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Medical Resource Scarcity and Inequality in COVID-19 Fatality Rates: Evidence From Hospitalized Patients in Wuhan, China. 医疗资源稀缺与 COVID-19 死亡率的不平等:中国武汉住院病人的证据。
IF 2 3区 医学 Q2 ECONOMICS Pub Date : 2024-11-11 DOI: 10.1002/hec.4916
Dandan Zhang, Xiang-Ming Zhang, Xiao Liu

Wuhan, China, where SARS-CoV-2 was detected first, has been recorded as one of the epicenters with the highest COVID-19 fatality rates worldwide. High COVID-19 fatality rates may stem from severe medical resource scarcity, especially in the early stage of the pandemic outbreak. In the first few weeks of the COVID-19 outbreak, Wuhan experienced the hardship of a severe "hospital run" period, when hospitals operated far beyond their maximum capacity and then soon transformed into "inclusive healthcare," that is, every infectious person can access free medical treatment. Based on detailed administrative data of hospital admission and medical treatment for 1537 COVID-19 patients, we investigate how the COVID-19 fatality rates can be affected by the patient's socioeconomic status (SES) and differences in the effect between the two periods. Our estimation results show that low-SES patients had higher fatality rates during the "hospital run" period. Differential opportunities for hospitalization do not drive this inequality in fatality rates; rather, they are driven by the medical treatment after hospital admission, namely reduced treatment intensity and limited access to specific medical treatment and medications for COVID-19. When the government implemented the "inclusive healthcare" policy, severe medical resource scarcity was alleviated, and the inequality in fatality rates ceased to exist. These findings verify the existence of medical inequality among low-SES people amid severe medical resource shortages and also highlight the importance of rapidly increasing hospital capacity and medical supply in reducing possible unequal treatment and tackling inequalities in medical outcomes, especially during a public health crisis.

中国武汉是最早发现 SARS-CoV-2 的地方,也是全球 COVID-19 死亡率最高的震中之一。COVID-19 的高死亡率可能源于医疗资源的严重匮乏,尤其是在疫情爆发初期。在 COVID-19 爆发的最初几周,武汉经历了严重的 "跑医院 "时期,医院的运营远远超出了其最大能力,随后很快转变为 "包容性医疗",即每个感染者都能获得免费治疗。基于 1537 名 COVID-19 患者入院和治疗的详细行政数据,我们研究了患者的社会经济地位(SES)如何影响 COVID-19 死亡率,以及两个时期的影响差异。我们的估计结果表明,社会经济地位低的患者在 "住院期间 "的死亡率较高。住院机会的不同并没有导致死亡率的不平等,而是由入院后的医疗治疗导致的,即治疗强度降低,COVID-19 的特殊医疗和药物治疗受到限制。政府实施 "包容性医疗 "政策后,严重的医疗资源稀缺问题得到缓解,死亡率不平等现象也不复存在。这些研究结果验证了在医疗资源严重短缺的情况下,低社会经济地位人群中存在医疗不平等现象,同时也强调了迅速提高医院能力和医疗供应量对于减少可能出现的不平等待遇和解决医疗结果不平等问题的重要性,尤其是在公共卫生危机期间。
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引用次数: 0
Employment shocks and demand for pain medication: Understanding the channels that drive opioid use. 就业冲击与止痛药需求:了解驱动阿片类药物使用的渠道。
IF 2 3区 医学 Q2 ECONOMICS Pub Date : 2024-11-07 DOI: 10.1002/hec.4901
Isabel Musse

Higher employment ratios can affect opioid use through two main channels: by increasing physical pain from working or by reducing mental distress that may contribute to substance misuse. To separate these channels, I contrast the effect of labor demand shocks on the use of opioids with the effect on the use of over-the-counter painkillers-commonly used to treat pain but not mental distress. I find that during local economic expansions, opioid use declines while the demand for over-the-counter pain relief medication increases. Employment changes in high injury industries accentuate this pattern. One possible explanation is that, during local economic expansions, the use of pain medications to manage work injuries increases while the misuse of opioids decreases.

较高的就业率可通过两个主要渠道影响阿片类药物的使用:一是增加工作带来的身体疼痛,二是减少可能导致药物滥用的精神痛苦。为了区分这些渠道,我将劳动力需求冲击对阿片类药物使用的影响与对非处方药止痛药使用的影响进行了对比--非处方药止痛药常用于治疗疼痛,但不治疗精神痛苦。我发现,在地方经济扩张期间,阿片类药物的使用量会减少,而非处方止痛药的需求量会增加。高伤害行业的就业变化加剧了这一模式。一种可能的解释是,在地方经济扩张期间,使用止痛药控制工伤的情况增加,而滥用阿片类药物的情况减少。
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引用次数: 0
Horizontal inequity in the use of mental healthcare in Australia. 澳大利亚精神保健使用中的横向不平等。
IF 2 3区 医学 Q2 ECONOMICS Pub Date : 2024-11-06 DOI: 10.1002/hec.4910
Nicole Black, David W Johnston, Martin Knapp, Michael A Shields, Gloria H Y Wong

For people experiencing mental health problems, timely access to high-quality healthcare is imperative for improving outcomes. However, limited availability of services, high out-of-pocket costs, insufficient health literacy and stigmatizing attitudes may mean people do not receive the necessary treatment. We analyze Australian longitudinal data to document the extent and predictors of horizontal inequity in mental healthcare use among people with a newly developed mild or moderate mental disorder. Importantly, we compare people with similar health, residing in the same area, thus controlling for differences in healthcare needs and availability of services. Results suggest that mental healthcare use is not significantly associated with household income or financial hardship. In contrast, we find significant inequities by educational attainment, with university graduates around 50% more likely to receive mental healthcare than high-school dropouts. These findings are robust across subsamples and alternative modeling approaches, including panel data models with individual fixed-effects. Additional explorations of the education gradient suggest a potential pathway through mental health-specific knowledge and attitudes.

对于有心理健康问题的人来说,及时获得高质量的医疗服务对于改善治疗效果至关重要。然而,有限的服务供应、高昂的自付费用、不足的健康知识以及轻蔑的态度可能意味着人们无法接受必要的治疗。我们对澳大利亚的纵向数据进行了分析,记录了新近出现轻度或中度精神障碍的患者在使用精神医疗保健服务时横向不平等的程度和预测因素。重要的是,我们对居住在同一地区、健康状况相似的人进行了比较,从而控制了医疗保健需求和服务可用性方面的差异。结果表明,精神疾病的使用与家庭收入或经济困难并无明显关联。与此相反,我们发现受教育程度的差异非常明显,大学毕业生接受心理保健的可能性比高中辍学者高出约 50%。这些发现在不同的子样本和不同的建模方法(包括带有个人固定效应的面板数据模型)中都是稳健的。对教育梯度的其他探索表明,心理健康的特定知识和态度是一个潜在的途径。
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引用次数: 0
The addition of cannabis to prescription drug monitoring programs and medication fills in Medicaid. 将大麻纳入处方药监控计划和医疗补助中的药物填充。
IF 2 3区 医学 Q2 ECONOMICS Pub Date : 2024-11-04 DOI: 10.1002/hec.4911
Shelby R Steuart

To date, there is considerable evidence of the medical applications of cannabis, however concerns regarding the safety of cannabis are also mounting. To improve the safety of cannabis, nine states have added medical cannabis to their state PDMPs, helping providers to take patient cannabis use into consideration when making prescribing decisions. Across a variety of models using Medicaid State Drug Utilization claims data, I find statistically significant reductions in severely and moderately contraindicated medication fills across two outcomes. In my main specification, adding cannabis to a state PDMP is associated with a 14.4% (p < 0.01) and 7.74% (p < 0.001) decrease in the units per prescription, for severely and moderately contraindicated medications, respectively, as compared to states with legal medical cannabis dispensaries open. An interesting spillover effect of adding cannabis to PDMPs is an apparent decrease in the prescribing of scheduled narcotics, with Schedule II medications seeing a moderately significant decrease and Schedule IV medications seeing a 11.4% decrease (p < 0.01) in the prescribing rate and a 16.2% decrease (p < 0.001) in the units per prescription. The main analysis was conducted using the Borusyak et al. (2023) Imputation Estimator with a robustness check using the Callaway and Sant'Anna (2021) difference-in-difference. This work presents evidence that adding cannabis to a state PDMP impacts provider prescribing decisions involving medications that are contraindicated for use with cannabis as well as controlled substances. This paper demonstrates that adding cannabis to PDMPs influences prescribing and thus has the potential to make medical cannabis use safer. Conversely, this work indicates providers may have bias against patients who use cannabis and deny them life-improving medications (like controlled ADHD medication or opioids) on the basis of medical cannabis use. This paper also contributes to the literature comparing DD outcomes estimated using Borusyak, Jaravel, and Spiess' (2023) Imputation Estimator and Callaway and Sant'Anna's (2021) DD Estimator.

迄今为止,已有大量证据表明大麻具有医疗用途,但人们对大麻安全性的担忧也日益增加。为了提高大麻的安全性,九个州已将医用大麻添加到本州的 PDMP 中,帮助医疗服务提供者在开处方时考虑病人使用大麻的情况。在使用医疗补助(Medicaid)州药物使用报销数据的各种模型中,我发现在两种结果中,严重和中度禁忌药物的填充量在统计上有显著减少。在我的主要规范中,将大麻加入州 PDMP 与 14.4% (p
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引用次数: 0
Mental health impacts of spousal caregiving intensity in the US. 美国配偶照料强度对心理健康的影响。
IF 2 3区 医学 Q2 ECONOMICS Pub Date : 2024-10-27 DOI: 10.1002/hec.4908
Jennifer A Ailshire, Maria Casanova

In the US, spouses are a major source of informal care for older adults and, therefore, key to the US national strategy to provide long-term care to the growing population of older adults. Understanding the mental health impacts of spousal caregiving is therefore critically important. Existing studies on the topic have often been limited by methodological limitations, and most overlook the role of caregiving intensity. In this study, we assess the impact of providing different intensities of caregiving to a spouse on mental health outcomes using data from the Health and Retirement Study. We address the endogeneity of the decision to provide different caregiving intensities using an augmented inverse probability weighted (AIPW) estimator adapted to handle multivalued treatments. We check the robustness of our estimates to the AIPW's identifying assumptions by re-estimating the model using a dynamic fixed effects estimator. We find strong evidence that becoming a caregiver is associated with worsened mental health outcomes for women, while the evidence for men is weaker. When disaggregating by caregiving intensity, we find that transitions into high-intensity caregiving lead to large increases in depression symptoms and the probability of exhibiting major depression for both men and women. The overall mental health impact of transiting into caregiving is driven almost exclusively by the negative impact of high-intensity caregiving, as transitions into low- and moderate-intensity caregiving are not associated with worsening mental health in most specifications. This study provides timely insights that can inform the targeting of long-term care policies and programs aimed at supporting family caregivers of older adults.

在美国,配偶是老年人非正式护理的主要来源,因此也是美国为不断增长的老年人口提供长期护理的国家战略的关键。因此,了解配偶护理对心理健康的影响至关重要。现有的相关研究往往受到方法论的限制,而且大多数研究都忽略了护理强度的作用。在本研究中,我们利用健康与退休研究(Health and Retirement Study)的数据,评估了为配偶提供不同强度的护理对心理健康结果的影响。我们使用增强反向概率加权(AIPW)估计器来处理多值处理,从而解决了提供不同护理强度决策的内生性问题。我们使用动态固定效应估计器对模型进行了重新估计,从而检验了我们的估计结果对 AIPW 识别假设的稳健性。我们发现,有强有力的证据表明,女性成为照顾者与心理健康结果的恶化有关,而男性的证据则较弱。如果按照护理强度进行分类,我们会发现,无论是男性还是女性,过渡到高强度护理都会导致抑郁症状和表现出重度抑郁症的概率大幅上升。过渡到护理工作对心理健康的总体影响几乎完全由高强度护理工作的负面影响所驱动,因为在大多数规格中,过渡到低强度和中等强度护理工作与心理健康恶化无关。这项研究提供了及时的见解,可以为旨在支持老年人家庭照顾者的长期护理政策和计划的针对性提供参考。
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引用次数: 0
Scope of practice and opioid prescribing behavior of nurse practitioners serving Medicare beneficiaries. 为医疗保险受益人服务的执业护士的执业范围和阿片类药物处方行为。
IF 2 3区 医学 Q2 ECONOMICS Pub Date : 2024-10-05 DOI: 10.1002/hec.4904
Shishir Shakya, Alicia Plemmons

Policymakers aiming to increase access to health care while simultaneously keeping costs low and quality high are considering expanding the practice authority and prescriptive authority of nurse practitioners in order to address primary care shortages. While we know this increases access, some researchers argue that the expansion of job autonomy of nurse practitioners can compromise the quality and safety of rendered medical services. This paper investigates quality and safety outcomes in prescribing behaviors of nurse practitioners who have prescribed opioids for Medicare Part D beneficiaries using a unique source of policy variation, nurse practitioners with the ability to prescribe medication who move to either states with or without physician supervision. We find that scope of practice expansions do not compromise quality and safety in terms of potential abuse or misuse of prescriptive authority.

旨在增加医疗服务的可及性,同时保持低成本和高质量的政策制定者正在考虑扩大执业护士的执业权限和处方权,以解决初级医疗服务短缺的问题。虽然我们知道这可以增加医疗服务的可及性,但一些研究人员认为,扩大执业护士的工作自主权可能会影响所提供医疗服务的质量和安全。本文利用一个独特的政策变异来源,即有能力开处方的执业护士,在搬迁到有或没有医生监督的州后,为医疗保险 D 部分受益人开阿片类药物处方的行为质量和安全结果进行了调查。我们发现,就处方权的潜在滥用或误用而言,执业范围的扩大并不会影响质量和安全。
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引用次数: 0
Unpacking the care-related quality of life effect of England's publicly funded adult social care. A panel data analysis. 解读英格兰政府资助的成人社会护理对与护理相关的生活质量的影响。面板数据分析。
IF 2 3区 医学 Q2 ECONOMICS Pub Date : 2024-10-05 DOI: 10.1002/hec.4907
Andrea Salas-Ortiz, Francesco Longo, Karl Claxton, James Lomas

Adult Social Care (ASC) is the publicly-funded long-term care program in England that provides support with activities of daily living to people experiencing mental and/or physical challenges. Existing evidence suggests that ASC expenditure improves service users' care-related quality of life (CRQoL). However, less is known about the channels through which this effect exists and the effect on outcomes other than CRQoL. We fill this gap by analyzing survey data on ASC service users who received long-term support from 2014/15 to 2019/20 using panel data instrumental variable methods. We find that the beneficial impact of ASC expenditure on the CRQoL of both new and existing users is mostly driven by users aged 18-64 without any learning disability and users with no learning disability aged 65 or older receiving community-based ASC. Moreover, control over daily life, occupation, and social participation are the CRQoL domains that are improved the most. We also find that ASC expenditure has a beneficial effect on several other outcomes beyond CRQoL for both new and existing users including user satisfaction and experience, the ability to carry out activities of daily living independently, whether their home is designed around needs, accessibility to local places, general health, and mental health through reduced anxiety and depression. Greater ASC expenditure, however, does not address the need for other forms of support such as unpaid informal and privately-funded care.

成人社会护理(ASC)是英格兰由政府资助的长期护理项目,为精神和/或身体上有困难的人提供日常生活活动支持。现有证据表明,ASC 的支出可以改善服务使用者与护理相关的生活质量(CRQoL)。然而,人们对这一效果存在的渠道以及对 CRQoL 之外的其他结果的影响知之甚少。我们采用面板数据工具变量法分析了 2014/15 年至 2019/20 年期间接受长期支持的 ASC 服务使用者的调查数据,填补了这一空白。我们发现,ASC支出对新用户和现有用户的CRQoL的有利影响主要是由18-64岁无任何学习障碍的用户和65岁或以上接受社区ASC的无学习障碍用户所驱动的。此外,日常生活控制能力、职业和社会参与是 CRQoL 中改善最大的领域。我们还发现,对于新用户和现有用户而言,除了 CRQoL 之外,ASC 支出还对其他几项结果产生了有利影响,包括用户满意度和体验、独立进行日常生活活动的能力、他们的家是否根据需求进行了设计、前往当地场所的便利性、总体健康状况以及通过减少焦虑和抑郁而获得的心理健康。然而,增加 ASC 支出并不能解决对其他形式的支持的需求,例如无偿的非正式护理和私人资助的护理。
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引用次数: 0
Do health care quality improvement policies work for all? Distributional effects by baseline quality in South Africa 提高医疗质量的政策对所有人都有效吗?南非基线质量的分布效应。
IF 2 3区 医学 Q2 ECONOMICS Pub Date : 2024-10-03 DOI: 10.1002/hec.4899
Finn McGuire, Peter C. Smith, Nicholas Stacey, Ijeoma Edoka, Noemi Kreif

Health care quality improvement (QI) initiatives are being implemented by a number of low- and middle-income countries. However, there is concern that these policies may not reduce, or may even worsen, inequities in access to high-quality care. Few studies have examined the distributional impact of QI programmes. We study the Ideal Clinic Realization and Maintenance program implemented in health facilities in South Africa, assessing whether the effects of the program are sensitive to previous quality performance. Implementing difference-in-difference-in-difference and changes-in-changes approaches we estimate the effect of the program on quality across the distribution of past facility quality performance. We find that the largest gains are realized by facilities with higher baseline quality, meaning this policy may have led to a worsening of pre-existing inequity in health care quality. Our study highlights that the full consequences of QI programmes cannot be gauged solely from examination of the mean impact.

一些中低收入国家正在实施提高医疗质量(QI)的举措。然而,令人担忧的是,这些政策可能不会减少,甚至可能加剧在获得高质量医疗服务方面的不平等。很少有研究探讨过质量改进计划对分配的影响。我们研究了在南非医疗机构实施的理想诊所实现与维护计划,评估了该计划的效果是否对之前的质量表现敏感。我们采用 "差异中的差异 "和 "变化中的变化 "两种方法,估算了该计划对过去医疗机构质量绩效分布的影响。我们发现,基线质量较高的医疗机构获得的收益最大,这意味着该政策可能导致了医疗质量不平等的恶化。我们的研究强调,不能仅从平均影响的角度来衡量质量改进计划的全部后果。
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引用次数: 0
Socioeconomic inequalities in waiting times for breast cancer surgery. 乳腺癌手术等待时间的社会经济不平等。
IF 2 3区 医学 Q2 ECONOMICS Pub Date : 2024-10-03 DOI: 10.1002/hec.4906
Maria Ana Matias, Rita Santos, Luigi Siciliani, Peter Sivey, Andrew Proctor

Prompt access to cancer care is a policy priority in several OECD countries, because delayed access can exacerbate deleterious health outcomes. Access to care based on need remains a key pillar of publicly-funded health systems. This study tests for the presence of inequalities in waiting times by socioeconomic status for patients receiving breast cancer surgery (mastectomy or breast conserving surgery) in England using the Hospital Episode Statistics. We investigate separately the pre-COVID-19 period (April 2015-January 2020), and the COVID-19 period (February 2020-March 2022). We use linear regression models to study the association between waiting times and income deprivation measured at the patient's area of residence. We control for demographic factors, type and number of comorbidities, past emergency admissions and Healthcare Resource Groups, and supply-level factors through hospital fixed effects. In the pre-COVID-19 period, we do not find statistically significant associations between income deprivation in the patient's area of residence and waiting times for surgery. In the COVID-19 period, we find that patients living in the most deprived areas have longer waiting times by 0.7 days (given a mean waiting time of 20.6 days).

在一些经合组织国家,及时获得癌症治疗是政策优先事项,因为延迟获得治疗会加剧有害的健康结果。根据需要获得治疗仍然是公共资助医疗系统的关键支柱。本研究利用医院病例统计资料检验了英格兰接受乳腺癌手术(乳房切除术或保乳手术)的患者在等待时间上是否存在社会经济地位的不平等。我们分别调查了 COVID-19 之前的时期(2015 年 4 月至 2020 年 1 月)和 COVID-19 时期(2020 年 2 月至 2022 年 3 月)。我们使用线性回归模型来研究等候时间与患者居住地收入贫困之间的关系。我们通过医院固定效应来控制人口统计因素、合并症类型和数量、既往急诊入院情况和医疗资源组别,以及供应层面的因素。在 COVID-19 之前的时期,我们没有发现患者居住地区的收入贫困与手术等待时间之间存在统计学意义上的显著关联。在 COVID-19 期间,我们发现居住在最贫困地区的患者的等待时间要长 0.7 天(平均等待时间为 20.6 天)。
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引用次数: 0
Consumption responses to sweetened beverage taxes by household income in four U.S. cities 美国四个城市家庭收入对甜饮料税的消费反应。
IF 2 3区 医学 Q2 ECONOMICS Pub Date : 2024-09-30 DOI: 10.1002/hec.4905
Melissa A. Knox, Jessica C. Jones-Smith

Taxes on sweetened beverages have become an important policy response to growing obesity rates and the prevalence of type 2 diabetes in the U.S. and other nations. Since 2015, eight U.S. cities have implemented these taxes, but so far direct evidence of their impacts on household purchasing behavior is scarce. Of particular interest to many researchers and policy makers is the response of lower-income consumers to these taxes, both because they have higher sweetened beverage consumption on average and because of concerns that sweetened beverage taxes are regressive. This project investigates the income-stratified household response to SSB taxes using a data set containing the purchasing behavior of approximately 400 households in the cities of Seattle, San Francisco, Oakland, and Philadelphia, all of which have recently introduced beverage taxes. Using doubly-robust estimation of dynamic and heterogeneous treatment effects relative to a propensity-matched set of households in three comparison cities, we find that households in taxed cities experience increased prices and reduce their purchases of those beverages, with no evidence of cross-border shopping. We further find differential tax impacts by income level, with lower-income households (households with income <200% of the federal poverty line for their size) reducing their purchases of taxed beverages by nearly 50% — more than double the 18% reduction found in higher-income households (households with income >400% of the federal poverty line for their size). Our finding that lower-income households decrease their consumption more than twice as much as higher-income households suggests that these taxes may reduce health disparities and promote population health.

在美国和其他国家,针对日益增长的肥胖率和 2 型糖尿病患病率征收甜饮料税已成为一项重要的政策应对措施。自 2015 年以来,美国已有八个城市实施了此类税收,但迄今为止,有关其对家庭购买行为影响的直接证据还很少。许多研究人员和政策制定者尤其感兴趣的是低收入消费者对这些税收的反应,因为他们的平均甜饮料消费量较高,而且人们担心甜饮料税是累退的。本项目使用包含西雅图、旧金山、奥克兰和费城等城市约 400 个家庭购买行为的数据集,调查了收入分层家庭对 SSB 税的反应。相对于三个对比城市中的一组倾向匹配家庭,我们使用动态和异质性处理效应的双重稳健估算方法发现,征税城市的家庭经历了价格上涨并减少购买这些饮料的情况,但没有证据表明存在跨境购物。我们还发现,不同收入水平的家庭受到的税收影响也不同,低收入家庭(收入在联邦贫困线 400% 以内的家庭)受到的影响更大。我们发现,低收入家庭的消费量减少幅度是高收入家庭的两倍多,这表明这些税收可能会减少健康差距,促进人口健康。
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引用次数: 0
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Health economics
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