Health Economics Review最新文献

{"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":"https://doi.org/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":"","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":"","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}

{"title":"Catastrophic health expenditures and food insecurity among older cancer survivors in the United States.","authors":"Tae-Young Pak","doi":"10.1186/s13561-025-00596-w","DOIUrl":"10.1186/s13561-025-00596-w","url":null,"abstract":"<p><strong>Background: </strong>Cancer patients face a costly trade-off between medical care and basic necessities including food. This study aims to explore whether catastrophic health expenditures lead to food insecurity among older cancer survivors in the US.</p><p><strong>Methods: </strong>Longitudinal study of individuals aged 50 or older who were diagnosed with cancer during 2000-2020 and their follow-up measurements selected from the Health and Retirement Study. Data consists of 2505 cancer survivors and 11,614 person-year observations for an average of 4.6 observations per participant. Catastrophic health expenditures were defined as out-of-pocket costs exceeding 5%, 10%, or 15% of household income. Participants were classified as food insecure if they experienced insufficient access to food due to financial limitations. This study utilized fixed effects ordered logistic regression to implement a within-subject research design.</p><p><strong>Results: </strong>Of the 2505 cancer survivors, 77 (3.1%) were moderately food insecure and 73 (2.9%) were severely food insecure. In ordered logistic regression, all three measures of catastrophic health expenses were associated with a higher odds of food insecurity. These associations were more pronounced for males, ethnic minorities, survivors without college education, those in fair or poor health, retirees, and survivors with below-median income.</p><p><strong>Conclusions: </strong>The prevalence of food insecurity among older cancer survivors was relatively low, with 6% of the sample experiencing food insecurity. Multivariate regression analyses revealed that a major predictor of food insecurity among older cancer survivors is catastrophic health costs. Given the health benefits of secure food access, older cancer survivors should consult care providers about their financial capacity to afford recommended cancer treatments while maintaining healthy diets. Policymakers should also consider interventions to reduce out-of-pocket financial burden on older cancer survivors, as improved financial security may enhance treatment outcomes and lower cancer-related mortality.</p>","PeriodicalId":46936,"journal":{"name":"Health Economics Review","volume":"15 1","pages":"22"},"PeriodicalIF":2.7,"publicationDate":"2025-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11912643/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143651347","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":"A retrospective study \"myo-inositol is a cost-saving strategy for controlled ovarian stimulation in non-polycystic ovary syndrome art patients.\"","authors":"Cesare Aragona, Michele Russo, Samuel H Myers, Maria Salomé Bezerra Espinola, Gabriele Bilotta, Vittorio Unfer","doi":"10.1186/s13561-025-00609-8","DOIUrl":"10.1186/s13561-025-00609-8","url":null,"abstract":"<p><strong>Background: </strong>Fertility care represents a financial burden on patients and healthcare services alike and can represent a barrier to entry for many couples. Controlled ovarian stimulation (COH) is routinely used as part of in vitro fertilization and intracytoplasmic sperm injection (ICSI) procedures, as such the use of gonadotropins is a major contributing factor to the cost of the procedure. Recent studies have shown that myo-Inositol (myo-ins) may reduce the amount of gonadotrophins required in assisted reproductive technology (ART) procedures. This retrospective study measured the effect of myo-ins on the number of recombinant follicular stimulating hormone (rFSH) units used in IVF and ICSI and the relative cost to verify if this may be a cost saving strategy. We also investigated the oocyte and embryo quality, implantation rate, abortion rate, clinical pregnancy, and ovarian hyperstimulation syndrome.</p><p><strong>Methods: </strong>A total of 300 women undergoing either IVF or ICSI were distributed between two distinct and equal patient groups of 150 women. In control group (group A), folic acid (FA) alone was prescribed, meanwhile the treated group (group B) were prescribed FA, myo-Inositol (myo-ins) and alpha-lactalbumin (α-LA), both groups started this oral treatment in the middle of the luteal phase.</p><p><strong>Results: </strong>Myo-Ins supplementation in the treatment group significantly reduced the number of units of rFSH used in COH vs. the control group (2526 vs. 1647, p < 0.05); however, no changes were seen in other measured outcomes, likely due to the short treatment period.</p><p><strong>Conclusions: </strong>The use of myo-Ins presents a safe method for reducing the amount and subsequent costs of rFSH usage in ART protocols.</p><p><strong>Trial registration: </strong>The trial was retrospectively registered with the Institutional Review Board of ALMA RES IVF Center, trial number n°2/2024.</p>","PeriodicalId":46936,"journal":{"name":"Health Economics Review","volume":"15 1","pages":"20"},"PeriodicalIF":2.7,"publicationDate":"2025-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11909825/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143634854","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":"Cost-effectiveness analysis of combination therapies involving novel agents for first/second-relapse patients with multiple myeloma: a Markov model approach with calibration techniques.","authors":"Weijia Wu, Fengyuan Tang, Yannan Wang, Wenqianzi Yang, Zixuan Zhao, Yuan Gao, Hengjin Dong","doi":"10.1186/s13561-025-00611-0","DOIUrl":"10.1186/s13561-025-00611-0","url":null,"abstract":"<p><strong>Background: </strong>As the number of randomized clinical trials (RCTs) demonstrating the survival benefits of combination therapies in previously treated multiple myeloma (MM) patients increases, it is essential to determine the most cost-effective treatment through robust economic evaluation. This study aims to assess the cost-effectiveness of combination therapies for first/second-relapse MM patients from the perspective of the Chinese healthcare system.</p><p><strong>Methods: </strong>A Markov model was developed to evaluate three combination therapy groups based on primary drugs (bortezomib, lenalidomide, and carfilzomib). The economic evaluation was conducted within each group individually, rather than across different groups. Clinical inputs for the model were derived from RCT reports, while healthcare costs were sourced from the Zhejiang Province bidding database and a retrospective analysis. Utility values were obtained through an on-site survey using the Chinese version of the EuroQoL Five-dimensional Five-level Questionnaire. One-way and probabilistic sensitivity analyses were performed to assess the robustness of the base-case results.</p><p><strong>Results: </strong>In the bortezomib group, bortezomib-dexamethasone (Vd) yielded 2.42 quality-adjusted life years (QALYs) at a cost of ¥783,775. With a willingness-to-pay (WTP) threshold of three times the 2023 per capita GDP in China (¥258,074), pomalidomide-bortezomib-dexamethasone was the most cost-effective therapy (¥86,129/QALY) in this group. In the lenalidomide group, lenalidomide-dexamethasone (Rd) resulted in 3.06 QALYs at a cost of ¥840,509. Compared to Rd, the incremental cost-effectiveness ratios (ICERs) of elotuzumab-lenalidomide-dexamethasone (¥5,095,300/QALY), ixazomib-lenalidomide-dexamethasone (¥1,605,712/QALY), carfilzomib-lenalidomide-dexamethasone (¥955,255/QALY), and daratumumab-lenalidomide-dexamethasone (¥851,933/QALY) all exceeded the WTP threshold. In the carfilzomib group, carfilzomib-dexamethasone (Kd) resulted in 3.19 QALYs at a cost of ¥1,961,624. Compared to Kd, the ICERs of daratumumab-carfilzomib-dexamethasone (¥2,250,821/QALY) and isatuximab-carfilzomib-dexamethasone (¥4,977,964/QALY) also exceeded the WTP. Sensitivity analyses confirmed the robustness of the base-case results.</p><p><strong>Conclusions: </strong>Although this study did not fully account for the heterogeneity of subsequent treatment regimens among first/second-relapse MM patients, it highlights that the substantial financial burden associated with combination therapies involving novel agents poses a significant challenge in justifying their economic value.</p>","PeriodicalId":46936,"journal":{"name":"Health Economics Review","volume":"15 1","pages":"21"},"PeriodicalIF":2.7,"publicationDate":"2025-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11909854/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143634858","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":"Evaluation of the impact of social safety net program on health care utilization in Togo.","authors":"Yaovi Tossou","doi":"10.1186/s13561-025-00597-9","DOIUrl":"10.1186/s13561-025-00597-9","url":null,"abstract":"<p><strong>Background: </strong>The use of health care services by the most vulnerable households in low-and middle-income countries is a major challenge. This includes ensuring access to health services and protecting households from the financial risks of unaffordable medical care. In 2008, Togo put in place a social safety net program which aims to help vulnerable households benefit from cash transfers, free health care services, donated bed nets and food supplements.</p><p><strong>Methods: </strong>The data come from recent national household surveys in Togo. These are the 2018 Harmonized Household Living Conditions Survey (EHCVM). The sample size of the EHCVM survey is 6171 households. Using propensity scores (PSM) and the endogenous switching regression (ESR) model, we find that basic social nets have little direct effect on health care utilization.</p><p><strong>Results: </strong>These results show that households that are beneficiaries of the social safety nets would have had less -80.52% (-0.413/0.5129) use of health care services than if they had not participated in the social safety nets. These results show the indirect effect of the mitigation of social safety nets by policy makers to avoid hunger, malnutrition, poverty, unemployment. All of these strengthen the health status of households by avoiding certain diseases that may lead them to use health care services.</p><p><strong>Conclusion: </strong>This paper provides new evidence on the impact of social safety net programs on household health care utilization. Given the voluntary nature of participation in social safety nets by households, we exploit the uneven deployment of the program in rural areas as a natural experiment to explore causal inference. However, they do ensure good health status of households through different transmission channels, which reduces health care utilization. Policy makers should be encouraged to expand this program to other non-beneficiary groups.</p>","PeriodicalId":46936,"journal":{"name":"Health Economics Review","volume":"15 1","pages":"19"},"PeriodicalIF":2.7,"publicationDate":"2025-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11908038/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143630910","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}