ABSTRACT The Institute for Quality and Efficiency in Health Care (IQWiG) developed—in a consultation process with an international expert panel—the efficiency frontier (EF) approach to satisfy a range of legal requirements for economic evaluation in Germany’s statutory health insurance system. The EF approach is distinctly different from other health economic approaches. Here, we evaluate established tools for assessing and communicating parameter uncertainty in terms of their applicability to the EF approach. Among these are tools that perform the following: (i) graphically display overall uncertainty within the IQWiG EF (scatter plots, confidence bands, and contour plots) and (ii) communicate the uncertainty around the reimbursable price. We found that, within the EF approach, most established plots were not always easy to interpret
Author Archives: Health Economics Journal
ABSTRACT The paper discusses the impact of centre selection on the generalisability of randomised controlled trial (RCT)-based economic evaluations and suggests a future research agenda. The first section briefly reviews the current methods for addressing generalisability. We argue that these methods make no verifiable assumptions about how representative the recruiting centres are to the population of centres in the jurisdiction. The second section uses data from a multicentre RCT to illustrate that cost-effectiveness estimates can be influenced by the sample of recruiting centres. Finally, we propose two concepts that may advance generalisability research.
ABSTRACT In 2004, California became the first state to implement statewide minimum nurse-to-patient ratios in general hospitals. In spite of years of work to establish statewide staffing regulations, there is little evidence that the law was effective in attracting more nurses to the hospital workforce or improving patient outcomes. This paper examines the effects of this legislation on employment and wages of registered nurses. By using annual financial data from California hospitals, I show that nurse-to-patient ratios in medical/surgical units increased substantially following the staffing mandate.
ABSTRACT The origin of the obesity epidemic in developing countries is still poorly understood. It has been prominently argued that economic development provides a natural interpretation of the growth in obesity. This paper tests the main aggregated predictions of the theoretical framework to analyze obesity. Average body weight and health inequality should be associated with economic development. Both hypotheses are confirmed: we find higher average female body weight in economically more advanced countries.
ABSTRACT This paper demonstrates how Bayesian hierarchical modelling can be used to evaluate the performance of hospitals. We estimate a three-level random intercept probit model to attribute unexplained variation in hospital-acquired complications to hospital effects, hospital-specialty effects and remaining random variations, controlling for observable patient complexities. The combined information provided by the posterior means and densities for latent hospital and specialty effects can be used to assess the need and scope for improvements in patient safety at different organizational levels. Posterior densities are not conventionally presented in performance assessment but provides valuable additional information to policy makers on what poorly performing hospitals and specialties may be prioritized for policy action. We use surgical patient administrative data for 2005/2006 for 16 specialties in 35 public hospitals in Victoria, Australia
ABSTRACT Gender differences in drinking patterns are potentially important for public policies, especially policies that rely extensively on higher alcohol taxes and prices. This paper presents a systematic review of alcohol prices and gender differences in drinking and heavy drinking by adults and young adults. Starting with a database of 578 studies of alcohol demand and other outcomes, 15 studies are reviewed of adult drinking including discussion of samples, measurement issues, econometric models, special variables, and key empirical results. A similar discussion is presented for eight studies of drinking by young adults, ages 18–26 years. Four conclusions are obtained from the review
ABSTRACT This study exploits a natural experiment in the province of Ontario, Canada, to identify the impact of pay-for-performance (P4P) incentives on the provision of targeted primary care services and whether physicians’ responses differ by age, size of patient population, and baseline compliance level. We use administrative data that cover the full population of Ontario and nearly all the services provided by primary care physicians. We employ a difference-in-differences approach that controls for selection on observables and selection on unobservables that may cause estimation bias. We implement a set of robustness checks to control for confounding from other contemporaneous interventions of the primary care reform in Ontario. The results indicate that responses were modest and that physicians responded to the financial incentives for some services but not others.
Original post: WHEN DO FAT TAXES INCREASE CONSUMER WELFARE? REPLY TO NEILL
ABSTRACT We estimate the impact of six diabetes-related complications (myocardial infarction, ischaemic heart disease, stroke, heart failure, amputation and visual acuity) on quality of life, using seven rounds of EQ-5D questionnaires administered between 1997 and 2007 in the UK Prospective Diabetes Study. The use of cross-sectional data to make such estimates is widespread in the literature, being less expensive and easier to collect than repeated-measures data. However, analysis of this dataset suggests that cross-sectional analysis could produce biased estimates of the effect of complications on QoL. Using fixed effects estimators, we show that variation in the quality of life between patients is strongly influenced by time-invariant patient characteristics. Our results highlight the importance of studying quality-of-life changes over time to distinguish between time-invariant determinants of QoL and the effect on QoL of specific events such as diabetes complications.
ABSTRACT This paper empirically investigates the relationship between the health care expenditure of end-of-life patients and hospital characteristics in Taiwan where (i) hospitals of different ownership differ in their financial incentives; (ii) patients are free to choose their providers; and (iii) health care services are paid for by a single public payer on a fee-for-services basis with a global budget cap. Utilizing insurance claims for 11 863 individuals who died during 2005–2007, we trace their hospital expenditures over the last 24 months of their lives. We find that end-of-life patients who are treated by private hospitals in general are associated with higher inpatient expenditures than those treated by public hospitals, while there is no significant difference in days of hospital stay. This finding is consistent with the difference in financial incentives between public and private hospitals in Taiwan. Nevertheless, we also find that the public–private differences vary across accreditation levels.
ABSTRACT There have been numerous attempts to both document the income-health gradient in children and to understand the nature of the tie. In this paper, we review and summarize existing studies, and then use a unique school-based panel data set from the USA to attempt to further our understanding of the relationship. The long duration (5 observations, 9 years) allows us to add to the understanding of the pattern of the tie, through our ability to test for changes in health status and multiple measures of income, and the school-based nature of the data allow us to add community socioeconomic status to the model. Increasing understanding of the income-health gradient has clear policy implications in terms of effective targeting of interventions to decrease the gradient and hence decrease health disparities among children. Copyright © 2013 John Wiley & Sons, Ltd.
See the original post: Workshop and Special Issue on the Economics of Long Term Care
SUMMARY We explore two unexpected changes in flight regulations to estimate the causal effect of aircraft noise on health. Detailed measures of noise are linked with longitudinal data on individual health outcomes based on the exact address information. Controlling for individual heterogeneity and spatial sorting into different neighborhoods, we find that aircraft noise significantly increases sleeping problems and headaches. Models that do not control for such heterogeneity and sorting substantially underestimate the negative health effects, which suggests that individuals self-select into residence based on their unobserved sensitivity to noise. Our study demonstrates that the combination of quasi-experimental variation and panel data is very powerful for identifying causal effects in epidemiological field studies.
SUMMARY This paper studies short-run cyclical behaviour of public (government and social) and private health expenditure and GDP using both time series and panel data techniques. First, national time series data have been used within a multivariate Beveridge–Nelson decomposition framework to construct the permanent and cyclical components. The correlation analysis results for the cyclical components suggest that current public health expenditure is pro-cyclical while there is no clear evidence of a correlation between cycles in private health expenditure and in GDP growth. Next, using an instrumental variable method and the generalised method of moments estimator, provincial-level panel data analyses confirm pro-cyclical impacts of government spending on health. The provincial analysis also suggests that private health expenditure in urban China has a pro-cyclical association with GDP growth, but a lack of good instruments makes it difficult to identify a clear causal link between cycles in income growth and private health expenditure