Health Care Costs And Worker Opportunity Costs

A comment I posted to "What's Cost Got to Do with It?" by Joseph T. Salerno on the Mises Daily blog:

Two points.

1. Health care costs, direct and insurance, were and continue to be a big issue, but they follow the same pricing principles mentioned. All the economic articles and research I have seen on the topic discuss, analyze, and provide solutions on the cost side of medical services and health insurance especially that costs are higher in the US than other countries and the US spends more per capita for medical services. They ignore the value to the consumer.

Like all other products and services, the price paid is determined by the value to the consumer. The US has very high GDP per capita and very high productivity rates. These factors would make a worker's opportunity costs, on average, high in comparison to other countries.

With a high opportunity cost, one would expect US medical prices would be higher than other countries as long as the higher price lowers the opportunity costs of medical services to the consumer. Delays caused by waiting for doctor appointments, specialist appointments, medical tests scheduling (such as MRIs, etc.), use of less efficient older technologies, use of older less efficient drugs that require re-treatment, lost productivity from the medical condition, etc. have a high opportunity costs for American workers (who often also have to take off work time to care for an ill child, parent, or spouse). Using new, efficient (in the sense of diagnosis time and treatment) technologies and decreasing the total time (and opportunity cost including lost productivity) to the consumer from the first phone call for an appointment to final result is expensive and will result in higher US medical costs. Most looks at other country medical services find the US had shorter wait times, newer technology to speed diagnosis and treatment, newer, more effective (and more expensive) drugs, and fewer doctor visits per year and per medical condition. This is not to say anything about end results, which are often used as a measure of comparative health care. It is about the speed of reaching that end result, the opportunity costs, beginning from a consumer's awareness of the condition (not first doctor appointment, but the wait for the first appointment) to final recovery.

To me, medical costs in the US are high because these services have a high value and lower opportunity cost to Americans. All attempts to directly control medical costs will fail because the value of the service to the consumer will remain high. American consumers will find ways to spend more, under any medical cost regime, to reduce their opportunity costs while receiving medical services.

Medical costs in the US will rise until they are equal to the consumers' opportunity costs and value.

If the value of the medical services were lower to US consumers, the medical establishment would find ways to reduce costs.

2. To all the comments that say costs are factored into price before production are ignoring that many businesses fail, despite adequate business plans, because consumers are not buying the goods in sufficient numbers for the business to remain viable. At a lower price, the business will sell more, but at a loss. Lack of demand kills many businesses.

Businesses I know consider demand as much as production costs and some will even regularly sell items at or below cost, such as loss leaders, in hopes of increasing overall demand and hopefully increase sales of their other goods. If costs were the main or only consideration, then profit margins would be much higher than they are at most businesses. Demand is determined by value and it sets an upper limit on price and profit.

Also see my earlier post, "The Marginal Value Of US Medical Service Is High So Medical Prices Are High" relating to this topic.

The Marginal Value Of US Medical Service Is High So Medical Prices Are High

A comment I posted to "Health Care Prices: Ignored Once Again?" by Chris Fleming on HealthAffairs Blog:

It is the prices stupid, but if researchers only look at the cost of the medical service, as the authors mentioned above do, they miss the total economic price that a patient pays.

Opportunity costs to patients have to be included. Opportunity costs help explain the value of medical services to patients and why prices for US medical services appear to be high. As long as the price of a medical service has a positive marginal value to the patient, the patient will be willing to pay the higher price.

The US has very high productivity and high GDP per worker. A lost day's work has a very high opportunity cost to an American worker. Even if the worker receives sick pay, a day's absence from work often means for many a backlog of work when they return. An extra few day's work missed by going to the doctor more often for treatment or staying in the hospital longer is very expensive to an American worker. It is also not just the number of visits, but also the lost productivity due to the time it takes a patient to get better. For example, imagine a patient with a bad knee who can get knee surgery in a couple of weeks versus one who has to wait a few months for the surgery. The longer waiting time surgery might be cheaper, but the opportunity cost of the lost worker productivity until the surgery has to be included in the comparative cost. Medical costs studies as a rule do not include these opportunity costs to the patient and the employer.

American workers are willing to pay more for medical services because US medicine is more efficient and reduces the number of days of wait until treatment, of missed work due to doctor visits, uncured illness and hospital stays. This is why we visit the doctor less and have fewer days of hospital stay.

Opportunity costs extend to relatives of the patients. Often a parent is taking a child to the doctor or staying home with the child until the child gets well. Likewise, adult children often assist with the care of their elderly or sick parents.

I would say that the reason these studies were ignored is that they presented an interesting fact but also an incomplete story. Show me a comparative study that analyzes medical prices that includes patient (or caregiver) opportunity costs.

My gut feeling is that prices of medical services in the US are at a level where the marginal value to patients equals the marginal costs, including opportunity costs, to patients.

Also see my later post, "Health Care Costs And Worker Opportunity Costs" relating to this topic.