On the Efficiency of Public and Private Health Care Systems: An Application to Alternative Health Policies in the United Kingdom
Health policy will be a major issue in Britain’s next general election. The Labour government is committed to a substantial increase in funds for the National Health Service (NHS) and has eliminated tax relief for private health insurance. The Conservative Opposition party favors subsidizing private health insurance, though it has pledged to match the government’s funding increases for the NHS. This paper develops and implements a methodology for estimating the welfare effects of increasing public and private health care in the United Kingdom, when these policies are financed either by distortionary taxes or by user fees for the NHS. User fees are currently minimal, and the national health market “clears” by creating waiting costs. In the private sector we assume that prices approximately reflect marginal supply costs, and there are no waiting lists. We find that the welfare change from increasing NHS output could easily be negative, particularly when extra spending is financed by distortionary taxes. In contrast, expanding private health care is always efficiency-improving in our simulations. In our central estimates, increasing private health care by a pound’s worth of output produces an efficiency gain of 55 pence, but increasing national health output produces a net efficiency loss of 32 pence per pound! One reason for these results is that increasing the output of rationed health care has ambiguous effects on the total deadweight losses from waiting costs, but these costs unambiguously fall when the private health sector expands. Financing policies by user fees avoids the efficiency costs of raising distortionary taxes, and it also produces efficiency gains by reducing waiting lists. In fact, increasing national health care output produces an overall efficiency gain in most of our simulations, rather than an efficiency loss, when the policy is financed by higher user fees rather than by distortionary taxes. Still, the policy is generally less efficient than a user fee–financed increase in private health care.
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- Barzel, Yoram, 1974. "A Theory of Rationing by Waiting," Journal of Law and Economics, University of Chicago Press, vol. 17(1), pages 73-95, April.
- Lawrence Goulder, 1995. "Environmental taxation and the double dividend: A reader's guide," International Tax and Public Finance, Springer, vol. 2(2), pages 157-183, August.
- Martin Gaynor & Deborah Haas-Wilson & William B. Vogt, 2000.
"Are Invisible Hands Good Hands? Moral Hazard, Competition, and the Second-Best in Health Care Markets,"
Journal of Political Economy,
University of Chicago Press, vol. 108(5), pages 992-1005, October.
- Martin Gaynor & Deborah Haas-Wilson & William B. Vogt, 1998. "Are Invisible Hands Good Hands? Moral Hazard, Competition, and the Second Best in Health Care Markets," NBER Working Papers 6865, National Bureau of Economic Research, Inc.
- Propper, Carol, 1993. "Constrained choice sets in the U.K. demand for private medical insurance," Journal of Public Economics, Elsevier, vol. 51(3), pages 287-307, July.
- Zeckhauser, Richard, 1970. "Medical insurance: A case study of the tradeoff between risk spreading and appropriate incentives," Journal of Economic Theory, Elsevier, vol. 2(1), pages 10-26, March.
- Besley, T. & Coate, S., 1989.
"Public Provision Of Private Goods And The Redistribution Of Income,"
36, Princeton, Woodrow Wilson School - Discussion Paper.
- Besley, Timothy & Coate, Stephen, 1991. "Public Provision of Private Goods and the Redistribution of Income," American Economic Review, American Economic Association, vol. 81(4), pages 979-84, September.
- Victor R. Fuchs & Alan B. Krueger & James M. Poterba, 1998. "Economists' Views about Parameters, Values, and Policies: Survey Results in Labor and Public Economics," Journal of Economic Literature, American Economic Association, vol. 36(3), pages 1387-1425, September.
- Stiglitz, J. E., 1974. "The demand for education in public and private school systems," Journal of Public Economics, Elsevier, vol. 3(4), pages 349-385, November.
- Ian Parry, 1998. "A Second-Best Analysis of Environmental Subsidies," International Tax and Public Finance, Springer, vol. 5(2), pages 153-170, May.
- Lindsay, Cotton M & Feigenbaum, Bernard, 1984. "Rationing by Waiting Lists," American Economic Review, American Economic Association, vol. 74(3), pages 404-17, June.
- Deaton, Angus, 1981.
"Optimal Taxes and the Structure of Preferences,"
Econometric Society, vol. 49(5), pages 1245-60, September.
- Deacon, Robert T & Sonstelie, Jon, 1989. "The Welfare Costs of Rationing by Waiting," Economic Inquiry, Western Economic Association International, vol. 27(2), pages 179-96, April.
- Browning, Edgar K, 1987. "On the Marginal Welfare Cost of Taxation," American Economic Review, American Economic Association, vol. 77(1), pages 11-23, March.
- Ballard, Charles L. & Goddeeris, John H., 1999.
"Financing Universal Health Care in the United States: A General Equilibrium Analysis of Efficiency and Distributional Effects,"
National Tax Journal,
National Tax Association, vol. 52(n. 1), pages 31-51, March.
- Ballard, C.L. & Goddeeris, J.H., 1993. "Financing Universal Health Care in the United States: A General Equilibrium Analysis of Efficiency and Distributional Effects," Papers 9104, Michigan State - Econometrics and Economic Theory.
- Pauly, Mark V, 1974. "Overinsurance and Public Provision of Insurance: The Roles of Moral Hazard and Adverse Selection," The Quarterly Journal of Economics, MIT Press, vol. 88(1), pages 44-62, February.
- Browning, Edgar K & Gronberg, Timothy & Liu, Liqun, 2000. "Alternative Measures of the Marginal Cost of Funds," Economic Inquiry, Western Economic Association International, vol. 38(4), pages 591-99, October.
- Richard Blundell, 1992. "Labour supply and taxation: a survey," Fiscal Studies, Institute for Fiscal Studies, vol. 13(3), pages 15-40, January.
- Feldstein, Martin & Samwick, Andrew A., 1992.
"Social Security Rules and Marginal Tax Rates,"
National Tax Journal,
National Tax Association, vol. 45(1), pages 1-22, March.
- Gravelle, H. S. E., 1990. "Rationing trials by waiting: Welfare implications," International Review of Law and Economics, Elsevier, vol. 10(3), pages 255-270, December.
- Nichols, D & Smolensky, E & Tideman, T N, 1971. "Discrimination by Waiting Time in Merit Goods," American Economic Review, American Economic Association, vol. 61(3), pages 312-23, June.
- Pauly, Mark V, 1986. "Taxation, Health Insurance, and Market Failure in the Medical Economy," Journal of Economic Literature, American Economic Association, vol. 24(2), pages 629-75, June.
- Besley, Timothy & Hall, John & Preston, Ian, 1999.
"The demand for private health insurance: do waiting lists matter?,"
Journal of Public Economics,
Elsevier, vol. 72(2), pages 155-181, May.
- Tim Besley & John Hall & Ian Preston, 1996. "The demand for private health insurance: do waiting lists matter?," IFS Working Papers W96/07, Institute for Fiscal Studies.
- Martin, Stephen & Smith, Peter C., 1999. "Rationing by waiting lists: an empirical investigation," Journal of Public Economics, Elsevier, vol. 71(1), pages 141-164, January.
- Parry, Ian, 2000. "Comparing the Marginal Excess Burden of Labor, Gasoline, Cigarette and Alcohol Taxes: An Application to the United Kingdom," Discussion Papers dp-00-33-rev, Resources For the Future.
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