IDEAS home Printed from https://ideas.repec.org/a/wly/hlthec/v24y2015i5p506-515.html
   My bibliography  Save this article

Cost‐effectiveness Analysis and Insurance Coverage: Solving a Puzzle

Author

Listed:
  • Mark Pauly

Abstract

The conventional model for the use of cost‐effectiveness analysis for health programs involves determining whether the cost per unit of effectiveness of the program is lower than some socially determined maximum acceptable cost per unit of effectiveness. If a program is better by this criterion, the policy implication is that it should be implemented by full coverage of its cost by insurance; if not, the program should not be implemented. This paper examines the unanswered question of how cost‐effectiveness analysis should be performed and interpreted when insurance coverage may involve cost sharing. It explores the question of how cost sharing should be related to the magnitude of a cost‐effectiveness ratio. A common view that cost sharing should vary inversely with program cost‐effectiveness is shown to be incorrect. A key issue in correct analysis is whether there is heterogeneity in marginal effectiveness of care that cannot be perceived by the social planner but is known by the demander. It is possible that some programs that would fail the social efficiency test at full coverage will be acceptable with positive cost sharing. Combining individual and social preferences affects both the choice of programs and the extent of cost sharing. Copyright © 2014 John Wiley & Sons, Ltd.

Suggested Citation

  • Mark Pauly, 2015. "Cost‐effectiveness Analysis and Insurance Coverage: Solving a Puzzle," Health Economics, John Wiley & Sons, Ltd., vol. 24(5), pages 506-515, May.
    • Handle: RePEc:wly:hlthec:v:24:y:2015:i:5:p:506-515
    DOI: 10.1002/hec.3044
    as

    Download full text from publisher

    File URL: https://doi.org/10.1002/hec.3044
    Download Restriction: no
    File URL: https://libkey.io/10.1002/hec.3044?utm_source=ideas
    LibKey link: if access is restricted and if your library uses this service, LibKey will redirect you to where you can use your library subscription to access this item
    ---><---

    References listed on IDEAS

    as
    1. Amitabh Chandra & Jonathan Skinner, 2012. "Technology Growth and Expenditure Growth in Health Care," Journal of Economic Literature, American Economic Association, vol. 50(3), pages 645-680, September.
    2. Basu, Anirban, 2011. "Economics of individualization in comparative effectiveness research and a basis for a patient-centered health care," Journal of Health Economics, Elsevier, vol. 30(3), pages 549-559, May.
    3. Brouwer, Werner B. F. & Koopmanschap, Marc A., 2000. "On the economic foundations of CEA. Ladies and gentlemen, take your positions!," Journal of Health Economics, Elsevier, vol. 19(4), pages 439-459, July.
    4. Goddeeris, John H, 1984. "Medical Insurance, Technological Change, and Welfare," Economic Inquiry, Western Economic Association International, vol. 22(1), pages 56-67, January.
    5. Pauly, Mark V. & Blavin, Fredric E., 2008. "Moral hazard in insurance, value-based cost sharing, and the benefits of blissful ignorance," Journal of Health Economics, Elsevier, vol. 27(6), pages 1407-1417, December.
    6. Kevin M. Murphy & Robert H. Topel, 2007. "Social Value and the Speed of Innovation," American Economic Review, American Economic Association, vol. 97(2), pages 433-437, May.
    Full references (including those not matched with items on IDEAS)

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Basu, Anirban & Jena, Anupam B. & Philipson, Tomas J., 2011. "The impact of comparative effectiveness research on health and health care spending," Journal of Health Economics, Elsevier, vol. 30(4), pages 695-706, July.
    2. Basu, Anirban, 2015. "Welfare implications of learning through solicitation versus diversification in health care," Journal of Health Economics, Elsevier, vol. 42(C), pages 165-173.
    3. David D. Kim & Anirban Basu, 2017. "New Metrics for Economic Evaluation in the Presence of Heterogeneity: Focusing on Evaluating Policy Alternatives Rather than Treatment Alternatives," Medical Decision Making, , vol. 37(8), pages 930-941, November.
    4. Rebecca Myerson & Darius Lakdawalla & Lisandro D. Colantonio & Monika Safford & David Meltzer, 2018. "Effects of expanding health screening on treatment – What should we expect? What can we learn?," Working Papers 2018-014, Human Capital and Economic Opportunity Working Group.
    5. Olatunji A. Shobande & Lawrence Ogbeifun & Simplice A. Asongu, 2022. "Globalisation, technology and global health," Working Papers of the African Governance and Development Institute. 22/070, African Governance and Development Institute..
    6. Rebecca Mary Myerson & Darius Lakdawalla & Lisandro D. Colantonio & Monika Safford & David Meltzer, 2018. "Effects of Expanding Health Screening on Treatment - What Should We Expect? What Can We Learn?," NBER Working Papers 24347, National Bureau of Economic Research, Inc.
    7. Marc Fleurbaey & Stéphane Luchini & Christophe Muller & Erik Schokkaert, 2013. "Equivalent Income And Fair Evaluation Of Health Care," Health Economics, John Wiley & Sons, Ltd., vol. 22(6), pages 711-729, June.
    8. Alex R. Horenstein & Manuel S. Santos, 2012. "A Cross-Country Analysis of Health Care Expenditures," Working Papers 2013-05, University of Miami, Department of Economics.
    9. Abe Dunn & Eli Liebman & Adam Hale Shapiro, 2016. "Decomposing Medical Care Expenditure Growth," NBER Chapters, in: Measuring and Modeling Health Care Costs, pages 81-111, National Bureau of Economic Research, Inc.
    10. Amy Finkelstein & Petra Persson & Maria Polyakova & Jesse M. Shapiro, 2022. "A Taste of Their Own Medicine: Guideline Adherence and Access to Expertise," American Economic Review: Insights, American Economic Association, vol. 4(4), pages 507-526, December.
    11. Cristina Borra & Jerònia Pons-Pons & Margarita Vilar-Rodríguez, 2020. "Austerity, healthcare provision, and health outcomes in Spain," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 21(3), pages 409-423, April.
    12. Karine Lamiraud & Stephane Lhuillery, 2016. "Endogenous Technology Adoption and Medical Costs," Health Economics, John Wiley & Sons, Ltd., vol. 25(9), pages 1123-1147, September.
    13. Kuhn, Michael & Wrzaczek, Stefan & Prskawetz, Alexia & Feichtinger, Gustav, 2011. "Externalities in a life cycle model with endogenous survival," Journal of Mathematical Economics, Elsevier, vol. 47(4-5), pages 627-641.
    14. Pratt, John W & Zeckhauser, Richard J, 1996. "Willingness to Pay and the Distribution of Risk and Wealth," Journal of Political Economy, University of Chicago Press, vol. 104(4), pages 747-763, August.
    15. H. Evans & A. Basu, 2011. "Exploring comparative effect heterogeneity with instrumental variables: prehospital intubation and mortality," Health, Econometrics and Data Group (HEDG) Working Papers 11/26, HEDG, c/o Department of Economics, University of York.
    16. Leemore Dafny & Christopher Ody & Matt Schmitt, 2017. "When Discounts Raise Costs: The Effect of Copay Coupons on Generic Utilization," American Economic Journal: Economic Policy, American Economic Association, vol. 9(2), pages 91-123, May.
    17. Katherine Baicker & Sendhil Mullainathan & Joshua Schwartzstein, 2015. "Behavioral Hazard in Health Insurance," The Quarterly Journal of Economics, President and Fellows of Harvard College, vol. 130(4), pages 1623-1667.
    18. Howard Kunreuther & Mark Pauly, 2022. "Do people have a bias for low deductible insurance?," Journal of Risk and Uncertainty, Springer, vol. 64(1), pages 1-17, February.
    19. Stefan Rabbe & Meilin Möllenkamp & Benedetta Pongiglione & Hedwig Blommestein & Pim Wetzelaer & Renaud Heine & Jonas Schreyögg, 2022. "Variation in the utilization of medical devices across Germany, Italy, and the Netherlands: A multilevel approach," Health Economics, John Wiley & Sons, Ltd., vol. 31(S1), pages 135-156, September.
    20. Véra Zabrodina & Mark Dusheiko & Karine Moschetti, 2020. "A moneymaking scan: Dual reimbursement systems and supplier‐induced demand for diagnostic imaging," Health Economics, John Wiley & Sons, Ltd., vol. 29(12), pages 1566-1585, December.

    More about this item

    Statistics

    Access and download statistics

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:wly:hlthec:v:24:y:2015:i:5:p:506-515. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: Wiley Content Delivery (email available below). General contact details of provider: http://www3.interscience.wiley.com/cgi-bin/jhome/5749 .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.