International Journal of Health Economics and Management最新文献

{"title":"The incidence of catastrophic and impoverishing health spending in Morocco: the value added of new methodologies : Evidence from the 2014 National Household Living Standards Survey.","authors":"Abdeljalil Hassani, Mohcine Bakhat, Abdeslam Boudhar","doi":"10.1007/s10754-025-09397-4","DOIUrl":"https://doi.org/10.1007/s10754-025-09397-4","url":null,"abstract":"<p><p>One of the key objectives of the Moroccan government in achieving universal health coverage (UHC) in Morocco is to improve household financial protection against catastrophic health expenditure (CHE). However, there is no consensus on how to measure CHE. Moreover, measuring CHE using traditional methods poses a challenge for equity analysis and pro-poor policy initiatives. Therefore, this paper aims to conduct an in-depth national analysis to inform policymakers about the extent, distribution and causes of financial hardship. In addition, this study aimed to explore the equity and policy implications of different capacity-to-pay (CTP) methodologies for calculating CHE in Morocco. We present estimates of catastrophic and impoverishing health spending incidence using different methods. These methods include (i) the budget share method (BS method), (ii) the partial normative food expenditure method (Normative food method), (iii) Wagstaff and Eozenou's approach (WAE approach), and (iv) the normative food, housing (rent), and utilities (FHU) method (WHO EURO method). The data comes from the 2014 Moroccan National Household Consumption and Expenditure Survey (NHCES). To measure changes in financial protection between the four calculation methods, we also use a weighted financial protection index (FP index) and another index measuring the fairness of financial contributions (FFC). CHE incidence estimates were similar using the WHO EURO method and the BS method at the threshold of 15% of a household's CTP. The estimate of impoverishing out-of-pocket payments (OOP) was 1.31% when using the food poverty line (FOOD-PL) and 1.93% when using the FHU poverty line (FHU-PL). In addition, the further impoverishing OOP estimate was 3.39% and 5.41% using the FOOD-PL and FHU-PL, respectively. The study shows that, unlike the new methods, conventional methods overestimate the financial burden of the better-off. The BS method suggests that the Moroccan health system is egalitarian, while the new approaches suggest that it meets normative equity objectives. The FP index and the FFC decrease as the poverty line rises. Medicine is the first driver of financial hardship. The monetary transfer needed to compensate for the impoverishment caused by OOP is about 141 MAD and 269 MAD per person per year, using FOOD-PL and FHU-PL, respectively. The results suggest that the health insurance system should be reviewed to further reduce CHE and impoverishment in Morocco. The use of the BS method to track target 3.8.2 of the SDGs raises concerns about the ability of the SDG process to generate appropriate policy guidance on UHC. Studies using different approaches. such as this one. are expected to facilitate informed decision-making and prevent potential political manipulation in demonstrating the success or failure of a policy. HIGHLIGHTS: • Our study evaluates the equity implications of different CTP methods for estimating CHE in Morocco. • Traditional methods systematically ","PeriodicalId":44403,"journal":{"name":"International Journal of Health Economics and Management","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144112280","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"经济学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The causal effects of mandatory health insurance coverage expansion in Switzerland.","authors":"Boris Kaiser, Andreas Kohler, Christian P R Schmid","doi":"10.1007/s10754-025-09396-5","DOIUrl":"https://doi.org/10.1007/s10754-025-09396-5","url":null,"abstract":"<p><p>The expansion of public health insurance programs affects payers as well as the behavior of service providers. In this paper, we study the expansion of Swiss mandatory health insurance in 2012 to include complementary and alternative medicine physician services. The policy change provides a quasi-experimental design that allows us to estimate the causal effects on the payer and physician behavior using a difference-in-differences framework. First, we find that from the payer's perspective, expanding coverage to complementary and alternative medicine increases physician costs per patient by about 7 percent. Second, we find that the increase in physician service costs per patient in mandatory health insurance is almost exactly offset by a decrease in supplementary health insurance costs. Thus, suggesting that the behavior of physicians was unchanged by the coverage expansion.</p>","PeriodicalId":44403,"journal":{"name":"International Journal of Health Economics and Management","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144081252","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"经济学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The impact of periodic updates to health benefits plan: access gains without cost savings?","authors":"Oscar Espinosa, Paul Rodríguez-Lesmes, Jhonathan Rodríguez, Diego Ávila, Sergio Basto, Giancarlo Romano, Lorena Mesa, Hernán Enríquez","doi":"10.1007/s10754-025-09394-7","DOIUrl":"https://doi.org/10.1007/s10754-025-09394-7","url":null,"abstract":"<p><p>Expanding explicit Health Benefit Plans (HBP) is a key strategy for achieving universal health coverage while maintaining financial sustainability. However, little is known about the broader effects of periodic updates to these plans on healthcare utilization, expenditures, and market dynamics. This study examines the impact of including new health technologies in Colombia's HBP covered by the Capitation Payment Unit (CPU) between 2012 and 2019, using administrative data and a difference-in-differences approach with multiple periods. Our results indicate that inclusion in the HBP-CPU led to a substantial increase in utilization and access, particularly in remote areas, but had mixed effects on expenditures. While the number of unique users and prescription frequency rose significantly, the cost per user remained stable for procedures but increased for medications, likely due to higher demand and market structures. These findings suggest that although periodic HBP updates enhance access and effective coverage, they do not necessarily generate cost savings. Strengthening health technology assessment processes, integrating price regulation policies, and implementing cost-containment mechanisms are essential for ensuring the financial sustainability of health systems that regularly update benefit plans.</p>","PeriodicalId":44403,"journal":{"name":"International Journal of Health Economics and Management","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144040686","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"经济学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Influence of prior knowledge and experience on willingness to pay for home hospice services: a contingent valuation study.","authors":"Caroline Steigenberger, Andrea M Leiter, Uwe Siebert, Claudia Schusterschitz, Magdalena Flatscher-Thoeni","doi":"10.1007/s10754-025-09393-8","DOIUrl":"https://doi.org/10.1007/s10754-025-09393-8","url":null,"abstract":"<p><p>Home hospice services contribute to dying in dignity by addressing medical and social needs at the end of life. The respective monetary valuation in a sense of willingness to pay is not available yet. We aim to quantify the benefits of home hospice services to society using society's monetary valuation and examine the influence of prior knowledge and experience on willingness to pay for home hospice services. A nationwide cross-sectional contingent valuation study was conducted in Austria. We analyzed the impact of the determinants of interest on having a positive willingness to pay for home hospice services via multivariate Probit regression. Stated willingness to pay was analyzed using interval regression. Variable selection of potential influence factors and confounders was based on the literature. The variables of interest, prior knowledge of and experience with home hospice services, were represented by twelve related variables. We included 1262 respondents in the analysis. The two-part regression analysis showed a statistically significant positive impact on the probability of having a positive willingness to pay by prior knowledge of home hospice services, prior donations, and the wish of not dying alone. Prior donations also increase the level of willingness to pay. The probability of a positive willingness to pay was statistically significantly lower for respondents that stated to have experienced the death of more than ten close persons and perceived spending time with dying persons as burden than their respective counterparts. Our study provides evidence that information campaigns to increase the recognition and awareness of existing home hospice services could increase their perceived value in society.</p>","PeriodicalId":44403,"journal":{"name":"International Journal of Health Economics and Management","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143711502","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"经济学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The predicted impact of the proposed alcohol production deregulation policy on consumption in Thailand.","authors":"Sukampon Chongwilaikasaem, Eva Ayaragarnchanakul, Chaleampong Kongcharoen, Chalermpat Pongajarn, Jürgen Rehm","doi":"10.1007/s10754-025-09395-6","DOIUrl":"https://doi.org/10.1007/s10754-025-09395-6","url":null,"abstract":"<p><p>Alcohol deregulation has recently been a topic of debate in Thailand, with policymakers weighing the potential economic benefits against public health harms and social concerns. This study estimates the impact on alcohol consumption levels in Thailand if barriers to producing alcoholic beverages are removed. Since the deregulation has not yet been implemented, we employed a randomized survey design for a Volumetric Choice Experiment administered to 1220 individuals, both drinkers and non-drinkers. The \"treatment\" group (with deregulation) was compared to the \"control\" group (without deregulation). While respondents in the control group were presented with existing drinks supplied by large producers, respondents in the treatment group were presented with new drinks supplied by small local producers alongside the existing options. Deregulation would introduce a wider variety of drinks, including cheaper local craft beer, white spirits, and brown spirits. Various scenarios of product availability and pricing were validated by experts. Our analysis reveals a 19.93% rise in total annual alcohol per capita consumption (APC), with a statistically significant difference between the treatment and control groups at a 90% confidence level. Further exploration into cross-price elasticities of demand suggests new drinks would partly substitute current options. Policymakers should carefully consider the public health implications, including increased risks of alcohol-related harms, as well as potential economic benefits from market liberalization. Regulatory measures, such as taxation, age restrictions, and public awareness campaigns, may be necessary to mitigate the projected consumption increase and associated social costs.</p>","PeriodicalId":44403,"journal":{"name":"International Journal of Health Economics and Management","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143658270","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"经济学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Physicians' incentives, patients' characteristics, and quality of care: a systematic experimental comparison of performance-pay systems.","authors":"Jeannette Brosig-Koch, Mona Groß, Heike Hennig-Schmidt, Nadja Kairies-Schwarz, Daniel Wiesen","doi":"10.1007/s10754-025-09390-x","DOIUrl":"https://doi.org/10.1007/s10754-025-09390-x","url":null,"abstract":"<p><p>How performance pay affects physicians' medical service provision and the quality of care is relevant for researchers and policy-makers alike. This paper systematically studies how performance pay, complementing either fee-for-service or capitation, affects physicians' medical service provision and the quality of care for heterogeneous patients. Using a series of controlled behavioral experiments with physicians and students, we test the incentive effect of performance pay at a within-subject level. We consider a performance pay scheme which grants a discrete bonus if a quality threshold is reached, which varies with the patients' severity of illness. We find that performance pay significantly reduces non-optimal service provision and enhances the quality of care. Effect sizes depend on the patients' severity of illness and whether performance pay is blended with fee-for-service or capitation. Health policy implications, including a cost benefit analysis of introducing performance pay, are discussed.</p>","PeriodicalId":44403,"journal":{"name":"International Journal of Health Economics and Management","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143665052","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"经济学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Informal and formal long-term care utilization and unmet needs in Europe: examining socioeconomic disparities and the role of social policies for older adults.","authors":"Viktoria Szenkurök, Daniela Weber, Marcel Bilger","doi":"10.1007/s10754-024-09378-z","DOIUrl":"10.1007/s10754-024-09378-z","url":null,"abstract":"<p><p>The rising number of older adults with limitations in their daily activities has major implications for the demands placed on long-term care (LTC) systems across Europe. Recognizing that demand can be both constrained and encouraged by individual and country-specific factors, this study explains the uptake of home-based long-term care in 18 European countries with LTC policies and pension generosity along with individual factors such as socioeconomic status. Using data from the Survey of Health, Ageing and Retirement in Europe conducted in 2019, we apply a two-part multilevel model to assess if disparities in use of LTC are driven by disparities in needs or disparities in use of care when in need. While individual characteristics largely affect the use of care through its association with disparities in need, country-level characteristics are important for the use of care when in need. In particular, the better health of wealthier and more educated individuals makes them less likely to use any type of home-based personal care. At the country level, results show that the absence of a means-tested benefit scheme and the availability of cash-for-care benefits (as opposed to in-kind) are strongly associated with the use of formal care, whether it is mixed (with informal care) or exclusive. LTC policies are, however, shown to be insufficient to significantly reduce unmet needs for personal care. Conversely, generous pensions are significantly associated with lower unmet needs, underscoring the importance of considering the likely adverse effects of future pension reforms.</p>","PeriodicalId":44403,"journal":{"name":"International Journal of Health Economics and Management","volume":" ","pages":"87-106"},"PeriodicalIF":1.5,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12003520/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141077158","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"经济学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The pharmaceutical distributors' efficiency in Italy: an assessment of the impact of the 2010 reimbursable drug pricing reform.","authors":"Giorgio Matteucci, Daniele De Santis","doi":"10.1007/s10754-024-09387-y","DOIUrl":"10.1007/s10754-024-09387-y","url":null,"abstract":"<p><p>To assess the impact on pharmaceutical wholesalers' financial viability and efficiency of the reform of the wholesalers' and pharmacies' margins on reimbursable drugs enacted in 2010 that halved the distributors' margins. We perform a stochastic frontier analysis on a large original dataset comprising financial and production data from 2009, a year prior to the reform, to 2019 gathered in order to assess the impact of the reform on firms' profitability and efficiency. The implemented policies have not been successful in fostering the development of a more efficient market that would ultimately benefit social welfare. Overall, our findings indicate that bigger firms lag behind their smaller counterparts in terms of efficiency, even in the long run. Our findings also suggest that an efficient pharmaceutical wholesaler is currently unable to generate normal profit from the distribution of reimbursable drugs. Compared to the other European countries, that seem to have a cost oriented approach, Italy provides one of the lowest margins to pharmaceutical wholesalers without properly considering the costs of the drugs' distribution. A new regulatory approach to wholesaling margins is needed in order to improve efficiency and welfare.</p>","PeriodicalId":44403,"journal":{"name":"International Journal of Health Economics and Management","volume":" ","pages":"1-26"},"PeriodicalIF":1.5,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142606689","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"经济学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Do depressive symptoms influence nonattendance at work? A semiparametric approach.","authors":"Patricia Moreno-Mencia, Ana Fernández-Sainz, Juan M Rodríguez-Póo","doi":"10.1007/s10754-025-09389-4","DOIUrl":"10.1007/s10754-025-09389-4","url":null,"abstract":"<p><p>Depression is a common disorder that impacts on individuals' ability to perform daily activities, including those required for working. People with poor health tend to have problems needing medical care and therefore need time away from their work. This paper considers a structural model of labor absenteeism, considering the effect of depression. Our objective is to estimate the effects that depressive symptoms (among other factors) have on absenteeism while avoiding inconsistency in estimators due to sample selection and endogenous regressor. We are unwilling to impose strong assumptions, which are sometimes not required by theory, so our model is semiparametric. Based on microdata from the European Health Survey in Spain, our results indicate that depressive symptoms have a negative effect on working time and increase absenteeism. We conclude that depressed workers lose on average around 12 more days per year than non depressed ones. Levels of absenteeism are also estimated to be higher on average among obese people and among older people (the effect of age is positive). On the other hand, non-college education, being male and being self-employed are factors related to lower levels of absenteeism.</p>","PeriodicalId":44403,"journal":{"name":"International Journal of Health Economics and Management","volume":" ","pages":"67-85"},"PeriodicalIF":1.5,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12003569/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143543896","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"经济学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Equity and efficiency effects of flat premiums.","authors":"Cristian Pardo, Jorge Sabat","doi":"10.1007/s10754-024-09388-x","DOIUrl":"10.1007/s10754-024-09388-x","url":null,"abstract":"<p><p>This paper analyzes the impact of flat premiums on equity and efficiency within a regulated market. We examine the consequences of shifting from a risk-adjusted premium model to a flat premium system, particularly focusing on how this shift affects different income groups and market efficiency. Using a combination of theoretical modeling and empirical analysis, we find that flat premiums may lead to increased cross-subsidization among participants, with notable effects on both equity and efficiency. Our results suggest that while flat premiums simplify the regulatory framework, they also introduce trade-offs that policymakers must carefully consider.</p>","PeriodicalId":44403,"journal":{"name":"International Journal of Health Economics and Management","volume":" ","pages":"27-49"},"PeriodicalIF":1.5,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142865513","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"经济学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}