Health Economics Review最新文献

{"title":"Medicare Advantage penetration and the financial distress of rural hospitals.","authors":"Guido Cataife, Siying Liu","doi":"10.1186/s13561-025-00599-7","DOIUrl":"10.1186/s13561-025-00599-7","url":null,"abstract":"<p><strong>Background: </strong>Medicare Advantage (MA) penetration rates have shown an increase in rural areas in the past decade, increasing the bargaining power of MA plans relative to rural hospitals. We study the effect that this increase has had in the revenue of rural hospitals through reductions in the number of inpatient days paid by the plans, which has been reported to be part of the financial bargaining between the two parties.</p><p><strong>Methods: </strong>We use 2014-2020 hospital level data from the American Hospital Association's annual survey and county-level MA penetration rates. We estimate the correlation between MA penetration rates and Medicare and non-Medicare inpatient days using multivariate regressions with hospital and year fixed effects. We use results for urban areas where competition among multiple MA sponsors reduces their individual bargaining power as a falsification test.</p><p><strong>Results: </strong>We find that a 10 percentage points increase in the county-level MA penetration rate is associated with a decrease of 0.87% inpatient days paid to rural hospitals, which unveils a new main factor affecting the fragile finances of rural hospitals. Consistent with our hypothesis, urban hospitals do not exhibit similar effects, underscoring the role of MA plans in rural areas.</p><p><strong>Conclusions: </strong>As MA plans increase their penetration in rural areas, their bargaining power increases relative to rural hospitals. MA plans use this increased bargaining power to reduce the number of paid inpatient days, which creates adverse financial conditions for rural hospitals. Policymakers can safeguard rural hospitals by modifying the fee-for-service prices received by rural hospitals or strengthening the network adequacy criteria of MA plans for rural areas.</p>","PeriodicalId":46936,"journal":{"name":"Health Economics Review","volume":"15 1","pages":"9"},"PeriodicalIF":2.7,"publicationDate":"2025-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11817615/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143400225","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":"Correction: The effect of basic public health service equalization on settlement intention of migrant workers in China: the mediating effect model based on subjective feelings.","authors":"Pei Liu, Zhiping Long, Xuemeng Ding","doi":"10.1186/s13561-025-00593-z","DOIUrl":"10.1186/s13561-025-00593-z","url":null,"abstract":"","PeriodicalId":46936,"journal":{"name":"Health Economics Review","volume":"15 1","pages":"8"},"PeriodicalIF":2.7,"publicationDate":"2025-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11818285/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143400255","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":"Risky behaviours and injuries amongst Catalan children with ADHD: does pharmacological treatment improve outcomes?","authors":"Toni Mora, Rowena Jacobs, Jordi Cid, David Roche","doi":"10.1186/s13561-025-00595-x","DOIUrl":"10.1186/s13561-025-00595-x","url":null,"abstract":"<p><strong>Background: </strong>Attention-Deficit/Hyperactivity Disorder (ADHD) prevalence rates are around 5-10% of school-aged children. We test whether medication use for ADHD decreases the likelihood of risky behaviour (sexual behaviour, alcohol, tobacco, and drug consumption) and injuries amongst children aged 6-18.</p><p><strong>Methods: </strong>We use a large administrative dataset for the whole population of Catalan children in Spain who were born between 1998 and 2012. We apply a scale that contains alternative definitions of ADHD so that over-diagnosis is also identified and estimate a count data model to explain the number of visits whilst accounting for confounding. Our identification strategy relies on instrumenting medication using an average indicator of the probability of prescribing medication for each most visited healthcare centre provider.</p><p><strong>Results: </strong>Our results suggest that medication use significantly reduced the number of visits of children diagnosed with ADHD for injuries but not risky behaviour. This finding is robust irrespective of the considered span or the grace period after including ADHD-related comorbidities as controls.</p><p><strong>Conclusion: </strong>In line with previous literature, medication use amongst children with ADHD reduces the prevalence of injuries but not risky behaviours.</p>","PeriodicalId":46936,"journal":{"name":"Health Economics Review","volume":"15 1","pages":"7"},"PeriodicalIF":2.7,"publicationDate":"2025-02-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11806674/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143371302","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":"What does it drive the relationship between cardiovascular disease mortality and economic development? New evidence from Spain.","authors":"Carla Blázquez-Fernández, David Cantarero-Prieto","doi":"10.1186/s13561-025-00594-y","DOIUrl":"10.1186/s13561-025-00594-y","url":null,"abstract":"<p><strong>Background: </strong>During the last decades, there has been a great interest on the link between macroeconomic conditions and health. More precisely, many studies had studied as health outcome cardiovascular disease mortality, focusing in different countries, determinants, and using numerous econometric techniques. Due to its importance, in this paper, we analyse cardiovascular disease mortality across the 17 Spanish regions over the period 2002-2019.</p><p><strong>Methods: </strong>In doing so, we estimated several panel data models considering differences by sub-periods of time while also considering gender differences. That is, we transmit a difference on previous evidence by considering a longer period of time and different explanatory factors, so we provide new highlights for Spain.</p><p><strong>Results: </strong>Our empirical results show that: (i) both socioeconomic and environmental factors have a significant importance; (ii) political factors appear not to be significant; and (iii) there exists a Mediterranean (macro-region) cardiovascular disease mortality pattern.</p><p><strong>Conclusions: </strong>These results may have usefulness for cardiovascular disease mortality prevention in Spain.</p>","PeriodicalId":46936,"journal":{"name":"Health Economics Review","volume":"15 1","pages":"6"},"PeriodicalIF":2.7,"publicationDate":"2025-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11800419/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143256953","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":"Does privatization decrease the structural efficiency in the Chinese hospital sector?","authors":"Xinju He, Yi Liu","doi":"10.1186/s13561-024-00568-6","DOIUrl":"10.1186/s13561-024-00568-6","url":null,"abstract":"<p><p>This paper examines the resource mismatch in China's healthcare sector from 2010 to 2019. We use structural efficiency to measure the resource mismatch in the healthcare industry (0.2-0.7). We find that an increase in the proportion of private hospitals decreases the healthcare resource mismatch across provincial regions. This ameliorative effect is evident in non-coastal as well as central provinces. In addition, we also find that an increase in the proportion of private hospitals leads to a greater supply of healthcare resources and the number of healthcare services, which in turn better meets the healthcare needs of local residents and decreases the healthcare resource mismatch between regions in each province.</p>","PeriodicalId":46936,"journal":{"name":"Health Economics Review","volume":"15 1","pages":"5"},"PeriodicalIF":2.7,"publicationDate":"2025-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11786494/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143075863","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":"Overuse of medical imaging and effects of payer-provider integration: quasi-experimental evidence from Finland.","authors":"Konsta Lavaste","doi":"10.1186/s13561-025-00592-0","DOIUrl":"10.1186/s13561-025-00592-0","url":null,"abstract":"<p><strong>Background: </strong>Healthcare expenditures have risen in middle- and high-income countries. One of the potential contributors is the overuse of diagnostics. I explore whether medical imaging is overused when privately owned clinics in Finland treat patients with voluntary private health insurance (VPHI).</p><p><strong>Methods: </strong>I employ administrative insurance claims data from a major Finnish insurance company, covering 2016-2019, and exploit two market entries of clinics owned by the company in 2017. The underlying assumption is that the insurance company's own clinics had weaker incentives to overuse imaging than other privately owned clinics because the payer and the provider belonged to the same entity. I identify the overuse using the staggered difference-in-differences (DID) strategy, in which I consider patients from cities with a market entry as the treatment group and compare them to patients in other similar cities.</p><p><strong>Results: </strong>I find that the market entries decreased the use of radiography and ultrasound imaging in the treatment of VPHI policyholders, suggesting that private clinics overused these imaging technologies. The more expensive computed tomography (CT) and magnetic resonance imaging (MRI) were, however, not overused.</p><p><strong>Conclusions: </strong>The results show that private clinics in Finland overused some imaging technologies when treating VPHI policyholders. The extent and magnitude of overuse can, however, vary considerably between imaging technologies and medical ailments.</p>","PeriodicalId":46936,"journal":{"name":"Health Economics Review","volume":"15 1","pages":"4"},"PeriodicalIF":2.7,"publicationDate":"2025-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11776152/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143053933","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":"Matters arising: cost-utility and cost-effectiveness analysis of disease-modifying drugs of relapsing-remitting multiple sclerosis: a systematic review.","authors":"Carlo Lazzaro, Roberto Bergamaschi, Mauro Zaffaroni, Rocco Totaro, Damiano Paolicelli","doi":"10.1186/s13561-024-00562-y","DOIUrl":"10.1186/s13561-024-00562-y","url":null,"abstract":"<p><strong>Background: </strong>In their interesting systematic review, Gallehzan et al. quoted our article Cost-utility analysis of teriflunomide in naïve vs. previously treated patients with relapsing-remitting multiple sclerosis (RRMS) in Italy. While we are grateful to Gallehzan et al. for their interest in the aim of our research, we would like to clarify some points.</p><p><strong>Methods: </strong>We compare Gallehzan et al.'s statements about our article with the original publication.</p><p><strong>Results: </strong>Gallehzan et al. omitted or misreported some relevant methodological issues and findings presented in our article. As far as methods are concerned, the main omissions were the 7-year time horizon of our study (that falls in between the 5-10 years range mentioned by Gallehzan et al. for other contributions) and the number of simulated RRMS naïve patients (1000). Regarding findings, Gallehzan et al. mistook the 0.480 incremental Quality-Adjusted Life Year gained by RRMS naïve patients vs. RRMS experienced patients on teriflunomide for the base case Incremental Cost-Utility Ratio (ICUR) calculated according to the societal viewpoint. In fact, for both the healthcare sector and societal perspectives adopted in our Markov model-based cost-utility analysis, the baseline results showed teriflunomide in RRMS naïve patients to be strongly dominant (that is, producing more QALYs and being, at the same time, cost-saving) vs. RRMS experienced patients. Therefore, the calculation of the two ICURs was not necessary.</p><p><strong>Conclusions: </strong>As systematic reviews play a remarkable role in disseminating health economic research, a careful description of the methods and the findings reported in the included studies is of paramount importance.</p>","PeriodicalId":46936,"journal":{"name":"Health Economics Review","volume":"15 1","pages":"3"},"PeriodicalIF":2.7,"publicationDate":"2025-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11748521/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143013626","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 of the addition of sintilimab as a first-line therapy for locally advanced or metastatic oesophageal squamous cell carcinoma: a Chinese healthcare system perspective.","authors":"Cuicui Yu, Yingqi Wu, Yadi Geng, Hui Yan, Pengli Zhu, Peng Ji, Fei Wu, Lijuan Ning, Yubin Feng, Aizong Shen","doi":"10.1186/s13561-024-00588-2","DOIUrl":"10.1186/s13561-024-00588-2","url":null,"abstract":"<p><strong>Background: </strong>The ORIENT-15 double-blind randomized controlled trial demonstrated that the addition of sintilimab to chemotherapy for locally advanced or metastatic oesophageal squamous cell carcinoma (OSCC) resulted in better clinical outcomes. In this analysis, we sought to evaluate the cost-effectiveness of sintilimab as a first-line treatment for locally advanced or metastatic OSCC from a healthcare system perspective in China.</p><p><strong>Methods: </strong>A partitioned survival model was constructed to perform a cost-effectiveness analysis comparing chemotherapy alone with sintilimab for locally advanced or metastatic OSCC patients. Clinical data were obtained from the ORIENT-15 trial and extrapolated to 10 years. Health state utilities and costs were sourced from the literature and from public healthcare institutions. The primary outcomes included the incremental cost-effectiveness ratio (ICER) and quality-adjusted life-years (QALYs). Two different sensitivity analyses, one-way and probabilistic, were performed to assess model uncertainty.</p><p><strong>Results: </strong>Sintilimab-based chemotherapy was more costly ($31699.21 vs. $20687.42) and more effective (0.74 vs. 0.53) than placebo-based chemotherapy, resulting in an ICER of $51908.19 /QALY, which is greater than the willingness-to-pay (WTP) threshold of China ($38223/QALY). Sensitivity analysis demonstrated that the PFS and cost of sintilimab were the major influencing factors affecting the results.</p><p><strong>Conclusions: </strong>In patients with locally advanced or metastatic OSCC, sintilimab chemotherapy could improve survival time and health benefits compared with traditional chemotherapy, but the present analysis suggests that sintilimab is not a cost-effective treatment option in China.</p>","PeriodicalId":46936,"journal":{"name":"Health Economics Review","volume":"15 1","pages":"2"},"PeriodicalIF":2.7,"publicationDate":"2025-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11720610/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142956632","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 impact of multidimensional poverty on antenatal care service utilisation in Malawi.","authors":"Amanda Grace Chatata, Gowokani Chijere Chirwa","doi":"10.1186/s13561-024-00581-9","DOIUrl":"10.1186/s13561-024-00581-9","url":null,"abstract":"<p><strong>Background: </strong>Poverty remains a key barrier to accessing essential maternal health services, particularly in low- and middle-income countries like Malawi. Despite the recognised importance of antenatal care (ANC) in ensuring healthy pregnancies as well as improving maternal and child health outcomes, ANC services remain underutilised by many women living in poverty. This underutilisation is not solely driven by a lack of financial resources but also by a range of non-monetary factors that constitute multidimensional poverty, such as limited access to education, healthcare services, and infrastructure. While much of the existing literature focuses on monetary poverty, this study explores how multidimensional poverty impacts ANC utilisation. By examining how various deprivations intersect to limit access to ANC, this research contributes to understanding the broader issue of healthcare inequality.</p><p><strong>Aim: </strong>We assess the impact of multidimensional poverty (non-monetary) on antenatal care use in Malawi.</p><p><strong>Method: </strong>Multidimensional poverty was constructed using the Forster-Akire method of the Oxford Poverty and Human Initiative (OPHI). We use data from the 2015-16 Demographic Health Survey (DHS), which includes information on women aged 15-49 who gave birth within five years of the survey. To mitigate selection bias, we use Propensity Score Matching (PSM) techniques for our principal analysis.</p><p><strong>Results: </strong>Our findings reveal that 52% of women adequately utilised ANC services. About 8,428 women were identified as multidimensionally poor, and 4,685 were classified as non-poor. The results of our PMS analysis show a significant negative relationship between ANC utilisation and multidimensional poverty (B = 0.52; P < 0.008), indicating that multidimensionally poor women are less likely to use ANC services. Similarly, the timing of ANC visits also showed a negative relationship with multidimensional poverty (B = 0.26; P < 0.04), highlighting that multidimensionally poor women are less likely to attend ANC visits within the recommended first trimester.</p><p><strong>Conclusion: </strong>The findings suggest that there is a need for sustainable investments in poverty alleviation programs to address and reduce multidimensional poverty as well as raise awareness of sexual and reproductive health concerns among adolescents and women in Malawi to improve maternal health outcomes.</p>","PeriodicalId":46936,"journal":{"name":"Health Economics Review","volume":"15 1","pages":"1"},"PeriodicalIF":2.7,"publicationDate":"2025-01-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11699699/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142928427","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":"Business cycle sensitivity of Statutory Health Insurance: evidence from the Czech Republic.","authors":"Petra Landovská","doi":"10.1186/s13561-024-00586-4","DOIUrl":"10.1186/s13561-024-00586-4","url":null,"abstract":"<p><strong>Background: </strong>The Statutory Health Insurance scheme is one of two main schemes of health care system financing in Europe. This scheme mainly relies on wage-based contributions from employers and employees and is thus prone to business cycle fluctuations. This turned out to be a problem especially after the 2008 crisis. We estimate the magnitude of the effect of the business cycle on health insurance funds' revenues in the Czech Republic where the health care system financing is based on the Statutory Health Insurance scheme. The relationship between the business cycle and healthcare system's revenues has not been quantified to this date.</p><p><strong>Methods: </strong>We use static and lagged regression models to estimate the impact of business cycle on health care system's revenues. The business cycle is proxied by eight different indicators (nominal GDP, unemployment, industrial production, recession index, business cycle index, GDP gap, consumer price index and consumer expenditure). Using quarterly data from 2000-2017, we examine the effect of business cycle on total revenues and its two main components: the employer-employee contributions and state contributions.</p><p><strong>Results: </strong>Health insurance funds' revenues display significant pro-cyclicality, which is mainly driven by employer-employee contributions. Out of all eight business cycle indicators, nominal GDP has the largest effect. In particular, the model estimates that if quarter-over-quarter GDP increases by 1%, then quarter-over-quarter healthcare system's revenues increase by 0.7% and quarter-over-quarter employer-employee contributions increase by 1.1%. The lagged effect of business cycle on healthcare system's revenues is smaller in magnitude. State contributions on behalf of economically inactive people do not display a significant relationship with business cycle in the static nor lagged model. The effect is consistent across different business cycle indicators, although the magnitudes of the effect vary.</p><p><strong>Conclusion: </strong>The results show large pro-cyclicality in healthcare system's revenues in Statutory Health Insurance schemes. Counter-cyclical mechanisms are needed to offset this loss of revenues during economic downturns to ensure sufficient resources in healthcare.</p>","PeriodicalId":46936,"journal":{"name":"Health Economics Review","volume":"14 1","pages":"108"},"PeriodicalIF":2.7,"publicationDate":"2024-12-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11673554/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142899196","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}