Decisions on whether to invest or not in an organization may involve a wide variety of information, from financial reports, to assumptions about industry sectors, to evaluations of the quality of corporate management. Prior research demonstrates that investors may rely heavily upon non-financial information provided by a company. We examine the demand for Corporate Social Responsibility information and the demand for informational materials that are easier to read and quicker to assimilate and conclude that females differ significantly from males in their demand for both of these items. Integration of these findings with extant research addressing the supply of information suggests that female's information needs are not attended to the same degree as the information needs of males. The economic power and independence of females is increasing, while time poverty and related resource constraints remain strong; the potential for marginalization of this investing group may represent a cause for concern among regulatory bodies tasked with maintaining a level playing field in the capital markets.
{"title":"Will Women Lead the Way? Gender and Information Preferences in Investment Decisions","authors":"Leda E. Nath, Lori L. Holder-Webb, David Wood","doi":"10.2139/ssrn.1341897","DOIUrl":"https://doi.org/10.2139/ssrn.1341897","url":null,"abstract":"Decisions on whether to invest or not in an organization may involve a wide variety of information, from financial reports, to assumptions about industry sectors, to evaluations of the quality of corporate management. Prior research demonstrates that investors may rely heavily upon non-financial information provided by a company. We examine the demand for Corporate Social Responsibility information and the demand for informational materials that are easier to read and quicker to assimilate and conclude that females differ significantly from males in their demand for both of these items. Integration of these findings with extant research addressing the supply of information suggests that female's information needs are not attended to the same degree as the information needs of males. The economic power and independence of females is increasing, while time poverty and related resource constraints remain strong; the potential for marginalization of this investing group may represent a cause for concern among regulatory bodies tasked with maintaining a level playing field in the capital markets.","PeriodicalId":342948,"journal":{"name":"iHEA 2007 Sixth World Congress: Explorations in Health Economics (Archive)","volume":"18 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2009-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122154354","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
This paper addresses the simultaneous determination of fast-food availability on obesity rates through the use of instrumental variables, specifically the number of interstate exits in the county of residence. Using the 2005 Behavioral Risk Factor Surveillance Survey and self-collected data on the density of various fast-food restaurants in US counties, I find that a ten percent increase in the number of restaurants from the mean would increase BMI by .33 points, roughly 1.05kg for a male 1.78 meters tall and .88kg for a female 1.64 meters tall. The results are robust to the selection criteria for counties and the method yields results comparable to previous work looking at rural counties, though the sample employed here is much more generalizable.
{"title":"Obesity and the Availability of Fast-Food: An Instrumental Variables Approach","authors":"R. Dunn","doi":"10.2139/ssrn.989363","DOIUrl":"https://doi.org/10.2139/ssrn.989363","url":null,"abstract":"This paper addresses the simultaneous determination of fast-food availability on obesity rates through the use of instrumental variables, specifically the number of interstate exits in the county of residence. Using the 2005 Behavioral Risk Factor Surveillance Survey and self-collected data on the density of various fast-food restaurants in US counties, I find that a ten percent increase in the number of restaurants from the mean would increase BMI by .33 points, roughly 1.05kg for a male 1.78 meters tall and .88kg for a female 1.64 meters tall. The results are robust to the selection criteria for counties and the method yields results comparable to previous work looking at rural counties, though the sample employed here is much more generalizable.","PeriodicalId":342948,"journal":{"name":"iHEA 2007 Sixth World Congress: Explorations in Health Economics (Archive)","volume":"50 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2008-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115391563","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2007-12-01DOI: 10.1017/S1389135907002322
G. Rona
This note explores the use and abuse by the U.S. of the law of armed conflict, and related consequences in the realm of international human rights obligations, that result from designation of persons as 'enemy combatants' or 'unlawful enemy combatants' in the fight against terrorism. Section II briefly describes factors that do and do not trigger application of the law of armed conflict and the consequences of whether or not it applies. Section III describes the two subcategories of armed conflict - international and non-international - and how IHL does and does not apply to various aspects of the so-called 'war against terror', as they fall within the scope of international armed conflict, non-international armed conflict and non-armed conflict. It then describes the IHL concept of 'combatant' (privileged belligerent) and its alternative, 'civilian', the appropriate designation for persons who do not qualify for combatant status even though they may participate in hostilities. Having distinguished between the two categories of armed conflict and of individuals who fall there under, Section III then discusses the scope of application of human rights law to such individuals, even where IHL is the primary source of applicable law. With the scope of application of legal frameworks to distinct categories of individuals having been established in Sections II and III, Section IV then describes the non-conforming concept and consequences of being designated an 'enemy combatant' by the US administration, and how that concept and those consequences have been debated and affected by domestic legislation and litigation. Finally, Section V concludes with recommendations to bring US practice back in to line with US international legal obligations.
{"title":"An Appraisal of US Practice Relating to 'Enemy Combatants'","authors":"G. Rona","doi":"10.1017/S1389135907002322","DOIUrl":"https://doi.org/10.1017/S1389135907002322","url":null,"abstract":"This note explores the use and abuse by the U.S. of the law of armed conflict, and related consequences in the realm of international human rights obligations, that result from designation of persons as 'enemy combatants' or 'unlawful enemy combatants' in the fight against terrorism. Section II briefly describes factors that do and do not trigger application of the law of armed conflict and the consequences of whether or not it applies. Section III describes the two subcategories of armed conflict - international and non-international - and how IHL does and does not apply to various aspects of the so-called 'war against terror', as they fall within the scope of international armed conflict, non-international armed conflict and non-armed conflict. It then describes the IHL concept of 'combatant' (privileged belligerent) and its alternative, 'civilian', the appropriate designation for persons who do not qualify for combatant status even though they may participate in hostilities. Having distinguished between the two categories of armed conflict and of individuals who fall there under, Section III then discusses the scope of application of human rights law to such individuals, even where IHL is the primary source of applicable law. With the scope of application of legal frameworks to distinct categories of individuals having been established in Sections II and III, Section IV then describes the non-conforming concept and consequences of being designated an 'enemy combatant' by the US administration, and how that concept and those consequences have been debated and affected by domestic legislation and litigation. Finally, Section V concludes with recommendations to bring US practice back in to line with US international legal obligations.","PeriodicalId":342948,"journal":{"name":"iHEA 2007 Sixth World Congress: Explorations in Health Economics (Archive)","volume":"37 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2007-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"121715180","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
This paper explores the relationship between health-related quality of life (HRQOL) measures and employment status in light of a constructed index related to Seasonal Affective Disorder that depends only on latitude and day of year. In models including demographic covariates and indicators for state, year, and quarter, more hours of darkness is associated with poorer HRQOL, which in turn is associated with a lower likelihood of employment. The relationships between the darkness index and HRQOL measures are stronger overall for women than for men. Inclusion of both the darkness index and the HRQOL measures in models of employment status determinants provides some evidence that the former operates through the latter in predicting a lower likelihood of employment. When specifying the darkness index as an instrument for HRQOL, each additional day of poor mental health per month leads to a 0.76 percentage point increase in the probability of unemployment among women.
{"title":"Mental Health and Employment: The SAD Story","authors":"Nathan Tefft","doi":"10.2139/ssrn.966456","DOIUrl":"https://doi.org/10.2139/ssrn.966456","url":null,"abstract":"This paper explores the relationship between health-related quality of life (HRQOL) measures and employment status in light of a constructed index related to Seasonal Affective Disorder that depends only on latitude and day of year. In models including demographic covariates and indicators for state, year, and quarter, more hours of darkness is associated with poorer HRQOL, which in turn is associated with a lower likelihood of employment. The relationships between the darkness index and HRQOL measures are stronger overall for women than for men. Inclusion of both the darkness index and the HRQOL measures in models of employment status determinants provides some evidence that the former operates through the latter in predicting a lower likelihood of employment. When specifying the darkness index as an instrument for HRQOL, each additional day of poor mental health per month leads to a 0.76 percentage point increase in the probability of unemployment among women.","PeriodicalId":342948,"journal":{"name":"iHEA 2007 Sixth World Congress: Explorations in Health Economics (Archive)","volume":"40 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2007-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132059234","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
This study evaluates the impact of the Mexican conditional cash transfer (CCT) program, Oportunidades and the Nicaraguan program, Red de Proteccion Social, on vaccination coverage for Bacille Calmette-Guerin (vaccine against tuberculosis), Diphtheria-Pertussis-Tetanus Vaccine, Oral Polio Vaccine and Measles-Containing Vaccine in children less than three years of age, using a randomized treatment and control design at the community level. The intent-to-treat effect on vaccination coverage is assessed using a double-difference estimator. This study found that in Mexico and Nicaragua, CCTs significantly contribute to increased vaccination coverage among children, particularly among those not reached by traditional program strategies, such as children living further from health facilities and with mothers having less than primary school
本研究采用社区一级的随机治疗和对照设计，评估了墨西哥有条件现金转移(CCT)计划(Oportunidades)和尼加拉瓜“社会保护计划”(Red de Proteccion Social)对三岁以下儿童接种卡介苗(Bacille Calmette-Guerin，结核病疫苗)、白喉-百日咳-破伤风疫苗、口服脊髓灰质炎疫苗和含麻疹疫苗的影响。意向治疗对疫苗接种覆盖率的影响使用双差估计器进行评估。本研究发现，在墨西哥和尼加拉瓜，有条件现金援助极大地提高了儿童的疫苗接种覆盖率，特别是那些传统规划战略无法覆盖到的儿童，例如居住在离卫生设施较远的地方的儿童以及母亲接受过小学以下教育的儿童
{"title":"Beyond 80%: Are There New Ways of Increasing Vaccination Coverage? Evaluation of CCT Programs in Mexico and Nicaragua","authors":"L. Brenzel, T. Barham, J. Maluccio","doi":"10.2139/ssrn.993760","DOIUrl":"https://doi.org/10.2139/ssrn.993760","url":null,"abstract":"This study evaluates the impact of the Mexican conditional cash transfer (CCT) program, Oportunidades and the Nicaraguan program, Red de Proteccion Social, on vaccination coverage for Bacille Calmette-Guerin (vaccine against tuberculosis), Diphtheria-Pertussis-Tetanus Vaccine, Oral Polio Vaccine and Measles-Containing Vaccine in children less than three years of age, using a randomized treatment and control design at the community level. The intent-to-treat effect on vaccination coverage is assessed using a double-difference estimator. This study found that in Mexico and Nicaragua, CCTs significantly contribute to increased vaccination coverage among children, particularly among those not reached by traditional program strategies, such as children living further from health facilities and with mothers having less than primary school","PeriodicalId":342948,"journal":{"name":"iHEA 2007 Sixth World Congress: Explorations in Health Economics (Archive)","volume":"24 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2007-06-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122443782","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A. Alban, Ditte Hjort Hansen, M. Fatima, S. Nielsen
Background: The HIV epidemic in Pakistan is at present concentrated among high-risk groups including IDUs. Pakistan has approx. 75 000 IDUs - 12 300 are living in Karachi. The HIV prevalence rate among the IDUs in Karachi is 26%. During 2005 and 2006 Pakistan Society, an NGO working for vulnerable populations in Pakistan, established three Drop-In-Centres, DICs, in Karachi including outreach services using motorbikes. At present 850 IDUs visit at a daily basis for clean needles, counselling and care services including detoxification (10%). Objectives: 1) To discuss the methodologies used to determine the cost-effectiveness of IDU interventions in Pakistan when up-scaling to 60% coverage as recommended by UNAIDS, 2) to examine how these interventions fair comparative to the findings from a literature review, and finally 3) to suggest policy options to improve efficiency of providing HIV preventive services that will keep the HIV epidemic from spreading into the general population. Methodology: The cost information was collected in May - June 2006. The costs included are financial and economic costs from the perspective of the provider. The Rapid Costing Approach, RCA, was used to generate total costs as well as the unit costs over five years under different up-scaling assumptions. The behaviour change for the IDU population in Karachi is derived from surveys undertaken in 2005/2006 and imputed into a dynamic mathematical model (IDU 2.4) with data from the IDU population in Karachi. The costs of the IDU interventions in Karachi is being compared with the findings from a literature survey on costing and cost-effectiveness studies in Asia and Eastern Europe, which is also characterized by HIV epidemics driven by IDUs and sex workers. Results: The results show unit costs of IDU interventions in the range of USD 74-105 per IDU/year ranging from 100% utilisation of capacity to 70%. The cost-effectiveness ratio is estimated at USD 78-242 per HIV over five years - the range covering different coverage of intervention (7-60%) and 3% or 6% discount rate, respectively. A comparison with results from Bangladesh (3 year time horizon) shows that the IDU interventions provide a relatively better cost-effectiveness ratio at USD 64-200 per HIV averted comparative to Karachi IDU interventions at USD 117-260. Both IDU approaches are very cost-effective by any measure at USD 2-25 per DALY gained. Discussions: The discussion includes how sensitive the results are to changes of key variables and what it will take to ensure such favourable cost-effectiveness ratio; the validity and reliability of the mathematical model; and finally what messages the result bring to the table of decision makers.
{"title":"Cost-Effectiveness of Drop-in-Centres to Prevent HIV Among Injecting Drug Users, IDUs, in Karachi, Pakistan","authors":"A. Alban, Ditte Hjort Hansen, M. Fatima, S. Nielsen","doi":"10.2139/SSRN.993120","DOIUrl":"https://doi.org/10.2139/SSRN.993120","url":null,"abstract":"Background: The HIV epidemic in Pakistan is at present concentrated among high-risk groups including IDUs. Pakistan has approx. 75 000 IDUs - 12 300 are living in Karachi. The HIV prevalence rate among the IDUs in Karachi is 26%. During 2005 and 2006 Pakistan Society, an NGO working for vulnerable populations in Pakistan, established three Drop-In-Centres, DICs, in Karachi including outreach services using motorbikes. At present 850 IDUs visit at a daily basis for clean needles, counselling and care services including detoxification (10%). Objectives: 1) To discuss the methodologies used to determine the cost-effectiveness of IDU interventions in Pakistan when up-scaling to 60% coverage as recommended by UNAIDS, 2) to examine how these interventions fair comparative to the findings from a literature review, and finally 3) to suggest policy options to improve efficiency of providing HIV preventive services that will keep the HIV epidemic from spreading into the general population. Methodology: The cost information was collected in May - June 2006. The costs included are financial and economic costs from the perspective of the provider. The Rapid Costing Approach, RCA, was used to generate total costs as well as the unit costs over five years under different up-scaling assumptions. The behaviour change for the IDU population in Karachi is derived from surveys undertaken in 2005/2006 and imputed into a dynamic mathematical model (IDU 2.4) with data from the IDU population in Karachi. The costs of the IDU interventions in Karachi is being compared with the findings from a literature survey on costing and cost-effectiveness studies in Asia and Eastern Europe, which is also characterized by HIV epidemics driven by IDUs and sex workers. Results: The results show unit costs of IDU interventions in the range of USD 74-105 per IDU/year ranging from 100% utilisation of capacity to 70%. The cost-effectiveness ratio is estimated at USD 78-242 per HIV over five years - the range covering different coverage of intervention (7-60%) and 3% or 6% discount rate, respectively. A comparison with results from Bangladesh (3 year time horizon) shows that the IDU interventions provide a relatively better cost-effectiveness ratio at USD 64-200 per HIV averted comparative to Karachi IDU interventions at USD 117-260. Both IDU approaches are very cost-effective by any measure at USD 2-25 per DALY gained. Discussions: The discussion includes how sensitive the results are to changes of key variables and what it will take to ensure such favourable cost-effectiveness ratio; the validity and reliability of the mathematical model; and finally what messages the result bring to the table of decision makers.","PeriodicalId":342948,"journal":{"name":"iHEA 2007 Sixth World Congress: Explorations in Health Economics (Archive)","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2007-06-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129990817","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Obesity is an important problem of public health, which is often initiated by unhealthy behaviours during adolescence. Food habits among young people are generally influenced by their peers, the so-called "peer pressure", as well as other hazardous consumptions such as alcohol, tobacco and drugs. In this work, obesity is viewed as a household produced good, and self-image and social interactions are likely to play a key role in determining adolescent weight. The main objective of this paper is to identify the risk factors which may explain obesity/overweight among the group of adolescents, according to the Body Mass-for-age, a medical criterion alternative to the BMI adapted to adolescents. Moreover, it aims to draw attention to the dimension of the problem in a risk group composed of potential future obese adults, with all the associated health costs. Particular attention is paid to the potential influence of the peer pressure effect on obesity, since consumption decisions are affected by age peers. A recursive simultaneous equation model, involving two binary choice variables, has been developed, incorporating the importance of peer effects and to control its potential endogenous nature. Control variables include age, gender, school performance, family cohesion, friendship cohesion, social and economical family level, food habits, sports practice, and consumption of addictive substances. The data used are from a Portuguese survey on the health of adolescents made in 2002. The universe of this survey is composed of students in the 6th, 8th and 10th years of secondary education, with ages between 11 and 25 years old. The key finding is that peer effects play a significant role in the probability of obesity. Dieting and corporal self-image are also important determinants of obesity.
{"title":"Can Adolescents' Obesity Be a Consequence of Peers Lifestyles?","authors":"M. I. Clímaco, Pedro P. Barros, Ó. Lourenço","doi":"10.2139/ssrn.992964","DOIUrl":"https://doi.org/10.2139/ssrn.992964","url":null,"abstract":"Obesity is an important problem of public health, which is often initiated by unhealthy behaviours during adolescence. Food habits among young people are generally influenced by their peers, the so-called \"peer pressure\", as well as other hazardous consumptions such as alcohol, tobacco and drugs. In this work, obesity is viewed as a household produced good, and self-image and social interactions are likely to play a key role in determining adolescent weight. The main objective of this paper is to identify the risk factors which may explain obesity/overweight among the group of adolescents, according to the Body Mass-for-age, a medical criterion alternative to the BMI adapted to adolescents. Moreover, it aims to draw attention to the dimension of the problem in a risk group composed of potential future obese adults, with all the associated health costs. Particular attention is paid to the potential influence of the peer pressure effect on obesity, since consumption decisions are affected by age peers. A recursive simultaneous equation model, involving two binary choice variables, has been developed, incorporating the importance of peer effects and to control its potential endogenous nature. Control variables include age, gender, school performance, family cohesion, friendship cohesion, social and economical family level, food habits, sports practice, and consumption of addictive substances. The data used are from a Portuguese survey on the health of adolescents made in 2002. The universe of this survey is composed of students in the 6th, 8th and 10th years of secondary education, with ages between 11 and 25 years old. The key finding is that peer effects play a significant role in the probability of obesity. Dieting and corporal self-image are also important determinants of obesity.","PeriodicalId":342948,"journal":{"name":"iHEA 2007 Sixth World Congress: Explorations in Health Economics (Archive)","volume":"144 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2007-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115018850","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Rationale: A prospective reimbursement system based on Diagnosis Related Groups (DRGs) has been recently introduced in several European countries for acute inpatient treatment, e.g. in Germany in 2003. To enable the application of new health technologies a special reimbursement process has been developed for those technologies. Objectives: To present how new technologies can be reimbursed under DRG-conditions, using Germany as a case example. Methods: Material of the official German DRG-Institute (InEK - Institut fur das Entgeltsystem im Krankenhaus gGmbH), the German hospital society (DKG - Deutsche Krankenhausgesellschaft) and the biggest German health insurance (AOK - Allgemeine Ortskrankenkasse) was screened manually and electronically. In addition, interviews with experts of those organisations were conducted. Results: New technologies causing higher costs for hospitals are not adequately compensated within the current G- (German) DRG-system. Since 2005, they can be reimbursed with a special add on (NUB - Neue Untersuchungs- und Behandlungsmethode). Each hospital has to apply for a NUB individually by the end of October at the InEK which decides by the end of December whether the respective hospital will get a NUB for one year. This decision is based on the submitted evidence on the medical effectiveness and economic impact of the new technology on the hospital. The NUB will not be granted if there is not enough medical or economic evidence or if the new technology does not lead to a specific increase of costs. The value of this threshold is only known by the InEK. The amount of the NUB depends on negotiations between the individual hospital and the sick funds and can differ between hospitals. When there is enough data of resource use and costs for the new technology the InEK will determine either (1) a national add on (Zusatzentgelt) which is applicable for all hospitals or (2) adjust the payments for the existing DRGs which include the new technology or (3) even create a new DRG. The number of NUBs substantially increased from 26 in 2005 to 54 in 2006 while the number of national add ons increased from 71 to 82 in the same time period indicating that the system enables the dissemination of technologies causing higher costs for the hospital. Conclusions: The G-DRG-system seems not to substantially hinder the introduction and adaptation of new technologies causing substantially higher costs for the hospital. However, there are no incentives to implement new technologies that are rather inexpensive for the hospital. Clearly, this problem should be addressed by the InEK.
理由:基于诊断相关组(DRGs)的前瞻性报销系统最近在几个欧洲国家用于急性住院治疗，例如2003年在德国。为了能够应用新的保健技术，已经为这些技术制定了一个特别的偿还程序。目的:以德国为例，介绍在drg条件下如何补偿新技术。方法:对德国官方drg研究所(InEK -Institut fur das Entgeltsystem im Krankenhaus gGmbH)、德国医院学会(DKG - Deutsche Krankenhausgesellschaft)和德国最大的健康保险公司(AOK - Allgemeine Ortskrankenkasse)的资料进行人工和电子筛选。此外，我们亦与这些机构的专家进行了访谈。结果:新技术给医院带来更高的成本，在目前的G-(德国)drg系统中没有得到充分补偿。自2005年以来，他们可以通过特殊的附加(NUB - Neue Untersuchungs- and behandlunsmethod)来报销。每家医院必须在10月底之前单独向InEK提出申请，InEK在12月底之前决定该医院是否获得为期一年的NUB。这一决定是基于提交的关于新技术对医院的医疗效果和经济影响的证据。如果没有足够的医学或经济证据，或者新技术不会导致成本的具体增加，则不会批准NUB。这个阈值只有InEK知道。NUB的数额取决于个别医院和病人基金之间的谈判，不同医院之间可能有所不同。当有足够的新技术的资源使用和成本数据时，InEK将决定:(1)适用于所有医院的国家附加费用(Zusatzentgelt)，或(2)调整包括新技术的现有DRG的支付，或(3)甚至创建新的DRG。nub的数量从2005年的26家大幅增加到2006年的54家，而同期全国新增医院的数量从71家增加到82家，这表明该系统能够传播给医院带来更高成本的技术。结论:g - drg系统似乎不会严重阻碍新技术的引进和适应，从而导致医院的成本大幅增加。然而，对于医院来说，没有激励措施来实施相当便宜的新技术。显然，这个问题应该由InEK来处理。
{"title":"Reimbursement of New Health Technologies in a DRG-System","authors":"S. Briswalter, R. Welte","doi":"10.2139/SSRN.992773","DOIUrl":"https://doi.org/10.2139/SSRN.992773","url":null,"abstract":"Rationale: A prospective reimbursement system based on Diagnosis Related Groups (DRGs) has been recently introduced in several European countries for acute inpatient treatment, e.g. in Germany in 2003. To enable the application of new health technologies a special reimbursement process has been developed for those technologies. Objectives: To present how new technologies can be reimbursed under DRG-conditions, using Germany as a case example. Methods: Material of the official German DRG-Institute (InEK - Institut fur das Entgeltsystem im Krankenhaus gGmbH), the German hospital society (DKG - Deutsche Krankenhausgesellschaft) and the biggest German health insurance (AOK - Allgemeine Ortskrankenkasse) was screened manually and electronically. In addition, interviews with experts of those organisations were conducted. Results: New technologies causing higher costs for hospitals are not adequately compensated within the current G- (German) DRG-system. Since 2005, they can be reimbursed with a special add on (NUB - Neue Untersuchungs- und Behandlungsmethode). Each hospital has to apply for a NUB individually by the end of October at the InEK which decides by the end of December whether the respective hospital will get a NUB for one year. This decision is based on the submitted evidence on the medical effectiveness and economic impact of the new technology on the hospital. The NUB will not be granted if there is not enough medical or economic evidence or if the new technology does not lead to a specific increase of costs. The value of this threshold is only known by the InEK. The amount of the NUB depends on negotiations between the individual hospital and the sick funds and can differ between hospitals. When there is enough data of resource use and costs for the new technology the InEK will determine either (1) a national add on (Zusatzentgelt) which is applicable for all hospitals or (2) adjust the payments for the existing DRGs which include the new technology or (3) even create a new DRG. The number of NUBs substantially increased from 26 in 2005 to 54 in 2006 while the number of national add ons increased from 71 to 82 in the same time period indicating that the system enables the dissemination of technologies causing higher costs for the hospital. Conclusions: The G-DRG-system seems not to substantially hinder the introduction and adaptation of new technologies causing substantially higher costs for the hospital. However, there are no incentives to implement new technologies that are rather inexpensive for the hospital. Clearly, this problem should be addressed by the InEK.","PeriodicalId":342948,"journal":{"name":"iHEA 2007 Sixth World Congress: Explorations in Health Economics (Archive)","volume":"2 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2007-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129847285","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
This study considers heckit-type approximations useful for a number of different trivariate probit models. They are simple to use and have no convergence problems like full maximum likelihood. Simulations show that a heckit and a least squares approximation perform as well as the trivariate probit estimator in small samples when the degree of endogeneity is not too severe. A simple double-heckit and a heteroskedasticity corrected heckit approximation seem particularly robust and promising for testing exogeneity. The methods are used to estimate the impact of physician advice on physical activity, where the heckit approximations work as well as full maximum likelihood.
{"title":"Probit Models with Dummy Endogenous Regressors","authors":"J. Arendt, Holm Anders Larsen","doi":"10.2139/ssrn.994189","DOIUrl":"https://doi.org/10.2139/ssrn.994189","url":null,"abstract":"This study considers heckit-type approximations useful for a number of different trivariate probit models. They are simple to use and have no convergence problems like full maximum likelihood. Simulations show that a heckit and a least squares approximation perform as well as the trivariate probit estimator in small samples when the degree of endogeneity is not too severe. A simple double-heckit and a heteroskedasticity corrected heckit approximation seem particularly robust and promising for testing exogeneity. The methods are used to estimate the impact of physician advice on physical activity, where the heckit approximations work as well as full maximum likelihood.","PeriodicalId":342948,"journal":{"name":"iHEA 2007 Sixth World Congress: Explorations in Health Economics (Archive)","volume":"36 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2006-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126613793","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Objective: To analyze the quality of private health services in Bac Giang City, Vietnam. Method: All private health care providers were assessed for quality of care through site visits and interviews. Structure including equipment and staffing was assessed through interview with the facility manager and competence of private health providers was investigated through interviews of staff using vignettes on cases with tracer conditions for acute and chronic disease. Patient exit interviews were performed to assess patient satisfaction with services. In addition, staff in public Commune Health Centers was interviewed with vignettes to allow for comparison of skills with private providers. Results: 50 private medicine facilities were included in the study. The facilities were small in scope, mainly out-patient clinics. They were mostly operated by a single physician (66%), or small group of physicians. Services were mainly regular examination and treatment (76%) with common health problems. Only 20% offered more advanced services like ECG and X-Ray. Most private allopathic medicine providers had basic equipment for examining patients but little equipment for basic surgery and testing. Around half (55%) had sterilizing instrument. In patient interviews stated reasons for seeking private care were good attitude of staff (72%), proximity to home (69%), perceived competence of physician (63%) and time-saving (58%). Mean score of overall client satisfaction was 3.9 on a scale of 1-5. Knowledge on recognizing symptoms and handling cases of was low both in private and public facilities. Conclusion: Most private providers at urban district level are limited in size, staffing, service provision and patient load. Their services are usually appreciated by clients. However, their skills appear to be less than optimal, though not significantly lower than those of public sector staff.
{"title":"Quality of Private Health Services in Vietnam","authors":"Thuy Phan Thanh, Long Nguyen Hoang, B. Forsberg","doi":"10.2139/SSRN.992991","DOIUrl":"https://doi.org/10.2139/SSRN.992991","url":null,"abstract":"Objective: To analyze the quality of private health services in Bac Giang City, Vietnam. Method: All private health care providers were assessed for quality of care through site visits and interviews. Structure including equipment and staffing was assessed through interview with the facility manager and competence of private health providers was investigated through interviews of staff using vignettes on cases with tracer conditions for acute and chronic disease. Patient exit interviews were performed to assess patient satisfaction with services. In addition, staff in public Commune Health Centers was interviewed with vignettes to allow for comparison of skills with private providers. Results: 50 private medicine facilities were included in the study. The facilities were small in scope, mainly out-patient clinics. They were mostly operated by a single physician (66%), or small group of physicians. Services were mainly regular examination and treatment (76%) with common health problems. Only 20% offered more advanced services like ECG and X-Ray. Most private allopathic medicine providers had basic equipment for examining patients but little equipment for basic surgery and testing. Around half (55%) had sterilizing instrument. In patient interviews stated reasons for seeking private care were good attitude of staff (72%), proximity to home (69%), perceived competence of physician (63%) and time-saving (58%). Mean score of overall client satisfaction was 3.9 on a scale of 1-5. Knowledge on recognizing symptoms and handling cases of was low both in private and public facilities. Conclusion: Most private providers at urban district level are limited in size, staffing, service provision and patient load. Their services are usually appreciated by clients. However, their skills appear to be less than optimal, though not significantly lower than those of public sector staff.","PeriodicalId":342948,"journal":{"name":"iHEA 2007 Sixth World Congress: Explorations in Health Economics (Archive)","volume":"232 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115596944","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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