International Journal of Health Economics and Management最新文献

{"title":"Patient and provider-level factors associated with changes in utilization of treatments in response to evidence on ineffectiveness or harm.","authors":"Laura Barrie Smith,&nbsp;Nihar R Desai,&nbsp;Bryan Dowd,&nbsp;Alexander Everhart,&nbsp;Jeph Herrin,&nbsp;Lucas Higuera,&nbsp;Molly Moore Jeffery,&nbsp;Anupam B Jena,&nbsp;Joseph S Ross,&nbsp;Nilay D Shah,&nbsp;Pinar Karaca-Mandic","doi":"10.1007/s10754-020-09282-2","DOIUrl":"https://doi.org/10.1007/s10754-020-09282-2","url":null,"abstract":"<p><p>High-quality health care not only includes timely access to effective new therapies but timely abandonment of therapies when they are found to be ineffective or unsafe. Little is known about changes in use of medications after they are shown to be ineffective or unsafe. In this study, we examine changes in use of two medications: fenofibrate, which was found to be ineffective when used with statins among patients with Type 2 diabetes (ACCORD lipid trial); and dronedarone, which was found to be unsafe in patients with permanent atrial fibrillation (PALLAS trial). We examine the patient and provider characteristics associated with a decline in use of these medications. Using Medicare fee-for-service claims from 2008 to 2013, we identified two cohorts: patients with Type 2 diabetes using statins (7 million patient-quarters), and patients with permanent atrial fibrillation (83 thousand patient-quarters). We used interrupted time-series regression models to identify the patient- and provider-level characteristics associated with changes in medication use after new evidence emerged for each case. After new evidence of ineffectiveness emerged, fenofibrate use declined by 0.01 percentage points per quarter (95% CI - 0.02 to - 0.01) from a baseline of 6.9 percent of all diabetes patients receiving fenofibrate; dronedarone use declined by 0.13 percentage points per quarter (95% CI - 0.15 to - 0.10) from a baseline of 3.8 percent of permanent atrial fibrillation patients receiving dronedarone. For dronedarone, use declined more quickly among patients dually-enrolled in Medicare and Medicaid compared to Medicare-only patients (P < 0.001), among patients seen by male providers compared to female providers (P = 0.01), and among patients seen by cardiologists compared to primary care providers (P < 0.001).</p>","PeriodicalId":44403,"journal":{"name":"International Journal of Health Economics and Management","volume":"20 3","pages":"299-317"},"PeriodicalIF":2.4,"publicationDate":"2020-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1007/s10754-020-09282-2","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37886344","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":"Effects of pay-for-performance on prescription of hypertension drugs among public and private primary care providers in Sweden.","authors":"Lina Maria Ellegård","doi":"10.1007/s10754-020-09278-y","DOIUrl":"10.1007/s10754-020-09278-y","url":null,"abstract":"<p><p>This study exploits policy reforms in Swedish primary care to examine the effect of pay-for-performance (P4P) on compliance with hypertension drug guidelines among public and private health care providers. Using provider-level outcome data for 2005-2013 from the Swedish Prescription Register, providers in regions using P4P were compared to providers in other regions in a difference-in-differences analysis. The results indicate that P4P improved guideline compliance regarding prescription of angiotensin converting enzyme inhibitors and angiotensin receptor blockers. The effect was mainly driven by private providers, suggesting that policy makers should take ownership into account when designing incentives for health care providers.</p>","PeriodicalId":44403,"journal":{"name":"International Journal of Health Economics and Management","volume":"20 3","pages":"215-228"},"PeriodicalIF":2.4,"publicationDate":"2020-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1007/s10754-020-09278-y","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37560702","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":"Public satisfaction with health system coverage, empirical evidence from SHARE data.","authors":"Aida Isabel Tavares,&nbsp;Pedro Lopes Ferreira","doi":"10.1007/s10754-020-09279-x","DOIUrl":"https://doi.org/10.1007/s10754-020-09279-x","url":null,"abstract":"<p><p>People's satisfaction with the health system, including the coverage provided, has been a concern for some years now but research into the main explanatory factors is in progress. This work focuses on European countries plus Israel, using the SHARE database to find what determines people's satisfaction with the basic coverage provided by the health system of each country. On top of the usual individual socioeconomic characteristics, other explanatory factors were also considered. These include, at individual level, trust in others, political positioning, and risk aversion; at country level, they include access to specialist care and the type of health system financing. Estimation of an ordered logistic model found that the main predictors for satisfaction with a health system's basic coverage include trust in others, unmet health needs, self-assessed health, free access to specialists, health system financed through social insurance, and out-of-pocket payments. These results provide the basis for possible policies designed to improve people's satisfaction.</p>","PeriodicalId":44403,"journal":{"name":"International Journal of Health Economics and Management","volume":"20 3","pages":"229-249"},"PeriodicalIF":2.4,"publicationDate":"2020-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1007/s10754-020-09279-x","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37646840","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 the uninsured demand less care? Evidence from Maryland's hospitals.","authors":"Amanda Cook","doi":"10.1007/s10754-020-09280-4","DOIUrl":"https://doi.org/10.1007/s10754-020-09280-4","url":null,"abstract":"<p><p>Uninsured individuals receive fewer healthcare services for at least three reasons: responsibility for the entire bill, higher prices, and potential provider reductions for concern of nonpayment. I isolate reductions when uninsured patients are solely financially responsible by capitalizing on Maryland's highly regulated health care system. Prices are set by the state, are uniform across all patients, and hospitals are compensated for free care and bad debt. I use a unique feature of the data, multiple readmissions for patients who gain or lose insurance between visits, to isolate the reductions in quantity demanded when individuals are faced with paying the full price without an insurance contribution. A Blinder-Oaxaca decomposition estimates uninsured individuals receive 6% fewer services after accounting for differences in patient, illness, and hospital characteristics than when these same individuals are insured.</p>","PeriodicalId":44403,"journal":{"name":"International Journal of Health Economics and Management","volume":"20 3","pages":"251-276"},"PeriodicalIF":2.4,"publicationDate":"2020-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1007/s10754-020-09280-4","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37714679","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":"Competition and market structure in the dental industry.","authors":"Thanh An Nguyen Le,&nbsp;Anthony T Lo Sasso","doi":"10.1007/s10754-019-09277-8","DOIUrl":"https://doi.org/10.1007/s10754-019-09277-8","url":null,"abstract":"<p><p>We use Survey of Dental Practice data from 1983 to 2012 to examine market power of dentists and hygienists in private practice. Our findings are consistent with a dental market wherein practices use hygienist services as a \"loss leader\" in order to steer patients into more lucrative dental services, which exhibit the ability to markup price above marginal cost. Both dental care exhibits an elasticity of demand of roughly - 0.2, while hygienist care exhibits and elasticity of demand of nearly - 0.6. Another theme that emerged from our findings is the evidence for significant economies of scale in the dental market. The overall returns to scale parameter of 2.1 suggests significant increasing returns to scale are available to the typical dental practice. Given that the typical practice has 1.5 dentists, the finding is not surprising. While returns to scale diminishes with visit volume, the largest quartile of practices still has meaningful increasing returns to scale of roughly 1.75.</p>","PeriodicalId":44403,"journal":{"name":"International Journal of Health Economics and Management","volume":"20 2","pages":"201-214"},"PeriodicalIF":2.4,"publicationDate":"2020-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1007/s10754-019-09277-8","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37525015","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 European principle „rehabilitation–integration–return to the labor market“ and disability assessment","authors":"P. Mancheva","doi":"10.14748/hem.v19i3.6604","DOIUrl":"https://doi.org/10.14748/hem.v19i3.6604","url":null,"abstract":": Introduction: The restoration of the working ability with a definite period of employment is enshrined in the definition of the Expert Committee of Rehabilitation at WHO (1958). In Bulgaria, the Territorial Expert Medical Committees (TEMCs) only carry out a medical assessment of disability, and the social assistance based on it is the Social Assistance Agency’s commitment. The purpose of this article is to explore the importance of the expert decision (disability assessment) for the implementation of the principle „rehabilitation-integration-return to the labor market“. Material and Methods: The opinion of 612 patients with disabilities, certified/re-certified by General TEMC (St. Marina Hospital, Varna), was examined. The extract represents 10.2% of those who passed through the Commission in 2017 and was formed in accordance with the inclusion and exclusion criteria. They are organized in the following areas: Results and Discussion: The analysis of the demographic indicators of the persons included in the given extract allows us to get an idea of the characteristics of this vulnerable group in Varna region’s society. 85.9% of them are persons of working age (16 to 65 years), 64.1% are married, 59.6% are living in a regional city and 40.5% are without employment . Only 4.4% (n = 612) of the persons with a TEMC-determined invalidity/ disability considered rehabilitation sufficient. 81.9% (n = 209) of those who were denied a disability rate during their last re-certification reported that they were not advised to rehabilitation. Conclusion: The study of the principle „rehabilitation-integration-return to the labor market“ under the current Bulgarian legislation reveals a number of problems that do not allow its implementation. In Bulgaria, the activity of TEMC is oriented towards determining the medical assessment of disability without the possibility of introduction to mandatory rehabilitation and control afterwards.","PeriodicalId":44403,"journal":{"name":"International Journal of Health Economics and Management","volume":"77 1","pages":""},"PeriodicalIF":2.4,"publicationDate":"2020-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84652891","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 distributive fairness of out-of-pocket healthcare expenditure in the Russian Federation.","authors":"Pavitra Paul","doi":"10.1007/s10754-019-09268-9","DOIUrl":"https://doi.org/10.1007/s10754-019-09268-9","url":null,"abstract":"<p><p>This article examines the effects of socioeconomic position and urban-rural settlement on the distribution of out-of-pocket expenditure (OPE) for health in the Russian Federation. Data comes from 2005 to 2016 waves of the Russian Longitudinal Monitoring Survey. Concentration index reflects changes in the distribution of OPE between the worse-off and the better-off Russians over a 12-year period. Finally, unconditional quantile regression-a recentred influence function approach estimates differential impacts of covariates along the distribution of OPE. OPE is concentrated amongst the better-off Russians in 2016. Urban settlements contribute to top end OPE distribution for the richest and town settlements, at the median for the richest and the poorest. Our model for the analysis is unique in the context of study population, as it marginalises the effect over the distributions of other covariates used in the model.</p>","PeriodicalId":44403,"journal":{"name":"International Journal of Health Economics and Management","volume":"20 1","pages":"13-40"},"PeriodicalIF":2.4,"publicationDate":"2020-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1007/s10754-019-09268-9","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37054023","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 impact of hospital-acquired infections on the patient-level reimbursement-cost relationship in a DRG-based hospital payment system.","authors":"Klaus Kaier,&nbsp;Martin Wolkewitz,&nbsp;Philip Hehn,&nbsp;Nico T Mutters,&nbsp;Thomas Heister","doi":"10.1007/s10754-019-09267-w","DOIUrl":"https://doi.org/10.1007/s10754-019-09267-w","url":null,"abstract":"<p><p>Hospital-acquired infections (HAIs) are a common complication in inpatient care. We investigate the incentives to prevent HAIs under the German DRG-based reimbursement system. We analyze the relationship between resource use and reimbursements for HAI in 188,731 patient records from the University Medical Center Freiburg (2011-2014), comparing cases to appropriate non-HAI controls. Resource use is approximated using national standardized costing system data. Reimbursements are the actual payments to hospitals under the G-DRG system. Timing of HAI exposure, cost-clustering within main diagnoses and risk-adjustment are considered. The reimbursement-cost difference of HAI patients is negative (approximately - €4000). While controls on average also have a negative reimbursement-cost difference (approximately - €2000), HAI significantly increase this difference after controlling for confounding and timing of infection (- 1500, p < 0.01). HAIs caused by vancomycin-resistant Enterococci have the most unfavorable reimbursement-cost difference (- €10,800), significantly higher (- €9100, p < 0.05) than controls. Among infection types, pneumonia is associated with highest losses (- €8400 and - €5700 compared with controls, p < 0.05), while cost-reimbursement relationship for Clostridium difficile-associated diarrhea is comparatively balanced (- €3200 and - €500 compared to controls, p = 0.198). From the hospital administration's perspective, it is not the additional costs of HAIs, but rather the cost-reimbursement relationship which guides decisions. Costs exceeding reimbursements for HAI may increase infection prevention and control efforts and can be used to show their cost-effectiveness from the hospital perspective.</p>","PeriodicalId":44403,"journal":{"name":"International Journal of Health Economics and Management","volume":"20 1","pages":"1-11"},"PeriodicalIF":2.4,"publicationDate":"2020-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1007/s10754-019-09267-w","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37030287","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":"Reasons for unmet needs for health care: the role of social capital and social support in some western EU countries.","authors":"Damiano Fiorillo","doi":"10.1007/s10754-019-09271-0","DOIUrl":"https://doi.org/10.1007/s10754-019-09271-0","url":null,"abstract":"<p><p>This paper focuses on the demand side factors that determine access to health care and analyses the issues of unmet needs for health care and the reasons thereof in western EU countries. A probit model is estimated from a sample of the whole population, accounting for the possibility of individual selection in unmet needs for health care (UN) (selection equation). Expanded probit models (including the inverse Mills ratio) are then used on the reasons for unmet needs (RUN) with social capital and social support as determinants and using the European Union Statistics on Income and Living Conditions dataset from 2006. In the RUN equations, the findings show that females, large households, people with low income and financial constraints, the unemployed and those in poor health have a higher probability of declaring unmet needs due to economic costs. Additionally, people in tertiary education, those with high income and the employed have a higher probability of not visiting a doctor when needed due to time constraints. Furthermore, the frequency of contact with friends and the ability to ask for help are correlated with a lower probability of unmet needs due to economic costs, while the frequency of contact with relatives is correlated with a lower probability of unmet needs due to time constraints and distance. However, the ability to ask for help is also correlated with a higher probability of not having medical care due to time constraints and the wait-and-see approach.</p>","PeriodicalId":44403,"journal":{"name":"International Journal of Health Economics and Management","volume":"20 1","pages":"79-98"},"PeriodicalIF":2.4,"publicationDate":"2020-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1007/s10754-019-09271-0","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37411784","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":"Motivation structures of blood donation: a means-end chain approach.","authors":"Yeong Sheng Tey,&nbsp;Poppy Arsil,&nbsp;Mark Brindal,&nbsp;Sook Kuan Lee,&nbsp;Chi Teen Teoh","doi":"10.1007/s10754-019-09269-8","DOIUrl":"https://doi.org/10.1007/s10754-019-09269-8","url":null,"abstract":"<p><p>Understanding blood donation behaviours is pivotal to recruiting and retaining blood donors. Despite rich literature, this is the first study investigating the content and structure of motivations that underlie blood donation using a means-end chain approach. Based on soft laddering interviews with 227 respondents (31 first-time blood donors and 196 repeat blood donors) in the Klang Valley of Malaysia, we identified that their blood donation was primarily driven by the attribute 'help people', the consequences 'increase blood supply' (as perceived by first-time blood donors) and 'indirect downstream reciprocity' (as perceived by repeat blood donors) associated with the attribute and the belief that the consequences can lead to the fulfilment of the value 'humanitarianism'. Understanding of such hierarchical links between motivators is crucial in developing self-relevant communications. The resultant outcomes are likely to be more effective than the traditional approaches in behavioural change.</p>","PeriodicalId":44403,"journal":{"name":"International Journal of Health Economics and Management","volume":"20 1","pages":"41-54"},"PeriodicalIF":2.4,"publicationDate":"2020-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1007/s10754-019-09269-8","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37362888","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}