May 10-11, 2018 Economic ordeals are interventions that deliberately make access to products or services more difficult in an effort to improve resource allocation. In this vein, making patients wait in long lines to schedule an appointment with a specialist might discourage patients with needs that could be met by less qualified personnel from taking up the specialist’s time, thus freeing up time for those with complex needs. Similarly, putting brand-name medications at the bottom of a long list of options on clinicians’ computers might encourage them to prescribe a generic brand listed closer to the top. Recent research in development economics, behavioral economics, and health policy suggests that some economic ordeals could help target health resources to patients who are more likely to utilize these resources, without the regressive effects of co-pays and other forms of financial participation on the part of patients. However, making health care deliberately less accessible raises ethical challenges. Is it not the case that ordeals discourage utilization by patients with acute needs? Do these ordeals affect some disadvantaged populations disproportionately? And do deliberate obstacles to health resource utilization violate the human right to health? For more information, visit our website at: http://petrieflom.law.harvard.edu/events/details/ordeals-in-healthcare

1. Modeling Ordeals in Health
Reza Yaesoubi
Department of Health Policy and Management
Yale School of Public Health
Ordeals in Health Care: Ethics and Efficient Delivery
Harvard University
May 10-11, 2018

2. 2
Introduction to Simulation Modelling
Statistical models are used to study “if variable A is related to variable B”.
Examples:
- Does smoking increase the risk of lung cancer?
- Does using mammography at age 40 increase the life-expectancy of
women?

3. 3
Introduction to Simulation Modelling
There are scenarios where running experiments to collect data is unethical,
infeasible, or expensive.
- How much would we save if we decrease the number of ORs from 5 to
3?
- How would the waiting-time change if we increase the number of ORs
from 5 to 7?

4. 4
Introduction to Simulation Modelling
Simulation (mechanistic) models are computer prototypes of a physical
system (e.g. hospital or a health system) where the main goal is to generate
evidence about how the system would behave under different specifications
without implementing them in real life.

5. 5
Simulating Ordeals in Health Care
Rationing through inconvenience could:
- Lead to more efficient allocation
- Worsen disparity
- Impact individual and population health
- Be wasteful
- Increase administrative costs
A simulation model could provide an estimate for each of these performance
criteria under different specifications.

6. 6
How Does an Individual Decide?
To use or to not use a service:
- Service price (𝑝)
- Distance to the service location (𝑑)
- Waiting-time in line (𝑤)
- Time to fill out forms (𝑡)
- Health benefits (ℎ)
Individual would use the service if:
𝑈( 𝑝, 𝑑, 𝑤, 𝑡, ℎ) > 0.
𝑈: Utility function