Health economics最新文献

Impact of hospital-physician vertical integration on physician-administered drug spending and utilization. 医院-医生纵向一体化对医生管理药物支出和使用的影响。

IF 2 3区医学

Health economics Pub Date : 2025-02-01 Epub Date: 2024-11-12 DOI: 10.1002/hec.4909

Jonathan S Levin, Xiaoxi Zhao, Christopher Whaley

{"title":"Impact of hospital-physician vertical integration on physician-administered drug spending and utilization.","authors":"Jonathan S Levin, Xiaoxi Zhao, Christopher Whaley","doi":"10.1002/hec.4909","DOIUrl":"10.1002/hec.4909","url":null,"abstract":"We estimate the effects of hospital-physician vertical integration on spending and utilization of physician-administered drugs for hematology-oncology, ophthalmology, and rheumatology. Using a 100% sample of Medicare fee-for-service medical claims from 2013 to 2017, we find that vertical integration shifts treatments away from physician offices and toward hospital outpatient departments. These shifts are accompanied by increases in physician-administered drug administration spending per procedure for all three specialties. Spending on Part B drugs also increases for hematologist-oncologists. At the same time, physician treatment intensity, as measured by the number of beneficiaries who receive drug infusions/injections and the number of drug infusions, decreases across all three specialties. These results suggest that the incentives of the Medicare reimbursement system, particularly site-of-care payment differentials and outpatient drug reimbursement rates, interact with vertical integration to lead to higher overall spending. Policies and merger guidelines should attempt to restrain spending increases attributed to vertical integration.","PeriodicalId":12847,"journal":{"name":"Health economics","volume":" ","pages":"345-367"},"PeriodicalIF":2.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142618749","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Employment shocks and demand for pain medication: Understanding the channels that drive opioid use. 就业冲击与止痛药需求：了解驱动阿片类药物使用的渠道。

IF 2 3区医学

Health economics Pub Date : 2025-02-01 Epub Date: 2024-11-07 DOI: 10.1002/hec.4901

Isabel Musse

引用次数: 0

Scope of practice and opioid prescribing behavior of nurse practitioners serving Medicare beneficiaries. 为医疗保险受益人服务的执业护士的执业范围和阿片类药物处方行为。

IF 2 3区医学

Health economics Pub Date : 2025-02-01 Epub Date: 2024-10-05 DOI: 10.1002/hec.4904

Shishir Shakya, Alicia Plemmons

引用次数: 0

Horizontal inequity in the use of mental healthcare in Australia. 澳大利亚精神保健使用中的横向不平等。

IF 2 3区医学

Health economics Pub Date : 2025-02-01 Epub Date: 2024-11-06 DOI: 10.1002/hec.4910

Nicole Black, David W Johnston, Martin Knapp, Michael A Shields, Gloria H Y Wong

{"title":"Horizontal inequity in the use of mental healthcare in Australia.","authors":"Nicole Black, David W Johnston, Martin Knapp, Michael A Shields, Gloria H Y Wong","doi":"10.1002/hec.4910","DOIUrl":"10.1002/hec.4910","url":null,"abstract":"For people experiencing mental health problems, timely access to high-quality healthcare is imperative for improving outcomes. However, limited availability of services, high out-of-pocket costs, insufficient health literacy and stigmatizing attitudes may mean people do not receive the necessary treatment. We analyze Australian longitudinal data to document the extent and predictors of horizontal inequity in mental healthcare use among people with a newly developed mild or moderate mental disorder. Importantly, we compare people with similar health, residing in the same area, thus controlling for differences in healthcare needs and availability of services. Results suggest that mental healthcare use is not significantly associated with household income or financial hardship. In contrast, we find significant inequities by educational attainment, with university graduates around 50% more likely to receive mental healthcare than high-school dropouts. These findings are robust across subsamples and alternative modeling approaches, including panel data models with individual fixed-effects. Additional explorations of the education gradient suggest a potential pathway through mental health-specific knowledge and attitudes.","PeriodicalId":12847,"journal":{"name":"Health economics","volume":" ","pages":"297-315"},"PeriodicalIF":2.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142582340","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Socioeconomic inequalities in waiting times for breast cancer surgery. 乳腺癌手术等待时间的社会经济不平等。

IF 2 3区医学

Health economics Pub Date : 2025-02-01 Epub Date: 2024-10-03 DOI: 10.1002/hec.4906

Maria Ana Matias, Rita Santos, Luigi Siciliani, Peter Sivey, Andrew Proctor

{"title":"Socioeconomic inequalities in waiting times for breast cancer surgery.","authors":"Maria Ana Matias, Rita Santos, Luigi Siciliani, Peter Sivey, Andrew Proctor","doi":"10.1002/hec.4906","DOIUrl":"10.1002/hec.4906","url":null,"abstract":"Prompt access to cancer care is a policy priority in several OECD countries, because delayed access can exacerbate deleterious health outcomes. Access to care based on need remains a key pillar of publicly-funded health systems. This study tests for the presence of inequalities in waiting times by socioeconomic status for patients receiving breast cancer surgery (mastectomy or breast conserving surgery) in England using the Hospital Episode Statistics. We investigate separately the pre-COVID-19 period (April 2015-January 2020), and the COVID-19 period (February 2020-March 2022). We use linear regression models to study the association between waiting times and income deprivation measured at the patient's area of residence. We control for demographic factors, type and number of comorbidities, past emergency admissions and Healthcare Resource Groups, and supply-level factors through hospital fixed effects. In the pre-COVID-19 period, we do not find statistically significant associations between income deprivation in the patient's area of residence and waiting times for surgery. In the COVID-19 period, we find that patients living in the most deprived areas have longer waiting times by 0.7 days (given a mean waiting time of 20.6 days).","PeriodicalId":12847,"journal":{"name":"Health economics","volume":" ","pages":"203-224"},"PeriodicalIF":2.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142371559","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Mental health impacts of spousal caregiving intensity in the US. 美国配偶照料强度对心理健康的影响。

IF 2 3区医学

Health economics Pub Date : 2025-02-01 Epub Date: 2024-10-27 DOI: 10.1002/hec.4908

Jennifer A Ailshire, Maria Casanova

{"title":"Mental health impacts of spousal caregiving intensity in the US.","authors":"Jennifer A Ailshire, Maria Casanova","doi":"10.1002/hec.4908","DOIUrl":"10.1002/hec.4908","url":null,"abstract":"In the US, spouses are a major source of informal care for older adults and, therefore, key to the US national strategy to provide long-term care to the growing population of older adults. Understanding the mental health impacts of spousal caregiving is therefore critically important. Existing studies on the topic have often been limited by methodological limitations, and most overlook the role of caregiving intensity. In this study, we assess the impact of providing different intensities of caregiving to a spouse on mental health outcomes using data from the Health and Retirement Study. We address the endogeneity of the decision to provide different caregiving intensities using an augmented inverse probability weighted (AIPW) estimator adapted to handle multivalued treatments. We check the robustness of our estimates to the AIPW's identifying assumptions by re-estimating the model using a dynamic fixed effects estimator. We find strong evidence that becoming a caregiver is associated with worsened mental health outcomes for women, while the evidence for men is weaker. When disaggregating by caregiving intensity, we find that transitions into high-intensity caregiving lead to large increases in depression symptoms and the probability of exhibiting major depression for both men and women. The overall mental health impact of transiting into caregiving is driven almost exclusively by the negative impact of high-intensity caregiving, as transitions into low- and moderate-intensity caregiving are not associated with worsening mental health in most specifications. This study provides timely insights that can inform the targeting of long-term care policies and programs aimed at supporting family caregivers of older adults.","PeriodicalId":12847,"journal":{"name":"Health economics","volume":" ","pages":"267-282"},"PeriodicalIF":2.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142499075","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Unpacking the care-related quality of life effect of England's publicly funded adult social care. A panel data analysis. 解读英格兰政府资助的成人社会护理对与护理相关的生活质量的影响。面板数据分析。

IF 2 3区医学

Health economics Pub Date : 2025-02-01 Epub Date: 2024-10-05 DOI: 10.1002/hec.4907

Andrea Salas-Ortiz, Francesco Longo, Karl Claxton, James Lomas

{"title":"Unpacking the care-related quality of life effect of England's publicly funded adult social care. A panel data analysis.","authors":"Andrea Salas-Ortiz, Francesco Longo, Karl Claxton, James Lomas","doi":"10.1002/hec.4907","DOIUrl":"10.1002/hec.4907","url":null,"abstract":"Adult Social Care (ASC) is the publicly-funded long-term care program in England that provides support with activities of daily living to people experiencing mental and/or physical challenges. Existing evidence suggests that ASC expenditure improves service users' care-related quality of life (CRQoL). However, less is known about the channels through which this effect exists and the effect on outcomes other than CRQoL. We fill this gap by analyzing survey data on ASC service users who received long-term support from 2014/15 to 2019/20 using panel data instrumental variable methods. We find that the beneficial impact of ASC expenditure on the CRQoL of both new and existing users is mostly driven by users aged 18-64 without any learning disability and users with no learning disability aged 65 or older receiving community-based ASC. Moreover, control over daily life, occupation, and social participation are the CRQoL domains that are improved the most. We also find that ASC expenditure has a beneficial effect on several other outcomes beyond CRQoL for both new and existing users including user satisfaction and experience, the ability to carry out activities of daily living independently, whether their home is designed around needs, accessibility to local places, general health, and mental health through reduced anxiety and depression. Greater ASC expenditure, however, does not address the need for other forms of support such as unpaid informal and privately-funded care.","PeriodicalId":12847,"journal":{"name":"Health economics","volume":" ","pages":"246-266"},"PeriodicalIF":2.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142377783","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

The addition of cannabis to prescription drug monitoring programs and medication fills in Medicaid. 将大麻纳入处方药监控计划和医疗补助中的药物填充。

IF 2 3区医学

Health economics Pub Date : 2025-02-01 Epub Date: 2024-11-04 DOI: 10.1002/hec.4911

Shelby R Steuart

{"title":"The addition of cannabis to prescription drug monitoring programs and medication fills in Medicaid.","authors":"Shelby R Steuart","doi":"10.1002/hec.4911","DOIUrl":"10.1002/hec.4911","url":null,"abstract":"To date, there is considerable evidence of the medical applications of cannabis, however concerns regarding the safety of cannabis are also mounting. To improve the safety of cannabis, nine states have added medical cannabis to their state PDMPs, helping providers to take patient cannabis use into consideration when making prescribing decisions. Across a variety of models using Medicaid State Drug Utilization claims data, I find statistically significant reductions in severely and moderately contraindicated medication fills across two outcomes. In my main specification, adding cannabis to a state PDMP is associated with a 14.4% (p < 0.01) and 7.74% (p < 0.001) decrease in the units per prescription, for severely and moderately contraindicated medications, respectively, as compared to states with legal medical cannabis dispensaries open. An interesting spillover effect of adding cannabis to PDMPs is an apparent decrease in the prescribing of scheduled narcotics, with Schedule II medications seeing a moderately significant decrease and Schedule IV medications seeing a 11.4% decrease (p < 0.01) in the prescribing rate and a 16.2% decrease (p < 0.001) in the units per prescription. The main analysis was conducted using the Borusyak et al. (2023) Imputation Estimator with a robustness check using the Callaway and Sant'Anna (2021) difference-in-difference. This work presents evidence that adding cannabis to a state PDMP impacts provider prescribing decisions involving medications that are contraindicated for use with cannabis as well as controlled substances. This paper demonstrates that adding cannabis to PDMPs influences prescribing and thus has the potential to make medical cannabis use safer. Conversely, this work indicates providers may have bias against patients who use cannabis and deny them life-improving medications (like controlled ADHD medication or opioids) on the basis of medical cannabis use. This paper also contributes to the literature comparing DD outcomes estimated using Borusyak, Jaravel, and Spiess' (2023) Imputation Estimator and Callaway and Sant'Anna's (2021) DD Estimator.","PeriodicalId":12847,"journal":{"name":"Health economics","volume":" ","pages":"283-296"},"PeriodicalIF":2.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142575907","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Daylight Saving Time and Automobile Accidents: Evidence From Chile.

IF 2 3区医学

Health economics Pub Date : 2025-01-25 DOI: 10.1002/hec.4936

Roberto Gillmore

引用次数: 0

Health Shock Effects on Diet: More Severe Shock-Stronger Response?

IF 2 3区医学

Health economics Pub Date : 2025-01-22 DOI: 10.1002/hec.4940

Anna Kristina Edenbrandt, Kim Wadt Skak-Hansen, Sinne Smed

引用次数: 0