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The Distinguished Lecture program features internationally prominent economists who are visiting CHERE. The lectures provide an opportunity to learn about the latest developments in health economics and how this research influences health policy.
Follow this link to receive email notification about CHERE’s 2007 Distinguished Lecture program.
Past Lectures
March 2006
Is low pay for nurses bad for your health?
Professor Carol Propper, Director, Centre for Market and Public Organisation (CMPO), University of Bristol and Department of Economics, University of Bristol; Co-Director, Centre for Analysis of Social Exclusion (CASE), London School of Economics
Reforming public service delivery occupies a central position in the current policy agenda in many countries, Australia
included. Are administrators, or doctors and nurses working for a public hospital motivated in different ways to their private sector counterparts? And does this mean that monetary incentives are unimportant for those in the public sector? Carol Propper’s talk will focus on this issue, drawing on a small but growing body of evidence to suggest that public sector workers do respond to monetary incentives and that policy makers who ignore this do so at their peril.
September 2005
Economic evaluations of health care interventions: The biggest bang for the buck or the bigger bucks for the bang?
Professor Amiram Gafni, Ph.D. Centre for Health Economics and Policy Analysis, Department of Clinical Epidemiology and Biostatics, McMaster University, Hamilton, Ontario, Canada
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November 2004
The OECD experience in the quest for equitable health care systems: lessons for Australia.
Professor Eddy van Doorslaer, Professor of Health Economics at the Department of Health Policy and Management at Erasmus University, Rotterdam, The Netherlands
June 2004
Modelling private health insurance choice.
Professor Mike Keane, Professor of Economics, Yale University, USA
March 2004
Predictability and predictiveness of health care spending.
Professor Randall Ellis, Visiting Professor at CHERE and Professor at Boston University, USA
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November 2003
Trust me, I’m a doctor!
Professor Alan Maynard, Professor of Health Economics, University of York, England
August 2003
The future nursing workforce: challenges in health human resources planning
Professor Steve Birch, Department of Clinical Epidemiology and Biostatistics and a member of CHEPA at McMaster University, Canada
March 2003
Medical Testing and Insurance Market
Professor Ray Rees, Economics of Insurance, Munich University, Germany
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Visiting Scholars and Abstracts
Professor Amiram Gafni’s research interests are in the areas of economic evaluation of health care programs (both methods development and empirical applications), modelling of consumers' health‑care behaviour, and models of patient‑physician decision‑making (e.g., shared decision‑making), policy analysis and risk and decision analysis in health. Among his methodological contributions is the development of the healthy‑years equivalent (HYE) preference‑based measure of outcome for program evaluation and the development of a bedside decision instrument, a method for helping patients to reveal their preferences regarding treatment. He has published widely in the field of management science and economics on topics related to health.
Abstract: Concerns are often expressed about the failure of health care decision-makers at different levels of decision making to utilize the substantial literature on the cost-effectiveness of health care interventions. A recent survey of pharmaconomic assessment in 11 OECD countries reported that just under half of these countries use the technique of cost-effectiveness analysis (CEA) to determine the “value-for-money” of new pharmaceuticals. However, for several of these countries as well as others (including Australia and the province of Ontario, Canada) systems for integrating cost effectiveness information into reimbursement decisions have been in place for over a decade. On the other hands it has been argued that decision makers should maintain a healthy skepticism about the results of cost-effectiveness analysis and the usefulness of this information in purchasing and planning decisions.
Based on the experience to date in many jurisdictions it seems that one can determine if the perceived lack of usefulness of this methodology and literature is real. In other words, do we have evidence to demonstrate that the use of cost effectiveness analysis has helped those who used it to achieve their stated goals? If not, is this lack of usefulness due to flaws in the economic methods themselves or whether it is the result of the departure of the current CE methodology from the economics discipline as well as a failure to address the decision makers’ problems?
Professor Eddy van Doorslaer is a PhD and a Professor of Health Economics at the Department of Health Policy and Management at the Erasmus University, Rotterdam, The Netherlands. He is one of the project leaders of the ECuity Project, an EU-funded research project, which considers how equity is defined and compares equity in health care across European countries. He has also directed research projects on equity in health and health care for the OECD including Equity in Access, which applies the methods developed in the ECuity II project, measuring access to selected health care services. Currently, Eddy is also leading EQUITAP – an Equity in Asian-Pacific Health Systems study, aimed at understanding equity in health in developing countries He is an Associate Editor of the Journal of Health Economics and of the Journal of Health Services Research and Policy. He is one of the Programme Directors of a new MSc in Health Economics offered by the Erasmus University which started in September 2003. He has also acted as a health economics consultant to the World Bank, WHO and UNICEF. Eddy was a Visiting Professor at the University of British Columbia in 1996-97 and is currently visiting professor at CHERE.
The OECD experience in the quest for equitable health care systems: lessons for Australia.
Most OECD member countries have long achieved close to universal coverage of their population for a fairly comprehensive package of essential health services. There are exceptions, but in most countries, access to good quality physician and hospital services is ensured at relatively low and sometimes at zero financial cost. However, evidence suggests that this does not yet imply that people in equal need are treated equally, irrespective of other characteristics like income, place of residence, ethnicity, etc. Extensive cross-country comparative work demonstrates that in most OECD countries, some systematic, income-related deviations from this horizontal equity principle continue to exist. While it is certainly true that in most countries, people can get to see a doctor or get into a hospital when they think they need one, it is becoming more and more evident that the better-off and the less well-off generally do not use the health system in the same way. In particular, the rich tend to be more intensive users of medical specialist services than one would expect on the basis of differences in need for care. It is also evident that this phenomenon does not occur to the same extent in every country. Countries which offer more extensive or more generous options to ‘go private’ tend to witness more dramatic differences in the utilization mix of primary and secondary care services by income than countries which do not offer such choice.
This paper reviews the extensive empirical evidence on the highest-income countries and the limited evidence for Australia in order to see to what extent the Australian experience fits the general picture. Does its peculiar public-private mix confirm the expectations based on the international patterns or does it rather contradict these? Has Medicare managed to meet its equity goals and if so, to what extent are these being compromised by the expansion of the private sector? The paper finds that the Australian health care system generally offers a high level of access, and that treatment is very equally distributed with respect to primary care services. The risk is that, as in some other OECD countries, the Medicare objective of equal access for equal need will be compromised by the expansion of the private sector in secondary care services. To the extent that such inequalities in use may translate in inequalities in health outcomes, they appear to warrant some concern.
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Mike Keane is currently Professor of Economics at Yale, previously at New York University and University of Minnesota. His interests cover labour economics, empirical microeconomics, applied econometrics, and consumer choice behaviour. He has received grants from the National Institute of Health, the Institute for Research on Poverty at the University of Wisconsin, the National Science Foundation, and the U.S. Department of Labor to support his research. He has published on a wide array of topics, including poverty and public welfare programs, career decisions and human capital investment, consumption, and trade liberalization. He is also especially well-known in econometrics for his contributions to simulation methods for estimating complex choice models. Professor Keane has been published extensively in top international journals including the Journal of Political Economy, American Economic Review, Econometrica and Journal of Human Resources.
Modelling private health insurance choice.
Understanding why people choose health insurance and which type of cover they select is important to predicting the future of private health insurance in Australia. This paper develops an innovative approach to modelling insurance choice, using the US experience of supplementary private insurance for the elderly. US Medicare leaves many services uncovered and requires substantial cost sharing in the form of deductibles and coinsurance. As a result, many individuals supplement Medicare benefits by purchasing fee-for-service supplements, known as ‘Medigap’ plans, or by joining health maintenance organisations (HMOs). This paper models choice among health plans using data from a 1988 study of the Minneapolis–St. Paul Medicare health plan market. It shows how attitudinal data can be combined with market data to provide more reliable estimates of consumers’ preferences for and perceptions of health insurance plans. This results in a better model. Quality of health plan is important in determining consumer choice. Misperceptions of cost sharing arrangements in both Medicare and supplementary insurance are common.
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Randall Ellis is an Adjunct Professor at CHERE, UTS, and Professor of Economics at Boston University in the USA. He is currently a director of the International Health Economics Association and the American Society of Health Economists, as well as an associate editor of the Journal of Health Economics. Professor Ellis is widely published in economics and health services research journals, best known for his work on provider and health plan payment incentives, particularly on how payments affect consumers, providers and insurance plan decisions. His work has had important policy impact: he is one of the co-developers of a payment formula called Diagnostic Cost Groups currently being used in the United States to pay for health care for 6 million elderly and disabled beneficiaries in managed care plans.
Predictability and predictiveness of health care spending.
Adverse selection problems arise in health care markets when consumers or suppliers anticipate future levels of health care spending, and this knowledge affects their behaviour.
The magnitude of the adverse selection problem depends on the choices available as well as on how well agents can predict their future health care spending. Predictability (how well spending on certain services can be anticipated) and predictiveness (how well the predicted levels of certain services contemporaneously co-vary with total health care spending) both matter for adverse selection incentives.
A new empirical index of the direction and magnitude of selection incentives helps quantify the large selection incentives facing various types of health care services in the US Medicare program. The implications of this finding for Australia and other countries with publicly funded health systems will also be discussed.
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Professor Alan Maynard, Professor of Health Economics, University of York, England
Alan Maynard is Adjunct Professor at CHERE, UTS and Professor of Health Economics at the University of York in England. He was Founding Director of both the Graduate Programme in Health Economics at York (1977-1983) and Centre for Health Economics at York (1983-1995). Professor Maynard has worked as a consultant for various national and international agencies including the World Bank and the World Health Organisation in countries such as Brazil, China, Malawi and South Africa. He is Founding Editor of the journal Health Economics. He is a Visiting Professor at the University of Aberdeen and at the London School of Economics and Political Science and has been Chairman of the York NHS Trust Hospital since 1997. Professor Maynard has been widely published in economics and medical journals.
Trust me, I’m a doctor!
Confucius remarked that “without trust we cannot stand”. The relationship between the patient and the doctor is based on trust.
However, doctors are “double agents” acting on behalf of their patients to obtain the best care available and on behalf of their funders, public (Medicare) and private (insurers), to secure the best value for money. Does this allow doctors to deliver the best possible outcomes for their patients? And are they doing their best to deliver value for money to their funders - taxpayers and insurance premium payers?
Answers to these questions will be explored in the context of international evidence that shows large unexplained variations in clinical practice and a failure to measure the success of this expensive industry in terms of improving the health of patients.
How can doctor reward systems be reformed to deliver better care to patients and better value for money to funders of care? Without greater transparency and accountability, inefficient and costly performance management systems may be created that undermine trust and the quality of patient care.
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Professor Steve Birch, Department of Clinical Epidemiology and Biostatistics and a member of CHEPA at McMaster University, Canada.
Professor Stephen Birch is internationally known as health economist, with interests in the use and application of economic evaluation, funding of health and medical services, and equity in access, use and outcomes of health care. More recently, he has been working in the area of nursing workforce planning and workload assessment. Professor Birch is currently Professor of Health Economics in the Department of Clinical Epidemiology and Biostatistics and the Center for Health Economics and Policy Analysis at McMaster University, Hamilton, Ontario, Canada and Adjunct Professor at UTS. He is the Health Economics Editor of the highly respected journal, Social Science and Medicine. This is his fourth visit to CHERE.
The future nursing workforce: challenges in health human resources planning
Nurse shortages being experienced in Western countries, including Australia, reflect a failure by planners to recognize the increased intensity of the work. Nursing workforce planning has been too concerned with nurse-to-patient ratios and has not accounted for the effects of changes in health care policy.
During the past decade in Ontario (Canada) a policy of boosting community care and closing hospital beds has resulted in fewer hospital patients, but they are generally sicker and require a greater intensity of treatment. On average, individual cases are consuming more nursing and as a result, nurses have experienced increased workloads, dissatisfaction and burnout. This scenario could easily transfer to Australia.
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Professor Ray Rees, Economics of Insurance, Munich University, Germany.
Ray Rees is internationally known for his work on theoretical and applied microeconomics. He is the author of leading texts on microeconomics, mathematical economics and public enterprise economics, and has published widely in major economics journals.
His areas of research include principal-agent theory, the economics of asymmetric information and the regulation of insurance markets. More recently he has worked on modelling the decisions of multi-person households, with applications to taxation and social insurance policy. He graduated in economics from the LSE and taught economics at the University of London for the following twelve years. During this time he spent four years on secondment at HM Treasury as an economic advisor, working on taxation, public expenditure and the pricing and investment policies of public enterprises (at that time an important part of the economy). Following that he held a chair in economics at the University of Wales, also serving as a member of the Monopolies and Mergers Commission. He took up his present appointment, as professor for the economics of insurance, at the University of Munich in 1993. At Munich he has also been Dean of the Faculty of Economics and member of the University Senate. He has held visiting professorships at Northwestern University, USA, the University of Oxford, CORE, Belgium, and the ANU.
Medical Testing and Insurance Market
Considerable controversy has been generated by the development of medical testing techniques, for example genetic testing, and awareness of their possible impacts on the markets for health and life insurance. They raise a wide range of important economic as well as ethical issues. This paper takes as its starting point the economics of insurance markets under asymmetric information, and applies this to the analysis of the responses of insurers and the insured to the increasing availability, scope and precision of medical testing. The ultimate concerns addressed by the paper are the issues for public policy to which these developments give rise. The paper gives a survey and evaluation of the existing economics literature on this subject and also extends this literature in directions of relevance for public policy.
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