Category Archives: Health

Who Goes to the Doctor?

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Overheads for a presentation to an Independent Practitioners’ Association Seminar, April 2002.

Keywords: Distributional Economics; Health;

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This work comes from a report on research being prepared by Brian Easton and Suzie Ballantyne.

This research arises from a limited grant from the Health Research Council.

It uses Statistics New Zealand data. However they only provided the data, and the results presented in this study are the work of the author, not Statistics New Zealand.

The data is based on unit records from the Household Economic Survey for the three years between 1994/5 to 1996/7. Access to the data used in this study was provided by Statistics New Zealand in a secure environment designed to give effect to the confidentiality provisions of the Statistics Act 1975.

International Guidelines for Estimating the Costs Of Substance Abuse: (2 Ed)

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Report prepared for the Canadian Centre for Substance Abuse by Eric Single (coordinator–Canada), David Collins (Australia), Brian Easton (New Zealand), Henrick Harwood (United States), Helen Lapsley (Australia), Pierre Kopp (France) and Ernesto Wilson (Colombia).

This report was published by the World Health Organisation in September 2003.

Keywords: Health Economics

This revised edition of these guidelines represent modifications and additions to the first edition of the International Guidelines on Estimating the Social and Economic Costs of Substance Abuse, based on discussions held at the Third International Symposium on Estimating the Economic and Social Costs of Substance Abuse, held in Banff, Alberta, Canada, in 2000.

Executive Summary

Pain and Health Economics

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Paper to the 2001 Conference of the New Zealand Pain Society, June 8, 2001, published in New Zealand Pain Society Journal, Issue 3, September 2001, p.13-16.

Keywords: Health;

The initial concern when health economics first began as a part of the economics discipline – about 40 years ago – was ‘productive efficiency’, the extent to which the costs of any particular treatment could be reduced, thus focussing on the relative merits of different treatments of the same medical condition. However economists soon faced the necessity to compare the resource consequences of different medical conditions – ‘allocative efficiency’. The problem arises because ‘health’ is not a simply defined concept with a single index of performance – unlike material production which is measured by GDP – so comparisons between health outcomes are deeply problematic. (There is no policy problem here if health care is delivered entirely by the market mechanism of private payment, for the market implicitly resolves the difficulty by the sick’s payments on the basis of their perception and their ability to pay. But there is no country in the world where this applies.) Any comparison of the health status of two persons also involves deep philosophical issues, which practical economists may avoid, but which still lurk under their pragmatic solutions.

Estimating the Economic Costs Of Alcohol Misuse:

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Why We Should Do it Even Though We Shouldn’t Pay Too Much Attention to the Bottom-line Results

Paper presented at the annual meeting of the Kettil Bruun Society for Social and Epidemiological Research on Alcohol, Toronto, May 2001 by ERIC SINGLE and BRIAN EASTON.[1]

Keywords: Health Economics

Abstract

A coalition of provincial, national and international addictions agencies has sponsored a series of international symposia leading to the developing of international guidelines for estimating the costs of substance abuse. These guidelines have now been utilized in national studies in four continents, with more consistent and comparable results than in previous studies. Although the bottom-line results have been utilized to argue for alcohol issues having a higher place on the public policy agenda, the real value in such studies lies in the detailed results regarding mortality and morbidity attributable to alcohol, the relative contribution of acute vs. chronic conditions to overall problem levels, and the role of alcohol in adverse social consequences such as crime and economic productivity. Recent updated estimates are presented regarding the attributable proportion of various causes of disease and death due to alcohol misuse in Canada. There are a variety of factors which undermine the robustness of the findings, including lack of data, laying of assumptions and changes in the epidemiological knowledge base. It is argued that economic cost estimates should nonetheless be conducted and continually refined, as the detailed findings are of great utility to the design and targeting of prevention programming and policy.

Economy Of Substance: What We Can and Can’t Measure.

This entry was posted in Health, Listener on by .

Listener 28 April, 2001.

Keywords: Health.

Some social sciences – demography, economics, geography and psychology – started off well because they had could measure the concepts they were dealing with. Others – anthropology, politics, sociology – have never been as successful. But that something cannot be measured does not mean it is unimportant. We cannot quantify culture and related behaviour and institutions. Yet they seem to be a key elements in economic performance. Contrariwise, well-constructed measures of economic performance, such as per capita GDP, may not be good indicators of our social objectives.

Douglas Robb: 1899-1974

This entry was posted in Health, Political Economy & History on by .

Chapter 6 of The Nationbuilders

Keywords: Health; Political Economy & History;

Douglas Robb may appear to be among the most privileged of the nationbuilders in this book. His father was a manager of the Kauri Timber Company and the father-in-law from his marriage to Helen Seabrook in 1935 was even better placed. He was too young for the First World War, too old for the Second. The depression of the 1930s did not impact as heavily on the practice of the promising young surgeon as it did for many other occupations. But a year before he was born, Robb’s father came to New Zealand because the climate would be better for his tuberculosis. Two of his sons caught the disease in their infancy. There were no particularly effective therapies in those days, and the eldest died from TB at the age of 21. The second, Douglas, suffered until he was almost 40, when the symptoms suddenly disappeared.

Economics in the Healthcare Sector

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Pharmac Annual Review 2000, p.24

Keywords: Health;

It is increasingly common for an economist has been approached by some group lobbying for the introduction of a new therapy, or perhaps by the government who wants some guidance. The therapy is expensive, and so the question of whether it can be used involves issues of costs and benefits. Answering that question or, more precisely, making an economic contribution to answering that question is rarely easy, and yet the welfare of patients depends on it. Not only the welfare of those who may be treated but, given the overall budget constraint, diverting resources to the treatment of one disease will leave others without treatment or on a waiting list.

Eliminating the Tobacco Epidemic the New Zealand Experience

This entry was posted in Health, Regulation & Taxation on by .

Paper to a Seminar at the Department of Oncology, King Faisal Specialist Hospital, Riyadh, on Tuesday 10 Dhu Al Qadah (15 February 2000).

Keywords Health, Regulation

Introduction (1)

There is a huge body of evidence that the smoking of tobacco shortens life expectancy and damages health before that. Many western nations, including New Zealand, have therefore taken measures to reduce and eliminate smoking. They have been largely successfully both in terms of reducing the quantity of tobacco consumed and tobacco induced morbidity and mortality, although there is a considerable lag between the reduction in consumption and the reduction in disease. In another group of countries, typically the poorer ones, tobacco consumption levels are low in most social groups. However there are fears that with increases in discretionary incomes and more persuasive marketing by the international tobacco companies smoking will increase to levels as high as the peaks that occurred recently in Western nations a generation ago. Between these two groups of nations are those whose smoking has already reached peak Western levels, but have not yet taken measures to reduce them. They are, in effect, a generation behind the Western nations in terms of when they began smoking and also when the smoking induced disease becomes evident. The best documented is Japan, but some Middle East countries may belong to this category.

Funding Public Health Care: How and How Much?

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Health Issues, No 62, March 2000, p.27-30.

Keywords: Health;

We may be approaching a time in which we can have an honest discussion on how to fund the health system. The public discussion has been rarely so in the last decade, because too often there is a hidden ideological agenda advocating private funding – of privatisation.

Desperate for Funds: Are We Spending Enough on Health?

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Listener 6 November 1999.

Keywords Health

Most of us are aware of Multiple Sclerosis victims in wheelchairs or with walking sticks. In fact the disease may have affected the sufferer up to two decades earlier, initially with a loss of muscular coordination – perhaps at first vision, then isolated numbness, to a progressing weakness in the legs. It does not much affect life expectation, nor does it affect intellect. The sufferers know that they will experience an increasing loss of muscular control.

The Whimpering Of the State: Policy After MMP

This entry was posted in Business & Finance, Distributional Economics, Education, Governance, Health, History of Ideas, Methodology, Philosophy, Literature and Culture, Macroeconomics & Money, Political Economy & History, Regulation & Taxation, Retirement & Savings, Social Policy on by .


Auckland University Press, 1999. 269pp.

The policy process has changed dramatically following the introduction of MMP. Fascinated by the theatre of politics, we too easily ignore the major changes in policy approaches and outcomes. Today, without an assured parliamentary majority the government has to consult over its policies rather than impose them. Along with the increasing recognition that the policies of the past have failed, the policy blitzkrieg has almost ceased and commercialisation is being shelved.

The Whimpering of the State looks at the first three MMP years with the same lively, broad -ranging and informed approach as Easton’s successful The Commercialisation of New Zealand, which described the winner-takes-all regime before 1996. Again there are case studies: health, education, science, the arts, taxation. retirement policy, and infrastructure. Policy possibilities are explored. Yet, as the title of the book suggests, any releif from the ending of Rogernomics is offset be a realistic pessimism arising from a shrewd analysis of the continuing deficiencies in New Zealand’s political and social structure. Although written for the general public, this book will also be read by politicians, policy analysts and students, and will shape policy thinking in the MMP era. Publisher’s Blurb

Two Styles Of Management

This entry was posted in Governance, Health on by .

From The Whimpering of the State: Policy after MMP (Auckland University Press 1999) p.88-91.

Keywords: Governance; Health

Alan Schick argues that the central theme of the reforms was ‘influenced by two overlapping but distinctive sets of ideas, one derived from the vast literature on managerialism, the other from the frontiers of economics. Managerial reform is grounded on a simple principle: managers cannot be held responsible for results unless they have the freedom to act. The new institutional economics is grounded in a very old idea: people act in their own self-interest.’ In effect, Schick contrasted two approaches (or cultures) to public sector management. He only faintly praises accountability, but warmly describes responsibility as ‘a personal quality that comes from one’s professional ethic, a commitment to do one’s best, a sense of public service’.(1)

Health Policy

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Chapter 11 of The Whimpering of the State

Keywords: Health;

The chairman of the Health Funding Authority (HFA), Graham Scott, reported that the 1991 health reforms were predicated upon productivity gains in the public hospital sector, which had not occurred. As a result the Crown Health Enterprises (CHEs, now Hospital and Health Services – HHSs) are in permanent financial deficit. In Scott’s convoluted presentation ‘the current deficits in CHEs are not only about inefficiencies and variations in the quality of management but are also an outgrowth of the original efficient pricing policy [whatever that means]. In other words a share of these deficits was made in Wellington, because the policy did not work out as intended. They were inherent in the policy framework that assumed efficiency gains would be allocated to the deficit.’[1] More simply, the policy failed. Scott went on to explain that the failed theory derived from the experiences of corporatisation in other areas of government and in consultants’ reports.

The Hospital Balance Sheet Crisis

This entry was posted in Governance, Health on by .

Extract from The Whimpering of the State: Policy After MMP, p.131-132.

Keywords Governance; Health

However, the CCMAU report underestimated the size of the financial problem, as became clear when the CHE accounts for the year to June 1997 were published. …

The 1996 Health Post-election Briefings

This entry was posted in Governance, Health on by .

Chapter 10 of The Whimpering of the State

Keywords: Governance; Health;

An indicator of the poor functioning of democracy in recent years is the gap of perceptions between officials making policy and the concerned public. This is nicely illustrated by contrasting the Coalition Agreement on health policy, drafted by politicians, and the post-election briefings of the three administering agencies, which the politicians did not have access to during their negotiations.[1] While this chapter provides a background for the next on health policy , its primary purpose is to illustrate the gap.

Who Should Be Treated? Interferon-β for Multiple Sclerosis

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Presentation to Information Workshop on Disease Moderating Agents, sponsored by the Multiple Sclerosis Society of New Zealand: Thursday 17 June 1999.

Keywords Health

The Public Policy Context

Public policy is about problem solving. The specific problem I shall look at today is who with multiple sclerosis should be able to obtain access to Interferon-beta therapy? But public policy answers to such questions have to take place from a wider perspective. Resolving the public spending problem on multiple sclerosis has to take place mindful of the tradeoffs with other public spending (including on other diseases) and the raising of the revenue (typically via taxation) to fund them. There has to be a consistency between the specific answers, for otherwise the various decisions – the resolutions to the problems – becomes a matter of arbitrariness, creating ongoing tensions (and further problems) because of inconsistencies.

Up in Smoke

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Cigarette Smoking has fallen to the level of the 1890s thanks to New Zealand’s rigourous anti-smoking policies.
Listener 28 March, 1998.

The greatest epidemic the world faces is not HIV-Aids, but diseases from tobacco smoking, which kill more than Aids, maternal and childhood conditions, and tuberculosis combined. A peculiarity of the smoking epidemic is it is driven by the commercial imperatives of tobacco growers, manufacturers, and distributors. Most diseases are not profit driven, but it is becoming increasingly clear from records released during American litigation that the tobacco companies knew tobacco consumption was addictive, and were aware that smoking caused early death, and poorer quality of life. Yet they encouraged the addiction and promoted tobacco sales.

The Economic Regulation Of Tobacco Consumption in New Zealand

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The Economics of Tobacco control: Towards an Optimal Mix edited by I. Abedian, R. van der Merwe, Nick Wilkins, P. Jha ( Applied Fiscal Research: University of Captetown, 1998), the proceedings of a conference of the Economics of Control Project, School of Economics, the University of Cape Town, 18-20 February 1998, Cape Town.

Keywords Health.

Introduction: A Brief History of Tobacco in New Zealand (1)

Tobacco was introduced in New Zealand by the Europeans about 200 years ago. Smoking became very popular with the Maori: surgeon Henry Weekes wrote in the early 1840s that it was “universal among New Zealanders [the Maori] of both sexes.” (Rutherford & Skinner 1940) It was also used as a currency and a commodity of exchange in the middle of the nineteenth century. By 1860 attempts were made to grow tobacco leaf, although this was not a successful industry until the 1930s. Cigars were being manufactured by 1884.

The Seven Percent Solution: a Background to the Proposed Health Referendum.

This entry was posted in Health, Listener on by .

Listener 31 January 1998.

Keywords Health

The health reforms debate enters a new stage in 1998 with the indicative referendum that Government should increase its spending on health services to at least 7 percent of GDP, if necessary by increasing personal income tax. Over the last six years the government has taken the initiative. The referendum presents the people seizing the initiative in 1998.