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on Health Economics |
| By: | Andalón, Mabel; Gibson, John |
| Abstract: | Mexico’s ‘soda tax’ has been predicted to reduce average weight of Mexicans by up to three pounds, based on extant estimates of the own-price elasticity of quantity demand for soda of between −1.0 and −1.3. These elasticity estimates from household survey data are exaggerated by not accounting for how consumers adjust quality demanded as price changes. Some estimates also are biased by correlated measurement error. To illustrate these biases we use budget survey data and soda price data for Mexico to estimate demand models that correct for both errors. The corrected own-price elasticity of quantity demand is between −0.1 and −0.4, implying that the soda tax might cut average weight by just half a pound, which is too little to improve population health. |
| Keywords: | Demand, Household surveys, Quality, Price, Soda taxes, Mexico |
| JEL: | D12 I10 |
| Date: | 2018–04–25 |
| URL: | http://d.repec.org/n?u=RePEc:pra:mprapa:86370&r=hea |
| By: | Galizzi, Matteo M.; Miraldo, Marisa; Stavropoulou, Charitini; van der Pol, Marjon |
| Abstract: | We conduct a framed field experiment among patients and doctors to test whether the two groups have similar risk and time preferences. We elicit risk and time preferences using multiple price list tests and their adaptations to the healthcare context. Risk and time preferences are compared in terms of switching points in the tests and the structurally estimated behavioural parameters. We find that doctors and patients significantly differ in their time preferences: doctors discount future outcomes less heavily than patients. We find no evidence that doctors and patients systematically differ in their risk preferences in the healthcare domain. |
| Keywords: | field experiment; risk aversion; impatience; doctor-patient relationship; structural estimation |
| JEL: | C93 D91 I11 |
| Date: | 2016–12–01 |
| URL: | http://d.repec.org/n?u=RePEc:ehl:lserod:68143&r=hea |
| By: | Costa-i-Font, Joan; Mas, Núria |
| Abstract: | We examine the effect of globalization, in its economic and social dimensions, on obesity and caloric intake, namely the so –called ‘globesity’ hypothesis. Our results suggest a robust association between globalization and both obesity and caloric intake. A one standard deviation increase in globalization is associated with a 23.8 percent increase in obese population and a 4.3 percent rise in calorie intake. The effect remains statistically significant even with an instrumental variable strategy to correct for some possible reverse causality, a lagged structure, and corrections for panel standard errors. However, we find that the primary driver is ‘social’ rather than ‘economic’ globalization effects, and specifically the effects of changes in ‘information flows’ and ‘social proximity’ on obesity. A one standard deviation increase in social globalization increased the percentage of obese population by 13.7 percent. |
| Keywords: | health inequality; categorical data; entropy measures; health surveys; upward status; downward status. |
| JEL: | I18 P46 |
| Date: | 2016–10–18 |
| URL: | http://d.repec.org/n?u=RePEc:ehl:lserod:67966&r=hea |
| By: | Jennifer L. Steel; Lauren Terhorst; Kevin P. Collins; David A. Geller; Yoram Vodovotz; Juliana Kim; Andrew Krane; Michael Antoni; James W. Marsh; Lora E. Burke; Lisa H. Butterfield; Frank J. Penedo; Daniel J. Buysse; Allan Tsung |
| Abstract: | The aims of this study were to examine the potential association between sleep problems, symptom burden, and survival in advanced cancer patients. |
| Keywords: | sleep problems, cancer patients |
| JEL: | I |
| URL: | http://d.repec.org/n?u=RePEc:mpr:mprres:9680bebe743b4be2a18f69ad25da13b1&r=hea |
| By: | Jessica Heeringa; Debra Lipson; Rachel Machta; Keanan Lane; Rachel Vogt |
| Abstract: | This brief describes differences in incentive design features of six DSRIP demonstrations and assesses their strengths and limitations in promoting provider participation in delivery system reform and value-based payment (VBP) arrangements. |
| Keywords: | 1115 demonstrations, Medicaid, implementation, evaluation, delivery system reform incentive payments , DSRIP |
| JEL: | I |
| URL: | http://d.repec.org/n?u=RePEc:mpr:mprres:46aa64dfeb5e4f84b5f7406b8a8a0a6f&r=hea |
| By: | Julia Baller; Marian V. Wrobel; Natalya Verbitsky-Savitz; Mariel Finucane; Carol Irvin |
| Abstract: | This document is a supplement to the Medicaid 1115 Demonstration Evaluation Design Plan prepared by Mathematica Policy Research and submitted to the Centers for Medicare & Medicaid Services (CMS) in May 2015 (Irvin et al 2015). |
| Keywords: | 1115 demonstrations, delivery system reform incentive payments , DSRIP, premium assistance, healthy behaviors, managed long-term services and supports , MLTSS, program evaluation |
| JEL: | I |
| URL: | http://d.repec.org/n?u=RePEc:mpr:mprres:eb02adad5541406997b13bcffcee5977&r=hea |
| By: | Elena Grinza (Department of Economics and Statistics (Dipartimento di Scienze Economico-Sociali e Matematico-Statistiche), University of Torino, Italy); Francois Rycx (Université Libre de Bruxelles, Belgium) |
| Abstract: | We investigate the impact of sickness absenteeism on productivity by using rich longitudinal matched employer-employee data on Belgian private firms. We deal with endogeneity, which arises from unobserved firm heterogeneity and reverse causality, by applying a modified version of the Ackerberg et al's (2015) control function method, which explicitly removes firm fixed effects. Our main finding is that, in general, sickness absenteeism substantially dampens firm productivity. An increase of 1 percentage point in the rate of sickness absenteeism entails a productivity loss of 0.24%. Yet, we find that the impact is much diversified depending on the categories of workers who are absent and across different types of firms. Our results show that sickness absenteeism is detrimental mainly when absent workers are high-tenure or blue-collar workers. Moreover, they show that sickness absenteeism is harmful mostly to industrial firms, high capital-intensive companies, and small- and medium-sized enterprises. This overall picture is coherent with the idea that sickness absenteeism is problematic when absent workers embed high levels of firm/task-specific (tacit) knowledge, when the work of absent employees is highly interconnected with the work of other employees (e.g., along the assembly line), and when firms face more limitations in substituting temporarily absent workers. |
| Keywords: | Sickness absenteeism, firm productivity, semiparametric methods for estimating production functions, longitudinal matched employer-employee data. |
| JEL: | D24 M59 I15 |
| Date: | 2018–05 |
| URL: | http://d.repec.org/n?u=RePEc:tur:wpapnw:051&r=hea |
| By: | Eugene C. Rich |
| Abstract: | Primary care has been struggling in the USA for over 50 years. By the 1960s, the decline in new entrants to general practice led to the Millis Commission report defining essential attributes of the imperiled primary care role, as well as to the establishment of Family Practice (now Family Medicine) as a new specialty dedicated to primary care. |
| Keywords: | Primary care, payment reform, patient-centered medical home, PCMH |
| JEL: | I |
| URL: | http://d.repec.org/n?u=RePEc:mpr:mprres:50f5486843204abfb9be2fcd67f9fb7f&r=hea |
| By: | Rachel Shapiro; Robert G. Wood; Jean Knab; Lauren Murphy |
| Abstract: | This brief summarizes key findings from a study of the implementation of the Teen Choice curriculum, a 12-session program that uses interactive exercises and guided discussions to deliver information to groups of 8 to 12 students on abstinence, contraception, sexually transmitted infections, and healthy relationships. |
| Keywords: | Personal Responsibility Education Program (PREP) Evaluation, Adolescent Pregnancy Prevention, Alternative school, high-risk youth, New York |
| JEL: | I |
| URL: | http://d.repec.org/n?u=RePEc:mpr:mprres:2a723125999a4374ac0e4fa81580f794&r=hea |
| By: | Jessica Kasten; Debra Lipson; Paul Saucier; Jenna Libersky |
| Abstract: | This issue brief supports the national evaluation of Medicaid Section 1115 demonstrations by describing the diversity of the beneficiary groups enrolled in 35 MLTSS programs operating in 23 states as of July 2016. |
| Keywords: | 1115 demonstrations, Medicaid, evaluation, managed long-term services and supports , MLTSS |
| JEL: | I |
| URL: | http://d.repec.org/n?u=RePEc:mpr:mprres:2e014091f67c47afa55209cf1552a55c&r=hea |
| By: | Maggie Colby; Katharine Bradley; Kara Contreary; Brenda Natzke |
| Abstract: | This document is a supplement to the Medicaid 1115 Demonstration Evaluation Design Plan prepared by Mathematica Policy Research and submitted to CMS in May 2015. |
| Keywords: | 1115 demonstrations, delivery system reform incentive payments, DSRIP, premium assistance, healthy behaviors, managed long-term services and supports , MLTSS, program evaluation |
| JEL: | I |
| URL: | http://d.repec.org/n?u=RePEc:mpr:mprres:d16121eb4f59429f99df02ce8bf14c5a&r=hea |
| By: | Kelsey J. O'Connor (National Institute of Statistics and Economic Studies); Carol Graham (The Brookings Institution) |
| Abstract: | How was optimism related to mortality before the rise in “deaths of despair” that began in the late 1990s? We show that as early as 1968 more optimistic people lived longer (using the Panel Study of Income Dynamics). The relationship depends on many factors including gender, race, health, and education. We then evaluate these and other variables as determinants of individual optimism over the period 1968-1975. We find women and African Americans were less optimistic at the time than men and whites (although this has changed in recent years). Greater education is associated with greater optimism and so is having wealthy parents. We then predict optimism for the same individuals in subsequent years, thus generating our best guess as to how optimism changed for various demographic groups from 1976-1995. We find people with less than a high school degree show the greatest declines in optimism, which along with their long-run links to premature mortality and deaths of despair, highlights the importance of better understanding optimism’s causes and consequences. |
| Keywords: | PSID, Panel Study of Income Dynamics, optimism, despair, premature mortality |
| JEL: | I14 I00 J15 J24 |
| Date: | 2018–05 |
| URL: | http://d.repec.org/n?u=RePEc:hka:wpaper:2018-026&r=hea |
| By: | Masuda, Kazuya; Chitundu, Maureen |
| Abstract: | Background: In developing countries, micronutrient deficiency in infants is associated with growth faltering, morbidity, and delayed motor development. One of the potentially low-cost and sustainable solutions is to use locally producible food for the home fortification of complementary foods. Objective: The objectives were to test the hypothesis that locally producible spirulina platensis supplementation would achieve the following: 1) increase infant physical growth; 2) reduce morbidity; and 3) improve motor development. Design: We randomly assigned 501 Zambian infants into a control (CON) group or a spirulina (SP) group. Children in the CON group (n=250) received a soya-maize-based porridge for 12 months, whereas those in the SP group (n=251) received the same food but with the addition of spirulina. We assessed the change in infants’ anthropometric status, morbidity, and motor development over 12 months. Results: The baseline characteristics were not significantly different between the two groups. The attrition rate (47/501) was low. The physical growth of infants in the two groups was similar at 12 months of intervention, as measured by height-for-age z-scores (HAZ), and weight-for-age z-scores (WAZ). SP infants were less likely to suffer from cough by 11 percentage point (CI: -0.23, -0.00; P |
| Keywords: | chronic malnutrition, home-fortification, spirulina, infant growth, motor development, morbidity, Zambia |
| Date: | 2018–04 |
| URL: | http://d.repec.org/n?u=RePEc:hit:hitcei:2018-2&r=hea |
| By: | Kamila Cygam-Rehm; Christoph Wunder |
| Abstract: | This study estimates the causal effect of working hours on health. We deal with the endogeneity of working hours through instrumental variables techniques. In particular, we exploit exogenous variation in working hours from statutory workweek regulations in the German public sector as an instrumental variable. Using panel data, we run two-stage least squares regressions controlling for individual-specific unobserved heterogeneity. We find adverse consequences of increasing working hours on subjective and several objective health measures. The effects are mainly driven by women and parents of minor children who generally face heavier constraints in organizing their workweek. |
| Keywords: | Working time, health, standard workweek, Germany |
| JEL: | I10 J22 J81 |
| Date: | 2018 |
| URL: | http://d.repec.org/n?u=RePEc:diw:diwsop:diw_sp967&r=hea |
| By: | Hugo Mell (École normale supérieure - Paris (ENS Paris)); Lou Safra (École normale supérieure - Paris (ENS Paris)); Yann Algan (Département d'économie); Nicolas Baumard (École normale supérieure - Paris (ENS Paris)); Coralie Chevallier (École normale supérieure - Paris (ENS Paris)) |
| Abstract: | There is considerable variation in health and reproductive behaviours within and across human populations. Drawing on principles from Life History Theory, psychosocial acceleration theory predicts that individuals developing in harsh environments decrease their level of somatic investment and accelerate their reproductive schedule. Although there is consistent empirical support for this general prediction, most studies have focused on a few isolated life history traits and few have investigated the way in which individuals apply life strategies across reproductive and somatic domains to produce coordinated behavioural responses to their environment. In our study, we thus investigate the impact of childhood environmental harshness on both reproductive strategies and somatic investment by applying structural equation modeling (SEM) to cross-sectional survey data obtained in a representative sample of the French population (n = 1015, age: 19 – 87 years old, both genders). This data allowed us to demonstrate that (i) inter-individual variation in somatic investment (e.g. effort in looking after health) and reproductive timing (e.g. age at first birth) can be captured by a latent fast-slow continuum, and (ii) faster strategies along this continuum are predicted by higher childhood harshness. Overall, our results support the existence of a fast-slow continuum and highlight the relevance of the life history approach for understanding variations in reproductive and health related behaviours. |
| Keywords: | Psychosocial acceleration theory; Childhood adversity; Life History Theory; Reproductive strategies; Health strategies; Structural equation modeling |
| Date: | 2017–09 |
| URL: | http://d.repec.org/n?u=RePEc:spo:wpmain:info:hdl:2441/6n8ctn4s591erei1a40c2vlf7&r=hea |
| By: | Blanchflower, David G. (Dartmouth College, Stirling, NBER, Bloomberg and IZA); Oswald, Andrew J. (University of Warwick, CAGE, and IZA) |
| Abstract: | In Happiness for All?, Carol Graham raises disquieting ideas about today’s United States.The challenge she puts forward is an important one. Here we review the intellectual case and offer additional evidence. We conclude broadly on the author’s side. Strikingly, Americans appear to be in greater pain than citizens of other countries, and most subgroups of citizens have downwardly trended happiness levels. There is, however, one bright side to an otherwise dark story. The happiness of black Americans has risen strongly since the 1970s. It is now almost equal to that of white Americans. |
| Keywords: | Happiness; well-being; GHQ; mental-health; depression; life-course JEL Classification: I3, I31 |
| Date: | 2018 |
| URL: | http://d.repec.org/n?u=RePEc:cge:wacage:360&r=hea |
| By: | Frank, Richard G. (Harvard University); Zeckhauser, Richard J. (Harvard University) |
| Abstract: | Excess prices for drugs in the U.S. is a persistently vexing policy problem. While there is agreement among most policy analysts that supra competitive prices are necessary to promote innovation; significant disagreements arise over how much pricing discretion prescription drug manufacturers should be permitted, and what portion of the sum of producer plus consumer surplus in the prescription drug market should be claimed by manufacturers relative to consumers and other payers. This analysis first diagnoses the causes of the high costs in Medicare Part D. It then makes use of that diagnosis to provide a prescription for policy measures that have the potential to simultaneously reduce these costs without significantly sacrificing incentives to bring valuable new drugs to market. This paper focuses on an extremely costly component of the Medicare Part D program, the region of coverage that kicks in once a consumer has spent $4,950 on drugs in a calendar year (roughly $8,100 in total drug spending). At that point there are high levels of insurance for the consumer and reinsurance for the prescription drug plan. Consumers pay 5% of costs; plans pay 15% and the government 80%. That design generates serious inefficiencies. The significant subsidies to plans in the reinsurance region combined with the launch of unique high cost prescription drugs could be expected to lead to and has led to substantial departures from cost-effective outcomes in treatments delivered. As would be expected, spending has been growing rapidly in this so called “reinsurance region†. What is less well known is that a small number of very high-cost drugs account for almost all of this growth. Following this diagnosis, we present two, possibly complementary, prescriptions for reducing these inefficiencies. The first follows on the MedPac recommendation that the government reduce its share of risk bearing for the Part D reinsurance benefit. The second focuses on curbing price inefficiencies for those very high-cost drugs. That prescription has two components: eliminating monopolistic overpricing, and promoting the quality of drugs brought to market. It is grounded in the economics of two part tariffs, research on innovation prizes, performance-based contracts, and draws on the mechanism design literature. Such pricing could save substantially on costs without curtailing the most important R&D efforts for pharmaceuticals. Market conditions and political forces appear ripe for significant new approaches to pricing high cost drugs in Medicare Part D. We believe that the prescription discussion here, which draws on this paper’s diagnosis, identifies some promising approaches to a vexing problem. |
| Date: | 2018–01 |
| URL: | http://d.repec.org/n?u=RePEc:ecl:harjfk:rwp18-005&r=hea |
| By: | Saghafian, Soroush (Harvard University); Hopp, Wallace J. (University of Michigan) |
| Abstract: | Increasing quality transparency is widely regarded as a strong mechanism for improving the alignment between patient choices and provider capabilities, and thus, is widely pursued by policymakers as an option for improving the healthcare system. We study the effect of increasing quality transparency on patient choices, hospital investments, societal outcomes (e.g., patients’ social welfare and inequality), and the healthcare market structure (e.g., medical or geographical specialization). We also examine potential reasons behind the failure of previous public reporting efforts, and use our analysis to identify ways in which such efforts can become more effective in the future. Our analytical and numerical results calibrated with data reveal that increasing quality transparency promotes increased medical specialization, decreased geographical specialization, and induces hospitals to invest in their strength rather than their weakness. Furthermore, increasing quality transparency in the short-term typically improves the social welfare as well as the inequality among patients. In the long-term, however, we find that increasing transparency can decrease social welfare, and even a fully transparent system may not yield socially optimal outcomes. Hence, a policymaker concerned with societal outcomes needs to accompany increasing quality transparency with other policies that correct the allocation of patients to hospitals. Among such policies, we find that policies that incentivize hospitals are usually more effective than policies that incentivize patients. Finally, our results indicate that, to achieve maximal benefits from increasing quality transparency, policymakers should target younger, more affluent, or urban (i.e., high hospital density area) patients, or those with diseases that can be deferred. |
| Date: | 2017–11 |
| URL: | http://d.repec.org/n?u=RePEc:ecl:harjfk:rwp17-044&r=hea |
| By: | Boloori, Alireza (Arizona State University); Saghafian, Soroush (Harvard University); Chakkera, Harini A. A. (Mayo Clinic Hospital); Cook, Curtiss B. (Mayo Clinic Hospital) |
| Abstract: | Organ-transplanted patients typically receive high amounts of immunosuppressive drugs (e.g., tacrolimus) as a mechanism to reduce their risk of organ rejection. However, due to the diabetogenic effect of these drugs, this practice exposes them to greater risk of New-Onset Diabetes After Trans-plant (NODAT), and hence, becoming insulin-dependent. This common conundrum of balancing the risk of organ rejection versus that of NODAT is further complicated due to various factors that create ambiguity in quantifying risks: (1) false-positive and false-negative errors of medical tests,(2) inevitable estimation errors when data sets are used, (3) variability among physicians’ attitudes towards ambiguous outcomes, and (4) dynamic and patient risk-profile dependent progression of health conditions. To address these challenges, we propose an ambiguous partially observable Markov decision process (APOMDP) framework, where dynamic optimization with respect to a “cloud†of possible models allows us to make decisions that are robust to misspecifications of risks. We first provide various structural results that facilitate characterizing the optimal policy. Using a clinical data set, we then compare the optimal policy to the current practice as well as some other bench-marks, and discuss various implications for both policy makers and physicians. In particular, our results show that substantial improvements are achievable in two important dimensions: (a) the quality-adjusted life expectancy (QALE) of patients, and (b) medical expenditures. |
| Date: | 2017–08 |
| URL: | http://d.repec.org/n?u=RePEc:ecl:harjfk:rwp17-036&r=hea |
| By: | Slusky, David J. G. (University of Kansas); Zeckhauser, Richard J. (Harvard University) |
| Abstract: | Recent medical literature suggests that vitamin D supplementation protects against acute respiratory tract infection. Humans exposed to sunlight produce vitamin D directly. This paper investigates how differences in sunlight, as measured over several years within states and during the same calendar month, affect influenza incidence. We find that sunlight strongly protects against influenza. This relationship is driven by sunlight in late summer and early fall, when there are sufficient quantities of both sunlight and influenza activity. A 10% increase in relative sunlight decreases the influenza index in September by 3 points on a 10-point scale. This effect is far greater than the effect of vitamin D supplementation in randomized trials, a differential due to broad exposure to sunlight, hence herd immunity. We also find suggestive evidence, consistent with herd immunity theory, that the protective sunlight effect is strongest with a middle level of population density. |
| JEL: | I10 I12 I18 |
| Date: | 2018–02 |
| URL: | http://d.repec.org/n?u=RePEc:ecl:harjfk:rwp18-007&r=hea |
| By: | Pamela C. Smith (UTSA); Stephanie Ross; Paige Gee |
| Keywords: | Nonprofit hospital |
| JEL: | L30 |
| Date: | 2016–10–28 |
| URL: | http://d.repec.org/n?u=RePEc:tsa:wpaper:0170acc&r=hea |
| By: | Bogdan Savych; David Neumark; Randall Lea |
| Abstract: | We estimate the effect of opioid prescriptions on the duration of temporary disability benefits among workers with work-related low back injuries. We use local opioid prescribing patterns to construct an instrumental variable that generates variation in opioid prescriptions but is arguably unrelated to injury severity or other factors affecting disability duration. Local prescribing patterns have a strong relationship with whether injured workers receive opioid prescriptions, including longer-term prescriptions. We find that more longer-term opioid prescribing leads to considerably longer duration of temporary disability, but little effect of a small number of opioid prescriptions over a short period of time. |
| JEL: | I12 I18 J28 J38 |
| Date: | 2018–04 |
| URL: | http://d.repec.org/n?u=RePEc:nbr:nberwo:24528&r=hea |
| By: | Frank R. Lichtenberg |
| Abstract: | This study employs a two-way fixed effects research design to measure the mortality impact and cost-effectiveness of cancer drugs: it analyzes the correlation across 36 countries between relative mortality from 19 types of cancer in 2015 and the relative number of drugs previously launched in that country to treat that type of cancer, controlling for relative incidence. One additional drug for a cancer site launched during 2006-2010 is estimated to have reduced the number of 2015 disability-adjusted life years (DALYs) lost due to cancer at that site by 5.8%. The estimated cost per life-year gained at all ages in 2015 from cancer drugs launched during 2006-2010 is $1635. We estimate that drugs launched during the entire 1982-2010 period reduced the number of cancer DALYs lost in 2015 by about 23%. In the absence of new drug launches during 1982-2010, there would have been 26.3 million additional DALYs lost in 2015. |
| JEL: | I10 J10 L65 O33 |
| Date: | 2018–04 |
| URL: | http://d.repec.org/n?u=RePEc:nbr:nberwo:24536&r=hea |
| By: | Jina J. Kim; Daniel A. Axelrad; Chris Dockins |
| Abstract: | Preterm birth (PTB) is a predictor of infant mortality and later-life morbidity. Despite recent declines, PTB rates remain high in the United States. Growing research suggests a relationship between a mother’s exposure to air pollution and PTB of her baby. Many policy actions to reduce exposure to common air pollutants require benefit-cost analysis (BCA), and it’s possible that PTB will need to be included in BCA in the future. However, an estimate of the willingness to pay (WTP) to avoid PTB risk is not available, and a comprehensive alternative valuation of the health benefits of reducing pollutant-related PTB currently does not exist. This paper demonstrates a potential approach to assess economic benefits of reducing PTB resulting from environmental exposures when an estimate of WTP to avoid PTB risk is unavailable. We utilized a recent meta-analysis and county-level air quality and PTB data to estimate the potential health and economic benefits of a reduction in air pollution-related PTB, with fine particulate matter (PM2.5) as our case study pollutant. Using this method, a simulated 10% decrease from 2008 PM2.5 levels resulted in a reduction of 5,016 PTBs and savings of at least $339 million, potentially reaching over one billion dollars when considering later-life effects of PTB. |
| Keywords: | air pollution, preterm birth, benefits, PM2.5 |
| JEL: | D61 I18 J13 Q51 Q53 |
| Date: | 2018–03 |
| URL: | http://d.repec.org/n?u=RePEc:nev:wpaper:wp201803&r=hea |
| By: | Towse, A.; Garau, M. |
| Abstract: | The report addresses the implications of NICE appraising treatments for very rare diseases using a cost-per-QALY gained decision rule of the type used by NICE in its Technology Appraisal Programme to appraise therapies for more common conditions. Given the importance of non-QALY elements in the assessment of HSTs, such as treatment impact on the process of care and on the patients' or their carers' ability to go to school or to work respectively, and issues in measuring quality of life when the population affected are infants or young children, it is inappropriate to focus the appraisal of treatments for very rare diseases solely on a cost-per-QALY measure. Given the lack of empirical basis, the new £100,000 cost per QALY threshold and its further possible uplift up by a factor of three seem arbitrary. |
| Keywords: | Economics of Health Technology Assessment |
| JEL: | I1 |
| Date: | 2018–03–01 |
| URL: | http://d.repec.org/n?u=RePEc:ohe:conrep:001978&r=hea |
| By: | Karlsberg Schaffer, S.; West, P.; Towse, A.; Henshall, C.; Mestre-Ferrandiz, J.; Masterson, R.; Fischer, A. |
| Abstract: | Antimicrobial resistance (AMR) occurs when microorganisms such as bacteria, viruses, fungi and parasites change in ways that render the medications used to cure the infections they cause ineffective. Without new antibiotics, more patients will die from previously treatable infections. However, a key issue is how antibiotics can be appropriately assessed, particularly by payers and/or health technology assessment (HTA) bodies, to take account of AMR and reflect the full benefit they provide to patients and society. This Briefing discusses 10 elements of value which can be split into two groups - four relevant benefits typically included in HTA, and six other types of benefits not traditionally included. These were discussed at a multi-country, multi-disciplinary, multi-stakeholder Value Forum. Participants at the Forum also offered a number of valuable insights into how further work could be approached in order to maximise both its practicality and its potential policy impact. These are summarised in the Briefing. A two page summary of the briefing, written by Dr Chris Henshall and Professor Adrian Towse is available [here]( https://www.ohe.org/sites/default/files/ Final%202%20Page%20Briefing%20AMR%20and% 20HTA.pdf). |
| Keywords: | Economics of Health Technology Assessment |
| JEL: | I1 |
| Date: | 2017–05–01 |
| URL: | http://d.repec.org/n?u=RePEc:ohe:briefg:001851&r=hea |
| By: | Hampson, G.; Towse, A.; Henshall, C. |
| Abstract: | The 2015 meeting of the HTAi Asia Policy Forum meeting was held in Singapore, 29th -30th October 2015. The topic of the meeting was - How can HTA meet the needs of health system and government decision makers? This report represents the background paper for the meeting, as developed by OHE. The report sets out the issues to be addressed in considering where and when HTA could be a useful aid for decision making, what HTA can be used to achieve, and where the evidence for HTA can be obtained from (including a brief recap of the [transferability discussions in the 2014 meeting of the AHPF]( http://www.ohe.org/system/files/private/publications/HTAi%20AsiaForumBackground2014.pdf)). The final section considers how decision makers can combine all the relevant criteria and information to arrive at a decision; we discuss the spectrum of approaches from deliberative to more structured decision making processes including the use of Multi-Criteria Decision Analysis (MCDA). Various different approaches to MCDA could be used to add structure and transparency to decision making processes, and pilots conducted in Asia have been reported favourably. MCDA has not, however, been widely adopted in health care decision making to date. The background papers from the [2013]( https://www.ohe.org/publications/hta-and-decision-making-asia-how-can-available-resources-be-used-most-effectively#overlay-context=publications/transferability-hta), [2014]( https://www.ohe.org/publications/transferability-hta#overlay-context=publications) and [2016]( https://www.ohe.org/publications/assessing-value-budget-impact-and-affordability-inform-discussions-access-and) meeting are also available. |
| Keywords: | Economics of Health Technology Assessment |
| JEL: | I1 |
| Date: | 2017–04–01 |
| URL: | http://d.repec.org/n?u=RePEc:ohe:briefg:001836&r=hea |
| By: | Towse, A.; Henshall, C. |
| Abstract: | The HTAi Asia Policy Forum meeting 2013 was held in Seoul, 13th -14th June 2013. This was the first of several annual meetings of the HTAi Asia Policy Forum. The topic of the meeting was - How can the available resources be used most effectively to deliver high quality HTA that can be used by health system decision makers? This report represents the background paper for the meeting, as developed by OHE. The report begins by looking at the increasing interest in the use of HTA, how HTA has evolved, where HTA has got to in Asia. - The report then seeks to address the follow questions - What information do decision makers need? - How can HTA best meet these information needs? - How can HTA and decision making best be linked? The report also includes short appendices which provide an overview of the use of HTA in each of the health systems represented at the meeting - China, Japan, Korea, Malaysia, Philippines, Singapore, Taiwan and Thailand. The background papers from the [2014]( https://www.ohe.org/publications/transferability-hta#overlay-context=publications), [2015]( https://www.ohe.org/publications/how-can-hta-meet-needs-health-system-and-government-decision-makers) and [2016]( https://www.ohe.org/publications/assessing-value-budget-impact-and-affordability-inform-discussions-access-and) meeting are also available. |
| Keywords: | Economics of Health Technology Assessment |
| JEL: | I1 |
| Date: | 2017–04–01 |
| URL: | http://d.repec.org/n?u=RePEc:ohe:briefg:001838&r=hea |
| By: | Cole, A.; Marsden, G.; Devlin, N.; Grainger, D.; Lee, E.K; Oortwijn, W. |
| Abstract: | This report provides a detailed summary of a panel session which took place at the HTAi 2016 annual meeting in Tokyo. The panel session was entitled 'New Age Decision Making in HTA - Is It Applicable in Asia?'. To open the session, David Grainger (Eli Lilly & Company) provided an overview of the session, offering useful background information on the topic. |
| Keywords: | Economics of Health Technology Assessment |
| JEL: | I1 |
| Date: | 2016–08–01 |
| URL: | http://d.repec.org/n?u=RePEc:ohe:briefg:001741&r=hea |
| By: | Cole, A.; O'Neill, P.; Sampson, C.; Lorgelly, P. |
| Abstract: | Surgical practice has and continues to develop at a tremendous pace, reflecting the evolving technological landscape as well as the expanding skillset of the surgical workforce. Minimal access surgery (MAS) can offer improved recovery prospects for patients, but uptake in the UK is variable across both procedures and hospitals. Through in-depth interviews with key stakeholders (surgeons from both the NHS and private sector, clinical directors and finance directors), supported by an evaluation of the literature, we assess the benefits of minimal access surgery, the extent to which these benefits are realised in practice, and the major barriers to wider adoption. Whilst considerations need to be procedure-specific, both the literature and interviews supported the role for MAS in delivering clinically- and cost-effective patient care, and improving patient experience. Thematic analysis of the interviews identified five key themes as potentially affecting the uptake of MAS - (1) the evidence base, (2) the role of stakeholders (hospitals, commissioners, surgeons and patients), (3) training requirements, (4) the context of the service delivery model (in particular the financial constraints of the NHS), and (5) the forthcoming robotic era. The barriers are explored in detail, along with potential solutions to address them and to harness the benefits of MAS. |
| Keywords: | Economics of Health Care Systems |
| JEL: | I1 |
| Date: | 2018–03–01 |
| URL: | http://d.repec.org/n?u=RePEc:ohe:conrep:001976&r=hea |
| By: | Ferraro, J.; Towse, A.; Mestre-Ferrandiz, J. |
| Abstract: | A new OHE Briefing has just been published entitled - Incentives for New Drugs to Tackle Anti-Microbial Resistance. Resistance to antibiotics is growing, posing a major health risk in rich and poor countries. Additional ways of rewarding R&D are required. Mechanisms designed to encourage companies to undertake R&D on new medicines are generally characterised as either "push" or "pull" programs. Push funding alone will not generate new medicines. Pull incentives are key to stimulating R&D for new antibiotics and vaccines. In this Briefing we look at the proposals in the 2016 O'Neill Report commissioned by the UK government and the 2017 GUARD Report commissioned by the German government. Our assessment is that both Transferable Intellectual Property Rights and the Market Entry Reward should be further explored for use in the EU as a regional "pull" incentive. A lead group of countries need to work together to develop a set of pull incentives to drive new antibiotic and vaccine R&D in Europe and globally. |
| Keywords: | Economics of Industry; Economics of Health Care Systems |
| JEL: | I1 |
| Date: | 2017–05–01 |
| URL: | http://d.repec.org/n?u=RePEc:ohe:briefg:001842&r=hea |
| By: | Barnsley, P.; Hampson, G.; Towse, A.; Henshall, C. |
| Abstract: | The second HTAi Asia Policy Forum meeting (2014) was held in Manilla, 10th -11th June 2014. The topic of the meeting was - Transferability of HTA. This report represents the background paper for the meeting, as developed by OHE. HTA is a tool to support health systems to make decisions about allocating their limited health care resources. In turn, HTA needs to be efficient and effective if investment in HTA is to be a sensible use of money. One important part of ensuring this will be to avoid duplication of effort by making the best possible use of existing information, and ensuring that when resources devoted to HTA are generating new information, it is likely to be of sufficient value to justify its cost. This background paper sets out the issues to be addressed in considering when health systems can benefit from the transfer of HTA processes, decisions and/or data. We discuss the different kinds of decisions that may or may not be transferred, the different degrees of transfer possible, and how decisions can be adapted to different contexts. Overall, we conclude that some of the barriers to transferability may be lower than is generally believed. The background papers from the [2013]( https://www.ohe.org/publications/hta-and-decision-making-asia-how-can-available-resources-be-used-most-effectively#overlay-context=publications/transferability-hta), [2015]( https://www.ohe.org/publications/how-can-hta-meet-needs-health-system-and-government-decision-makers) and [2016]( https://www.ohe.org/publications/assessing-value-budget-impact-and-affordability-inform-discussions-access-and) meeting are also available. |
| Keywords: | Economics of Health Technology Assessment |
| JEL: | I1 |
| Date: | 2017–04–01 |
| URL: | http://d.repec.org/n?u=RePEc:ohe:briefg:001837&r=hea |
| By: | Neri, M.; Towse, A. |
| Abstract: | Antimicrobial resistance (AMR) is in part a natural phenomenon, but its growth has been accelerated over time by different causes that now exert a cumulative effect. On the one hand, bad practice favours the spread of infections, such as overuse of antibiotics in human and veterinary care, and poor prevention and hygiene practices. On the other hand, the scarcity of new treatments, both recently launched as well as in pharmaceutical industry development pipelines, reduces the chances of treating AMR effectively in the future. This publication is a report of a symposium held at the HTAi 2017 meeting in Rome. Throughout the session, the speakers provided recommendations for the strategies and actions that should be implemented in order to prevent the spread of AMR and to incentivise the development of new effective treatments. |
| Keywords: | Economics of Health Technology Assessment |
| JEL: | I1 |
| Date: | 2017–10–01 |
| URL: | http://d.repec.org/n?u=RePEc:ohe:briefg:001922&r=hea |
| By: | Cole, A.; Chan, A.; Mujoomdar, M.; Pichler, F.; Towse, A. |
| Abstract: | This report provides a detailed summary of a panel session which took place at the HTAi 2016 annual meeting, Tokyo. The panel session was entitled 'How Can HTA in Asia-Pacific Respond to Increased Clinical Uncertainty as a Consequence of Expedited US and EU Regulatory Processes?' and was chaired by Franz Pichler (Eli Lilly & Company). |
| JEL: | I1 |
| Date: | 2016–08–01 |
| URL: | http://d.repec.org/n?u=RePEc:ohe:briefg:001740&r=hea |
| By: | Hampson, G.; Towse, A.; Henshall, C. |
| Abstract: | The 2016 meeting of the HTAi Asia Policy Forum meeting was held in Kuala Lumpur, 17th -18th November 2016. The topic of the meeting was - Assessing Value, Budget Impact and Affordability to Inform Discussions on Access and Reimbursement - Principles and Practice, with Special Reference to High Cost Technologies. This report represents the background paper for the meeting, as developed by OHE. The paper begins with a discussion of how value can be defined, measured and factored into decisions on access and coverage. Next, the paper looks at how budget impact and affordability can be defined and measured - we explain how different countries have adopted different approaches to how and when budget impact has been included within the decision making process, and outline several different scenarios around affordability challenges. The final section considers whether high cost interventions call for new approaches to assessment and/or reimbursement, drawing on the recent high profile example of Sovaldi for the treatment of Hepatitis C. The background papers from the [2013]( https://www.ohe.org/publications/hta-and-decision-making-asia-how-can-available-resources-be-used-most-effectively#overlay-context=publications/transferability-hta), [2014]( https://www.ohe.org/publications/transferability-hta#overlay-context=publications) and [2015]( https://www.ohe.org/publications/how-can-hta-meet-needs-health-system-and-government-decision-makers) meeting are also available. Please note [a report of this meeting]( https://www.cambridge.org/core/journals/international-journal-of-technology-assessment-in-health-care/article/assessing-value-budget-impact-and-affordability-in-asia/4E4E7B24262B1A7D12CF3E63824D5EC6)has also been published in the International Journal of Technology Assessment in Health Care. |
| Keywords: | Economics of Health Technology Assessment |
| JEL: | I1 |
| Date: | 2017–04–01 |
| URL: | http://d.repec.org/n?u=RePEc:ohe:briefg:001835&r=hea |
| By: | Jiaqi Li; Thomas Bell; Deborah Chollet |
| Abstract: | Opioids are a class of drugs that include prescription opioid medications for pain relief —such as oxycodone (OxyContin®), hydrocodone (Vicodin®), codeine, morphine, and fentanyl—as well as illicitly produced drugs like heroin and fentanyl-related substances (also called fentanyl analogs). |
| Keywords: | Opioid, Minnesota, substance abuse |
| JEL: | I |
| URL: | http://d.repec.org/n?u=RePEc:mpr:mprres:dd6564dd045540429c10d6a0537c55a7&r=hea |
| By: | Maignen, F.; Berdud, M.; Hampson, G.; Lorgelly, P. |
| Abstract: | This report explores the consequences of the exit of the United Kingdom (UK) from the European Union (EU) on public health in the UK and in the EU. It also provides an estimate of the economic impact for pharmaceutical companies. The impact of Brexit will be highly dependent on the nature of any agreement resulting from the negotiations between the UK and the remaining countries of the EU, and the extent that the UK is involved in future EU public health activities. As such, the sensitivity of the various public health and economic impacts is assessed according to a number of different possible combinations of trade and regulatory agreements. We find that the public health implications of Brexit will become more severe as public health cooperation and trade relationships lessen between the EU and the UK. Importantly, the public health impacts may not just occur in the UK, but may also be significant in the remaining countries of the EU and the European Economic Area. This report contains a summary of our results based on a series of individual analyses. Detailed methods and results for each of the individual analyses presented in the [Technical Annex]( https://www.ohe.org/sites/default/files/ Technical%20Annex%20-%20final.pdf). |
| JEL: | I1 |
| Date: | 2017–12–01 |
| URL: | http://d.repec.org/n?u=RePEc:ohe:conrep:001933&r=hea |
| By: | Han Yu; Naci Mocan |
| Abstract: | This paper investigates the causal effect of high school curriculum on various student outcomes including academic performance at the university, happiness, physical and mental health, self-confidence, confidence in academic ability, and attitudes towards studying and learning. We exploit a curriculum reform in China, the implementation of which started in 2004. The reform covered all provinces and municipal cities, and was rolled out in different years in different provinces. The new curriculum pivoted away from the old lock-step course structure where all students took the same courses and only those subject that were covered in the national university entrance exam were considered important. In contrast, the new curriculum introduced a course credit system, changed textbooks, and provided flexibility in course selection. It also introduced elective courses and made such courses as arts and physical education mandatory, and a graduation requirement. Using survey data on university students and employing a difference-in-difference approach, we find that the students who were exposed to the new curriculum in high school have better academic performance in university. They are happier, and their physical and mental well-being is better. These students are more likely to have positive attitudes towards themselves and they are more involved in student clubs. They have more confidence in their academic ability, they have more positive attitudes towards studying, and they have more general self-confidence. These results indicate that the reform had a significant impact on students’ academic success and well-being by allowing them to focus on subject matters in which they are interested, and by reducing undue stress of a regimented curriculum. |
| JEL: | H0 I1 I20 I23 I3 J38 |
| Date: | 2018–05 |
| URL: | http://d.repec.org/n?u=RePEc:nbr:nberwo:24573&r=hea |
| By: | Hussien, Abdurohman; Ayele, Gashaw |
| Abstract: | While child health is influenced by parental inputs and access to public services, among other factors, the latter are not equitably distributed across children, leading to inequality of opportunity (IOp). Using standardized height-for-age and weight-for-height as health outcome measures, the study decomposes the total inequality in child health in to a part attributable to child circumstances such as parental background, and access to public services—hence IOp in child health, and a part due to random variation in health. Using the young lives survey data in 2002 and 2006, the study then demonstrates that IOp in child health has increased over this period, regardless of the method of inequality decomposition used. Further scrutiny reveals that while access to infrastructure accounts for the highest share of IOp in 2002, mother’s religion, household wealth, access to clean water and sanitation are more responsible for the increase in IOp in 2006. |
| Keywords: | inequality of opportunity, child health, nutrition, height-for-age, weight-for-height |
| JEL: | I14 |
| Date: | 2016–09–15 |
| URL: | http://d.repec.org/n?u=RePEc:pra:mprapa:86592&r=hea |
| By: | Giovanis, Eleftherios; Ozdamar, Oznur |
| Abstract: | Environmental quality is an important determinant of individuals’ well-being and one of the main concerns of the governments is the improvement on air quality and the protection of public health. This is especially the case of sensitive demographic groups, such as the old aged people. However, the question this study attempts to answer is how do individuals value the effects on the environment. The study explores the effects of old and early public pension schemes, as well as the impact of air pollution on health status of retired citizens. The empirical analysis relies on detailed micro-level data derived from the Survey of Health, Ageing and Retirement in Europe (SHARE). As proxies for health, we use the general health status and the Eurod mental health indicator.We examine two air pollutants: the sulphur dioxide (SO2) and ground-level ozone (O3). Next, we calculate the marginal willingness-to-pay (MWTP) which shows how much the people are willing to pay for improvement in air quality. We apply various quantitative techniques and approaches, including the fixed effects ordinary least squares (OLS) and the fixed effects instrumental variables (IV) approach. The last approach is applied to reduce the endogeneity problem coming from possible reverse causality between the air pollution, pensions and the health outcomes. For robustness check, we apply also a structural equation modelling (SEM) which is proper when the outcomes are latent variables. Based on our favoured IV estimates and the health status, we find that the MWTP values for one unit decrease in SO2 and O3 are respectively €221 and €88 per year. The respectiveMWTP values using the Eurod measure are €155 and €68. Overall, improvement of health status implies reduction in health expenditures, and in previous literature, ageing has been traditionally considered the most important determinant. However, this study shows that health lifestyle and socio-economic status, such as education and marital status, are more important, and furthermore, air pollution cannot be ignored in the agenda of policy makers. |
| Keywords: | Air pollution; Early retirements; Health status; Old age pensions; Structural equation modelling |
| JEL: | H0 H00 I10 Q51 Q53 |
| Date: | 2018–03–10 |
| URL: | http://d.repec.org/n?u=RePEc:pra:mprapa:86483&r=hea |
| By: | Barton H. Hamilton; Andrés Hincapié; Robert A. Miller; Nicholas W. Papageorge |
| Abstract: | This paper develops and estimates a dynamic structural model of demand for a multi-attribute product. The demand side equilibrium supports a product spectrum, the characteristics of which evolve over time in response to supply innovations induced by the composition and extent of aggregate demand. The direction and speed of innovation is inefficient because individuals create an externality by not accounting for their influence on the discovery process. We apply the model to drugs invented to combat the HIV epidemic, during which frequent, incremental innovations in medication were punctuated by sporadic breakthroughs. In this application products differ in their efficacy and their propensity to cause side effects. Our biennial data on four American cities track a replenished panel of individuals for over twenty years, from when drugs were not only ineffective but also created debilitating side effects, to when the market matured. We find that the externalities are quantitatively important and that even a temporary subsidy would have improved average social welfare and been more equitable. |
| JEL: | O31 |
| Date: | 2018–05 |
| URL: | http://d.repec.org/n?u=RePEc:nbr:nberwo:24577&r=hea |
| By: | Jörg Kalbfuß; Reto Odermatt; Alois Stutzer |
| Abstract: | The consequences of legal access to medical marijuana for individual welfare are a matter of controversy. We contribute to the ongoing discussion by evaluating the impact of the staggered introduction and extension of medical marijuana laws across US states on self-reported mental health. Our main analysis is based on BRFSS survey data from more than six million respondents between 1993 and 2015. On average, we find that medical marijuana laws lead to a reduction in the self-reported number of days with mental health problems. Reductions are largest for individuals with high propensities to consume marijuana for medical purposes and people who are likely to suffer from chronic pain. Moreover, the introduction of prescription drug monitoring programs lead to a reduction in bad mental health days only in states that allow medical marijuana. |
| Keywords: | medical marijuana laws, cannabis regulation, mental health, chronic pain, prescription drug monitoring |
| JEL: | H75 I12 I18 I31 K42 |
| Date: | 2018–05 |
| URL: | http://d.repec.org/n?u=RePEc:cep:cepdps:dp1546&r=hea |
| By: | Anek Belbase; Geoffrey T. Sanzenbacher; Abigail Walters |
| Abstract: | One of the first signs that a person has dementia is difficulty with financial tasks. At first, it may just take longer to balance a checkbook or pay bills on time. Eventually, though, dementia erodes the capacity to carry out everyday transactions. So people with dementia need someone to help them manage their money – at first to avoid mistakes and later on to make sure their resources are not misused or abused. Since 5.5 million Americans ages 65 and over have dementia today, it is important to know whether they receive the assistance they need. An earlier brief provided some positive news: most people with dementia potentially have access to financial help, often from family.2 But due to data limitations, the study could not examine whether these informal caregivers actually did assist with financial management, and if so, whether it made a difference in financial well-being. After all, it is not clear whether the help offered by caregivers, who may lack full knowledge about their charges’ finances, would necessarily prove effective and, in rare cases, caregivers could turn out to be financial abusers. In these instances, people receiving “help” could end up worse off. This brief explores how many dementia sufferers have help and whether it improves their situation. The discussion is organized as follows. The first section briefly introduces the challenge that dementia poses for handling finances. The second section addresses whether those with dementia have help managing their finances. The third section presents results on whether the assistance appears to improve financial well-being. The final section concludes that the vast majority of individuals with dementia have help managing their money, mostly from family, and that the assistance appears to reduce financial hardship. However, social service organizations should keep their eyes out for the minority who do not have help in order to prevent their financial situation from deteriorating. This vigilance will be especially important in the future, as lower fertility rates and higher divorce rates may leave more individuals without family to provide help. |
| Date: | 2018–03 |
| URL: | http://d.repec.org/n?u=RePEc:crr:issbrf:ib2018-6&r=hea |
| By: | Elena Andreyeva; Guy David; Hummy Song |
| Abstract: | Home health care has experienced significant growth as an industry and is viewed as one of the avenues for achieving reductions in the cost and utilization of expensive downstream health care services. Using a novel dataset on home health care visits, this study quantifies the effects of reduced time spent with patients during a post-acute home health visit on hospital readmissions. We focus in particular on the subset of patients with conditions that are subject to penalty under the Hospital Readmission Reduction Program. Since both visit length and readmission risk are likely to be correlated with unobserved illness severity, we use the daily sequence of provider visits and deviation from the provider’s average daily workload as instruments for visit length. We find that patients who are visited later in the provider’s day as well as those who are visited by a provider who has a higher than usual workload experience home health visits that are shorter than usual. Using our instruments and controlling for patient, visit, and provider characteristics, we find that home health visits that are longer than usual by one minute reduce the risk of hospital readmission by approximately 8 percent. These effects seem to be driven by providers with higher levels of discretion in their time management and care provision. We suggest several approaches that managers could take to attain reductions in readmissions without incurring significant additional costs. |
| JEL: | I1 J22 |
| Date: | 2018–04 |
| URL: | http://d.repec.org/n?u=RePEc:nbr:nberwo:24566&r=hea |
| By: | Lucia Leporatti (University of Genoa - Department of Political Science ?); Enrico di Bella (University of Genoa ? Department of Economics); Luca Gandullia (University of Genoa - Department of Political Science ?); Walter Locatelli (Alisa Regione Liguria); Marcello Montefiori (University of Genoa ? Department of Economics); Roberta Zanetti (Alisa Regione Liguria) |
| Abstract: | Frequent users of Emergency Departments (EDs) represent a particularly interesting category of users since they account to a small percentage of patients but they affect considerably accesses, overcrowding and the overall costs of ED activities. The literature on the topic is vast and it allows to delineate a profile of frequent users identifying socio-demographic (age, gender, nationality) and clinical (chronic diseases, drugs and alcohol abuse; psychic illnesses) risk factors. However, most of the studies on the topic limit the analysis to one-year period or to a single study site and there is no consensus on the definition of frequent use. Frequent users are generally defined as those patients reporting a number of accesses per year beyond a certain threshold. The selection of the threshold is often based on previous literature or on percentiles but the definitions vary considerably and the choice tends to be subjective.In this study, the focus will be placed on paediatric patients, with reference to which the contributions in the literature are still very limited. The objective is to identify the most important drivers of ED frequent use in the 19 EDs of Liguria region (Italy) during a three-year period (2013-2015). The dataset contains 287,242 accesses referred to 144,895 under 14 patients and it includes information on patients? characteristics and on their clinical pathway. To overcome the limitations connected to previous definitions of frequent use, we exploit the availability of data on three years; this allows to define, not only frequent use, but also its duration (i.e. One-shot / Multiple shot frequent use) and intensity (Normal, High, Very high). By the use of logit and multinomial logit regressions we identify a set of risk factors associated to frequent use and to the different forms of frequent use. Results show that even if frequent users represent a small share of patients (9%) they contribute to roughly 25% of accesses. Chronic conditions are the most relevant determinants of frequent use (particularly mental disorders, diseases of the respiratory system) but also foreign nationality turns out to be an important predictor. Differences emerge in the impact of regressors on the different forms of frequent use defined according to its duration and intensity.The study represents an important tool to support policy-making and to discriminate between the potentially preventable frequent use (i.e. inappropriate use) and that associated to complex medical conditions, such as chronic conditions. |
| Keywords: | Frequent use, Emergency Departments, Risk factors, paediatric patients |
| JEL: | I10 C50 I18 |
| Date: | 2018–04 |
| URL: | http://d.repec.org/n?u=RePEc:sek:iacpro:7508617&r=hea |
| By: | Zamora, B.; Maignen, F.; Lorgelly, P. |
| Abstract: | The centralised procedure was created in 1995 to facilitate access to innovative medicines across the European Union. Since then the scope of authorisation via the centralised procedure has been broadened and made mandatory for orphan and oncology medicines. We analysed routine funding in the NHS for new medicines recently authorised via the centralised procedure with a particular focus on oncology and orphan medicines. We utilised a database of outcomes of health technology assessment (HTA) evaluations conducted in the UK by NICE, AWMSG and SMC - OHE's Medicines Tracker. We considered centrally authorised products (CAP) approved between 1 January 2011 and 31 December 2016. We find that a substantial number of products that received an EU authorisation between 2011 and 2016 were not referred for a HTA evaluation in the UK. We also show that there is both variation across agencies and variation across therapeutic classes in terms of adoption decisions and access across England, Scotland and Wales. |
| JEL: | I1 |
| Date: | 2017–12–01 |
| URL: | http://d.repec.org/n?u=RePEc:ohe:conrep:001932&r=hea |
| By: | Zamora, B.; Maignen, F.; O'Neill, P.; Mestre-Ferrandiz, J.; Garau, M. |
| Abstract: | The European Commission's (EC) Orphan Medicinal Products Regulation intended to incentivise the research, development and marketing of new treatments for rare and chronically disabling or life-threatening diseases. Marketing authorisation granted to orphan medicinal products (OMPs) is however only the first step; patients have access to medicines once reimbursement or health technology assessment (HTA) decisions are implemented by national health systems. Our analysis found that since the implementation of the OMPs Regulation in 2000, 143 OMPs obtained a marketing authorisation in the EU. These OMPs are most widely accessible in Germany and France. In the other countries between 30% and 60% of OMPs are reimbursed. In England, less than 50% of OMPs are routinely funded by the NHS, with one-third of these recommended by NICE. The remaining products are directly procured and made available to patients by NHS England via commissioning policies or through the Cancer Drugs Fund. In Germany reimbursement is automatically granted to all medicines which receive a marketing authorisation, immediately after it. For the other countries, the shortest time from authorisation to a reimbursement decision is observed in France and Italy which takes on average 19 months. |
| Keywords: | Economics of Health Technology Assessment; Health Statistics and Data Analyses |
| JEL: | I1 |
| Date: | 2017–03–01 |
| URL: | http://d.repec.org/n?u=RePEc:ohe:conrep:001818&r=hea |
| By: | Marsden, G.; Towse, A. |
| Abstract: | In 2016 the University of York undertook a review exercise to determine whether NICE's existing methods and processes are appropriate for assessment of regenerative medicines. The purpose of this OHE report is to explore this review exercise and to assess whether or not the resulting conclusions are appropriate. The Report concludes that the York and NICE exercise provided a thorough mock appraisal of CAR T cell therapy. However, it did not seek to identify the most suitable approach for assessing regenerative medicines, but rather to test whether regenerative medicines could fit into the existing pathway developed for conventional medicines. The authors suggest a more interesting question would have been to look at whether or not use of the existing pathway is the most suitable approach, rather than whether or not it is possible. The report also questions the relevance of some additional parameters that were presented to the expert panel as part of the mock appraisal, arguing that the presentation of uncertainty is potentially misleading. It also suggests that NICE's end of life criteria and criteria for allowing use of a 1.5% discount rate should be amended in the context of regenerative medicines. |
| Keywords: | Economics of Health Technology Assessment |
| JEL: | I1 |
| Date: | 2017–02–01 |
| URL: | http://d.repec.org/n?u=RePEc:ohe:conrep:001802&r=hea |