HCMI 5243: Health Care Economics
Spring 2019 6:00 PM – 9:00 PM Mon Room GBLC 504
Instructor: Shane Murphy; Email: shane@uconn.edu; Website: https://shane-murphy.uconn.edu/teaching/spring-2019-hcmi-5243/; Office: BUSN 460
Office Hours: Mon & Wed 11:00 AM – 12:30 PM and by appointment

This is the website for HCMI 5243: Health Care Economics. The syllabus can be found here.

On this page you can find a calendar which includes links to materials from each week and lists the weeks readings. Homework assignments are here.

Information about the final exam is here.

Information about the final paper is here.

Course Schedule:

(for off campus access, you may need to use the UConn VPN)
January 28 (in class): Landscape of health in the US (slides)
• Fuchs, Victor R. “Major trends in the US health economy since 1950.” New England Journal of Medicine 366, no. 11 (2012): 973-977.
• Dieleman, Joseph L., et al. “US spending on personal health care and public health, 1996-2013.” Jama 316.24 (2016): 2627-2646.

February 4 (not in class): History of health economics and health economics in history
• Fuchs, Victor R. “Economics, values, and health care reform.” American Economic Review 86, no. 1 (1996): 1-24.
• Deaton, Angus. “The great escape: A review of robert fogel’s the escape from hunger and premature death, 1700-2100.” Journal of Economic Literature 44, no. 1 (2006): 106-114.
• Cutler, David, and Grant Miller. “The role of public health improvements in health advances: the twentieth-century United States.” Demography 42, no. 1 (2005): 1-22.
• Angus Deaton – “The Great Escape: Health, Wealth, and the Origins of Inequality” at the Woodrow Wilson School of Public Affairs

February 11 (in class): Health economic theory (slides)
• Cutler, David M., and Richard J. Zeckhauser. “Adverse selection in health insurance.” In Forum for Health Economics & Policy, vol. 1, no. 1. De Gruyter, 1998.
• Heckman, James J. “The economics, technology, and neuroscience of human capability formation.” Proceedings of the national Academy of Sciences 104, no. 33 (2007): 13250-13255.
• Nyman, John A. “Is ‘moral hazard’inefficient? The policy implications of a new theory.” Health Affairs 23, no. 5 (2004): 194-199.

February 18 (not in class): Rand and Oregon health experiments
• Gruber, Jonathan. The role of consumer copayments for health care: lessons from the RAND health insurance experiment and beyond. Menlo Park, CA: Henry J. Kaiser Family Foundation, 2006.
• James, Julia. “The Oregon Health Insurance Experiment, ” Health Affairs Health Policy Brief, July 16, 2015.
• Youtube video: The RAND Health Insurance Experiment: A Retrospective at 40 Years
• Youtube video: Friedman Forum with Amy Finkelstein: The Impact of Expanding Medicaid

February 25 (in class): Experiments in health economics (slides)
• Ahuja, Amrita, Sarah Baird, Joan Hamory Hicks, Michael Kremer, and Edward Miguel. “Economics of Mass Deworming Programs.” DCP-3 Education (2018): 201.

March 4 (not in class): Determinants of health
• Cutler, David, Angus Deaton, and Adriana Lleras-Muney. “The determinants of mortality.” Journal of economic perspectives 20, no. 3 (2006): 97-120.
• Cutler, David M., Edward L. Glaeser, and Jesse M. Shapiro. “Why have Americans become more obese?.” Journal of Economic perspectives 17, no. 3 (2003): 93-118.
• Almond, Douglas, and Janet Currie. “Killing me softly: The fetal origins hypothesis.” Journal of economic perspectives 25, no. 3 (2011): 153-72.

March 11 (in class): Cost-effectiveness analysis/Cost-benefit analysis (slides)
• Viscusi, W. Kip. "The value of risks to life and health." Journal of economic literature 31, no. 4 (1993): 1912-1946.
• Cutler, David M., and Mark McClellan. “Is technological change in medicine worth it?.” Health affairs 20, no. 5 (2001): 11-29.
• Skinner, Jonathan S., Douglas O. Staiger, and Elliott S. Fisher. “Is technological change in medicine always worth it? The case of acute myocardial infarction.” Health affairs 25, no. 2 (2006): w34-w47.

March 25 (in class): Health industrial organization (slides)
• Berndt, Ernst R. “Pharmaceuticals in US health care: determinants of quantity and price.” Journal of Economic perspectives 16, no. 4 (2002): 45-66.
Also watch the following video (link to come):
Medicare, Pharmaceutical Industry Lobbying, and Drug Development – Marcia Angell, MD
Martin Shkreli on Drug Price Hikes and Playing the World’s Villain
Alan Krueger | Keynote 3 | Subjective Well Being Over The Life Course
The following two papers are optional:
• Thomasson, Melissa A. “The importance of group coverage: How tax policy shaped US health insurance.” American Economic Review 93, no. 4 (2003): 1373-1384. (optional)
• Gaynor, Martin. “Issues in the industrial organization of the market for physician services.” Journal of Economics & Management Strategy 3, no. 1 (1994): 211-255. (optional)

April 1 (in class): Provision quality and pay-for-performance (slides)
• Rosenthal, Meredith B., and R. Adams Dudley. “Pay-for-performance: will the latest payment trend improve care?.” Jama 297, no. 7 (2007): 740-744.
• Jha, Ashish K., Karen E. Joynt, E. John Orav, and Arnold M. Epstein. “The long-term effect of premier pay for performance on patient outcomes.” New England Journal of Medicine 366, no. 17 (2012): 1606-1615.
• Mendelson, Aaron, Karli Kondo, Cheryl Damberg, Allison Low, Makalapua Motúapuaka, Michele Freeman, Maya O’neil, Rose Relevo, and Devan Kansagara. “The effects of pay-for-performance programs on health, health care use, and processes of care: a systematic review.” Annals of internal medicine 166, no. 5 (2017): 341-353. (optional)

April 8 (not in class): Global health
• Pritchett, Lant, and Lawrence H. Summers. Wealthier is healthier. Vol. 1150. World Bank Publications, 1993.
• Mills, Anne. “Reflections on the development of health economics in low-and middle-income countries.” Proceedings of the Royal Society B: Biological Sciences 281, no. 1789 (2014): 20140451.
• Watch: SPEAKERS Joseph L. Dieleman, Thomas Carothers, Simon Wigley, V. Kate Somvongsiri, Presiders Alyssa Ayres, Thomas J. Bollyky. “Democracy Matters in Global Health” Council on Foreign Relations, March 14, 2019

April 15 (in class): Cost (slides)
• Newhouse, Joseph P. “Medical care costs: how much welfare loss?.” Journal of Economic perspectives 6, no. 3 (1992): 3-21.
Also do additional reading from this reading list as described in the homework link.

April 22 (not in class): Medicare/Medicaid
• Sommers, Benjamin D., Katherine Baicker, and Arnold M. Epstein. “Mortality and access to care among adults after state Medicaid expansions.” New England Journal of Medicine 367, no. 11 (2012): 1025-1034.
• Card, David, Carlos Dobkin, and Nicole Maestas. “Does Medicare save lives?.” The quarterly journal of economics 124, no. 2 (2009): 597-636.

April 29 (in class): Health insurance reform (slides)
• Quadagno, Jill. “Why the United States has no national health insurance: Stakeholder mobilization against the welfare state, 1945-1996.” Journal of Health and Social Behavior (2004): 25-44.
• Obama, Barack. “United States health care reform: progress to date and next steps.” Jama 316, no. 5 (2016): 525-532.
• Courtemanche, Charles, James Marton, Benjamin Ukert, Aaron Yelowitz, and Daniela Zapata. “Early Effects of the Affordable Care Act on Health Care Access, Risky Health Behaviors, and Self‐Assessed Health.” Southern Economic Journal 84, no. 3 (2018): 660-691.
• Antonisse, Larisa, Rachel Garfield, Robin Rudowitz, and Samantha Artiga. “The effects of Medicaid expansion under the ACA: Updated findings from a literature review.” (2017). KFF

Additional reform plans readings:
Democratic plans:
* RAND, National Health Spending Estimates Under Medicare for All, 18 pages
* RAND, What is Single-Payer Health Care? A Review of Definitions and Proposals in the U.S. 10 pages
* American Progress, Medicare Extra for All A Plan to Guarantee Universal Health Coverage in the United States, 22* pages (inflated page count due to formatting)
KFF, Compare Medicare-for-all and Public Plan Proposals KFF, 11 pages 115116
Criticism of Democratic plans:
* Heritage, Government Monopoly: Senator Sanders’ “Single-Payer” Health Care Prescription Heritage, 19 pages
* AEI, The unanswered questions of Medicare for All Economics, Health Care, Health Economics, 10 pages
Republican plans:
* Commonwealth Fund, Evaluating the CARE Act: Implications of a Proposal to Repeal and Replace the Affordable Care Act, 22 pages
* RAND, The Effects of the American Health Care Act on Health Insurance Coverage and Federal Spending in 2020 and 2026, 17 pages
* Heritage, A Plan to Repeal and Replace Obamacare, 11 pages
* CATO, 36. Health Insurance Regulation, 20 pages (inflated page count due to formatting)
* CATO. 4. Repealing Obamacare, 12 pages (inflated page count due to formatting)
* KFF, Compare Proposals to Replace The Affordable Care Act
Criticism of Republican plans:
* CBPP, Latest Republican ACA Repeal Plan Would Have Similar Harmful Impacts on Coverage and Health as All the Others, 8 pages
* American Progress. Graham-Cassidy 2.0 New ACA Repeal Plan Revives Threats to Americans’ Health Care, 10 pages (inflated page count due to formatting)
Compromise proposals:
* AEI, The health reforms the GOP should embrace (but probably won’t), 4 pages
* AEI, Cost-reducing health policies: A response to Chairman Alexander and the Senate Committee on Health, Education, Labor, and Pensions, 17 pages