European Journal of Health Economics最新文献

{"title":"Does more generous health insurance reimbursement lead to moral hazard? Evidence from large-scale administrative data in China.","authors":"Jiakai Gong, Yingjie Zhu, Jiawu Dai, Chen Zhu","doi":"10.1007/s10198-026-01976-7","DOIUrl":"https://doi.org/10.1007/s10198-026-01976-7","url":null,"abstract":"<p><p>This paper exploits the discrete increase in reimbursement rates at the statutory retirement age as a quasi-natural experiment to examine ex post moral hazard in inpatient care in China. Using nationally representative administrative data covering more than 450,000 hospitalization records across 29 provinces, we implement a cohort difference-in-differences design to identify the causal effect of insurance generosity on healthcare utilization. We find that a 5-percentage-point increase in reimbursement rates increases length of stay by 1.73 days and total inpatient expenditures by RMB 709.98. The additional spending is primarily financed by the insurance pool, while patients' out-of-pocket payments decline, consistent with moral hazard predictions. Decomposition results show that the spending increase is concentrated in diagnostic services, pharmaceutical use, and inpatient care components such as bed and nursing services, rather than high-intensity treatments. Further analysis highlights the role of supply-side institutional constraints: under the Diagnosis-Intervention Packet (DIP) payment system, utilization responses are largely muted, whereas under non-DIP regimes they remain substantial. In addition, moral hazard is concentrated in secondary hospitals. Overall, these findings suggest that moral hazard in inpatient care reflects demand-side price responsiveness and manifests differently across supply-side institutional environments. This institutional heterogeneity also underscores the potential importance of provider payment reform in health insurance policy design.</p>","PeriodicalId":51416,"journal":{"name":"European Journal of Health Economics","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149118231","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":"Remote and self-monitoring for pregnant women at risk of gestational hypertensive disorders: a cost-effectiveness analysis.","authors":"Marie-Lien Gerits, Samantha Bielen, Dorien Lanssens, Wim Marneffe","doi":"10.1007/s10198-026-01995-4","DOIUrl":"https://doi.org/10.1007/s10198-026-01995-4","url":null,"abstract":"<p><strong>Objectives: </strong>Gestational hypertensive disorders (GHD) are common pregnancy-related disorders associated with adverse outcomes. Adequate blood pressure monitoring is essential to mitigate these risks. Remote monitoring (RM) and patient self-monitoring (PSM) may provide alternatives to conventional care. However, their cost-effectiveness remains unassessed. This study evaluated the cost-effectiveness of RM and PSM compared with conventional care for pregnant women at risk of GHD.</p><p><strong>Methods: </strong>This trial-based economic evaluation used PREMOM II trial data and InterMutualistic Agency cost data. A cost-utility analysis was conducted from a healthcare payer perspective, with results expressed as costs per quality-adjusted life year (QALY) gained. Uncertainty was assessed through one-way and probabilistic sensitivity analyses.</p><p><strong>Results: </strong>At the mother-infant dyad level, RM and PSM generated small QALY gains versus conventional care (0.001 and 0.004 QALYs) and higher costs (€337.91 and €898.45). ICERs were €304,046/QALY for RM and €222,483/QALY for PSM, both exceeding the NICE willingness-to-pay reference range of £25,000-£35,000/QALY. In the full incremental analysis, RM was extendedly dominated by PSM. Probabilistic sensitivity analysis showed substantial uncertainty across comparisons.</p><p><strong>Conclusions: </strong>There is insufficient evidence to determine the relative cost-effectiveness of RM or PSM compared with conventional care. Consequently, the analysis provides no evidence to justify reimbursement.</p><p><strong>Trial registration: </strong>The study is registered with ClinicalTrials.gov NCT04031430 on November 11, 2018.</p>","PeriodicalId":51416,"journal":{"name":"European Journal of Health Economics","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149118337","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 impact of free influenza vaccination schemes on vaccine uptake among older adults in Europe, 2019-2020.","authors":"Arthur Juet","doi":"10.1007/s10198-026-01983-8","DOIUrl":"https://doi.org/10.1007/s10198-026-01983-8","url":null,"abstract":"<p><p>We investigated the causal effect of free influenza vaccination schemes on vaccination uptake among adults aged 50 years and older across 25 European countries. All countries conducted annual information campaigns targeting older adults, but differed in whether vaccination was provided free of charge at the point of delivery and in the age at which eligibility began. Using cross-sectional data from the 2019/2020 Survey of Health, Ageing and Retirement in Europe (SHARE), we exploited this institutional variation through a difference-in-discontinuities design that compared age-based discontinuities in vaccination uptake across countries with and without free vaccination schemes, rather than relying on similarity in individual characteristics. We found that offering vaccination free of charge increased influenza vaccine uptake by around 6 percentage points at the eligibility threshold. By contrast, no discontinuity was observed in countries relying exclusively on information campaigns. These findings indicate that free access substantially increased vaccination coverage beyond the effect of information provision alone. We further found no evidence that the effect differed systematically by household income, suggesting that free vaccination schemes operated not only through the removal of direct financial barriers but also through broader reductions in non-financial frictions. Overall, our findings highlight free access as an effective policy instrument for increasing influenza vaccination uptake among older adults.</p>","PeriodicalId":51416,"journal":{"name":"European Journal of Health Economics","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149117685","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":"Digital transformation, governance multipliers, and healthcare efficiency: evidence from emerging and high-income health systems.","authors":"Manoj Kumar M V, Prashanth B S, Ariful Hoque, Nasser Al Muraqab, Immanuel Azaad Moonesar, Udo Christian Braendle, Ananth Rao","doi":"10.1007/s10198-026-01994-5","DOIUrl":"https://doi.org/10.1007/s10198-026-01994-5","url":null,"abstract":"<p><strong>Objectives: </strong>This study examines how digital finance, digital transformation, and governance quality jointly influence healthcare efficiency across emerging and high-income health systems. We assess whether digital innovations contribute to productivity improvements and whether institutional capacity conditions these effects.</p><p><strong>Study design: </strong>We analyse a balanced panel of 13 countries over 2000-2023 using a multi-method empirical strategy. Baseline OLS and fixed- and random-effects models establish structural patterns, while the two-step system GMM corrects for endogeneity, persistence, and unobserved heterogeneity. Random Forest Trees (RFT) provide complementary predictive validation.</p><p><strong>Data sources: </strong>Healthcare efficiency, digital readiness, governance indices, and macroeconomic indicators were sourced from the World Bank, WHO, Global Findex, and national statistics, yielding 325 country-year observations.</p><p><strong>Principal findings: </strong>Healthcare efficiency exhibits strong persistence over time. Digital finance and digital transformation significantly improve efficiency across all model specifications. Critically, governance quality amplifies these digital effects: interaction terms (GOV × DF, GOV × DT) remain robust in GMM and rank among the most influential predictors in the RFT model. Cross-country disparities in efficiency largely reflect differences in digital and institutional maturity rather than economic or demographic scale.</p><p><strong>Conclusion: </strong>Digital tools can enhance healthcare efficiency, but their effectiveness depends on the institutional environment in which they are deployed. Strengthening governance capacity alongside digital investment is therefore essential for improving system-wide performance and advancing SDG 3. The combined econometric-machine-learning approach provides robust causal and predictive evidence for policy design.</p>","PeriodicalId":51416,"journal":{"name":"European Journal of Health Economics","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149118219","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":"Hospital performance evaluation for UN Sustainable Developmental Goals (SDGs): a practical multi-criteria decision making model based on root assessment method (RAM).","authors":"Alireza Sotoudeh-Anvari","doi":"10.1007/s10198-026-01984-7","DOIUrl":"https://doi.org/10.1007/s10198-026-01984-7","url":null,"abstract":"<p><p>Hospitals as the heart of healthcare industry account for more than 40% of total healthcare costs and contribute significantly to sustainable development. Hence, the implementation of an efficient hospital performance evaluation system has the highest priority in the field. This study is the first in the literature which suggests an integrated multi-criteria decision making (MCDM) methodology comprising of best-worst method (BWM), step-wise weight assessment ratio analysis (SWARA) and root assessment method (RAM) to deal with the problem of hospital performance evaluation within the context of sustainability. First, we introduce a new subjective weighting method constructed by the convex combination of well-known methods, namely SWARA and BWM, named SWBW to improve the reliability of these methods. Next, RAM as one of the newest MCDM methods is implemented to rank the decision alternatives. A real-world case taken from literature is provided to illustrate the applicability of suggested methodology. The main feature of the suggested method is its applicability to any problem of hospital performance assessment in the context of sustainability with no limitation on the number of criteria and alternatives. SWBW-RAM can provide an adequately flexible decision-making method which is applicable to deal with highly complex real-world problems in different industries without major modifications. Through sensitivity analysis, the superiority of suggested method is showcased by demonstrating that its result is reliable and more robust than those derived from other existing methods. The implications of this study extend to policymakers and researchers who can leverage the findings of this paper to integrate the sustainability practices into the hospital management.</p>","PeriodicalId":51416,"journal":{"name":"European Journal of Health Economics","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149118290","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":"Psychometric properties of EQ-5D-Y-3L versus EQ-5D-Y-5L Arabic versions in healthy and diseased children.","authors":"Manar G Elgaar, Janine Verstraete, Fatma S E Ebeid, Maggie M Abbassi, Samar F Farid","doi":"10.1007/s10198-026-01993-6","DOIUrl":"https://doi.org/10.1007/s10198-026-01993-6","url":null,"abstract":"<p><strong>Background: </strong>There is growing interest in using Health-Related Quality of Life (HRQOL) instruments in clinical practice for children and adolescents. Before widespread use, it is important to critically evaluate the psychometric properties of new or updated HRQOL tools in different health conditions.</p><p><strong>Objectives: </strong>This study aimed to evaluate psychometric properties of the Arabic versions of EQ-5D-Y-3L and EQ-5D-Y-5L among children and adolescents with different health conditions in Egypt.</p><p><strong>Methods: </strong>Healthy children and adolescents from schools and those with cancer or diabetes from hospitals, aged 8-15, were self-completed EQ-5D-Y-3L and EQ-5D-Y-5L in randomized order. Feasibility, discriminatory power, ceiling effect, convergent validity, redistribution properties, and test-retest reliability were compared to evaluating performance.</p><p><strong>Results: </strong>A total of 273 participants completed the surveys for the first time at recruitment. There were 0% missing responses on both versions. Time to complete EQ-5D-Y-3L and EQ-5D-Y-5L was almost the same, with medians of 2.5 and 2.67 min, respectively. About 55.7% of participants preferred EQ-5D-Y-5L over EQ-5D-Y-3L, and 81.7% believed it best represented their health. The average improvement in absolute informativity of EQ-5D-Y-5L dimensions was 0.397. Ceiling effect was reduced by 19.4%. There were moderate to strong significant correlations across dimensions of both versions with EQ VAS. Inconsistent responses ranged from 1.5% to 5.9%. To assess reliability, 188 participants completed the surveys for the second time and weighted Kappa results showed moderate to substantial agreement. The EQ VAS, EQ-5D-Y-3L, and EQ-5D-Y-5L level sum scores demonstrated good reliability.</p><p><strong>Conclusion: </strong>Both Arabic versions are valid, feasible, reliable, and recommended for use among healthy and ill children/adolescents across age range (8-15 years). EQ-5D-Y-5L allows better health expression, improves absolute informativity, and reduces ceiling effects compared to EQ-5D-Y-3L, while maintaining comparable validity and reliability.</p>","PeriodicalId":51416,"journal":{"name":"European Journal of Health Economics","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149118370","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 consequences of medicine shortages on healthcare utilization and care fragmentation.","authors":"Jan Panhuysen, Eva Goetjes, Mujaheed Shaikh, Katharina E Blankart","doi":"10.1007/s10198-026-01953-0","DOIUrl":"https://doi.org/10.1007/s10198-026-01953-0","url":null,"abstract":"<p><p>We evaluate the consequences of medicine supply disruptions for healthcare utilization, care fragmentation, and costs. To provide causal evidence on such systemic effects, we examine the global recall of valsartan in July 2018, a widely used antihypertensive medicine. Drawing on German healthcare claims data covering 30,976 affected patients, we employ a difference-in-differences design with matched patients unaffected by supply disruptions. We find that nearly 70% of valsartan users discontinued medication but switched to other treatments, keeping the overall provision of antihypertensive care stable. Pharmaceutical costs rose, driven primarily by a 5.3% increase in costs for antihypertensives, imposing a significant financial burden on insurers. The recall temporarily increased general practitioner service utilization and care fragmentation, while pharmacy fragmentation persisted for up to a year, affecting one in five patients. Our quantification of hidden adjustment costs and burden-shifting effects in outpatient care underscores the need for pharmaceutical shortage management policies that recognize the temporary inefficiencies specifically introduced into medicine dispensing. Our findings generalize to other sudden supply disruptions and likely represent a benchmark of the consequences of medicine shortages.</p>","PeriodicalId":51416,"journal":{"name":"European Journal of Health Economics","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149076609","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":"Correction: Unraveling acceptance of healthcare innovations in neurorehabilitation: results from a discrete choice experiment.","authors":"Ann-Kathrin Fischer, Andrew Sadler, Thomas Kohlmann, Axel Mühlbacher","doi":"10.1007/s10198-026-01982-9","DOIUrl":"https://doi.org/10.1007/s10198-026-01982-9","url":null,"abstract":"","PeriodicalId":51416,"journal":{"name":"European Journal of Health Economics","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148992560","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":"Cost-utility and cost-effectiveness analysis of an AI-driven platform for standard postnatal care and breastfeeding: results from the COMLACT study.","authors":"Isaac Aranda-Reneo, Rafael Vila Candel, Desiree Mena-Tudela, Esmeralda Santacruz-Salas","doi":"10.1007/s10198-026-01951-2","DOIUrl":"https://doi.org/10.1007/s10198-026-01951-2","url":null,"abstract":"<p><strong>Objective: </strong>To assess whether an AI-driven technology for neonatal care is costeffective compared to usual primary care in improving women's health-related quality of life and breastfeeding self-efficacy.</p><p><strong>Methods: </strong>We conducted a cost-effectiveness analysis from the perspective of the healthcare payer, families, and society. Data from a randomised controlled trial with a six-month follow-up were used to obtain utility values and breastfeeding self-efficacy. Missing values were handled using multiple imputations by chained equations, and a complete case analysis was conducted as a sensitivity analysis. Incremental cost and effect differences were adjusted using seemingly unrelated regression, based on baseline participant characteristics.</p><p><strong>Results: </strong>The study included 174 women (mean age 33 years), 91% of whom were from European countries, recruited from Spanish primary care centres. Direct healthcare costs (€87.64) accounted for 35% of total costs (€248.50), while breastfeeding-related material costs (€146.26) represented the highest family expenses during follow-up. After adjusting for baseline covariates, the ICUR was €3,363/QALY from the healthcare payer's perspective and €2,964/QALY from the societal perspective, respectively. A slight cost-saving was observed from the family perspective (€ - 2.49, 95% CI: - 67.76 to 63.77), with minimal improvements in healthrelated quality of life (0.01, 95% CI: - 0.02 to 0.03) and slight worsening in breastfeeding self-efficacy scores (- 1.49, 95% CI: - 5.57 to 2.60) but with no clinical relevance.</p><p><strong>Conclusions: </strong>The mobile app's ICURs were below the commonly used European cost-effectiveness thresholds, due to a slight improvement in the health-related quality of life and low direct healthcare costs from the family perspective. However, usual care dominated the mobile app for improving breastfeeding self-efficacy, regardless of the cost perspective. TRIAL REGISTRATION NUMBER (CLINICALTRIALS.GOV): NCT05432700, prospectively registered.</p>","PeriodicalId":51416,"journal":{"name":"European Journal of Health Economics","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148984132","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":"Willingness to pay for health insurance in Italy: evidence from a survey on consumers' behaviour.","authors":"Dario Focarelli, Chiara Gesmundo, Carlo Savino","doi":"10.1007/s10198-026-01966-9","DOIUrl":"https://doi.org/10.1007/s10198-026-01966-9","url":null,"abstract":"<p><p>This paper examines the willingness to pay (WTP) for duplicative private health insurance in Italy, a country with universal healthcare system characterized by broad public coverage alongside substantial waiting times and relatively high out-of-pocket expenditure. Using nationally representative data from the Italian Survey of Consumer Expectations (ISCE), we elicit individual WTP through a structured bidding mechanism for insurance offering faster access to surgeries, outpatient procedures, and diagnostic examinations already covered by the public system. Willingness to pay increases with income, perceived health risk, prior medical expenditure, and familiarity with insurance products. WTP appears primarily driven by exposure to financial and opportunity costs associated with delayed access rather than by generalized dissatisfaction with public healthcare. We embed a randomized controlled trial providing factual information on public waiting times and private-sector costs. While the intervention does not significantly affect average WTP, it reshapes its determinants: information increases the responsiveness of WTP to direct financial exposure and raises valuations among self-employed individuals and respondents holding inaccurate prior beliefs. Overall, informational frictions influence how individuals weigh economic risks rather than its aggregate level.</p>","PeriodicalId":51416,"journal":{"name":"European Journal of Health Economics","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148867719","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}