Archive for the ‘Uncategorized’ Category

The Economics of Access to Healthcare

May 26, 2017

a guest post by Keith McCullough

Keith McCullough is a Senior Research Analyst at Arbor Research


     The economics of healthcare are complex, even within a single country. When making comparisons across countries, “How many poor people are there?”  – is a difficult question, let alone what we’re really interested in: “How does poverty impact access to healthcare?”
     Who is poor? How many poor people are there? The World Bank uses the purchasing power parity (PPP) statistic to address these problems. This statistic ‘translates’ the value of someone’s wages into a ‘standard’ basket of goods. Of course, there are difficulties with this approach. Prices for various goods can vary wildly depending on local circumstances, or whether the particular good is imported. Each item in the basket may need to be ‘translated’ to a local equivalent (e.g. a bag of rice instead of a bag of flour). The World Bank has described some of their efforts along these lines, including the need to consider urban v. rural, changes in value over time, and lack of data due to turbulent local conditions.
      The PPP is a reasonable metric for their purposes, but healthcare is not an easily-described ‘good’ with a well defined ‘price’. In many countries, including countries with universal healthcare (which is not the same as single-payer!), payment for a medical treatment or procedure can involve a combination of public insurance, private insurance, and ‘out of pocket’ costs. These costs might be calculated for each service, or bundled together into a single overall payment, which may make it nearly impossible to assign a single ‘price’ to a specific procedure.
     Even if we had a good set of healthcare procedures with well-defined costs, examining financial barriers to healthcare access is more complex than just translating someone’s income into a ‘healthcare’ PPP.
      Income alone isn’t enough information: A retiree with very low income might have good public and/or private insurance, and thus very good access to healthcare.
Wealth + income isn’t enough information: Many procedures are simply outside the purchasing power of the vast majority of the population, which is why we have insurance.
        Wealth + income + insurance isn’t enough information: Our ‘healthcare’ PPP is extremely sensitive to location (it’s hard to ‘ship’ healthcare). For example, pregnancy ultrasounds cost over four times higher (on average) in Alaska than in Arizona. Many procedures and treatments are simply not available in some countries at any reasonable cost, due to lack of infrastructure, patent issues, or other reasons.
Wealth + income + insurance + location isn’t enough information: Even if a procedure is completely covered by some sort of insurance, and you live in an area where the procedure is available, there may still be long wait times for some procedures (e.g. hip replacement). Wait times limit access to the people who survive the wait. In many countries with universal healthcare, citizens who are capable of doing so will purchase additional insurance to improve their access (via decreased wait times), or go to other countries for procedures, but sometimes this is not an option. Someone’s access to a procedure depends on what everyone else is doing, not just their own resources and location.
      Just to be clear: my description of the difficulties in comparing international data is not an attempt to rationalize away international comparisons that indicate that US citizens have generally low access compared to other first-world countries. I favor increased healthcare coverage, mainly because current research shows that increased coverage saves lives, e.g. through early detection of serious conditions. I also like the fact that increased coverage reduces the unfairly high prices poor people tend to pay for the same procedures. This article is simply describing the fact that this is a complex issue that researchers have been working on for some time.


Enhancers’ Campaign

April 26, 2015

After going through a variety of titles, I decided on Enhancers’ Campaign.

Enhancers' Campaign Two

Melal just wanted to escape the maltreatment of enhancers, but found herself protecting deluded girls who believed that it was a good idea to go to war to end religious persecution. The magical ability Melal had to enhance led her to a mission for a god with the help of an attractive stranger. The god promised a reward if they succeeded but didn’t promise either of them would live to collect it.

Upcoming Enhancer book

February 10, 2015
Possible cover

Possible cover

I hope to publish the next enhancer book in March


Melal was an enhancer, which meant she had the ability to do magic. She lived in an area where enhancers were harassed and persecuted. As things got worse she decided to leave, joining a woman named Nefance whose wagon offered her a quick way out of town. What she didn’t realize was that Nefance was with a group that intended to start a war.

Tekad was unfairly thrown out of his home because of the treachery of Nefance, the woman who raised him. As a homeless vagabond, he met Nefance again, along with Melal.

Tekad wanted nothing to do with the war, but Melal was attractive and she wanted to save a group of deluded girls who were all enhancers and thought that they were doing a wonderful thing to help the war. In both war and peace, Tekad and Melal found that caring for young enhancers was both dangerous and rewarding.

Another release

July 23, 2014

I’ve published a short story, Kidnapped by Fae, on Amazon. It is another story about Bengt and Tian, who appear in The Secret of Sanctua.

The Secret of Sanctua

May 27, 2014

The Secret of Sanctua is now available on Amazon.



Practical Math

February 2, 2013

One of my colleagues, I will call X, was helping a friend of his shop for a car. The price was reached and financing discussed. A printout of payments was given to the friend, and X asked for a copy. He then asked to see the manager.

He informed the manager that he was taking this piece of paper to his lawyer and planned to sue. The interest rate that was advertised and told to the buyer was 1.9%. The interest rate that made these payments was 4.9%. The manager said he would recalculate. X informed the manager that the other dealership under the same management was advertising 0.9% and that’s what he expected his friend to get. The contract was written that way. X saved his friend quite a bit of money, because he knew math and brought his calculator. I wonder how many people actually paid 4.9% interest without realizing it. Probably quite a few.

On the other hand, I met a former student who told me she used some of the math she learned from me in a video game. That’s not really practical math.

KTT Prize

March 5, 2012

This is for those at KTT who want to know what I won. Samaya sent me this bag. The card with the bag says Tika Art  Email:

My poor students!

February 9, 2012

I teach at a community college that is in an affluent community. Nevertheless, many of my students are apparently quite poor. They can’t afford the textbook, they come to class without a calculator, or even a pencil. I would feel very sorry for their level of poverty, but I see evidence suggesting they aren’t quite so poor.

They have fancy cell phones that have games and Internet connections. They dye their hair and wear jewelry, and often have multiple piercings. They have tattoos. They bring Starbuck’s coffee to class. They buy their lunch. They talk about the movies they’ve seen.

I am not going to try to tell them how to spend their money, and I will sometimes lend them a pen or even a calculator for classwork, but I am not going to lose any sleep about how their lack of money is interfering with their education.