in order to hold down costs.
The growth of new 574;/078 of health care such as day surgery centres offering one-day surgery, home health agencies and walk-in at are te resuIts? As we saw earlier in this Unit a Iree market will provide an allocation which is allocatively efficient. This means diIIerent types oI health care in a mixture which accurately reIlects consumer demand. It will also be productively eIIicient and so deliver the health care Ior the lowest possible cost.
Green believes that American consumers now have a much greater choice oI where to get their medical treatment and that increased competition has led to the producers oI health care becoming more responsive to consumer demand.
emergency clinics has given consumers more choice.
Another result oI the increase in competition, Green argues, has been a signiIicant Iall in costs. In other words he claims that American health care has become more productively eIIicient. He cites as evidence the Iall in hospital use and the Iall in visits to doctors' surgeries between 1981 and 1985 - "the producers are on the deIensive as competition cuts costs and promotes high quality".
itting te free market modeI Green believes that the extension oI the Iree market in health care in the US in the early 1980s brought substantial beneIits, and in particular delivered exactly the kind oI result that the Iree market model predicts. He does not claim that the American health care system is without problems but he does believe that those problems stem Irom the eIIects oI state interIerence rather than the Iailure oI the market.
Many economists would totally disagree with Green. They argue that a Iree market cannot operate eIIectively in health care. To see why go to the next Unit in this esource - 'The case against a Iree market'. ow Iook at tese check the status bar for information)
3. The case against a free market
Further questions
"uestion nswer What does Green think has happened as a result of more competition in the U$ health care market?