6. Are health gains the only outcomes?
The demand for health care arises not because the use of health care services is
enjoyable but because it leads to improvements in health. But health gains are
not the oħly benefits of health care consumption. There are other
characteristics of health care which affect consumer welfare. Therefore, health
gains are not the only relevant health outcomes. Two of these other factors are
information and satisfaction with the process or quality of service delivery.
Typically, health care consumers are not well informed either about their own
health state or the effectiveness of health care. Individuals who are not
medically trained cannot interpret their own symptoms - they need to visit the
doctor to find out if they need a doctor! Hence information itself may be an
important output of health care (Mooney 1992, Evans 1984, McGuire et al
1988).
Once individuals have a diagnosis, they do not know, typically, what treatment
will be effective. Therefore they are unable to judge the value of health care in
producing health. They must rely on their doctor’s advice about treatment and
its effectiveness. To use our earlier analogy, individuals can judge how much a
car will contribute to their welfare because they know how much they value
transport, comfort and status symbolism although they do not have the
technical information about how a car is made. But they cannot judge so easily
how health care will affect their welfare.
The process of production of health care is also important. Typically, production
processes are treated as ’black boxes’ by economists because the performance of
an industry or firm can be judged simply by the ratio of output to input or
income to costs. But health care is a service and production cannot be
separated from consumption. Unlike inanimate raw materials, which have no
preferences about how they are transformed from inputs to outputs, consumers
are not indifferent to whether they are treated with dignity and compassion.
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