Health Economics Review最新文献

{"title":"Cost-effectiveness analysis of duodenal-jejunal bypass sleeve device for people with obesity.","authors":"Qian Xu, Wei Yan, Luo Li, Bao Liu","doi":"10.1186/s13561-025-00623-w","DOIUrl":"https://doi.org/10.1186/s13561-025-00623-w","url":null,"abstract":"<p><strong>Background: </strong>Obesity has become major public health problem around the world. Lifestyle interventions, Pharmacotherapy and bariatric surgery are the common intervention to reduce weight in clinical practice. This study aims to conduct an economic evaluation of Duodenal-Jejunal Bypass Sleeve (DJBS) plus Intensive Lifestyle Intervention (ILI) compared with ILI only in people with obesity in China.</p><p><strong>Methods: </strong>A hybrid model using a Decision Tree and Markov model was used to compare 9-month and lifetime horizon cost-effectiveness between DJBS plus ILI and ILI only. The data on clinical effectiveness were based on a prospective, open-label, and randomized trial (NCT05938231). This study employed 1-3 times the Gross Domestic Product (GDP) per capita (¥85,498, exchange rate: $1 US dollar = ¥6.73, 2022) and disposable income per capita (¥36,883, 2022) as the Willingness-To-Pay (WTP) thresholds. One-way, probabilistic sensitivity and scenario analysis were performed to test the robustness of the results.</p><p><strong>Results: </strong>The results of the 9-month decision tree model showed that compared to ILI only, DJBS plus ILI decreased body mass index (BMI) by 1.69 kg/m2 (1.41 vs. 3.10), with an increasing cost of ¥28,963.98 yuan (¥29,111.06 vs.¥147.08). The incremental cost-effectiveness ratio (ICER) was ¥17,138.45 per unit decrease of BMI. The lifetime horizon model showed that compared to ILI only, DJBS plus ILI had a higher cost of ¥13261.94 yuan (¥31,688.98 vs. ¥18,427.04), while with a life-year increase of 0.02 (9.43 vs. 9.41) and quality-adjusted life years (QALYs) increase of 0.15 (7.82 vs. 7.67) per people with obesity. The ICER was ¥88,412.93 per QALY gained. Probability sensitivity analysis showed the robustness of the economic evaluation results.</p><p><strong>Conclusion: </strong>The findings suggested that DJBS plus ILI was not a cost-effective strategy over a lifetime horizon when the WTP threshold was set at GDP per capita and disposable income per capita. However, it was considered cost-effective when the threshold was set at 1.03 times GDP per capita.</p>","PeriodicalId":46936,"journal":{"name":"Health Economics Review","volume":"15 1","pages":"32"},"PeriodicalIF":2.7,"publicationDate":"2025-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143812692","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"经济学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Health insurance premium in Colombia for 2025: a strictly political-ideological decision without technical-scientific arguments?","authors":"Oscar Espinosa, Paul Rodríguez-Lesmes, Sergio Prada, Mery Bolívar, Juan Diego Mejía-Becerra, Andrés I Vecino-Ortíz","doi":"10.1186/s13561-025-00620-z","DOIUrl":"https://doi.org/10.1186/s13561-025-00620-z","url":null,"abstract":"<p><p>The Colombian Ministry of Health's decision to increase the health insurance premium (Capitation Payment Unit) by 5.36% for 2025, close to the inflation rate, has sparked controversy. This adjustment disregards factors that contribute to rising healthcare costs, leading to concerns over the guarantee the right to health for Colombians and financial sustainability of the health system. The insufficient increase raises the likelihood of surpassing premium coverage, as evidenced by recent actuarial studies. This decision could affect the quality of services and jeopardize the health of 50 million inhabitants in the Colombian territory. The paper calls for a more robust, technical approach to ensure the financial stability and quality of care in the Colombian health system.</p>","PeriodicalId":46936,"journal":{"name":"Health Economics Review","volume":"15 1","pages":"31"},"PeriodicalIF":2.7,"publicationDate":"2025-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143812694","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"经济学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Building an integrated healthcare system of China: an assessment of coupling coordination between disease prevention, medical services, and healthcare financing from 2012 to 2021.","authors":"Guowu Huang, Wanying Wu, Qiaoxi Wen, Liyong Lu, Jay Pan","doi":"10.1186/s13561-025-00616-9","DOIUrl":"10.1186/s13561-025-00616-9","url":null,"abstract":"<p><strong>Background: </strong>Universal Health Coverage (UHC) is a central component of the Sustainable Development Goals, and integrated healthcare is recognized as a key pathway to achieving UHC. China's healthcare reform, aimed at realizing the \"Healthy China 2035\" goal, faces challenges in ensuring the coordinated development of disease prevention, medical services, and healthcare financing. However, empirical research assessing the integration of these three systems in China is scarce.</p><p><strong>Purpose: </strong>This study aims to assess the coupling and coordination between disease prevention, medical services, and healthcare financing in China from 2012 to 2021, with the goal of providing a comprehensive evaluation of the progress made in building an integrated healthcare system.</p><p><strong>Methods: </strong>The study employs the Entropy Weight Method (EWM) to determine the weight of each system index, followed by the Coupling Coordination Degree Model (CCDM) to measure the coordination among the three components. The Grey Correlation Analysis (GCA) is used to identify key driving factors, and the Grey Prediction Model (GM (1.1)) is applied to forecast future trends of integrated healthcare development across Chinese provinces.</p><p><strong>Results: </strong>The coupling coordination degree of the three systems ranged from 0.12 to 0.73 from 2012 to 2021, reflecting a shift from moderate imbalance to mild imbalance over time. Regional disparities were observed, with eastern provinces showing higher levels of integration than western provinces. The disease prevention subsystem emerged as the primary constraint to the overall integration process. Most regions exhibited a consistent upward trend in the coupling coordination index, though development speeds varied significantly across provinces.</p><p><strong>Conclusion: </strong>While China's integrated healthcare system has shown progress, there is still considerable room for improvement. Strengthening disease prevention efforts is critical to enhancing the overall coordination of the healthcare system. This study provides valuable insights for other developing countries facing similar challenges in healthcare integration.</p>","PeriodicalId":46936,"journal":{"name":"Health Economics Review","volume":"15 1","pages":"30"},"PeriodicalIF":2.7,"publicationDate":"2025-04-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11971905/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143789205","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"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 importance of political and religious affiliation in explaining county-level COVID-19 Vaccine Hesitancy.","authors":"Declan R Carroll, Stephen J Conroy, Adriana Vamosiu","doi":"10.1186/s13561-025-00605-y","DOIUrl":"10.1186/s13561-025-00605-y","url":null,"abstract":"<p><p>The authors use county-level data to test whether an array of socioeconomic, demographic, political and religious variables explain COVID-19 vaccination rates. Results presented here build upon previous investigations of COVID-19 vaccine hesitancy in different contexts and are largely consistent with those findings. Background controls such as county's percent male (+), median age (+), percent White (-), median household income (+), percent self-employed (-), and the percent with a college or higher education (+) explain county-level vaccination rates for COVID-19. Political affiliation (Percent Republican (-)) remains the strongest predictor in terms of overall statistical significance. The county's percent Catholic (+) and percent Evangelical (-) are also very strong predictors, though in opposite directions. This analysis includes state-level fixed effects and several robustness checks.</p>","PeriodicalId":46936,"journal":{"name":"Health Economics Review","volume":"15 1","pages":"29"},"PeriodicalIF":2.7,"publicationDate":"2025-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11966783/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143774649","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"经济学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impacts of the diagnosis-intervention packet reform on costs and healthcare resource utilization: evidence from Guangzhou, China.","authors":"Bingxue Fang, Yawen Jiang","doi":"10.1186/s13561-025-00615-w","DOIUrl":"10.1186/s13561-025-00615-w","url":null,"abstract":"<p><strong>Background: </strong>The diagnosis-intervention packet (DIP) payment reform, utilizing big data for patient classification and payment standardization, was initially developed and piloted in China. Guangzhou, the pilot mega-city, rolled out DIP payment reform in 2018 to regulate medical expenditures. We estimated the impacts of DIP on costs and healthcare resource utilization in Guangzhou using a nine-year panel data set of Guangzhou and other regions between 2018 and 2020.</p><p><strong>Methods: </strong>By employing the synthetic difference-in-difference (SDID) method, we captured changes in outcome variables before and after DIP implementation in Guangzhou and non-reforming regions.</p><p><strong>Results: </strong>DIP payment reform increased per-episode inpatient costs by CNY 1574.735 (95% CI: 148.330 to 3001.140, P < 0.05), CNY 1583.413 (95% CI: 247.356 to 2919.470, P < 0.05), and CNY 1448.065 (95% CI: -132.051 to 3028.181.140, P < 0.1) among all hospitals, public hospitals, and private hospitals, respectively. In contrast, DIP had little effect on the average length of stay (LOS) among all hospitals from 2018 to 2020. Although DIP did not impact in-hospital mortality (IHM) overall, it increased IHM by 0.330 percentage points (95% CI: 0.008 to 0.652, P < 0.05) and 0.311 percentage points (95% CI: 0.158 to 0.463, P < 0.01) among private hospitals and secondary hospitals.</p><p><strong>Conclusions: </strong>Our results suggest that the effects of DIP payment reform were mixed. While it did increase healthcare costs, its impacts on quality and operation efficiency varied significantly across different types of hospitals.</p>","PeriodicalId":46936,"journal":{"name":"Health Economics Review","volume":"15 1","pages":"28"},"PeriodicalIF":2.7,"publicationDate":"2025-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11956188/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143754960","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"经济学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Relationship between economic recessions and health inequity: analysis of the gap in life expectancy at birth between Mexican States.","authors":"Juan Pablo Gutiérrez, Karina Mendoza, Armando Sánchez-Vargas, Stefano M Bertozzi","doi":"10.1186/s13561-025-00618-7","DOIUrl":"10.1186/s13561-025-00618-7","url":null,"abstract":"<p><strong>Objective: </strong>To estimate the effect of economic recessions on health inequality, with a focus on identifying recessions that have a health component.</p><p><strong>Methods: </strong>This retrospective observational study uses the interannual rate of change in gross domestic product (GDP) as an indicator of economic conditions, and life expectancy at birth among Mexican states as a measure of health inequality. We calculated the Gini coefficient of life expectancy for the period 1980 to 2021 and examined its relationship with identified recessions through graphical analysis and an interrupted time series model.</p><p><strong>Results: </strong>The disparity in life expectancy at birth between states decreased over the study period. However, the Gini coefficient of life expectancy showed an inverse relationship with the interannual rate of GDP change, indicating increased inequality during economic recessions, with the most pronounced effect observed during the COVID-19-associated recession in 2020.</p><p><strong>Conclusion: </strong>Economic recessions have detrimental effects on health, exacerbating pre-existing inequalities. It is crucial to implement protection mechanisms targeted at socially vulnerable populations to mitigate these effects and prevent the widening of health inequalities.</p>","PeriodicalId":46936,"journal":{"name":"Health Economics Review","volume":"15 1","pages":"27"},"PeriodicalIF":2.7,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11951656/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143736158","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"经济学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diabetes diagnosis based on glucose control levels and time until diagnosis: a regression discontinuity approach to assess the effect on direct healthcare costs.","authors":"Toni Mora, Beatriz Rodríguez-Sánchez","doi":"10.1186/s13561-025-00613-y","DOIUrl":"10.1186/s13561-025-00613-y","url":null,"abstract":"<p><p>We estimate the difference in direct healthcare costs of individuals diagnosed with diabetes depending on their glucose level, considering different timespans and subgroups. Using data from administrative registers of 285,450 individuals in Catalonia from 2013 to 2017, we used a fuzzy regression discontinuity design to estimate the causal effect of being diagnosed with diabetes at a given timespan (based on an average glucose value equal to or above 6.5%, the treated group) vs. not (having an average glucose level below the threshold, the control group) on healthcare costs across different timespans (6, 9, 12, 15, 18, 21, and 24 months after the first laboratory test) and distances, in days, between the laboratory test and the doctor's diagnosis. When average glucose level was the only independent parameter and the time until diagnosis was 30 days or less, at the cut-off value (6.5%) healthcare costs were between €3,887 and €5,789 lower for the treated group compared to the control group. Smaller differences were reported as the delay in diagnosis increased, even when additionally controlling for sociodemographic characteristics and health status. Our results highlight the importance of prompt diagnosis and might open the debate about the usefulness of the 6.5% reference value in the blood glucose level as the main diagnostic tool in diabetes.</p>","PeriodicalId":46936,"journal":{"name":"Health Economics Review","volume":"15 1","pages":"26"},"PeriodicalIF":2.7,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11931748/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143694001","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"经济学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Using microdata as a basis for long term projections of hospital care spending: the added value of more detailed information.","authors":"Peter Paul F Klein, Sigur Gouwens, Katalin Katona, Niek Stadhouders, Talitha L Feenstra","doi":"10.1186/s13561-025-00607-w","DOIUrl":"10.1186/s13561-025-00607-w","url":null,"abstract":"<p><strong>Background: </strong>Component-based projections are commonly used to predict future growth in healthcare spending. The current study aimed to compare pure component-based projections to projections using microlevel data to investigate their added value.</p><p><strong>Methods: </strong>The microdata was used to find disease-specific time trends in the number of patients that use hospital care and in annual per patient hospital spending (APHS). Total expenditure projections were then based on APHS and hospital use per disease category combined with demographic projections. As comparator, we used projections with a composite growth term derived from total spending time trends. Furthermore, extensive uncertainty analyses were performed.</p><p><strong>Results: </strong>Time -trends were present both in hospital care usage and in annual per patient hospital spending (APHS) for most disease groups. What is known as the \"residual growth\" category in many projections of healthcare spending can be split into these two time- trends, offering more insight into their sources. The advantage of explicit modeling as done in this paper is that trends in usage and per patient spending can be separated. The use of microdata allowed further refinement of component-based models for projections in healthcare spending and a more elaborate analysis of uncertainty surrounding these projections.</p><p><strong>Conclusions: </strong>We found time trends in both hospital care usage and APHS in most disease groups. Incorporating these trends into cost projections for various disease groups results in more conservative estimates of future hospital spending compared to merely using demographic projections of per capita costs and adjusting them for observed historical growth. The use of microdata for component-based modelling has benefits but also downsides. A positive side of using microlevel data is that individuals could be followed over multiple years, a downside was the vast amount of computing power and time needed to perform these extensive analyses. Our results could support policy makers to adjust for hospital (staffing) capacity not purely on demographic changes but also based on observed trends in the use of specific types of hospital care, per disease.</p>","PeriodicalId":46936,"journal":{"name":"Health Economics Review","volume":"15 1","pages":"25"},"PeriodicalIF":2.7,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11921507/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143665071","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"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 productivity in the healthcare sector: a bibliometric and content analysis.","authors":"Ionela-Andreea Puiu, Abigaela Bîlbîie","doi":"10.1186/s13561-025-00612-z","DOIUrl":"10.1186/s13561-025-00612-z","url":null,"abstract":"<p><strong>Background: </strong>Productivity in the healthcare sector has evolved as an appealing research topic in the last few years. Despite the growing interest, the extant scientific literature mostly concentrates on methodologies rather than theoretical and practical insights. Although diverse methodologies provide valuable quantitative wisdom, their application is often misaligned with broader economic theories or healthcare purposes, limiting their contribution to advancing theoretical and practical understanding of efficiency and productivity in healthcare systems. In this respect, the current study endeavors to bridge the research gap concerning the lack of a comprehensive overview of productivity measurements in the healthcare sector.</p><p><strong>Methods: </strong>We investigate this concern through a bibliometric and content analysis of articles published on healthcare productivity measurement techniques in the Web of Science database between 2003 and 2023. We provide a quantitative and critical analysis of conceptualization, methods, findings, and implications of the selected published articles concerning productivity measurements in the healthcare sector.</p><p><strong>Results: </strong>Our research discovered that the sanitary crisis generated by COVID-19 boosted the publication of scientific papers on productivity measurements in healthcare, with Europe emerging as a leading region in publication output. Although Data Envelopment Analysis and the Malmquist Index monopolize the range of measurement techniques used to quantify productivity, current research highlights the requirement for alternative methodologies to grasp the multidimensionality of healthcare productivity, including its interaction with quality and technological progress.</p><p><strong>Conclusions: </strong>We raise awareness that future efforts should prioritize multidimensional and context-sensitive approaches to measuring healthcare productivity, balancing efficiency, technological progress, and quality of care. Policymakers should focus on designing context-specific policies tailored to regional challenges and promoting targeted research funding to explore underrepresented areas of healthcare services.</p>","PeriodicalId":46936,"journal":{"name":"Health Economics Review","volume":"15 1","pages":"24"},"PeriodicalIF":2.7,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11916973/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143659140","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"经济学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Confidence in China's healthcare system: a focus on lower-middle class.","authors":"Yifan Jiang, Bin Peng, Dandan Jin, Xinxin Peng, Jinghua Zhang","doi":"10.1186/s13561-025-00608-9","DOIUrl":"10.1186/s13561-025-00608-9","url":null,"abstract":"<p><strong>Background: </strong>During the post-pandemic era, there has been growing anxiety regarding health security, especially among the middle class worldwide. The public's confidence in the healthcare system encompasses their expectations and perceptions of the healthcare system's ability to meet their needs without financial hardship. This study aims to examine the disparities of confidence and to identify potential vulnerable subgroups.</p><p><strong>Methods: </strong>Adopting the China General Social Survey (CGSS) 2021, we performed multivariate logistic regression to analyze the associations between confidence level and socioeconomic classes, controlling for demographics.</p><p><strong>Results: </strong>Among all respondents (n = 2341), 71% reported confidence. However, respondents identified as lower-middle class had the least likelihood of reporting confidence (OR = 0.64, p = 0.006) compared to the lowest social class. De facto married respondents had 21% lower odds of confidence (OR = 0.78, p = 0.046) compared to unpartnered respondents.</p><p><strong>Conclusions: </strong>Our findings reveal that, contrary to expectations, the lower-middle class in China-rather than the lowest social strata-exhibits the least confidence in the healthcare system. This low confidence appears closely linked to heightened insecurity about downward social mobility stemming from catastrophic healthcare expenditure. Moreover, married individuals also revealed low level of confidence in the healthcare system. These results underscore the urgent need for universal healthcare policies in China and similar emerging economies that specifically address the unique health security concerns of the lower-middle class and consider the dynamics inherent in marriages and families associated.</p>","PeriodicalId":46936,"journal":{"name":"Health Economics Review","volume":"15 1","pages":"23"},"PeriodicalIF":2.7,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11917120/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143651348","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"经济学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}