Essays on the regulation of health care provision and the economics of chronic diseases

This thesis comprises two main topics. The first part of the thesis focuses
on the regulation of health care provision, while the second part provides empirical
evidence ofthe economic consequences ofchronic diseases in developing countries.
The first part examines the incentives that condition the relationship between
hospitals and health care purchasers (Chapters 1 and 2) and the provision .ofpreventive
care in a competitive health insurance market (Chapter 3). There are three main
areas ofconsideration. Chapter 1 presents an axiomatic bargaining model of prices
and activity, examining the negotiation between hospitals and purchasers in situations
where, as usually occurs, none of the parties hold all of the bargaining power.
Chapter 2 estimates the effect of waiting times on hospital costs using a sample of
283 hospitals over the period 1995-2002 in the NHS. This analysis seeks to clarifY
the efficiency effects ofimposing waiting times for elective surgeries. Chapter 3 extends
Rothschild and Stiglitz's (1976) model of adverse selection in a competitive
health insurance market by considering the incentives for prevention.
The second part of the thesis consists of two. empirical investigations regarding
the economic effects of chronic diseases in Brazil, India and Russia. Chapter
4 provides an analysis of the relationship between socio-economic inequality .
and chronic diseases, whilst Chapter 5 estimates the effect of chronic diseases
on household economic performance, as measured by health expenditures, nonhealth
expenditures and labour productivity. The results emphasise the relevance of chronic diseases for developing countries, challenging the view that this problem is
restricted to more developed societies.