International journal of health care finance and economics最新文献_第4页

Refining estimates of catastrophic healthcare expenditure: an application in the Indian context. 修正灾难性医疗保健支出的估计:在印度的应用。

International journal of health care finance and economics Pub Date : 2013-06-01 Epub Date: 2013-02-24 DOI: 10.1007/s10754-013-9125-6

Indrani Gupta, William Joe

{"title":"Refining estimates of catastrophic healthcare expenditure: an application in the Indian context.","authors":"Indrani Gupta, William Joe","doi":"10.1007/s10754-013-9125-6","DOIUrl":"https://doi.org/10.1007/s10754-013-9125-6","url":null,"abstract":"Empirics of catastrophic healthcare expenditure, especially in the Indian context, are often based on consumption expenditure data that inadequately informs about the ability to pay. Use of such data can generate a pro-rich bias in the estimation of catastrophic expenditure thereby suggesting greater concentration of such expenditures among richer households. To improve upon the existing approach, this paper suggests a multidimensional approach to comprehend the incidence of catastrophic expenditure. Here, we integrate the information on health expenditure with other social and economic parameters of deprivation. An empirical illustration is provided by using nationally representative survey on morbidity and healthcare in India. The results of the multidimensional approach are consistent with the theoretical underpinnings of the ability-to-pay approach and emphasizes on the severity of the problem in rural areas. The suggested methodology is flexible and allows for context-specific prioritization in selection of parameters of vulnerability while estimating the incidence of catastrophic expenditures.","PeriodicalId":73453,"journal":{"name":"International journal of health care finance and economics","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2013-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1007/s10754-013-9125-6","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"31352627","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 12

Responding to financial pressures. The effect of managed care on hospitals' provision of charity care. 应对财政压力。管理式护理对医院提供慈善护理的影响。

International journal of health care finance and economics Pub Date : 2013-06-01 Epub Date: 2013-02-07 DOI: 10.1007/s10754-013-9124-7

Núria Mas

引用次数: 8

Generic substitution, financial interests, and imperfect agency. 一般替代、经济利益和不完全代理。

International journal of health care finance and economics Pub Date : 2013-06-01 Epub Date: 2013-03-14 DOI: 10.1007/s10754-013-9126-5

Maurus Rischatsch, Maria Trottmann, Peter Zweifel

引用次数: 26

Appraising financial protection in health: the case of Tunisia. 评估卫生领域的财务保护:突尼斯的案例。

International journal of health care finance and economics Pub Date : 2013-03-01 Epub Date: 2013-02-05 DOI: 10.1007/s10754-013-9123-8

Mohammad Abu-Zaineh, Habiba Ben Romdhane, Bruno Ventelou, Jean-Paul Moatti, Arfa Chokri

{"title":"Appraising financial protection in health: the case of Tunisia.","authors":"Mohammad Abu-Zaineh, Habiba Ben Romdhane, Bruno Ventelou, Jean-Paul Moatti, Arfa Chokri","doi":"10.1007/s10754-013-9123-8","DOIUrl":"https://doi.org/10.1007/s10754-013-9123-8","url":null,"abstract":"Despite the remarkable progress in expanding the coverage of social protection mechanisms in health, the Tunisian healthcare system is still largely funded through direct out-of-pocket payments. This paper seeks to assess financial protection in health in the particular policy and epidemiological transition of Tunisia using nationally representative survey data on healthcare expenditure, utilization and morbidity. The extent to which the healthcare system protects people against the financial repercussions of ill-health is assessed using the catastrophic and impoverishing payment approaches. The characteristics associated with the likelihood of vulnerability to catastrophic health expenditure (CHE) are examined using multivariate logistic regression technique. Results revealed that non-negligible proportions of the Tunisian population (ranging from 4.5 % at the conservative 40 % threshold of discretionary nonfood expenditure to 12 % at the 10 % threshold of total expenditure) incurred CHE. In terms of impoverishment, results showed that health expenditure can be held responsible for about 18 % of the rise in the poverty gap. These results appeared to be relatively higher when compared with those obtained for other countries with similar level of development. Nonetheless, although households belonging to richer quintiles reported more illness episodes and received more treatment than the poor households, the latter households were more likely to incur CHE at any threshold. Amongst the correlates of CHE, health insurance coverage was significantly related to CHE regardless of the threshold used. Some implications and policy recommendations, which might also be useful for other similar countries, are advanced to enhance the financial protection capacity of the Tunisian healthcare system.","PeriodicalId":73453,"journal":{"name":"International journal of health care finance and economics","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2013-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1007/s10754-013-9123-8","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"31306686","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 30

Health care utilization by immigrants in Italy. 意大利移民的医疗保健利用情况。

International journal of health care finance and economics Pub Date : 2013-03-01 Epub Date: 2012-12-13 DOI: 10.1007/s10754-012-9119-9

Giuliana De Luca, Michela Ponzo, Antonio Rodríguez Andrés

{"title":"Health care utilization by immigrants in Italy.","authors":"Giuliana De Luca, Michela Ponzo, Antonio Rodríguez Andrés","doi":"10.1007/s10754-012-9119-9","DOIUrl":"https://doi.org/10.1007/s10754-012-9119-9","url":null,"abstract":"Healthcare utilization studies show how well documented disparities between migrants and non-migrants. Reducing such disparities is a major goal in European countries. However, healthcare utilization among Italian immigrants is under-studied. The objective of this study is to explore differences in healthcare use between immigrant and native Italians. Cross-sectional study using the latest available (2004/2005) Italian Health Conditions Survey. We estimated separate hurdle binomial negative regression models for GP, specialist, and telephone consultations and a logit model for emergency room (ER) use. We used logistic regression and zero-truncated negative binomial regression to model the zero (contact decision) and count processes (frequency decisions) respectively. Adjusting for risk factors, immigrants are significantly less likely to use healthcare services with 2.4 and 2.7 % lower utilization probability for specialist and telephone consultations, respectively. First- and second-generation immigrants' probability for specialist and telephone contact is significantly lower than natives'. Immigrants, ceteris paribus, have a much higher probability of using ERs than natives (0.7 %). First-generation immigrants show a higher probability of visiting ERs (1 %). GP visits show no significant difference. In conclusion Italian immigrants are much less likely to use specialist healthcare and medical telephone consultations than natives but more likely to use ERs. Hence, we report an over-use of ERs and under-utilization of preventive care among immigrants. We recommend improved health policies for immigrants: promotion of better information dissemination among them, simplification of organizational procedures, better communications between providers and immigrants, and an increased supply of health services for the most disadvantaged populations.","PeriodicalId":73453,"journal":{"name":"International journal of health care finance and economics","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2013-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1007/s10754-012-9119-9","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"31122404","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 63

Hospital cost and quality performance in relation to market forces: an examination of U.S. community hospitals in the "post-managed care era". 医院成本和质量表现与市场力量的关系:对“后管理式医疗时代”美国社区医院的考察。

International journal of health care finance and economics Pub Date : 2013-03-01 Epub Date: 2013-01-26 DOI: 10.1007/s10754-013-9122-9

H Joanna Jiang, Bernard Friedman, Shenyi Jiang

{"title":"Hospital cost and quality performance in relation to market forces: an examination of U.S. community hospitals in the \"post-managed care era\".","authors":"H Joanna Jiang, Bernard Friedman, Shenyi Jiang","doi":"10.1007/s10754-013-9122-9","DOIUrl":"https://doi.org/10.1007/s10754-013-9122-9","url":null,"abstract":"Managed care substantially transformed the U.S. healthcare sector in the last two decades of the twentieth century, injecting price competition among hospitals for the first time in history. However, total HMO enrollment has declined since 2000. This study addresses whether managed care and hospital competition continued to show positive effects on hospital cost and quality performance in the \"post-managed care era.\" Using data for 1,521 urban hospitals drawn from the Healthcare Cost and Utilization Project, we examined hospital cost per stay and mortality rate in relation to HMO penetration and hospital competition between 2001 and 2005, controlling for patient, hospital, and other market characteristics. Regression analyses were employed to examine both cross-sectional and longitudinal variation in hospital performance. We found that in markets with high HMO penetration, increase in hospital competition over time was associated with decrease in mortality but no change in cost. In markets without high HMO penetration, increase in hospital competition was associated with increase in cost but no change in mortality. Overall, hospitals in high HMO penetration markets consistently showed lower average costs, and hospitals in markets with high hospital competition consistently showed lower mortality rates. Hospitals in markets with high HMO penetration also showed lower mortality rates in 2005 with no such difference found in 2001. Our findings suggest that while managed care may have lost its strength in slowing hospital cost growth, differences in average hospital cost associated with different levels of HMO penetration across markets still persist. Furthermore, these health plans appear to put quality of care on a higher priority than before.","PeriodicalId":73453,"journal":{"name":"International journal of health care finance and economics","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2013-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1007/s10754-013-9122-9","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"31191756","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 19

Health expenditures, health outcomes and the role of good governance. 卫生支出、卫生成果和良好治理的作用。

International journal of health care finance and economics Pub Date : 2013-03-01 Epub Date: 2012-12-25 DOI: 10.1007/s10754-012-9120-3

Marwa Farag, A K Nandakumar, Stanley Wallack, Dominic Hodgkin, Gary Gaumer, Can Erbil

引用次数: 157

Competitive bidding for health insurance contracts: lessons from the online HMO auctions. 健康保险合同的竞争性投标:来自HMO在线拍卖的经验教训。

International journal of health care finance and economics Pub Date : 2012-12-01 Epub Date: 2012-12-06 DOI: 10.1007/s10754-012-9118-x

Alok Gupta, Stephen T Parente, Pallab Sanyal

{"title":"Competitive bidding for health insurance contracts: lessons from the online HMO auctions.","authors":"Alok Gupta, Stephen T Parente, Pallab Sanyal","doi":"10.1007/s10754-012-9118-x","DOIUrl":"https://doi.org/10.1007/s10754-012-9118-x","url":null,"abstract":"Healthcare is an important social and economic component of modern society, and the effective use of information technology in this industry is critical to its success. As health insurance premiums continue to rise, competitive bidding may be useful in generating stronger price competition and lower premium costs for employers and possibly, government agencies. In this paper, we assess an endeavor by several Fortune 500 companies to reduce healthcare procurement costs for their employees by having HMOs compete in open electronic auctions. Although the auctions were successful in generating significant cost savings for the companies in the first year, i.e., 1999, they failed to replicate the success and were eventually discontinued after two more years. Over the past decade since the failed auction experiment, effective utilization of information technologies have led to significant advances in the design of complex electronic markets. Using this knowledge, and data from the auctions, we point out several shortcomings of the auction design that, we believe, led to the discontinuation of the market after three years. Based on our analysis, we propose several actionable recommendations that policy makers can use to design a sustainable electronic market for procuring health insurance.","PeriodicalId":73453,"journal":{"name":"International journal of health care finance and economics","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2012-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1007/s10754-012-9118-x","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"31110498","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 17

The employment costs of caregiving in Norway. 挪威护理人员的雇佣成本。

International journal of health care finance and economics Pub Date : 2012-12-01 Epub Date: 2012-09-16 DOI: 10.1007/s10754-012-9116-z

Andreas Kotsadam

引用次数: 33

Physician response to financial incentives when choosing drugs to treat breast cancer. 医生在选择治疗乳腺癌的药物时对经济激励的反应。

International journal of health care finance and economics Pub Date : 2012-12-01 Epub Date: 2012-11-03 DOI: 10.1007/s10754-012-9117-y

Andrew J Epstein, Scott J Johnson

{"title":"Physician response to financial incentives when choosing drugs to treat breast cancer.","authors":"Andrew J Epstein, Scott J Johnson","doi":"10.1007/s10754-012-9117-y","DOIUrl":"https://doi.org/10.1007/s10754-012-9117-y","url":null,"abstract":"This paper considers physician agency in choosing drugs to treat metastatic breast cancer, a clinical setting in which patients have few protections from physicians' rent seeking. Physicians have explicit financial incentives attached to each potential drug treatment, with profit margins ranging more than a hundred fold. SEER-Medicare claims and Medispan pricing data were formed into a panel of 4,503 patients who were diagnosed with metastatic breast cancer and treated with anti-cancer drugs from 1992 to 2002. We analyzed the effects of product attributes, including profit margin, randomized controlled trial citations, FDA label, generic status, and other covariates on therapy choice. Instruments and drug fixed effects were used to control for omitted variables and possible measurement error associated with margin. We find that increasing physician margin by 10% yields between an 11 and 177% increase in the likelihood of drug choice on average across drugs. Physicians were more likely to use drugs with which they had experience, had more citations, and were FDA-approved to treat breast cancer. Oncologists are susceptible to financial incentives when choosing drugs, though other factors play a large role in their choice of drug.","PeriodicalId":73453,"journal":{"name":"International journal of health care finance and economics","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2012-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1007/s10754-012-9117-y","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"31026046","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 24