Inflation

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Price indices are useful for calculating inflation over time.  The consumer price index (CPI) measures changes in prices for the overall economy.  Researchers can also use price indices to understand the evolution of the price of health care over time.  For instance, the Bureau of Labor Statistics also calculates a CPI for Medical Care and Medical Care Services.

The question of how to calculate a price index is far from trivial however.  To calculate the change in the price of any good between years 1 and T, one could simply use the following formula:

  • Psimple=piT/pi1

However, a price index indicates the change in prices for a basket of goods.  If you are considering the change in price of 10 medical services, how much weight to you give to each one?

Economists have generally come up with the solution: the goods that make up a large share of total expenditures should be weighed more than those that make up a small share.  For instance, let us imagine a simple example where you have two expenses: food and medical care.  The price of food goes up by 10% and the price of medical care goes up by 20%.  Let us assume that food makes up a larger share of your budget than medical expenses and that the initial value of the price index is 1.0 (i.e., T=1).  Thus, if 80% of your income goes to food and 20% of your income goes to medical expenses, than the value of the price index one year from now would be would be 80%*1.1+20%*1.2=1.12.

Sounds easy right?  Not so fast.

I said that 80% of the person’s budget was made up by food, but does that figure refer to your budget expenditures in the first time period or the second time period?  Let us assume the following:

  • Pfood,1=$1; Qfood,1=800; Efood,1=$800;
  • Pfood,2=$1.1; Qfood,2=800; Efood,2=$880;
  • Pmed,1=$100; Qmed,1=2; Emed,1=$200;
  • Pmed,2=$120; Qmed,2=3; Emed,2=$360;

Above, P, Q and E refers to price, quantity and expenditures respectively; the first subscript in the formulas above refers to the good (food or medicine) and the second subscript refers to the time period (1 or 2).  In the example, 80% of the person’s budget in period 1 is for food and 20% is for medical supplies.  If we use the budget shares in the first period to weight the price changes, then we could calculate the price index as:

  • (800*$1.1+2*$120)/(800*$1+2*$100)=1.120

This method is known as the Laspeyres price index.  The general formula is: [Σ pitqi0]/[Σ pi0qi0].

An alternative measure is the Paasche  price index.  In this case, we weight the price changes depending on the bundle of goods in the last time period under consideration.  In the example, our price index would be:

  • (800*$1.1+3*$120)/(800*$1+3*$100)=1.127

The price index is higher now.  Why?  In the last period, the quantity of medical care we purchased increase (for 2 to 3) compared to the quantity of food purchased (stayed the same at 800).  This means that the Paasche price index will put relatively more weight on the price changes for medicine.  Since the price of medicine increased faster than the price of food, the overall price index level be higher in this example than in the case of the Laspeyres price index.  The general formula for the Paasche price index is: [Σ pitqiT]/[Σ pi0qiT].

However, both the Laspeyres and Paasche indices do not take into account substitution effects between goods. Goods are weighed statically based on the quantity purchased in either the first period (Laspeyres) or last period (Paasche). To solve this problem, one can use the Fisher price index. This index does account for individuals substituting across different types of goods. To calculate the Fischer index, one simply takes the geometric mean of the Laspeyres and Paasche indices. According to the example above, this means the price index would be:

  • Pf=(Pp*Pl)0.5=(1.120*1.127)0.5=1.123

One can also chain the Fisher index calculations from each year in order to produce a chain-weighted Fisher price index, but I’ll save that explanation for another day.

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A paper by  Claudio Lucarelli and Sean Nicholson  (2009) examines the skyrocketing cost of colorectal cancer treatment.  In 1993, the price of treating these patients with chemotherapy was only $100.  By 2005, this price had skyrocketed to $36,000.  Is this what is wrong with our health care system?

The authors claim that the answer is no.  Although prices increased, so did quality.  Thus, the price per unit of quality has stayed fairly constant over time.  In the author’s words:

Using discrete choice methods to estimate demand, we construct a price index for colorectal cancer drugs for each quarter between 1993 and 2005 that takes into consideration the quality (i.e., the efficacy and side effects in randomized clinical trials) of each drug on the market and the value that oncologists place on drug quality.  A naive price index, which makes no adjustments for the changing attributes of drugs on the market, greatly overstates the true price increase.  By contrast, a hedonic price index and two quality-adjusted price indices show that prices have actually remained fairly constant over this 13-year period, with slight increases or decreases depending on a model’s assumptions.

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At least this is what David Williams of the Health Business Blog has experienced in paying for his firm’s Blue Cross/Blue Shield plan.  “This year’s increase is 13.3 percent, on top of last year’s 26.3 percent increase and an 11 percent increase the year before. Thanks to the magic of compounding it means the premium has gone up about 60 percent in three years. Health insurance has become a serious burden for us.”

With these large increases, Williams sympathizes with Wal-mart’s aversion to providing health care for their workers.

“A worker making the US minimum wage of $6.55 per hour, working 40 hours per week, 50 weeks per year would make $13,100. By contrast our company’s premium is more than $15,000 per family. And of course that doesn’t count the out-of-pocket payments if someone actually wants to use their insurance.”

With rising gas and food prices, in addition to the near constant pace of insurance price increases, consumers buying power is definitely getting squeezed.

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For many years price increases in the medical sector has outpaced overall inflation by a significant amount. According to the Bureau of Labor Statistics, here is the increase in consumer prices over the last few years.

Year Medical CPI CPI Δ
2001 4.7 1.6 3.1
2002 5.0 2.4 2.6
2003 3.7 1.9 1.8
2004 4.2 3.3 0.9
2005 4.3 3.4 0.9
2006 3.6 2.5 1.1
2007 5.2 4.1 1.1
2008 (est.) 3.2 3.1 0.1
Average 4.2 2.8 1.5

Medical inflation is outpacing general inflation by an average of 1.5% per year. But is this measure of medical inflation accurately measured? Not according to paper by Joseph Newhouse (1992). Here are 4 reasons why not.

  1. Medical CPI measures input, not final goods. The CPI for medical services focuses on inputs such as physician visits or hospital days. However, the service the patient consumers is treatment for a specific disease. An increase or decrease in the requisite number of doctors visits is a change in the input towards treatment. A true measure of medical CPI would measure how the price to treat a disease changes over time.
  2. Actual Prices not observed. Generally, statisticians use the list price as the price of medical services. However, very few people pay this list price. Most individuals have insurance and these insurance companies negotiate bulk discounts. Thus, the list price is not the relevant price for most individuals.
  3. Quality changes. Even if one uses the same amount of inputs in treating a disease, the quality of medical care has likely increased over time. Of course, observing quality changes in medical care is extremely difficult.
  4. Medical CPI weight out-of-pocket expenses. Medical CPI weighs the cost to consumers of medical spending. However, since most people have health insurance, items which are paid more frequently out of pocket receive a higher weight. For instance, dental care is more frequently paid out of pocket and thus receives a higher weight in the CPI. [I am not sure if this weighting has changed in more recent versions of the medical CPI].

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