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Keogh-Brown, Marcus Richard; Smith, Richard D.; Edmunds, John W.; Beutels, Philippe
doi: 10.1007/s10198-009-0210-1pmid: 19997956
The 2003 outbreak of severe acute respiratory syndrome (SARS) showed that infectious disease outbreaks can have notable macroeconomic impacts. The current H1N1 and potential H5N1 flu pandemics could have a much greater impact. Using a multi-sector single country computable general equilibrium model of the United Kingdom, France, Belgium and The Netherlands, together with disease scenarios of varying severity, we examine the potential economic cost of a modern pandemic. Policies of school closure, vaccination and antivirals, together with prophylactic absence from work are evaluated and their cost impacts are estimated. Results suggest GDP losses from the disease of approximately 0.5–2% but school closure and prophylactic absenteeism more than triples these effects. Increasing school closures from 4 weeks at the peak to entire pandemic closure almost doubles the economic cost, but antivirals and vaccinations seem worthwhile. Careful planning is therefore important to ensure expensive policies to mitigate the pandemic are effective in minimising illness and deaths.
doi: 10.1007/s10198-009-0213-ypmid: 20052515
Increased health care expenditure could be used to improve quality of care or reduce waiting time and could therefore be expected to affect the health and sickness absence of a population. Still, based on data from a panel of Swedish municipalities, public health care expenditure was found to have no, or only a negligible effect on absence due to sickness or disability. The same result was obtained when separate estimates were done for men and women and for absence due to sickness and disability.
doi: 10.1007/s10198-009-0214-xpmid: 20066461
The fiscal sustainability of government health expenditures is defined as the gap between growth rates of spending and measures of the resource base. The results show that over the period 1965–2008, real per capita Canadian provincial government health spending has grown at rates that exceed growth in basic measures of the resource base such as per capita gross domestic product (GDP), per capita federal transfers and per capita provincial government revenues. Forecasts of future spending to 2035 using determinant regression and growth rate extrapolation techniques show that Canadian provincial government health spending is projected to continue rising in the future and its share of provincial GDP will rise. While the amount spent on health is ultimately a public policy choice, provincial government health spending also cannot continue growing faster than the resource base indefinitely.
doi: 10.1007/s10198-010-0282-ypmid: 20949303
This is a comment on a recent paper by Bengt Liljas (Eur J Health Econ 11:5–13, 2010) in this Journal. The author’s analysis is flawed because he fails to take the envelope theorem into account. As a bottom line, we conclude that from a welfare theoretic point of view, future consumption and future labor hours should not be considered in a valid CEA.
doi: 10.1007/s10198-010-0283-xpmid: N/A
A critical question in cost-effectiveness analysis (CEA) is what costs should be included. In an earlier paper in this journal, I argued that the same principle (internal consistency) that has been applied to the discussion about future non-medical costs should also be applied to the case when survival is not affected. Internal consistency in this case implies that a cost should only be included if its corresponding utility is also included. As Quality-Adjusted Life-Years can rarely be considered to be consistent with a broad definition of utility, I built a case for recommending to not including the costs for changes in consumption and absence from work (whereas changes in the productivity at work may still be included) when applying a welfare theoretic foundation. As one of several parts of building this case, and to further highlight the elements of importance, I constructed a simple welfare theoretic model. Unfortunately, this model did not take the envelope theorem into account (which was correctly pointed out by Prof. Friedrich Breyer). However, most of the arguments still hold and the policy implications are actually even confirmed in the analysis by Prof. Friedrich Breyer. Building on these results, a related and equally interesting question is what the implications are on the so-called societal perspective. It seems as if a societal perspective in CEA may not be consistent with a welfare theoretic foundation. However, even if such a foundation is not seen as important, it may still be of interest—for reasons of internal consistency—to take a societal perspective on both costs and benefits.
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