European Journal of Health Economics最新文献

{"title":"Coordinating care across hospitals: how integration shapes patient mobility.","authors":"Guérin Loïc, Sirven Nicolas","doi":"10.1007/s10198-026-01939-y","DOIUrl":"10.1007/s10198-026-01939-y","url":null,"abstract":"<p><strong>Background: </strong>In 2016, France reformed its health system by requiring public hospitals to form territorial groups. Policymakers, following experiences with integrated care provision in the United States and NHS-type networks in Italy and England, expected these groups to improve coordination and system efficiency. However, it remains unclear whether such administrative integration creates new care pathways within groups or substitutes for existing referral relationships with external providers.</p><p><strong>Methods: </strong>We analyzed national hospital administrative data from 2013 to 2021. Changes in inter-facility transfer rates were estimated using a synthetic difference-in-differences approach. The main outcome was the annual percentage of patients transferred to another hospital, overall and within the same group.</p><p><strong>Results: </strong>Following group formation, smaller local hospitals experienced an average increase of 1.25 percentage points in transfers to hospitals within their group. Transfers to hospitals outside the group remained broadly stable, suggesting limited substitution away from pre-existing referral channels.</p><p><strong>Conclusions: </strong>Territorial grouping are associated with an increase in internal patient mobility, particularly among local hospitals, without reducing exchanges with external providers. These findings suggest that administrative integration may have layered new coordination arrangements onto existing care pathways and reinforced patterns of functional specialization. The results contribute to understanding how network-based integration reshapes organizational behaviour and patient mobility in regulated health systems.</p>","PeriodicalId":51416,"journal":{"name":"European Journal of Health Economics","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148354697","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A comparative analysis of managed entry agreements in Europe: trends, reporting practices, and financial outcomes.","authors":"N Franzen, J Vancoppenolle, V P Retèl, S Vogler, W H van Harten","doi":"10.1007/s10198-026-01942-3","DOIUrl":"10.1007/s10198-026-01942-3","url":null,"abstract":"<p><strong>Background: </strong>Payers use Managed Entry Agreements (MEAs) across Europe to manage the financial risks associated with high-cost medicines. While these agreements aim to improve affordability and address uncertainty, their confidential nature raises concerns about transparency, international price referencing, and the validity of economic evaluations. This study examines MEA practices across 13 European countries, analyzing adoption trends, reporting practices, and financial outcomes, and their implications for payer decision-making.</p><p><strong>Methods: </strong>Data from 2016 to 2022 were collected through (1) mapping national MEA frameworks, stakeholders, and implementation processes; (2) desk research on publicly available activity and financial reports; and (3) validation interviews with public-sector negotiators in each country.</p><p><strong>Results: </strong>Across 13 countries, 24 MEA frameworks were identified. MEA usage increased substantially, with the highest numbers in 2022 in Germany (356) and France (349), and the largest growth in Belgium (+ 250%) and Norway (+ 227%). Reported expenditure reductions ranged from €0.04 billion (Slovakia) to €5.56 billion (France), with estimated discounts between 14% (Germany) and 54% (Belgium). Reporting remained heterogeneous, with activity data available for fourteen frameworks and financial data for ten. More granular reporting, such as by discount mechanism (Netherlands), therapeutic class (France), or gender (Sweden), was uncommon.</p><p><strong>Conclusion: </strong>The growing use of MEAs across Europe has widened the gap between list and actual prices. Incomplete and non-standardized reporting reduces the ability to assess financial performance and limits cross-country comparability. Harmonized reporting of aggregated data, without compromising confidentiality, could improve transparency, accountability, and support value-based pricing strategies.</p>","PeriodicalId":51416,"journal":{"name":"European Journal of Health Economics","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-06-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148347344","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Development and validation of solomon's socioeconomic status index (SESI): a multidimensional household classification tool for South Asia.","authors":"Sheikh Mohd Saleem, Shah Sumaya Jan","doi":"10.1007/s10198-026-01959-8","DOIUrl":"https://doi.org/10.1007/s10198-026-01959-8","url":null,"abstract":"<p><strong>Background: </strong>Existing socioeconomic status (SES) scales in India are limited by outdated income categories, urban-centric assumptions, and unidimensional frameworks that inadequately capture contemporary socioeconomic realities. This study aimed to develop and validate a theoretically grounded, multidimensional SES assessment tool suitable for Indian settings with potential relevance for South Asia.</p><p><strong>Methods: </strong>A cross-sectional study was conducted to design and validate Solomon's Socioeconomic Status Index (SESI). Scale development was informed by literature review, expert consultation, and focus group discussions. SESI comprises nine weighted dimensions: education (15%), occupation (15%), housing quality (20%), land ownership (10%), vehicle ownership (10%), business ownership (10%), durable assets (10%), locality type (5%), and digital access (5%). The tool was administered to 1,247 households across diverse geographic regions of India. Reliability was assessed using Cronbach's alpha and split-half methods, while validity was evaluated using exploratory and confirmatory factor analyses and correlations with established SES scales.</p><p><strong>Results: </strong>SESI demonstrated strong internal consistency (Cronbach's α = 0.84) and high test-retest reliability (r = 0.89, p < 0.001). Exploratory factor analysis identified a three-factor structure explaining 68.3% of variance, supported by confirmatory factor analysis (CFI = 0.94, RMSEA = 0.051). SESI showed significant correlations with the Modified Kuppuswamy Scale (r = 0.72) and BG Prasad Scale (r = 0.68), indicating good convergent validity.</p><p><strong>Conclusion: </strong>SESI provides a reliable and theoretically informed multidimensional measure of socioeconomic status that captures both traditional and emerging determinants, including digital access. It offers improved precision for socioeconomic classification in health research and policy, with potential applicability to South Asian contexts subject to further validation.</p>","PeriodicalId":51416,"journal":{"name":"European Journal of Health Economics","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148341102","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparing universal health coverage models: an analysis of policy transmission efficiency in SAARC and ASEAN countries.","authors":"Avik Ghosh","doi":"10.1007/s10198-026-01958-9","DOIUrl":"https://doi.org/10.1007/s10198-026-01958-9","url":null,"abstract":"<p><p>This study empirically examines the role of Universal Health Coverage (UHC) as a strategic facilitator in enhancing the effectiveness of government health expenditure (GHE) on financial protection and health outcomes across 14 SAARC and ASEAN nations from 2000 to 2023. Using a Two-Way Fixed Effects (TWFE) regression model, the study identifies that higher GHE alone does not guarantee reductions in out-of-pocket (OOP) expenses or mortality rates, but its impact is significantly mediated by UHC adoption and structure. To capture distributive heterogeneity, quantile regression analysis is employed, revealing that mandatory insurance-based and hybrid UHC models provide greater financial protection, particularly for lower-income populations, while public-sector-dominant service provision maximizes mortality reductions. The findings emphasize that UHC enhances the transmission of government health investments into tangible sectoral benefits, reinforcing its role as a policy accelerator for achieving Sustainable Development Goal (SDG) 3.8. Policy recommendations include strengthening UHC financing, optimizing risk-pooling mechanisms, and aligning fiscal priorities with equitable healthcare access. This study contributes to global UHC discourse by offering an empirically grounded, region-specific roadmap for ensuring financial sustainability and universal healthcare accessibility in emerging economies.</p>","PeriodicalId":51416,"journal":{"name":"European Journal of Health Economics","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148341005","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Who pays and Who benefits? A distributional health-economic evaluation of strengthening the UK soft drinks industry levy.","authors":"Siamand Hesami","doi":"10.1007/s10198-026-01957-w","DOIUrl":"https://doi.org/10.1007/s10198-026-01957-w","url":null,"abstract":"<p><p>This paper examines the distributional welfare effects of strengthening the UK Soft Drinks Industry Levy (SDIL). Using individual-level dietary data from the UK National Diet and Nutrition Survey, we simulate three scenarios for strengthening the SDIL within a comparative risk assessment framework and translate policy-induced reductions in sugar intake from sugar-sweetened beverages into changes in quality-adjusted life years over a 10-year horizon. Health gains are monetised at willingness-to-pay thresholds of £20,000 and £30,000 per quality-adjusted life year, while consumer burden is expressed relative to household resources using Office for National Statistics income and expenditure benchmarks.Results show that stronger levy designs yield greater reductions in sugar intake and body mass index, and deliver positive net monetised benefits under the two stronger scenarios. Health gains are disproportionately concentrated among more deprived groups because baseline sugar-sweetened beverage exposure is socially graded, and these groups exhibit greater price responsiveness. Health-gain ratios between the most and least deprived quintiles consistently exceed the corresponding burden ratios across all age groups. When expressed relative to income or expenditure, consumer burden shares decline monotonically from the most to the least deprived quintile, confirming financial regressivity. Weighted gradient tests show that this regressivity is a consistent structural feature across age groups rather than being concentrated in any particular life stage. Overall, a strengthened levy appears regressive in payment incidence but progressive in health terms, highlighting the importance of jointly assessing financial burdens and health benefits when evaluating corrective health taxes.</p>","PeriodicalId":51416,"journal":{"name":"European Journal of Health Economics","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148341188","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Getting fairer over time? Assessing changes in health technology funding processes using the accountability for reasonableness (A4R) framework.","authors":"Jing Jing Li, Marcus Sellars, Joanna Coast, Stacy M Carter, Kirsten Howard, Duncan Mortimer, Emily Lancsar","doi":"10.1007/s10198-026-01946-z","DOIUrl":"https://doi.org/10.1007/s10198-026-01946-z","url":null,"abstract":"<p><p>Fair distribution of limited health funding is a universal challenge for health systems. Decisions about funding new technologies provide a helpful lens on this complex issue. This study examined how two of the world's most mature centralised review processes for health technology funding, namely the Australian Pharmaceutical Benefits and Medical Services Advisory Committees (PBAC and MSAC) have approached fairness over time. Using the Accountability for Reasonableness (A4R) framework, which defines fair priority-setting through four conditions (Relevance, Publicity, Revision, and Enforcement), we conducted (i) a detailed document review of policy changes (2014-2022) and (ii) semi-structured interviews with decision-makers at PBAC and MSAC in 2014 (n = 12) and 2021/22 (n = 11). In both the document review and the interviews, we found increased alignment with A4R principles over time, including enhanced Relevance through increased consumer representation, increased Publicity of decision rationales, and greater Enforcement through broader committee deliberation. However, Revision was not a pressing concern of committee members at either time point despite notable policy changes that improved Revision. Persistent barriers to Publicity were identified, particularly the redaction of decision rationales in public summary documents due to sponsor confidentiality requirements and challenges of explaining nuanced deliberations rather than formulaic criteria. Our findings illustrate how A4R principles are applied in practice and highlight the challenge of balancing procedural fairness with substantive ethical considerations, such as equity and cost effectiveness, that underlie the criterion of Relevance.</p>","PeriodicalId":51416,"journal":{"name":"European Journal of Health Economics","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148303915","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Italian National Health Service: still alive for long?","authors":"Livio Garattini","doi":"10.1007/s10198-026-01947-y","DOIUrl":"https://doi.org/10.1007/s10198-026-01947-y","url":null,"abstract":"","PeriodicalId":51416,"journal":{"name":"European Journal of Health Economics","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148303960","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Economic value of non-professional care in Spain. An analysis of the last decade.","authors":"Juan Oliva-Moreno, Cristina Vilaplana-Prieto, Luz María Peña-Longobardo","doi":"10.1007/s10198-026-01952-1","DOIUrl":"https://doi.org/10.1007/s10198-026-01952-1","url":null,"abstract":"<p><p>The objective of this work is to estimate the time and value of the non-professional care, also called informal care, provided to people with limited autonomy in Spain, and to analyze its evolution between 2008 and 2021. We used as the main source of information the Survey of Situations of Disability, Personal Autonomy and Dependency carried out in the years 2008 and 2020-21. Non-professional care time has been assessed using replacement cost and contingent valuation methods. The analysis was carried out from the individual (main caregiver) and aggregate (national level) perspective. Additionally, care time was analyzed using multivariate regression models. The number of non-professional caregivers increased by 20.5% between 2008 and 2021. The estimated non-professional care time in 2021 was 5,156 million hours (25% more than in 2008). The most conservative estimates of care time assessment represent 1.42%, 2.96% and 6.72% of GDP, using the Willingness to Pay, Willingness to Accept and replacement cost, respectively. The multivariate analysis indicates that the degree of dependency was the main variable to account for the probability of receiving non-professional care. We conclude that despite the growth of the Spanish System for Autonomy and Care for Dependent Patients over the last 18 years, the non-professional network continues to provide invaluable support for the care provided to dependent people. The estimated results and their evolution constitute valuable information for use in planning policies to promote autonomy and care for dependent people, as well as support for caregivers today and in the coming years.</p>","PeriodicalId":51416,"journal":{"name":"European Journal of Health Economics","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148279813","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Different family caregiver- and care recipient-related factors are associated with the cost of care in the early, mild, and moderate stages of Alzheimer's disease in Finland: A 5-year ALSOVA study.","authors":"Viivi Jetsonen, Tarja Välimäki, Tuomas Selander, Virpi Kuvaja-Köllner, Janne Martikainen, Anne M Koivisto","doi":"10.1007/s10198-026-01950-3","DOIUrl":"https://doi.org/10.1007/s10198-026-01950-3","url":null,"abstract":"<p><strong>Purpose: </strong>Alzheimer's disease (AD) accounts for a significant proportion of health and social care costs. We studied family caregiver (FC), care recipient (CR), and formal care provider-related factors, which are associated with the cost of care in different stages of AD in Finland.</p><p><strong>Methods: </strong>A 5-year follow-up was conducted with 231 individuals with AD (CRs) and their FCs as a part of the ALSOVA project. The data was collected between 2002 and 06. Significant factors associated with costs were identified using a stepwise backward elimination procedure. Neuropsychiatric symptoms were measured with the Neuropsychiatric Inventory (NPI).</p><p><strong>Results: </strong>Across all stages of AD, each additional year of CR's education was associated with a 3.4% reduction in costs (rate ratio [RR] 0.966, 95% CI 0.940-0.993). Conversely, a one-point increase on the Neuropsychiatric Inventory was associated with a 1.8% increase in costs (RR 1.018, 95% CI 1.011-1.025). CR's neuropsychiatric symptoms (RR 1.028, 95% CI 1.010-1.047) and male FC (RR 1.756, 95% CI 1.266-2.437) were associated with increased total costs in early AD, CR's comorbidities (RR 1.138, 95% CI 1.068-1.212) and FC's burden (RR 1.032, 95% CI 1.012-1.053) in mild AD and FC being a spouse (RR 1.451, 95% CI 1.105-1.905) in moderate AD. No formal care provider-related factors were associated with total costs in any stage of AD.</p><p><strong>Conclusions: </strong>This study reveals several factors that may be manageable to control the costs of AD. Comprehensive prevention, evaluation, and treatment of a CR's neuropsychiatric symptoms and comorbidities should be executed early. Informal care can act as a substitute for formal care in early-stage AD, and supportive measures toward FCs should be considered.</p>","PeriodicalId":51416,"journal":{"name":"European Journal of Health Economics","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148280100","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Business cycles and mortality in Italy.","authors":"Adriano Ruggiero, María Cervini-Plá","doi":"10.1007/s10198-026-01944-1","DOIUrl":"https://doi.org/10.1007/s10198-026-01944-1","url":null,"abstract":"<p><p>Our study examines the relationship between business cycles and mortality rates in Italy over the period 2004-2019. Using the unemployment rate as a proxy for macroeconomic conditions, we investigate how economic fluctuations affect mortality rates across causes of death, age groups, genders, and educational levels. The analysis relies on data from the National Institute of Statistics (ISTAT) and applies panel data methods to control for province-specific heterogeneity and time effects. The findings reveal a procyclical pattern, with higher unemployment rates associated with lower mortality. Substantial heterogeneity emerges across demographic groups and causes of death. To test robustness, the analysis is extended to include the COVID-19 pandemic years (2020-2021), thereby assessing its impact on the previously identified relationships. Results suggest that the pandemic disrupted established unemployment-mortality dynamics, particularly for transport accidents and respiratory diseases. Overall, the findings highlight the importance of targeted public policies to mitigate health risks during economic expansions and provide insights into how macroeconomic conditions shape public health outcomes in Italy.</p>","PeriodicalId":51416,"journal":{"name":"European Journal of Health Economics","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148280067","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}