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on Health Economics |
| By: | Franco Sassi; Michele Cecchini; Jeremy Lauer; Dan Chisholm |
| Abstract: | Overweight and obesity rates have been increasing relentlessly over recent decades in all industrialised countries, as well as in many lower income countries. OECD analyses of trends over time support the grim picture drawn in the international literature and so do projections of overweight and obesity rates over the next ten years. The circumstances in which people have been leading their lives over the past 20-30 years, including physical, social and economic environments, have exerted powerful influences on their overall calorie intake, on the composition of their diets and on the frequency and intensity of physical activity at work, at home and during leisure time. Many countries have been concerned not only about the pace of the increase in overweight and obesity, but also about inequalities in their distribution across social groups, particularly by socio-economic status and by ethnic background.<BR>Les taux de surpoids et d’obésité ne cessent d’augmenter depuis plusieurs décennies dans tous les pays industrialisés, ainsi que dans beaucoup de pays ayant un revenu plus faible. Les analyses consacrées par l’OCDE aux tendances structurelles confirment le sombre tableau qui a été brossé dans les publications internationales, tout comme le font les prévisions établies sur les taux de surpoids et d’obésité pour les dix prochaines années. Les conditions dans lesquelles vivent les individus depuis vingt ou trente ans, notamment sur le plan matériel, social et économique, ont très fortement influé sur leur ration calorique globale, la composition de leur alimentation, ainsi que la fréquence et l’intensité de leur activité physique au travail, à la maison et pendant les loisirs. Beaucoup de pays sont préoccupés non seulement par le rythme auquel progressent le surpoids et l’obésité, mais aussi par le caractère inégal de leur répartition entre les catégories sociales, en particulier selon la situation socioéconomique et l’origine ethnique. |
| JEL: | D61 D63 H51 I12 I18 |
| Date: | 2009–11–20 |
| URL: | http://d.repec.org/n?u=RePEc:oec:elsaad:48-en&r=hea |
| By: | Saskia Drösler; Patrick Romano; Lihan Wei |
| Abstract: | This paper reports on the progress in the research and development of the set of patient safety indicators developed by the Health Care Quality Indicators project. The indicators presented here have been recommended by an expert group for further consideration in international reporting on the quality of care on the key dimension of safety. The indicators have been selected by expert consensus, undergone validity testing and have been tested for comparability. While concern remains related to differences in coding and reporting from administrative hospital databases, the rigour with which the indicator work has been undertaken has resulted in the improved ability of countries to report on the quality of care. The work on the development of the patient safety indicators highlights the technical progress made in constructing measures and the ongoing need for methodological improvements. The indicators reported here should not be considered as making inferences on the state of patient safety in countries, but are intended to raise questions towards improving understanding of the reported differences.<BR>Ce document présente l’état d’avancement de la recherche et du développement d’un ensemble d’indicateurs en matière de sécurité des patients dans le cadre du projet sur les indicateurs de la qualité des soins (HCQI). Un groupe d’experts a recommandé l’utilisation des indicateurs présentés ici pour les comparaisons internationales sur une dimension clé de la qualité des soins : la sécurité. Les indicateurs ont été sélectionnés par un consensus d’experts, leur validité et leur comparabilité ont été testées. Bien qu’il reste quelques problèmes quant aux différences de codage et de déclaration venant des bases de données administratives hospitalières, la rigueur du travail sur les indicateurs a permis d’améliorer la capacité des pays à rendre compte de la qualité des soins. Le développement des indicateurs de la sécurité des patients met l’accent sur les progrès techniques réalisés dans la construction de mesures et le besoin récurrent d’améliorer la méthodologie. Les indicateurs présentés ici ne doivent pas donner lieu à des conclusions quant à la situation de la sécurité des patients dans les pays, mais visent plutôt à poser des questions pour une meilleure compréhension des différences observées. |
| JEL: | I19 |
| Date: | 2009–11–23 |
| URL: | http://d.repec.org/n?u=RePEc:oec:elsaad:47-en&r=hea |
| By: | Randall S. Jones |
| Abstract: | Japan’s health-care system has provided universal access to care and contributed to the outstanding health status of the Japanese. Public spending has been kept below the OECD average through high co-payment rates and reductions in medical fees. However, with continued upward pressure on expenditure, in part due to rapid population ageing, reforms are needed to limit spending increases through greater efficiency, while improving quality. It is essential to shift long-term care out of hospitals, reform the pricing mechanism away from pay-for-visit, increase the use of generic drugs, encourage healthy ageing and promote restructuring in the hospital sector. Quality should be improved by increasing the availability of effective new drugs and medical devices. In funding spending increases, it is important to limit the share borne by employees to avoid negative effects on the labour market. Japan may need to allow more mixed billing to enhance access to some advanced medical treatments.<P>La réforme des soins de santé au Japon : Maîtriser les dépenses, améliorer la qualité et préserver l’équité<BR>Le système de santé japonais assure l’accès universel aux soins, contribuant à l’excellent état de santé de la population du pays. Le niveau des dépenses publiques a été maintenu au-dessous de la moyenne de l’OCDE en demandant aux assurés une participation élevée aux coûts et en réduisant les tarifs médicaux. Toutefois, comme les dépenses subissent toujours des pressions à la hausse, en partie du fait du vieillissement rapide de la population, il faut procéder à des réformes pour limiter leur accroissement par le biais d’une meilleure efficacité, tout en améliorant la qualité. Il est indispensable de transférer les soins de longue durée en dehors des hôpitaux, de réformer le système de rémunération en abandonnant le paiement à l’acte, de développer l’utilisation des médicaments génériques, d’encourager un vieillissement en bonne santé et de promouvoir la restructuration du secteur hospitalier. La qualité doit être améliorée en développant l’offre de nouveaux médicaments et dispositifs médicaux efficaces. Pour financer les dépenses supplémentaires, il importe de limiter la part assumée par les salariés de manière à éviter des retombées négatives sur le marché du travail. Le Japon devra peut-être permettre encore plus la facturation groupée pour améliorer l’accès à certains traitements médicaux de pointe. |
| Keywords: | Diagnosis Procedure Combination, drug lag, generic drugs, health insurance, healthy ageing, hospital, Japanese health care, long-term care, medical devices, medical expenditures, mixed billing, National Health Insurance, PMDA, universal coverage, assurance maladie, assurance santé nationale, assurance, couverture universelle, dépenses médicales, dispositifs médicaux, facturation groupée, hôpital, médicaments génériques, PMDA, retard dans le domaine des médicaments, soins de longue durée, système de santé japonais, vieillissement en bonne santé |
| JEL: | I1 |
| Date: | 2009–12–04 |
| URL: | http://d.repec.org/n?u=RePEc:oec:ecoaaa:739-en&r=hea |
| By: | Filip Pertold |
| Abstract: | The start of daily smoking is often shortly after the resorting of students between elementary and secondary education. This paper employs a novel identification strategy based on this resorting, in order to estimate peer effects in youth smoking. We address the reflection problem by peers’ pre-secondary-school smoking, which is not influenced by the current social interaction of classmates. The self-selection of students into secondary schools, based on their unobserved preferences toward smoking, is controlled for using own pre-secondary school behavior and the existing prevalence of smoking among older schoolmates. The empirical findings based on data from the Czech Republic, where the prevalence of youth smoking prevalence reached high levels, suggest that male youth smoking is significantly affected by classmates, while female smoking is not. |
| Keywords: | Peer effects, smoking, sorting. |
| JEL: | I12 D1 |
| Date: | 2009–11 |
| URL: | http://d.repec.org/n?u=RePEc:cer:papers:wp399&r=hea |
| By: | Eva Hromadkova |
| Abstract: | We assess the ability of health insurance plans with gatekeeping restrictions to control the utilization of medical care through their inuence on the choice of the initial provider. Empirical results are based on the individuallevel utilization panel data from 2001-2006 Medical Expenditure Panel Survey. We nd only small dierences between the initial provider chosen by individuals enrolled in gatekeeping and non-gatekeeping plans. This, together with the fact that within gatekeeping plans, 21 percent of patients self-refer to specialists, imply that the intended cost-containment eect of gatekeeping, namely restricting the utilization of specialty care, is surprisingly weak. |
| Keywords: | Health insurance, gatekeeping, health care utilization, episodic demand model, initial provider. |
| JEL: | I11 I19 |
| Date: | 2009–11 |
| URL: | http://d.repec.org/n?u=RePEc:cer:papers:wp400&r=hea |
| By: | Juergen Jung (Department of Economics, Towson University); Chung Tran (School of Economics, University of New South Wales) |
| Abstract: | In this paper we develop a general equilibrium overlapping generations (OLG) model with health shocks to analyze the life-cycle pattern of insurance choice and health care spending. We use data from the Medical Expenditure Panel Survey (MEPS) and show that our model is able to match the life-cycle trends of insurance take up ratios and average medical expenditures in the U.S. We then demonstrate how this model can be used to conduct health care policy analysis by evaluating the macroeconomic effects of a counter factual health care reform using a system of universal health insurance vouchers. Our results suggest that health insurance vouchers are able to extend insurance coverage to the entire population but they also increase aggregate spending on health. More importantly, we find that the positive insurance effect (efficient risk pooling) dominates the negative incentive effect (tax distortions and moral hazard) which results in significant welfare gains for all generations when a payroll tax is used to finance the voucher program. In addition, our results suggest that the choice of tax financing instrument and accounting for general equilibrium price adjustments are critical in determining the performance of the voucher program. |
| Keywords: | Public health insurance; private health insurance; vouchers; dynamic stochastic general equilibrium model; endogenous health production |
| JEL: | H51 I18 I38 |
| Date: | 2009–11 |
| URL: | http://d.repec.org/n?u=RePEc:swe:wpaper:2009-12&r=hea |
| By: | Edmund Cannon (University of Bristol) |
| Abstract: | Parametric forecasts of future mortality improvements can be based on models with a small number of factors which summarise both the improvement in mortality and changes in the relationship between mortality and age. I extend the analysis of the two‐factor model of Cairns, Blake and Dowd (2006) to a more general dynamic process for the factors and also consider the problems arising from modelling estimated rather than observed factors. The methods are applied to mortality data for sixteen countries and are used to estimate the value of an annuity and measures of risk. The consequences for the money's worth of an annuity and reserving are also considered. |
| Keywords: | stochastic mortality, mortality projections, annuity, money's worth |
| Date: | 2009–12 |
| URL: | http://d.repec.org/n?u=RePEc:ver:wpaper:65/2009&r=hea |
| By: | Pita Barros, Pedro; Medalho Pereira, Isabel |
| Abstract: | This paper studies the performance of immigrants relative to natives, in terms of their health status, use of health care services, lifestyles, and coverage of health expenditures. We base the analysis on international evidence that identified a healthy immigrant effect, complemented by empirical research on the Portuguese National Health Survey. Furthermore, we assess whether differences in health performance depend on the personal characteristics of the individuals or can be directly associated with their migration experience. |
| Keywords: | Migration; health status; health care; healthy immigrant effect; Portugal |
| JEL: | O15 C33 |
| Date: | 2009–07–01 |
| URL: | http://d.repec.org/n?u=RePEc:pra:mprapa:18201&r=hea |
| By: | Eric C. Sun; Anupam B. Jena; Darius N. Lakdawalla; Carolina M. Reyes; Tomas J. Philipson; Dana P. Goldman |
| Abstract: | For decades, the US public and private sectors have committed substantial resources towards cancer research, but the societal payoff has not been well-understood. We quantify the value of recent gains in cancer survival, and analyze the distribution of value among various stakeholders. Between 1988 and 2000, life expectancy for cancer patients increased by roughly four years, and the average willingness-to-pay for these survival gains was roughly $322,000. Improvements in cancer survival during this period created 23 million additional life-years and roughly $1.9 trillion of additional social value, implying that the average life-year was worth approximately $82,000 to its recipient. Health care providers and pharmaceutical companies appropriated 5-19% of this total, with the rest accruing to patients. The share of value flowing to patients has been rising over time. These calculations suggest that from the patient's point of view, the rate of return to R&D investments against cancer has been substantial. |
| JEL: | I1 I18 I28 I31 |
| Date: | 2009–12 |
| URL: | http://d.repec.org/n?u=RePEc:nbr:nberwo:15574&r=hea |