International Journal of Health Economics and Management最新文献

{"title":"Association between patient continuity of care and physicians' hypoglycaemic medication prescription trends.","authors":"Joana Gomes-da-Costa, Sara R Machado, Nuno Sousa Pereira","doi":"10.1007/s10754-026-09410-4","DOIUrl":"10.1007/s10754-026-09410-4","url":null,"abstract":"<p><p>The general prevalence of chronic non-communicable diseases, such as diabetes mellitus is rapidly increasing while exacerbating the burden of disease on healthcare systems. Its management, as opposed to communicable diseases, is typically long term and requires ongoing healthcare interventions, such as dietary control and medication prescription, with associated costs. The prescription requires an interaction between patients and physicians, which may be sporadic or continuous, and can be used as a proxy measure for the strength of patient–doctor relationship. We hypothesize that fragmentation of care, across physician specialties and payers, plays a role on prescription behaviour, above and beyond for patient and prescription characteristics. A panel of patients’ prescriptions events with the universe of all prescriptions and dispensing in Portugal from January 2015 to October 2019 (N = 791.467) provided by Serviços Partilhados do Ministério da Saúde, EPE was considered. We measured the association between care fragmentation of care and prescription behavior of antihyperglycaemic medication using negative binomial regression models. Results suggest that Specialists play a secondary role on the prescription of DPP-4i and SGLT2i, prescribing 12.3 and 4.3% less respectively, while playing a central role on the prescription of GLP-1, in comparison with GPs. Fragmentation of care also plays a part on prescription trends, i.e., physicians with higher of continuity of care present higher rates of prescription of approximately 5.9% for DPP-4i, 6.5% for SGLT2i and 39.6% for GLP-1. The comparison of prescription trends amongst public and private payers suggests that public payers have lower rates of prescriptions (DPP-4i: 9.6%; SGLT2i: 7.2%; GLP-1: 85.6%). We find important differences in prescription patterns between specialists and primary care physicians. Higher continuity of care is associated with increased prescription frequency. Finally, public payers are associated with lower prescription rates. Physician specialty, payer, and care fragmentation all interact in the prescription patterns of antihyperglycaemic medication.</p>","PeriodicalId":44403,"journal":{"name":"International Journal of Health Economics and Management","volume":"26 2","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13018013/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147515601","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":"Exploring the association between women's autonomy and overweight: Empirical analysis in Côte d'Ivoire.","authors":"Ouattara Zieh Moussa, Toure Talnan Aboulaye, Yves-Géthème Bienvenu Gbehe","doi":"10.1007/s10754-026-09412-2","DOIUrl":"10.1007/s10754-026-09412-2","url":null,"abstract":"<p><p>Much of the literature has associated women’s participation in household decision-making with better health outcomes. In Côte d’Ivoire, a plump body with particularly prominent hips and buttocks has long been the predominant standard of beauty for women. The prevalence of overweight is greater among women, thereby increasing their vulnerability to life-threatening illnesses. We investigated the association between women’s autonomy in household decision-making and overweight, using the most recent demographic and health survey. In our estimation models, we included region fixed effects to account for unobserved socioeconomic and cultural differences across geographic areas. Overall, we found that women with low autonomy and those with high autonomy were more likely to be overweight than those with no autonomy. Further investigations suggest no association between autonomy and overweight for women in urban areas. However, for women in rural areas, autonomy was associated with a higher likelihood of being overweight, particularly for those with no formal education. These findings suggest that programs promoting women’s autonomy in household decision-making should be accompanied by targeted health education for rural women, to raise awareness of the health risks associated with being overweight.</p>","PeriodicalId":44403,"journal":{"name":"International Journal of Health Economics and Management","volume":"26 2","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147494649","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 health literacy on healthcare spending: theory and evidence from China.","authors":"Yisong Wang, Xuezheng Qin","doi":"10.1007/s10754-026-09411-3","DOIUrl":"10.1007/s10754-026-09411-3","url":null,"abstract":"<p><p>We develop a theoretical model where health literacy endogenously shapes healthcare spending decisions. The model predicts an inverted U-shaped relationship between literacy and spending, driven by two channels: the 'attention' effect, where increased health literacy enhances health awareness, and the 'productivity' effect, where health literacy improves health production efficiency. We empirically test these predictions based on an adult subsample of 2020 China Family Panel Studies, where individual-level health literacy is measured using a self-design questionnaire (the Chinese Health Literacy Survey) following internationally comparable and established instruments. To address the potential endogeneity, we apply Natural Language Processing on 2.16 million news articles to construct an instrumental variable for health literacy coverage.​ This instrument exploits province–month variation in news coverage of concepts related to understanding and navigating health information. Our quantitative analysis reveals that a 10% increase in health literacy correlates with a 5% reduction in healthcare expenditure. Through mechanism analysis, we provide evidence for the attention and the productivity effects, respectively. For robustness, we conduct alternative IV construction and use Double Machine Learning to control for observable and high-dimensional confounding. Our findings imply that improving health literacy can be an effective policy measure to curb the rising healthcare spending and promote efficient healthcare utilization around the globe.</p>","PeriodicalId":44403,"journal":{"name":"International Journal of Health Economics and Management","volume":"26 1","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147475827","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":"Compensate at your own risk: heterogeneity in compliance with preventive behaviors through the lens of economic and social preferences.","authors":"Antoine Lacombe, Marlène Guillon","doi":"10.1007/s10754-026-09409-x","DOIUrl":"10.1007/s10754-026-09409-x","url":null,"abstract":"<p><p>Preventive behaviors are crucial for controlling the spread of infectious diseases. Until now, most of the literature on the understanding of the willingness to comply with preventive behaviors at the individual level has focused on either one of those behaviors or studied several behaviors but independently. However, preventive behaviors might not be independent of each other’s and the question of the relationship between these various behaviors deserves to be further investigated. The COVID-19 pandemic represents an interesting setting to study compliance with preventive behaviors when several prophylactic measures aiming to reduce the same infection risk are available. The aim of this study is to investigate how economic and social preferences may shape the relationship between three types of COVID-19 preventive behaviors among a representative sample of the French population: (1) compliance with restrictions on movement, (2) adherence to barrier gestures and (3) COVID-19 testing. Using a Latent Class Analysis, we identify four groups of individuals with diverging patterns of compliance with preventive behaviors, differing both in terms of intensity and types of prophylactic measures followed: individuals who apply all preventive behaviors, those who reject them all, individuals that do not respect restrictions on movement but still protect themselves and others by applying barrier gestures, and those who do not use barrier gestures but comply with restrictions on movement. Our results support the existence of a risk compensation process leading some individuals to tailor their menu of preventive behaviors until they reach the risk threshold they are willing to handle. The composition of the menu of preventive behaviors appears to be linked with individuals’ economic and social preferences including risk and time preferences, prosociality, and interpersonal trust. Exploring heterogeneity in preventive behaviors may inform the design of targeted prevention and communication campaigns that are better tailored to achieve public health goals.</p>","PeriodicalId":44403,"journal":{"name":"International Journal of Health Economics and Management","volume":"26 1","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147475795","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":"Health shocks and multidimensional poverty: is health insurance a safety net?","authors":"Emmanuel Attobrah, Francis Kwaw Andoh, Emmanuel Ekow Asmah, Joshua Sebu","doi":"10.1007/s10754-025-09405-7","DOIUrl":"10.1007/s10754-025-09405-7","url":null,"abstract":"<p><p>In Low- and Middle-Income Countries (LMICs), health shocks continue to push many households into poverty by reducing income and access to basic services. Specifically, this study investigates the effect of health shocks on multidimensional poverty in Ghana. Moreover, it examines the pathways through which health shocks influence multidimensional poverty, and lastly, it explores the extent to which health insurance moderates the effect of health shocks on multidimensional poverty. Using panel data from the 2023 Ghana Annual Household Income and Expenditure Survey covering 33,143 households, we employed Instrumental Variable Generalised Method of Moments to investigate the purpose of the study. The results reveal that health shocks significantly increase multidimensional poverty by 2.62%, mainly through increased out-of-pocket health expenditures and reduced labour hours. Female-headed households experience more severe effects (4.24% points) compared to male-headed households (1.92% points), while rural and urban areas show comparable effects (2.69 and 2.56% points, respectively). While the National Health Insurance Scheme (NHIS) reduces the poverty effect of health shocks by 35%, its effectiveness varies by gender and location. We therefore recommend that the Ministry of Health should strengthen healthcare financing through health insurance by improving benefit packages and the quality of services to accelerate progress toward the attainment of SDGs 1 and 3.</p>","PeriodicalId":44403,"journal":{"name":"International Journal of Health Economics and Management","volume":"26 1","pages":"4"},"PeriodicalIF":1.5,"publicationDate":"2026-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146214489","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":"Misperception, self-reported probabilities and long-term care insurance take-up in the United States.","authors":"Thomas Blavet, Bertrand Chopard, Thomas Rapp, Jonathan Sicsic","doi":"10.1007/s10754-025-09408-4","DOIUrl":"10.1007/s10754-025-09408-4","url":null,"abstract":"<p><p>In the United States as in other developed countries, the take-up of Long-Term Care (LTC) insurance remains very low, suggesting that many individuals underestimate their future needs for professional LTC services. This paper examines the relationship between subjective expectations and LTC insurance demand, with a particular focus on miscalibration of survival beliefs. Using 12 waves of the Health and Retirement Study (1996-2018), we estimate various random effects linear probability models of LTC insurance take-up among individuals aged 50-75 years. We rely on two self-reported expectation measures: the probability of survival and the probability of nursing home entry. We then classify individuals into three groups - consistent, positive deviation, and negative deviation - based on the difference between subjective survival beliefs and life-table benchmarks. Robustness analyses are carried using alternative miscalibration measures, age groups and control variables. Our findings reveal strong heterogeneity. Individuals whose beliefs are consistent with life-table probabilities purchase more LTC insurance when they expect to live longer, in line with higher anticipated old-age expenditures. By contrast, individuals who substantially overestimate survival (\"positive deviation\" group) display no systematic response to either type of expectation, which could be related to cognitive difficulties in projecting future needs. Those who underestimate survival (\"negative deviation\" group) are responsive to nursing home expectations but less so to survival, indicating that they may anticipate short-term care needs but not long-term expenditures. Taken together, these results suggest that miscalibration of survival beliefs is an important determinant of insurance demand. They highlight that underestimation and overestimation reflect different mechanisms - potential private health information in the former case and cognitive limitations in the latter - ultimately contributing to the persistently low take-up of LTC insurance in the U.S.</p>","PeriodicalId":44403,"journal":{"name":"International Journal of Health Economics and Management","volume":"26 1","pages":"3"},"PeriodicalIF":1.5,"publicationDate":"2026-02-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12894182/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146158760","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 performance-based capitation on diabetes care: Evidence from Indonesia's national health insurance program.","authors":"Febriansyah Budi Pratama, Teguh Dartanto","doi":"10.1007/s10754-025-09407-5","DOIUrl":"10.1007/s10754-025-09407-5","url":null,"abstract":"<p><p>Indonesia’s National Health Insurance (JKN) introduced the Performance-Based Capitation scheme (Kapitasi Berbasis Komitmen, KBK) in 2015–2016 as a supplement to the existing capitation system and scaled it nationally in 2019. This study evaluates the impact of KBK on Diabetes Mellitus (DM)-related primary care utilization using 2015–2020 BPJS Kesehatan sample data, as DM alone accounted for IDR 8.23 trillion (USD 499 million) in JKN claims in 2022, raising concerns about the JKN financial sustainability. We employ a Regression Discontinuity in Time (RDiT) design to estimate causal effects, using a donut hole specification to address anticipation bias, applying alternative bandwidths for sensitivity analysis, and conducting placebo tests to assess robustness. Our findings indicate modest but significant improvements in primary care utilization at Puskesmas, particularly in contact rates (3.3% points), visit rates (6.9% points) and visit frequency (3.1% points). However, KBK had minimal impact on private clinic (klinik pratama), with most utilization metrics remaining insignificant, except for a 6.3% point increase in visit frequency. Additionally, despite increased service utilization at primary health care (FKTPs), referral rates to Advanced Referral Healthcare Facilities (FKRTLs) did not significantly decline. The study concludes that while KBK has led to some improvements, it has not fully met its objectives. Accordingly we recommend strengthening outcome-based performance indicators, mandating Prolanis enrollment for DM patients, and reformulating capitation incentives to better align with provider behavior and capacity. </p>","PeriodicalId":44403,"journal":{"name":"International Journal of Health Economics and Management","volume":"26 1","pages":"2"},"PeriodicalIF":1.5,"publicationDate":"2026-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146012250","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 design of insurance contracts for home versus nursing home long-term care.","authors":"Claire Borsenberger, Helmuth Cremer, Denis Joram, Jean-Marie Lozachmeur, Estelle Malavolti","doi":"10.1007/s10754-025-09406-6","DOIUrl":"10.1007/s10754-025-09406-6","url":null,"abstract":"<p><p>We study the design of optimal (private and/or social) insurance schemes for formal home care and institutional care. We consider a three period model. Individuals are either in good health, lightly dependent or heavily dependent. Lightly dependent individuals can buy formal home care which reduces the severity of dependency and reduces the probability to become severely dependent in the next period. Severely dependent individuals pay for nursing home care. In both states of dependency individuals can receive a (private or public) insurance benefit (transfers). These benefits can be flat or depend on the formal care consumed (or a combination of the two). These benefits are financed by a premium (or a tax). Individuals may be alive until the end of the last period or die at the beginning of one of the last two periods with a certain probability, which may depend on their state of health. The laissez faire is inefficient because individuals consume a too low level of formal home care and are not insured. The first-best insurance scheme requires a transfer to lightly dependent individuals that, (under some conditions) increases with the amount of formal home care consumed. Severely dependent individuals, on the other hand, must receive a flat transfer (from private or social insurance). The theoretical analysis is illustrated by a calibrated numerical example which show that the expressions have the expected signs under plausible conditions.</p>","PeriodicalId":44403,"journal":{"name":"International Journal of Health Economics and Management","volume":"26 1","pages":"1"},"PeriodicalIF":1.5,"publicationDate":"2026-01-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145913336","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":"Publish or Perish - do French hospitals disclose their greenhouse gas emissions for vertical differentiation?","authors":"Nathalie Clavel, Laurie Marrauld, Myriam Lescher-Cluzel, Estelle Baurès, Nicolas Sirven","doi":"10.1007/s10754-025-09402-w","DOIUrl":"10.1007/s10754-025-09402-w","url":null,"abstract":"<p><p>French legislation requires large and medium-sized hospitals to publicly report their greenhouse gas (GHG) emissions. Yet, many hospitals fail to comply with this regulation, while others report voluntarily. The organizational drivers behind this behavior remain underexplored. This study examines whether hospitals disclose their GHG emissions as part of a broader strategy to differentiate themselves-similar to how they report patient satisfaction scores to signal quality. We explore whether carbon reporting is used as a vertical differentiation strategy in the French healthcare system. We used a mixed-methods approach. First, we analyzed national administrative data to test whether reporting GHG emissions is associated with reporting patient satisfaction scores. Second, we conducted semi-structured interviews with hospital managers to understand the motivations behind emissions reporting. Quantitatively, we found no significant association between the two types of reporting. Hospitals do not appear to use GHG emissions disclosure and patient satisfaction scores as part of the same signaling strategy. Qualitative findings confirmed that GHG reporting is primarily driven by internal factors such as executive leadership, process improvement, and organizational values, rather than external differentiation or patient demand. Carbon reporting in French hospitals is not currently used as a differentiation strategy. Stronger regulatory enforcement is needed to ensure compliance. In addition, hospitals require support-through methodological guidance, training, and the development of dedicated sustainability roles-to integrate environmental performance into their management systems and contribute meaningfully to healthcare decarbonization.</p>","PeriodicalId":44403,"journal":{"name":"International Journal of Health Economics and Management","volume":" ","pages":"487-507"},"PeriodicalIF":1.7,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12685999/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144973277","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":"Measuring the impact of occupational accidents on value-added labor productivity in Korea.","authors":"Myung-Joong Kim, Sunyoung Park","doi":"10.1007/s10754-025-09403-9","DOIUrl":"10.1007/s10754-025-09403-9","url":null,"abstract":"<p><p>This study applies econometric methodologies to conduct a quantitative assessment of the overall impact of occupational accidents on changes in firms' labor productivity. In particular, it examines whether the magnitude of this impact varies according to the technological intensity required for production and further explores the mechanisms through which occupational accidents affect productivity, as well as the duration of these effects. The empirical results demonstrate that increases in occupational accident rates are significantly associated with declines (1%p increase in the accident rate reduces 3.9% in the average labor productivity) in labor productivity, with such adverse effects evident in both very low- and very high-technology firms. Moreover, the analysis identifies a self-reinforcing vicious cycle for approximately 3 to 4 years, wherein higher accident rates lead to productivity deterioration, exacerbating accident incidence. The findings also indicate that a substantial period (about 2 to 3 years) is required for firms to recover from productivity losses attributable to occupational accidents. Our findings catalyze firms to undertake proactive and voluntary measures to prevent occupational accidents and will provide an empirical foundation for policy interventions targeting vulnerable groups that are disproportionately affected by productivity losses resulting from such incidents.</p>","PeriodicalId":44403,"journal":{"name":"International Journal of Health Economics and Management","volume":" ","pages":"509-531"},"PeriodicalIF":1.7,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145087734","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}