(Download PDF) Health Economics 6th Edition Santerre Solutions Manual Full Chapter
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CHAPTER 7
7-1
The value of the elasticity of substitution ranges from zero to infinity and
measures the degree to which two inputs can be substituted for one another in
the production process. Mathematically, it equals the percentage change in the
input ratio, divided by the percentage change in the ratio of the inputs’ marginal
productivities. Its magnitude is affected by the ease of substitution as indicated
by technical and legal considerations.
7. Suppose that with 400 patients per year, the SAFC, SATC and SMC of
operating a physician clinic are $10, $35, and $30 per patient, respectively.
Furthermore, suppose the physician decides to increase the annual patient
load by one more patient. Using short-run cost theory, explain the impact
of this additional patient on the SAVC and SATC. Do they increase or
decrease? Why?
The new SAVC will increase since the SMC of $30 exceeds the original SAVC of
$25, found by subtracting SAFC from SATC. The new SATC will decline since
the SMC of $30 is below the original SATC of $35.
8. What factors shift the short-run average variable and total cost curves?
Explain why these curves would shift up or down in response to changes
in these factors?
Any change in variable input prices, the quality of care, or the patient case-mix
will shift the short-run average variable and total cost curves. In addition, a
change in fixed costs will shift the total cost curve but not the short-run average
variable cost curve. For example, an increase in labor costs would cause both
curves to shift upward because the marginal cost of production would increase.
The curves would also shift upward if the medical care provider increased the
quality of care or serviced a more severe patient case-mix.
9. Suppose you were to specify a short-run total variable cost function for a
nursing home. Explain the variables you would include in the function.
What is the expected relation between a change in each of these variables
and short-run total variable costs?
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7-2
The short-run total variable cost function for a nursing home should consider the
following variables: the quantity of patient days, a measure for the quality of care
provided, patient case-mix, input prices for various types of labor inputs including
nursing labor, auxiliary labor, administrative and professional labor, and the cost
of medical supplies. The function should also include a measure for the capital
stock that considers the size of the facility and medical equipment. Any increase
in output, quality of care provided, patient case-mix severity, or input prices
should positively impact short-run total variable costs.
11. Explain the reasoning behind the U shape of the long-run average total
cost curve. Why might this cost curve shift upward?
In the long run, all inputs can be altered and the U shape of a long-run average
total cost curve depends upon the existence of economies and diseconomies of
scale. Any increase in input prices will cause the curve to shift upward.
Technological change also shifts the curve upward if it is cost-enhancing.
12. You are responsible for hiring one of two hygienists for a dental office.
The first dental hygienist has 25 years of experience. Given her record, she
is likely to satisfactorily service 16 patients per day. Her hourly wage would
be approximately $16 per hour. The other hygienist is new to the industry.
He is expected to satisfactorily service 10 patients per day at an hourly
wage of $8. Which dental hygienist would be the better hire? Why?
The less experienced hygienist is the better hire since his marginal productivity
per dollar spent equals 1.25 (10/8) whereas the marginal productivity per dollar of
the more experienced hygienist is 1.00 (16/16).
13. Santerre and Bennett (1992) estimated the short-run total variable cost
function for a sample of 55 for-profit hospitals in Texas (t-statistics are in
parentheses below the estimated coefficients).
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7-3
ln STVC = 1.31 + 0.47ln q + 0.80ln w + 0.73ln QUALITY
(0.69) (3.31) (4.42) (2.58)
+ 0.11ln CASEMIX + 0.29ln k + 0.07ln DOC
(1.48) (3.16) (0.88)
+ Other factors
Adj. R 2 = .95
N = 55
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permitted in a license distributed with a certain product or service or otherwise on a password-protected website for classroom use.
7-4
The coefficient estimate implies ceteris paribus that a 10 percent increase in
wages leads to an 8 percent increase in short-run total variable costs.
14. Draw a U-shaped LATC curve. Then draw the related long-run marginal
cost (LMC) curve, keeping in mind the geometric relation between marginal
cost and average cost (see the discussion on short-run cost curves). What
is the relation between LATC and LMC when increasing returns to scale are
present? Between LATC and LMC when the production process exhibits
decreasing returns to scale? What type of returns to scale holds when LMC
equals LATC?
The LMC is less than the LATC when increasing returns to scale are present,
and the LMC is greater than the LATC when decreasing returns to scale are
present. When the LMC equals the LATC, constant returns to scale exist.
15. Describe the two limitations associated with the cost theory provided in
this chapter when it is applied to explain the behavior of medical firms.
First, a number of medical care providers are not-for-profit entities and may not
have the incentive to operate on their cost curves. Second, medical firms face an
uncertain demand for their services and may operate with a certain level of
reserve capacity in order to accommodate unanticipated increases in demand.
16. Suppose that you are interested in comparing the costs of producing
inpatient services at Saving Grace Hospital with those at ACME Hospital.
Further suppose that the two hospitals annually admit about 24,000 and
32,000 patients, respectively, at average short-run total costs per
admission of roughly $11,000 and $12,000.
A. Why may these average STC figures not represent the economic cost of
providing inpatient services at these two hospitals? Explain fully.
These figures may represent only the explicit costs and not the implicit costs of
operating the hospitals. The implicit costs reflect the opportunity costs of the
resources that are owned by the two hospitals.
B. Suppose that these cost figures accurately reflect the economic costs of
providing inpatient services at these two hospitals and that the two
hospitals face the same average total cost curve. Draw a graphical
representation of the average total cost curve (only) and graphically show
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7-5
and verbally explain why ACME Hospital produces at a higher cost than
Saving Grace Hospital.
Saving Grace Hospital is likely producing at a level of output closer to the
minimum point on the average total cost curve (Qs) whereas ACME Hospital
produces an output level further to the right of the minimum point on the average
total cost curve (Qa).
$
ATC
0 Qs Qa Q
C. Using cost theory as presented in the text, identify and fully discuss four
other factors that might explain why ACME Hospital has higher average
costs of production than Saving Grace Hospital.
Input prices, quality of care, patient case-mix severity, and the amount of the
fixed inputs. Specifically, higher input prices, greater quality of care, a more
severe patient case-mix, and excessive fixed inputs may all individually cause
ACME’s average cost curve to be located at a higher position than Saving Grace
Hospital’s average cost curve.
7-6
Agency theory and transaction cost economics argue that vertically integrated
delivery systems lead to lower production costs if the savings brought about by
lower transaction costs exceed the costs resulting from incentive problems.
Higher production costs result if the opposite is true such that incentive costs
exceed the savings resulting from lower transaction costs.
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7-7
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to the company as if nothing had happened; and marriages
were sometimes kept a profound secret for months. It was
not a good fashion, and brought about a good many
complicated lawsuits, but it was not considered at all
disreputable.
I think Mrs. Chloe suffered the most of any one from this
very unexpected healing of Mrs. Philippa's twenty years'
heart-break. She missed her sister, whom she had really
loved despite her unkindness, and I am sure she felt it hard
that Mrs. Philippa should get a rich husband, while she
herself had none at all. It was truly pitiable to see how the
poor thing's thoughts still ran upon such things, though
every one in the house could see with half an eye that she
was not long for this world. She grew thinner and weaker
every day, and her little dry cough kept her awake in spite
of all Mrs. Deborah's bread jellies, and poppy and lettuce
syrups.
But Mr. Cheriton did Mrs. Chloe good in other and better
ways. He himself proposed that as she could not go to
church, he should have prayers for her benefit every
Sunday evening, after which he would read her his sermon.
He was a true "son of consolation," and knew just what to
say and what not. Whenever he spent the evening with us,
we had evening prayers, which we did not at other times,
and Mr. Cheriton usually said a few words upon the Gospel
for the day or week.
"I don't know how it is, but they seem somehow to express
just what I want!" she said rather apologetically to Mrs.
Deborah one day. "And, you know, Sister Deborah, that Mr.
Wesley is a regularly ordained clergyman of the Church of
England."
"Do read them as much as you like, if they are any comfort
to you, Sister Chloe!" was Mrs. Deborah's reply.
"Mrs. Chloe does not talk any more about the set of chairs
she was going to begin in the spring," remarked Amabel.
"She never says anything now about getting well when the
warm weather comes, but I think she seems a great deal
happier than she used."
"She has given up!" said I. "You know dear Mother Superior
used to say that there was great happiness in giving up.
Mrs. Chloe told me the other day, that you and Mr. Cheriton,
between you, had done her more good than you would ever
know."
Amabel stopped short. It was the first time she had given
me a hint that she had guessed my secret.
The next day but one, as Amabel and I were returning from
the village school, we were astonished to meet Mr. Cheriton.
His face was pale, his dress disordered, and his jaded horse
showed how fast he had travelled. It was just at the
entrance of the avenue, and one of the grooms being at
hand, Mr. Cheriton gave him the horse, with a charge to be
careful of him, as he had made a hasty journey.
"We were not looking for you!" said Amabel. "What has
brought you in such a hurry?" Then turning pale as Mr.
Cheriton did not answer, "Walter, what is it! You have ill
news. What does it mean?"
"Yes, but who? I did not know that I had one. I know some
idle tales were told about me at one time, but I thought
they had all died out long ago. Amabel, you will not—"
"You are right, Lucy!" said Mr. Cheriton. "I hardly know what
I am doing. Let us go to Mrs. Deborah, as you say."
"Too well!" said she. "I also have had a letter which explains
it all. Child, your father is married again, and to Lady
Throckmorton."
CHAPTER XX.
VISITORS.
"If I had never begun it, she could not have found occasion
against me!" returned Mr. Cheriton. "My sin hath found me
out."
As for me, I was too fiercely angry to cry. Mr. Cheriton, who
had in some degree regained his self-control, at the sight of
Mrs. Deborah's distress, now spoke in his deep voice—
"Let us pray!"
"He is very good!" said Mr. Cheriton, with a look on his face
and a tone of bitterness in his voice, which I never
witnessed or heard before. "If I will give up preaching to the
poor and seeking the lost, that is to say, if I will give up the
work I am doing for the Lord, he will possibly overlook what
I am said to have done for the devil. As to Lady
Throckmorton, as I have never affronted her, I owe her no
apology. What say you, Amabel? Shall I give up my
preaching to the colliers and ballast men, for your sake?"
"Never!" said Amabel firmly. "I would rather never see you
more in this world, than that you should swerve one hair's
breadth from your duty for my sake."
But a sad interval was to pass before the matter was again
discussed. We had not yet separated, when Jenny came in
all haste to say, that Mrs. Chloe had fallen into a fainting-fit,
and her woman could not bring her to, with all she could do.
"It was just that grinning fool Richard!" said Jenny in great
wrath. "He must come in with a basket of sticks, for Mrs.
Chloe wanted a bright fire, and what must he do, but
congratulate her on the happy news as he called it, and
when Mrs. Chloe asked what it meant, he said master was
married to Lady Throckmorton, and poor Mrs. Chloe, she
just gave one mournful cry and sunk back like one dead."
All these particulars were given to us, for Mrs. Deborah had
hurried to her sister. Poor Mrs. Chloe came out of her
fainting-fit, only to have a dreadful bleeding from her lungs.
An express was sent in all haste for the doctor, and another
for Mrs. Philippa—Mrs. Brown, I should say. The doctor did
not arrive till night, and then gave no hopes. Mrs. Chloe
survived about a week, and then passed quietly away, in
the comfort of a reasonable, religious, and holy hope. I
suppose she could not have lived long at any rate; but there
is no doubt that the news of her brother's marriage to a
woman whom she disliked, and with the best of reasons,
hastened her end. She gave Mrs. Deborah written directions
as to the disposition of her affairs, and said that she had
made her will, which was in the hands of Mr. Thirlwall, the
family lawyer and man of business at Newcastle. I had
supposed as much, knowing that he had paid her several
visits during the winter.
He could not well find fault with the arrangements for the
funeral, seeing that Mrs. Chloe had ordered them all
herself; but he frowned at the needless expense, as he
called it, of giving new frieze coats to the poor men in the
alm-houses, and new gray gowns to the old women; and
swore roundly, when he heard that Mrs. Chloe had ordered
Mr. Cheriton to officiate at her funeral, "that he would not
have the canting Methodist enter his house."
I fell in love with her at once, and she was kind enough to
take equally to me. Her presence was a great comfort to us
all, and especially to Mrs. Deborah. She was a beautiful old
lady, with silvery white hair which would curl in spite of her,
eyes the exact counterpart of Amabel's, and a perfectly
refined and ladylike manner. She spoke with a very strong
Scotch accent, but we had learned Scotch enough from
Elsie, not to mind that.
The funeral was celebrated, and then came the reading of
the will, at which all the family were present. It seemed
that Mrs. Chloe was much richer than either of her sisters,
since beside her share of her mother's fortune, which was
not inconsiderable, she had inherited some five thousand
pounds from a god-mother, for whom she was named.
Sir Julius, on the contrary, did not try to hide his vexation.
It was plain that he had always counted on Mrs. Chloe's
leaving all her money to himself, and I was wicked enough
to be glad to see him disappointed. He swore roundly at Mr.
Thirlwall for allowing Mrs. Chloe to make such an absurd
will, and for not letting him know about it in time to have it
altered.
"I would not have the lass build too much on her father's
present mood," said the old lady from Thornyhaugh, as we
two sat together in the little south room the evening after
Sir Julius had departed. "I should not speak so of my nevoy
belike, but he aye minds me of what was said of King James
the Sixth by ane wha keened him weel. 'Do you ken a
jackanape?' said he. 'If you hold Jocko by the chain you can
make him bite me, but if I hold him by the chain I can make
him bite you.'"
"Just like her!" was the comment. "What's bred in the bone
stays long in the blood. I keened her mother before her, and
she was just such another. A fine guardian, truly, to set over
his daughter. Aweel, Lucy Corbet, I am no Papist nor favorer
of Papists, or of them that would bring them back on this
land, but, saving their religion, I would wish you and my
niece were safe back yonder in your convent. Poor children!
This world is a hard place for motherless lassies."
"Say what is in your mind, bairn," said the old lady, "I shall
never repeat a word."
"Mr. Cheriton."
"I think you are quite right, aunt," said she. "If my father
requires me to give up Mr. Cheriton I will do so, at least till I
am of age, but nothing shall ever make me marry any one
else, while he lives—nothing!"
"I can see it!" said I peeping into the very narrow space
between the cabinet and the wall. "But I cannot reach it. Let
us try to move the cabinet out a little, Amabel."
"See here, Amabel!" said I. "This door opens into the ghost
room! Are you not afraid?"
"Would you dare open it?" said I. "I have a curiosity to see
how a room looks into which no one has set foot for two
hundred years and more."
"Well, look then! What harm can it do! And yet after all I
would let it alone, I think!" said Amabel. "Perhaps Mrs.
Deborah would not like it."