HMGT 495 WK 2 DISC 2

CHAPTER

153

10SUPPLY AND DEMAND ANALYSIS

Learning Objectives

After reading this chapter, students will be able to

• define demand and supply curves, • interpret demand and supply curves, • use demand and supply analysis to make simple forecasts, and • identify factors that shift demand and supply curves.

Key Concepts

• A supply curve describes how much producers are willing to sell at different prices.

• A demand curve describes how much consumers are willing to buy at different prices.

• At the equilibrium price, producers want to sell the amount that consumers want to buy.

• Markets generally move toward equilibrium outcomes. • Expansion of insurance usually makes the equilibrium price and

quantity rise. • Regulation and technology influence the supply of medical goods and

services. • Demand and supply curves shift when a factor other than the product

price changes.

10.1 Introduction

Markets are in a constant state of flux. Prices rise and fall. Volumes rise and fall. New products succeed at first and then fall by the wayside. Familiar products falter and revive. Economics teaches us that, underneath the seem- ingly random fluctuations of healthcare markets, systematic patterns can be detected. Understanding these patterns requires an understanding of supply

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C o p y r i g h t 2 0 1 9 . H e a l t h A d m i n i s t r a t i o n P r e s s .

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Economics for Healthcare Managers154

and demand. Even though healthcare managers need to focus on the details of day-to-day operations, they also need an appreciation of the overview that supply and demand analysis can give them.

The basics of supply and demand illustrate the usefulness of econom- ics. Even with little data, managers can forecast the effects of changes in policy or demographics using a supply and demand analysis. For example, the impact of added taxes on hospitals’ prices, the impact of increased insurance coverage on the output mix of physicians, and the impact of higher electricity prices on pharmacies’ prices can be analyzed. Supply and demand analysis is a powerful tool that managers can use to make broad strategic decisions or detailed pricing decisions.

10.1.1 Supply Curves Exhibit 10.1 is a basic supply and demand diagram. The vertical axis shows the price of the good or service. In this simple case, the price sellers receive is the same price buyers pay. (Insurance and taxes complicate matters, because the price the buyer pays is different from the price the seller receives.) The horizontal axis shows the quantity customers bought and producers sold.

The supply curve (labeled S) describes how much producers are will- ing to sell at different prices. From another perspective, it describes what the price must be to induce producers to be willing to sell different quantities. The supply curve in exhibit 10.1 slopes up, as do most supply curves. This upward slope means that, when the price is higher, producers are willing to sell more of a good or service or more producers are willing to sell a good or service. When the price is higher, producers are more willing to add workers,

supply curve A graph that describes how much producers are willing to sell at different prices.

120

$0

$50

$100

$150

$200

$250

$300

$350

S

D

Pr ic e

Quantity

10080200 40 60

EXHIBIT 10.1 Equilibrium

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Chapter 10: Supply and Demand Analysis 155

equipment, and other resources to sell more. In addition, higher prices allow firms to enter a market they could not enter at lower prices. When prices are low, only the most efficient firms can profitably participate in a market. When prices are higher, firms with higher costs can also earn acceptable profits.

10.1.2 Demand Curves The demand curve (labeled D) describes how much consumers are willing to buy at different prices. From another perspective, it describes how much the marginal consumer (the one who would not make a purchase at a higher price) is willing to pay at different levels of output. The demand curve in exhibit 10.1 slopes down, meaning that, for producers to sell more of a product, its price must be cut. Such a sales increase might be the result of an increase in the share of the population that buys a good or service, an increase in consumption per purchaser, or some mix of the two.

10.1.3 Equilibrium The demand and supply curves intersect at the equilibrium price and quan- tity. At the equilibrium price, the amount producers want to sell equals the amount consumers want to buy. In exhibit 10.1, consumers want to buy 60 units and producers want to sell 60 units when the price is $100.

Markets tend to move toward equilibrium points. If the price is above the equilibrium price, producers will not meet their sales forecasts. Some- times producers cut prices to sell more. Sometimes producers cut production. Either strategy tends to equate supply and demand. Alternatively, if the price is below the equilibrium price, consumers will quickly buy up the available stock. To meet this shortage, producers may raise prices or produce more. Either strategy tends to equate supply and demand.

Markets will not always be in equilibrium, especially if conditions change quickly, but the incentive to move toward equilibrium is strong. Pro- ducers typically can change prices faster than they can increase or decrease production. A high price today does not mean a high price tomorrow. Prices are likely to fall as additional capacity becomes available. Likewise, a low price today does not mean a low price tomorrow. Prices are likely to rise as capacity decreases. We will explore this concept in more detail in our examination of the effects of changes in insurance on the incomes of primary care physicians.

10.1.4 Professional Advice and Imperfect Competition Healthcare markets are complex. The influence of professional advice on con- sumer choices is a complication of particular concern. The assumption that changes in supply will not affect consumers’ choices (i.e., demand) can be misleading. If changes in factors that ought not to affect consumers’ choices (e.g., providers’ financial arrangements with insurers) influence providers’

demand curve A graph that describes how much consumers are willing to buy at different prices.

equilibrium price The price at which the quantity demanded equals the quantity supplied. (There is no shortage or surplus.)

shortage A situation in which the quantity demanded at the prevailing price exceeds the quantity supplied. (The best indication of a shortage is that prices are rising.)

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Economics for Healthcare Managers156

recommendations, a supply and demand analysis that does not take this effect into account could be equally misleading. Even more important, few health- care markets fit the model of a competitive market (i.e., a market with many competitors who perceive they have little influence on the market price). We must condition any analysis on the judgment that healthcare markets are competitive enough that conventional supply curves are useful guides. In markets that are not competitive enough, producers’ responses to changes in market conditions are likely to be more complex than supply curves suggest. This text focuses on applications of demand and supply analysis in which neither providers’ influence on demand nor imperfect competition is likely to be a problem.

10.2 Demand and Supply Shifts

A movement along a demand curve is called a change in the quantity demanded. In other words, a movement along a demand curve traces the link between the price consumers are willing to pay and the quantity they demand. Demand and supply analysis is most useful to healthcare manag- ers, however, in understanding how the equilibrium price and quantity will change in response to shifts in demand or supply. This application helps man- agers the most. With limited information, a working manager can sketch the impact of a change in policy on the markets of most concern.

What factors might cause the demand curve to shift to the right (greater demand at every price or higher prices for every quantity)? We need detailed empirical work to verify the responses of demand to market condi- tions, but the list of standard responses is short. Typically, a shift to the right results from an increase in income, an increase in the price of a substitute (a good or service used instead of the product in question), a decrease in the price of a complement (a good or service used along with the product in question), or a change in tastes.

Economists often use mathematical notation to describe demand. Q = D(P,Y) is an example of this notation. It says that the quantity demanded varies with prices (represented by P) and income (represented by Y), which means that quantity, the relevant prices, and income are systematically related. A demand curve traces this relationship when income and all prices other than the price of the product itself do not change.

What factors might cause the supply curve to shift to the right (greater supply at every price or lower prices at every quantity)? Typically, a shift to the right results from a reduction in the price of an input, an improvement in technology, or an easing of regulations. In mathematical notation, we can describe supply as Q = S(P,W). Here, W represents the prices of inputs (the

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Chapter 10: Supply and Demand Analysis 157

factors such as labor, land, equipment, buildings, and supplies that a business uses to produce its product). Unless technology or regulations are the focus of an analysis, we do not make their role explicit.

Worrying About Demand Shifts

More than 12 million Americans rely on long-term services and supports in home, community, or

institutional settings. This number may more than double by 2050 (Commission on Long-Term Care 2013). Only a small share get services in nursing homes, and the trend is toward lower rates of nursing home care.

Several factors may influence how and where Americans get these services (Spetz et al. 2015). First, Medicaid is a major funder of long- term services and supports, so any changes in Medicaid policy can have major effects. Second, rates of disability have been trending down for a number of years, but there is no guarantee that this trend will continue. Third, use of long-term services and supports varies widely among major ethnic groups, so changes in the composition of the population might have major effects on demand.

Technology represents a wild card in efforts to predict the volume and nature of long-term services and supports. For example, the devel- opment of smart homes and devices might well increase the share of the population getting these services in their homes.

Case 10.1

(continued)

Quantity

Pr ic e

Q 1

P 1

S

D

EXHIBIT 10.2 The Demand and Supply of Nursing Home Care

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Economics for Healthcare Managers158

10.2.1 A Shift in Demand We begin our demand and supply analyses by looking at a classical problem in health economics: What will happen to the equilibrium price and quantity of a product used by consumers if insurance expands? Insurance expands when the insurance plan agrees to pay a larger share of the bill or the proportion of the population with insurance increases. This sort of change in insurance causes a shift in demand (or demand shift). As shown in exhibit 10.3, the entire demand curve rotates. As a result of this insurance expansion, the

shift in demand A shift that occurs when a factor other than the price of the product itself (e.g., consumer incomes) changes.

Quantity

Pr ic e

Q 1

Q 2

P 2

P 1

D 2

S D

1

EXHIBIT 10.3 An Expansion of

Insurance

Discussion Questions • What sorts of policy changes seem likely to

shift the demand for nursing home care?

• How would exhibit 10.2 change given the scenario you outline?

• What sorts of demographic changes seem likely to shift the demand for nursing home care?

• How would exhibit 10.2 change given the scenario you outline?

• What sorts of technological changes seem likely to shift the demand for nursing home care?

• How would exhibit 10.2 change given the scenario you outline?

• What sorts of health changes seem likely to shift the demand for nursing home care?

• How would exhibit 10.2 change given the scenario you outline?

Case 10.1 (continued)

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Chapter 10: Supply and Demand Analysis 159

equilibrium price rises from P1 to P2 and the equilibrium quantity rises from Q1 to Q2. For example, as coverage for pharmaceuticals has become a part of more Americans’ insurance, the prices and sales of prescription pharmaceu- ticals have risen.

10.2.2 A Shift in Supply Exhibit 10.4 depicts a shift in supply (or supply shift). The supply curve has contracted from S1 to S2. This shift means that at every price, producers want to supply a smaller volume. Alternatively, it means that to produce each volume, producers require a higher price. A change in regulations might result in a shift like the one from S1 to S2. For example, suppose that state regulations mandated improved care planning and record keeping for nurs- ing homes. Some nursing homes might close down, but the majority would raise prices for private-pay patients to cover the increased cost of care. The net effect would be an increase in the equilibrium price from P1 to P2 and a reduction in the equilibrium quantity from Q1 to Q2. A manager should be able to forecast this effect with no information other than the realization that the demand for nursing home care is relatively inelastic (meaning that the slope of the demand curve is steep) and that the regulation would shift the supply curve inward.

Responses to changing market conditions depend on how much time passes. A change in technology, such as the development of a new surgical technique, initially will have little effect on supply. Over time, however, as more surgeons become familiar with the technique, its impact on supply will grow. Short-term supply and demand curves generally look different from

shift in supply A shift that occurs when a factor (e.g., an input price) other than the price of the product changes.

Quantity

Pr ic e

Q 2

Q 1

P 2

P 1

S 1

S 2

D

EXHIBIT 10.4 A Supply Shift

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Economics for Healthcare Managers160

long-term supply and demand curves. The more time consumers and pro- ducers have to respond, the more their behavior changes.

10.3 Shortage and Surplus

A shortage exists when the quantity demanded at the prevailing price exceeds the quantity supplied. In markets that are free to adjust, the price should rise so that equilibrium is restored. At a higher price, less will be demanded, leav- ing a greater supply.

In some markets, though, prices cannot adjust, often because a public or private insurer sets prices too low and consumers demand more than pro- ducers are willing to supply. Exhibit 10.5 depicts a shortage situation. The equilibrium price is P* and the equilibrium quantity is Q*, but the insurer has set a price of P2, so consumers demand QD and producers supply QS. Because the price cannot adjust, a shortage equal to QD − QS exists.

A surplus exists when the quantity supplied at the prevailing price exceeds the quantity demanded. In markets that are free to adjust, the price should fall so that equilibrium is restored. In some markets, prices are free to fall but do so slowly. For example, in the 1990s, many hospitals had unfilled hospital beds because the combination of managed care and new technology reduced the demand for inpatient care. Over time, insurance companies used this excess capacity to secure much lower rates (even though Medicare and Medicaid rates remained unchanged), and enough hospitals closed or down- sized to eliminate the excess capacity.

surplus A situation in which the quantity supplied at the prevailing price exceeds the quantity demanded. (The best indication of a surplus is that prices are falling.)

Quantity

Pr ic e

Q S

Q* Q D

P 2

P*

SD

EXHIBIT 10.5 A Shortage

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Chapter 10: Supply and Demand Analysis 161

How Large Will the Shortage of Primary Care Physicians Be?

The Affordable Care Act (ACA) has increased the share of the popu- lation with health insurance. Most of the newly insured are young and reasonably healthy. As a result, the ACA will primarily affect the demand for primary care services, and many anticipate a shortage of primary care physicians (Porter 2015).

But some other observers suggest that this concern is overblown (Auerbach et al. 2013). The production of primary care is changing in ways that shift its supply. One change is the rapid expansion of patient-centered medical homes, which emphasize a greater role for technology, nurses, physician assistants, and nurse practitioners. Another change is the growth of nurse-managed clinics (of which MinuteClinic, discussed in case 7.1, is an example). Both of these inno- vations reduce the number of physicians needed to provide primary care for a population.

Discussion Questions • If there were a shortage of primary care physicians, what would

happen to their incomes?

• Set up a model of the demand and supply for primary care physicians. (It should have salary on the vertical axis and number of primary care physicians on the horizontal axis.) Assuming that the production of primary care does not change (i.e., the supply curve does not shift), how do you expect the market equilibrium to change?

• How have the incomes of primary care physicians changed in the last few years? Are these changes consistent with your prediction? (You can get income data from Medscape Physician Compensation Reports.)

• Do the changes in the incomes of primary care physicians suggest there is a shortage?

• If retail clinics and patient-centered medical homes continue to expand, how will they affect the market equilibrium? Which curve would shift as a result: demand or supply?

Case 10.2

(continued)

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Economics for Healthcare Managers162

10.4 Analyses of Multiple Markets

Demand and supply models can also be helpful in forecasting the effects of shifts in one market on the equilibrium in another. Such forecasts can be made only if the markets are related—that is, the products need to be complements or substitutes.

Parente and colleagues (2017) provide an example of this effect. They argue that the ACA’s subsidies for health insurance will shift the demand for registered nurses from D1 to D2 (see exhibit 10.6). As a result, employment will rise from Q1 to Q2 and wages will rise from W1 to W2.

Quantity

Pr ic e

Q 1

Q 2

W 1

W 2

S 2D

2

D 1

EXHIBIT 10.6 Insurance

Subsidies Shift Demand for Registered

Nurses

• Deductibles have been rising quickly in recent years. How would that affect the incomes of primary care physicians?

• Patient-centered medical homes typically expand the roles of registered nurses. How would this affect the demand for primary care physicians?

• The ACA increased some payments for primary care. How would this affect the demand for primary care physicians?

Case 10.2 (continued)

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Chapter 10: Supply and Demand Analysis 163

10.5 Conclusion

Supply and demand analysis can help managers anticipate the effects of changes in policy, technology, or prices. Supply and demand analysis is a valuable tool that managers can use to quickly anticipate the effects of shifts in demand or supply curves. Short-term shifts in demand are likely to result from one of two factors: changes in insurance or shifts in the prices or char- acteristics of substitutes or complements. Short-term shifts in supply are likely to result from one of three factors: changes in regulations, shifts in the prices or characteristics of inputs, or changes in technology.

Make sure you understand the basic shapes of demand and supply curves. Most demand curves slope down, which means that consumers will buy more if prices are lower. It also means that consumers who are willing to purchase a product only at a low price do not place a high value on it. In contrast, most supply curves slope up, which means that higher prices will motivate producers to sell additional output (or motivate more producers to sell the same output).

Exercises

10.1 Physicians’ offices supply some urgent care services (i.e., services patients seek for prompt attention but not for preservation of life or limb). a. Name three other providers of urgent care services. b. What sort of shift in supply or demand would result in a market

equilibrium with higher prices and sales volume? c. What might cause such a shift? d. What sort of shift in supply or demand would result in a market

equilibrium with higher prices but lower sales volume? e. What might cause such a shift?

10.2 Suppose the market equilibrium price for immunizations is $40 and the volume is 25,000. a. Identify three providers of immunization services. b. What sort of shift in supply or demand would reduce both prices

and sales volume? c. What might cause such a shift? d. What sort of shift in supply or demand would result in a market

equilibrium with a price above $40 and a volume below 25,000? e. What might cause such a shift?

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Economics for Healthcare Managers164

10.3 The table contains data on the number of doses of an antihistamine sold per month in a small town.

Price Demand Supply

$10 185 208

$9 187 205

$8 188 202

$7 190 199

$6 191 196

$5 193 193

$4 194 190

$3 196 187

$2 197 184

$1 199 181

a. To sell 196 doses to customers, what will the price need to be? b. For stores to be willing to sell 196 doses, what will the price need

to be? c. How many doses will customers want to buy if the price is $2? d. How many doses will suppliers want to sell if the price is $2? e. Is there excess supply or excess demand at $2? f. What is the equilibrium price? How can you tell?

10.4 The table contains demand and supply data for eyeglasses in a local market.

Price Demand Supply

$300 7,400 8,320

$290 7,480 8,200

$280 7,520 8,080

$270 7,600 7,960

$260 7,640 7,840

(continued)

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Chapter 10: Supply and Demand Analysis 165

Price Demand Supply

$250 7,720 7,720

$240 7,760 7,600

$230 7,840 7,480

$220 7,880 7,360

a. At $280, how many pairs will consumers want to buy? b. How many pairs will consumers want to buy if the price is $290? c. How many pairs will stores want to sell at $290? d. Is $290 the equilibrium price? e. Is there excess supply or excess demand at $290? f. What is the equilibrium price? How can you tell?

10.5 The graph below shows a basic demand and supply graph for home care services. Identify the equilibrium price and quantity. Label them P* and Q*. a. Retirements drive up the wages of home care workers. How

would the graph change? How would P* and Q* change? b. Improved technology lets home care workers monitor use of

medications without going to clients’ homes. How would the graph change? How would P* and Q* change?

c. The number of people needing home care services increases. How would the graph change? How would P* and Q* change?

d. A change in Medicare rules expands coverage for home care services. How would the graph change? How would P* and Q* change?

Quantity

Pr ic e Supply

Demand

(continued)

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Economics for Healthcare Managers166

10.6 The demand function is Q = 600 − P, with P being the price paid by consumers. Put a list of prices ranging from $400 to $0 in a column labeled P. (Use intervals of $50.) a. Consumers have insurance with 40 percent coinsurance. For each

price, calculate the amount that consumers pay. (Put this figure in a column labeled PNet.)

b. Calculate the quantity demanded when there is insurance. (Put this figure in a column labeled DI.)

c. Plot the demand curve, putting P (not PNet) on the vertical axis. d. The quantity supplied equals 2 × P. Put these values in a column

labeled S. e. What is the equilibrium price? f. How much do consumers spend? g. How much does the insurer spend?

10.7 The demand function is Q = 1,000 − (0.5 × P). P is the price paid by consumers. Calculate the quantity demanded when there is no insurance. (Put these values in column DU of the table.)

P DU PNet DI S

$1,000

$960

$920

$880 560 $176 912 952

$840

$800

$760

$720

$680

$640

$600

$560

The state mandates coverage with 20 percent coinsurance, meaning that the demand function becomes 1,000 − (0.5 × 0.2 × P). a. For each price, calculate the amount consumers pay. (Put this

figure in column PNet.) b. Calculate the quantity demanded when there is insurance. (Put

this figure in column DI.)

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Chapter 10: Supply and Demand Analysis 167

c. Plot the two demand curves, putting P (not PNet) on the vertical axis.

d. How do DU and DI differ? Which is more elastic? 10.8 The supply function for the product in exercise 10.7 is 160 + (0.9 ×

P). P is the price received by the seller. At the equilibrium price, the quantity demanded will equal the quantity supplied. a. What was the equilibrium price before coverage? After? b. After coverage begins, how much will the product cost insurers?

How much will the product cost patients? How much did patients pay for the product before coverage started?

10.9 Consumers who can buy health insurance through an employer get a tax subsidy. Use demand and supply analysis to assess how this subsidy affects consumers who cannot buy insurance through an employer.

10.10 Why are price controls unlikely to make consumers better off if a market is reasonably competitive?

10.11 Make the business case why healthcare providers should advocate for expansion of insurance coverage for the poor.

References

Auerbach, D. I., P. G. Chen, M. W. Friedberg, R. Reid, C. Lau, P. I. Buerhaus, and A. Mehrotra. 2013. “Nurse-Managed Health Centers and Patient-Centered Medical Homes Could Mitigate Expected Primary Care Physician Shortage.” Health Affairs 32 (11): 1933–41.

Commission on Long-Term Care. 2013. Report to the Congress. Published September 30. www.gpo.gov/fdsys/pkg/GPO-LTCCOMMISSION/pdf/GPO-LTC COMMISSION.pdf.

Parente, S. T., R. Feldman, J. Spetz, B. Dowd, and E. E. Baggett. 2017. “Wage Growth for the Health Care Workforce: Projecting the Affordable Care Act Impact.” Health Services Research 52 (2): 741–62.

Porter, S. 2015. “Significant Primary Care, Overall Physician Shortage Predicted by 2025.” American Academy of Family Physicians. Published March 3. www .aafp.org/news/practice-professional-issues/20150303aamcwkforce.html.

Spetz, J., L. Trupin, T. Bates, and J. M. Coffman. 2015. “Future Demand for Long- Term Care Workers Will Be Influenced by Demographic and Utilization Changes.” Health Affairs 34 (6): 936–45.

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