Production of Health

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Production of Health

• FGS - Chapter 4

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General Formulation

• HS f (Health Care, Environment, Human Biology,
  Life Style)
• HS f (HC, Env, HB, LS)
• If were concentrating on health care,
• Total Product HS f (HC, Env, HB, LS)
• Marginal Product MP DHS/DHC
• Average Product AP HS/HC
• (Excel Spreadsheet - Ch 4.xls)

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Measures of Health Status

• Death rates (easiest to measure)
• Healthy days
• Morbidity rates
• It may be critical to distinguish between total
  and marginal contributions, since low marginals
  may accompany high totals.

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Total v. Marginal

• It is critical to distinguish between total and
  marginal contributions. It may turn out that
  although the total contribution may be
  substantial, the marginal contribution may be
  very small. Why do we care?
• Because many decisions are made at the margin.
  Additions to the amount spent, may not be worth
  it.

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Marginal Products

• Under most conditions, marginal products are
  always going to be non-negative. Why?
• Can DH/Dx (where x health care) be negative?
• ltAgt Yes! 2 Possibilities

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Iatrogenic (physician caused) disease

• Iatrogenic (physician caused) disease. All
  procedures have their risks. For example, in
  anesthesia, you kill someone a little bit -- You
  may do it too much.
• Suppose, that the more we do the higher the risk.
• More care gives lower marginal product, higher
  risk

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Iatrogenic Picture

• Impacts of care
• mgl product ()
• mgl risk (-)
• Net impact
• mgl product - mgl risk.

Marginal impacts
Net impact.
Mgl. Prod.

• Here, its positive.

Mgl. Risk
Health care, x
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Iatrogenic Picture

• Here, its negative.

Marginal impacts
Net impact.

• Why?

Mgl. Prod.
Mgl. Risk
Health care, x
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Examples of Iatrogenic (physician caused) disease

• Examples
• smallpox vaccine is a prime example
• flu shots, for many, are another.
• Medical malpractice may be a third (i.e. the more
  done, the more possible mistakes).

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Medicalization of Health Care

• Ivan Illich has argued that the medicalization
  (substituting medical for home care) of health
  care could effectively lead to less personal
  consumer effort to produce health. How would
  this work?

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On the Historical Role of Medicine and Health
Care

• McKeown focused on dramatic rise in population in
  England and Wales since 1750.
• It seems that world population rose and fell
  without any upward trend, up until that time.
• How does population increase? (Discuss)
• ltAgt Increased births
• Decreased deaths
• Increased inmigration

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KEY !!!

• Decreased deaths due to
• 1. airborne causes -- tuberculosis, bronchitis,
  pneumonia, and influenza
• 2. waterborne causes
• Table 4.1.

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McKinlay and McKinlay

• Figure 4.2 shows that availability of effective
  medical intervention occurred well after the
  largest mortality decline.

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Measles
Scarlet Fever
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Public Health

• If not medical care, than what?
• McKeown argues that its public health
• Immunization of populations
• Quarantines
• Sanitary standards for water and sewage
• Sanitary standards for food handling and
  treatment

Key point, though is increased nutrition
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Increased Nutrition

• Infectious disease creates a relationship
  between host and parasite. While control of the
  parasite is directly helpful in reducing disease
  incidence, the condition of the host helps to
  determine its resistance to disease. A person
  who is better housed, better rested, and ...
  better fed, will be more resistant and less
  likely to die subsequent to exposure. FGS, Ch.
  4