International Journal of Health Economics and Management最新文献

{"title":"Bad times make mothers depressed.","authors":"Chung-Liang Lin, Te-Fen Lo","doi":"10.1007/s10754-025-09400-y","DOIUrl":"10.1007/s10754-025-09400-y","url":null,"abstract":"<p><p>This research conducts the first comprehensive analysis of how prenatal economic fluctuations affect postpartum depression and documents its counter-cyclicality. Using population-based claims data, we examine outpatient utilization related to mental disorders among women in Taiwan during the six-month, nine-month, and one-year postpartum periods from 1998 to 2012. The results indicate that medical utilization for postpartum depression within the six-month and nine-month postpartum periods is influenced by economic conditions during the second trimester of pregnancy. This study also aims to understand the mediating channels behind the relationship between postpartum depression and prenatal economic activity. We find that negative prenatal economic shocks lead to higher outpatient expenses for conditions such as excessive weight gain, nutritional deficiency, depressive disorders, hypertension, and sleep disorders during pregnancy, all of which can deteriorate maternal postpartum mental health. Furthermore, our study highlights that postpartum depression medical utilization among low-income mothers is particularly sensitive to prenatal economic fluctuations. These findings suggest that low-income mothers, who may have limited resilience and fewer resources during economic downturns, are more likely to experience nutritional deficiencies and increased maternal stress, ultimately leading to a deterioration in postpartum mental health.</p>","PeriodicalId":44403,"journal":{"name":"International Journal of Health Economics and Management","volume":" ","pages":"437-462"},"PeriodicalIF":1.5,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145092656","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":"Socioeconomic inequities impacting complete continuum of maternal healthcare service utilisation over time in Ethiopia.","authors":"Ayal Debie, Molla M Wassie, Annabelle Wilson, Claire T Roberts, Jacqueline H Stephens","doi":"10.1007/s10754-025-09401-x","DOIUrl":"10.1007/s10754-025-09401-x","url":null,"abstract":"<p><strong>Objective: </strong>To quantify socioeconomic inequities of complete continuity of maternal healthcare service over time using Ethiopian Demography and Health Survey data from 2011 to 2019.</p><p><strong>Methods: </strong>A total of 10,768 women who had at least one antenatal care visit during their most recent childbirth were included for the analysis. Concentration index and concentration curve were used to assess wealth-based inequities. A generalized linear model with binomial distribution and a logit link function was used to decompose the Erreygers concentration index and measure each determinant's contribution.</p><p><strong>Results: </strong>Complete continuum of maternal health service utilization in 2011, 2016, and 2019 among the wealthiest women were 25.9%, 33.7%, and 50.8%, respectively. In contrast, the corresponding continuum of maternal health service utilisation was 3.0%, 6.1%, and 11.2% among the lowest wealth categories. The Erreygers concentration indices of complete continuum of maternal health service utilization in 2011, 2016, and 2019 surveys were 0.203, 0.195, and 0.311, respectively, with the highest inequity observed in 2019. Concentration curves in each survey showed a pro-rich distribution of complete continuum of maternal health service utilisation. A unit percentage change in women's education, early initiation of antenatal care, being informed about pregnancy-related complications, and blood pressure monitoring during pregnancy increased their probability of completing continuum of maternal health service utilization. Specifically, a 1% increase in the proportion of secondary or higher education corresponded to a 0.02%, 0.01%, and 0.07% increase in the probability of completing continuum of maternal health service utilisation in 2011, 2016, and 2019, respectively. Conversely, in 2011, a 1% increase in the proportion of rural women and those with more than four parities led to a 0.11% and 0.05% decrease in the probability of completing continuum of maternal health service utilisation, respectively.</p><p><strong>Conclusion: </strong>Complete continuum of maternal health service utilization was more likely amongst women without disadvantage, demonstrating wealth-based inequities in continuum of maternal health service utilization continue in Ethiopia. In this analysis, continuum of maternal health service utilisation remains inelastic across all surveys highlightsits the service is an essential form of care for women. Provision of maternal healthcare services targeting women from low household wealth status, residing in rural communities, and uneducated women must be prioritised by policymakers.</p>","PeriodicalId":44403,"journal":{"name":"International Journal of Health Economics and Management","volume":" ","pages":"463-486"},"PeriodicalIF":1.7,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12685972/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144973275","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 effect of medicaid expansion on hospital finances: evidence from Washington and Idaho.","authors":"Erica H Johnson","doi":"10.1007/s10754-025-09404-8","DOIUrl":"10.1007/s10754-025-09404-8","url":null,"abstract":"<p><p>The study aims to analyze the impact of Medicaid Expansion on hospital finances. Medicaid eligibility may increase hospital reimbursements and lower uncompensated care costs if patients are moving from no insurance coverage to Medicaid. However, if patients taking up Medicaid are moving from a private insurance plan to Medicaid, then it is also possible that hospital reimbursements may be lower under Medicaid expansion. Medicaid expansion increased the eligibility for Medicaid coverage to a broader group of people and raised the income threshold to 138% of the federal poverty level. Some states chose to expand Medicaid while others did not. Using a natural experiment, I compare hospital revenues and uncompensated care costs in Eastern Washington, which chose to expand Medicaid in 2014, and in Idaho, which chose not to expand until 2020. Medicaid expansion may be associated with lower net revenues, higher Medicaid received, and lower uncompensated care costs per hospital bed, ceteris paribus. I find no significant impact on operating margins. This study adds to the current literature looking at Medicaid Expansion and hospital finances by looking at a different region than has been previously studied. This region offers similar demographic and economic situations in both states. These areas are more rural areas and have less populated cities, which allows for a unique perspective and contributes to the understanding of how Medicaid Expansion may impact hospital finances.</p>","PeriodicalId":44403,"journal":{"name":"International Journal of Health Economics and Management","volume":" ","pages":"533-556"},"PeriodicalIF":1.5,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145349053","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 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":"10.1007/s10754-025-09397-4","url":null,"abstract":"&lt;p&gt;&lt;p&gt;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":"337-382"},"PeriodicalIF":1.5,"publicationDate":"2025-09-01","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":"Is there a link between self-reported unmet needs and healthcare expenditure?","authors":"Liliane Bonnal, Pascal Favard, Thomas Laurent","doi":"10.1007/s10754-025-09399-2","DOIUrl":"10.1007/s10754-025-09399-2","url":null,"abstract":"<p><p>This study aims to investigate the factors associated with self-reported unmet healthcare needs among individuals aged 65 and older in France, as well as to determine whether healthcare expenditure and its determinants differ based on self-reported unmet needs. We use data from the 2012 Health and Welfare Survey, matched with health insurance records. Healthcare expenditure for ambulatory care-excluding inpatient care-is modeled using a regime-switching regression approach. Our findings highlight that social and behavioral disparities are the primary factors influencing self-reported unmet needs. The determinants of healthcare expenditure are generally similar, regardless of whether individuals report unmet needs, except for pre-frailty and the number of medical conditions. Surprisingly, we do not find a significant marginal effect of self-reported unmet needs on healthcare expenditure. In our view, this challenges the use of self-reported unmet needs as an indicator of access to care.</p>","PeriodicalId":44403,"journal":{"name":"International Journal of Health Economics and Management","volume":" ","pages":"407-435"},"PeriodicalIF":1.5,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144585208","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":"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":"293-315"},"PeriodicalIF":1.7,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12568916/pdf/","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":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Fee cuts for radiology and low-value imaging.","authors":"David H Howard, Michal Horný, Marcus Dillender","doi":"10.1007/s10754-025-09398-3","DOIUrl":"10.1007/s10754-025-09398-3","url":null,"abstract":"<p><p>Based on the belief that fee-for-service reimbursement contributes to the overuse of costly medical procedures, policymakers have sought to cut payments for low-value services. Using a difference-in-differences model and Medicare claims linked with cancer registry records, we evaluate the impact of a large payment reduction for an imaging procedure commonly used in prostate cancer patients. We find that the payment cut did not affect imaging use, even in low-risk patients for whom imaging is not recommended. Our results suggest that supply may be relatively insensitive to fee levels when decisions about the use of a service are made exclusively by referring physicians, not the physicians who deliver and receive payment for it.</p>","PeriodicalId":44403,"journal":{"name":"International Journal of Health Economics and Management","volume":" ","pages":"383-406"},"PeriodicalIF":1.5,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144700006","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":"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":"317-336"},"PeriodicalIF":1.7,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12568849/pdf/","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":"OA","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":"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":"271-292"},"PeriodicalIF":1.5,"publicationDate":"2025-06-01","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":"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":"217-243"},"PeriodicalIF":1.7,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12360989/pdf/","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":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}