Specialty medications have piqued the attention of employers because spending on specialty medications has been increasing. In 2012, specialty medications accounted for 24 percent of total drug spending in the commercial market, but by 2016 specialty medications accounted for 36 percent. By 2020, specialty medications are expected to account for nearly one-half of total drug spending in the commercial market. Managing specialty medications is considered one of the most effective tactics when it comes to controlling health care costs. In this Issue Brief, the Employee Benefit Research Institute (EBRI) examines the impact of plan type on use of specialty medications. This paper also focuses on the impact that use of specialty medications both among workers and their dependents has on worker productivity. The analysis was conducted on nearly 100,000 unique individuals with rheumatoid arthritis (RA), Crohn's disease, ulcerative colitis, psoriasis, and multiple sclerosis (MS) using data from the Truven Health Analytics MarketScan® Research Commercial Claims and Encounters Database. Use of specialty medications among individuals with multiple sclerosis (MS): Among individuals with MS, there was no difference in the likelihood of filling a prescription for a specialty medication by type of health plan. However, among individuals with MS that had filled a specialty medication prescription, individuals with preferred provider organization/point of service (PPO/POS) and health reimbursement arrangement (HRA) plans used more specialty medications than those with health maintenance organization/exclusive provider organization (HMO/EPO) plans. There was no difference between those with health savings account (HSA)-eligible health plans and those with HMO/PPO coverage. Use of specialty medications among individuals with rheumatoid arthritis (RA), Crohn's disease, ulcerative colitis, and psoriasis: Plan type had no impact on whether any specialty medications were used, with one exception. Among individuals with RA, those with an HRA were less likely than those in HMO/EPO plans to use any specialty medications. Among individuals that had filled specialty medication prescriptions, we found mixed effects on the number of fills. For the most part, there were no differences in the number of fills by plan type. However, among individuals with RA, those in HRA plans filled fewer specialty medications than those in HMO/EPO plans. Among individuals with Crohn’s disease, those in PPO/POS plans used more specialty medications than those in HMO/EPO plans. Use of Specialty Medications and Worker Productivity: Any Use: We found few instances where productivity was affected by use of specialty medications. We did not find any relationship between any use of specialty medication and any use of sick or vacation leave, or number of days absent. We also did not find that any use of specialty medications affected whether a worker took short-term disability. However, we did find th
专业药物引起了雇主的注意，因为专业药物的支出一直在增加。2012年，专业药物占商业市场总药物支出的24%，但到2016年，专业药物占36%。到2020年，专业药物预计将占商业市场总药物支出的近一半。管理专业药物被认为是控制医疗成本最有效的策略之一。在本问题简报中，员工福利研究所(EBRI)调查了计划类型对特殊药物使用的影响。本文还侧重于特殊药物的使用在工人和他们的家属对工人的生产力的影响。该分析是对近10万名患有类风湿性关节炎(RA)、克罗恩病、溃疡性结肠炎、牛皮癣和多发性硬化症(MS)的独特个体进行的，使用的数据来自Truven Health Analytics MarketScan®研究商业声明和遭遇数据库。多发性硬化症(MS)患者使用专业药物:在多发性硬化症患者中，按健康计划类型填写专业药物处方的可能性没有差异。然而，在填写专业药物处方的MS患者中，选择首选提供者组织/服务点(PPO/POS)和健康报销安排(HRA)计划的个体比选择健康维护组织/独家提供者组织(HMO/EPO)计划的个体使用更多的专业药物。有健康储蓄账户(HSA)资格的健康计划和有HMO/PPO保险的人之间没有区别。类风湿关节炎(RA)、克罗恩病、溃疡性结肠炎和牛皮癣患者的专业药物使用:计划类型对是否使用任何专业药物没有影响，只有一个例外。在类风湿性关节炎患者中，HRA患者比HMO/EPO计划患者更不可能使用任何特殊药物。在填写专业药物处方的个人中，我们发现对填写次数的影响是混合的。在大多数情况下，不同计划类型的填充数量没有差异。然而，在类风湿性关节炎患者中，参加HRA计划的患者比参加HMO/EPO计划的患者使用更少的特殊药物。在克罗恩病患者中，PPO/POS计划的患者比HMO/EPO计划的患者使用更多的专业药物。专业药物的使用和工人的生产力:任何使用:我们发现很少有使用专业药物影响生产力的情况。我们没有发现任何特殊药物的使用与病假或休假或缺勤天数之间的任何关系。我们也没有发现任何特殊药物的使用会影响工人是否患有短期残疾。然而，我们确实发现，任何特殊药物的使用都能使克罗恩病患者的短期残疾天数减少37.6天，牛皮癣患者的短期残疾天数减少42.6天。药物数量:关于专业药物填充数量对生产力的影响，我们没有发现对休假的可能性或短期残疾的可能性有影响。有证据表明，更多的专业药物填充增加了克罗恩病和牛皮癣患者缺勤天数。然而，这些影响的幅度非常小，克罗恩病患者的缺勤天数增加了0.53天，牛皮癣患者的缺勤天数增加了0.25天。也有证据表明，更多的专业药物填充会使多发性硬化症患者的短期残疾时间延长5.6天。依赖使用:我们还通过检查工人生产率是否受到依赖人员使用专业药物的影响来检查使用专业药物对工人生产率的影响。我们通过研究配偶对已婚工人使用特殊药物的影响来验证这一点。我们几乎没有发现任何证据表明使用专业药物可以减少员工的缺勤率，只有一个例外——在使用溃疡性结肠炎专业药物的配偶中，员工缺勤天数减少了6.5天。对于那些至少服用过一种处方药的人服用的特殊药物的数量，我们发现了不同的结果。对患有克罗恩病、牛皮癣或多发性硬化症的配偶的工人缺勤率没有影响。在患有溃疡性结肠炎的配偶中，使用更多的专业药物可以减少缺勤率，但在患有类风湿性关节炎的配偶中，使用更多的专业药物会增加缺勤率。
{"title":"The Relationship Between Health Plan Type, Use of Specialty Medications, and Worker Productivity","authors":"P. Fronstin, M. Roebuck","doi":"10.2139/ssrn.3245199","DOIUrl":"https://doi.org/10.2139/ssrn.3245199","url":null,"abstract":"Specialty medications have piqued the attention of employers because spending on specialty medications has been increasing. In 2012, specialty medications accounted for 24 percent of total drug spending in the commercial market, but by 2016 specialty medications accounted for 36 percent. By 2020, specialty medications are expected to account for nearly one-half of total drug spending in the commercial market. Managing specialty medications is considered one of the most effective tactics when it comes to controlling health care costs. In this Issue Brief, the Employee Benefit Research Institute (EBRI) examines the impact of plan type on use of specialty medications. This paper also focuses on the impact that use of specialty medications both among workers and their dependents has on worker productivity. The analysis was conducted on nearly 100,000 unique individuals with rheumatoid arthritis (RA), Crohn's disease, ulcerative colitis, psoriasis, and multiple sclerosis (MS) using data from the Truven Health Analytics MarketScan® Research Commercial Claims and Encounters Database. Use of specialty medications among individuals with multiple sclerosis (MS): Among individuals with MS, there was no difference in the likelihood of filling a prescription for a specialty medication by type of health plan. However, among individuals with MS that had filled a specialty medication prescription, individuals with preferred provider organization/point of service (PPO/POS) and health reimbursement arrangement (HRA) plans used more specialty medications than those with health maintenance organization/exclusive provider organization (HMO/EPO) plans. There was no difference between those with health savings account (HSA)-eligible health plans and those with HMO/PPO coverage. Use of specialty medications among individuals with rheumatoid arthritis (RA), Crohn's disease, ulcerative colitis, and psoriasis: Plan type had no impact on whether any specialty medications were used, with one exception. Among individuals with RA, those with an HRA were less likely than those in HMO/EPO plans to use any specialty medications. Among individuals that had filled specialty medication prescriptions, we found mixed effects on the number of fills. For the most part, there were no differences in the number of fills by plan type. However, among individuals with RA, those in HRA plans filled fewer specialty medications than those in HMO/EPO plans. Among individuals with Crohn’s disease, those in PPO/POS plans used more specialty medications than those in HMO/EPO plans. Use of Specialty Medications and Worker Productivity: Any Use: We found few instances where productivity was affected by use of specialty medications. We did not find any relationship between any use of specialty medication and any use of sick or vacation leave, or number of days absent. We also did not find that any use of specialty medications affected whether a worker took short-term disability. However, we did find th","PeriodicalId":396916,"journal":{"name":"Health Economics Evaluation Methods eJournal","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131217021","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}
Emergency contraceptive drugs like Plan B are controversial, and there have been cases within at least 25 states of pharmacists refusing to provide the drug to patients. In response to pressure from activist groups on both sides of the debate, some states passed "Patients' Rights Laws" and other states passed "Pharmacist Rights Laws" dictating pharmacists' legal ability to refuse to fill emergency contraceptive prescriptions. Patients Rights Laws expand access to emergency contraception and protect patients' rights to receive prescribed drugs regardless of pharmacists' personal beliefs. Pharmacist Rights Laws restrict access to emergency contraception and favor pharmacists' rights of refusal. This paper studies substitution behavior among contraception spurred by both policies. I find that both types of laws cause a 7-18% increase in the prescribing rate of regular birth control pills, and both laws cause decreases in purchases of condoms as well as over-the-counter Plan B. There is not evidence that the policies have effects on rates of sexually transmitted diseases or birthrates on aggregate, however the states that pass the Pharmacist Rights Laws may experience decreases in birthrates for some groups. I find that policies that would be thought to either increase or decrease access to emergency contraception both cause substitution onto the birth control pill, which suggests that the policies may work through an information channel rather than by directly impacting rates of pharmacist refusal.
{"title":"The Effect of Pharmacist Refusal Clauses on Contraception, Sexually Transmitted Diseases, and Birthrates","authors":"Justine Mallatt","doi":"10.2139/ssrn.3182680","DOIUrl":"https://doi.org/10.2139/ssrn.3182680","url":null,"abstract":"Emergency contraceptive drugs like Plan B are controversial, and there have been cases within at least 25 states of pharmacists refusing to provide the drug to patients. In response to pressure from activist groups on both sides of the debate, some states passed \"Patients' Rights Laws\" and other states passed \"Pharmacist Rights Laws\" dictating pharmacists' legal ability to refuse to fill emergency contraceptive prescriptions. Patients Rights Laws expand access to emergency contraception and protect patients' rights to receive prescribed drugs regardless of pharmacists' personal beliefs. Pharmacist Rights Laws restrict access to emergency contraception and favor pharmacists' rights of refusal. This paper studies substitution behavior among contraception spurred by both policies. I find that both types of laws cause a 7-18% increase in the prescribing rate of regular birth control pills, and both laws cause decreases in purchases of condoms as well as over-the-counter Plan B. There is not evidence that the policies have effects on rates of sexually transmitted diseases or birthrates on aggregate, however the states that pass the Pharmacist Rights Laws may experience decreases in birthrates for some groups. I find that policies that would be thought to either increase or decrease access to emergency contraception both cause substitution onto the birth control pill, which suggests that the policies may work through an information channel rather than by directly impacting rates of pharmacist refusal.","PeriodicalId":396916,"journal":{"name":"Health Economics Evaluation Methods eJournal","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130644741","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}
Common health state valuation methodology, such as time trade-off (TTO) and standard gamble (SG), is typically applied under several descriptively invalid assumptions, for example assuming linear QALYs or expected utility (EU) theory. Hence, health state valuation exercises may lead to biased QALY weights. This bias may in turn affect decisions based on economic evaluations using such weights. Methods have been proposed to correct for these biases associated with different health state valuation techniques. In this paper we outline the relevance of prospect theory (PT), which has become the dominant descriptive alternative to EU, for health state valuations and economic evaluations. We provide an overview of work suggesting a solution for the dependence of QALY weights on the chosen methodology. We label this the corrective approach. By quantifying PT parameters, such as loss aversion, probability weighting and non-linear utility, it may be possible to correct TTO and SG for biases, in an attempt to produce more valid estimates of preferences for health states. Through straightforward examples this paper illustrates the effects of this corrective approach. Several unresolved issues currently limit the relevance of corrected weights for policy, these are listed and suggestions for research addressing these issues are provided. However, if validly corrected weights are available, we argue in favor of a deliberative approach to correcting biased health state valuations, in which policy makers utilize corrected weights. Finally we suggest that loss aversion premium for prevented health losses may be applied when deemed relevant.
{"title":"Prospect Theory and the Corrective Approach: Policy Implications of Recent Developments in QALY Measurement","authors":"S. Lipman, W. Brouwer, A. Attema","doi":"10.2139/ssrn.3195710","DOIUrl":"https://doi.org/10.2139/ssrn.3195710","url":null,"abstract":"Common health state valuation methodology, such as time trade-off (TTO) and standard gamble (SG), is typically applied under several descriptively invalid assumptions, for example assuming linear QALYs or expected utility (EU) theory. Hence, health state valuation exercises may lead to biased QALY weights. This bias may in turn affect decisions based on economic evaluations using such weights. Methods have been proposed to correct for these biases associated with different health state valuation techniques. In this paper we outline the relevance of prospect theory (PT), which has become the dominant descriptive alternative to EU, for health state valuations and economic evaluations. We provide an overview of work suggesting a solution for the dependence of QALY weights on the chosen methodology. We label this the corrective approach. By quantifying PT parameters, such as loss aversion, probability weighting and non-linear utility, it may be possible to correct TTO and SG for biases, in an attempt to produce more valid estimates of preferences for health states. Through straightforward examples this paper illustrates the effects of this corrective approach. Several unresolved issues currently limit the relevance of corrected weights for policy, these are listed and suggestions for research addressing these issues are provided. However, if validly corrected weights are available, we argue in favor of a deliberative approach to correcting biased health state valuations, in which policy makers utilize corrected weights. Finally we suggest that loss aversion premium for prevented health losses may be applied when deemed relevant.","PeriodicalId":396916,"journal":{"name":"Health Economics Evaluation Methods eJournal","volume":"49 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131734735","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 examines how diabetes and complications from diabetes affect the impact of age on the probability a person nearing retirement age remains employed. The results presented here indicate that diabetics, especially those with complications tend to leave the workforce prior to 62 and becoming eligible for Social Security benefits. Diabetes and complications from diabetes also reduces the ability of people to remain in the workforce to increase their Social Security benefit. Increases in the eligibility age for receiving Social Security benefits would impose substantial hardships on diabetics. Programs that reduce the number of people with diabetes and eliminate diabetic-related complications could expand the workforce and stimulate economic growth. These benefits should be counted when considering the cost of programs to reduce diabetes.
{"title":"How Does Diabetes Influence the Impact of Aging on the Probability of Employment?","authors":"David P. Bernstein","doi":"10.2139/ssrn.3164567","DOIUrl":"https://doi.org/10.2139/ssrn.3164567","url":null,"abstract":"This paper examines how diabetes and complications from diabetes affect the impact of age on the probability a person nearing retirement age remains employed. The results presented here indicate that diabetics, especially those with complications tend to leave the workforce prior to 62 and becoming eligible for Social Security benefits. Diabetes and complications from diabetes also reduces the ability of people to remain in the workforce to increase their Social Security benefit. Increases in the eligibility age for receiving Social Security benefits would impose substantial hardships on diabetics. Programs that reduce the number of people with diabetes and eliminate diabetic-related complications could expand the workforce and stimulate economic growth. These benefits should be counted when considering the cost of programs to reduce diabetes.","PeriodicalId":396916,"journal":{"name":"Health Economics Evaluation Methods eJournal","volume":"79 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123382862","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}
P. Russo, G. Favato, G. Rosano, T. Staniscia, F. Romano
Cost-effectiveness analysis (CEA) has been widely applied to compare alternative options when a difference in health effects is observed. In contrast, a cost-minimization analysis (CMA) must be performed if the health effects of the alternatives can be considered reasonably similar. However, several authors have been suggested the death of CMA and supported the use of CEA alongside registrative clinical trials, even if the clinical end points of a study fail to demonstrate a statistically significant difference. The aim of the article is to discuss the potentially misleading implications of the inadequate use of CEA in translating results into clinical recommendations. A case study based on main findings from a published CEA evaluating the use of direct acting oral anticoagulants (DOACs), vitamin K antagonists, or antiplatelet drugs for the prevention of stroke in patients with atrial fibrillation, has been considered. The CEA recommends the use of apixaban as the first choice among DOACs, since it ranks the highest on the balance of efficacy, safety, and cost. However, no clinical evidence supporting this recommendation is available. In contrast, from a therapeutic perspective, several aspects support the preferential use of the other DOACs as a better first choice. In the case-study discussion, the step in which the incremental net benefit is calculated in the absence of at least one better alternative option either in regard to QALYs or total cost is critical and may promote incorrect conclusions and misleading clinical recommendations. The article proposed synoptic framework of the adequate use of economic evaluations based on the endpoints of registrative clinical trials, considering limitations on the use of CEAs and the expansion of CMA applications. Thus, CMAs should not only be limited to comparisons of products with evidence of efficacy from studies using an equivalence hypothesis test.
{"title":"Adequate Use of Economic Evaluations Based on the Endpoints of a Registrative Clinical Trial: Cost-Minimization Analysis and the Return of the Living Dead","authors":"P. Russo, G. Favato, G. Rosano, T. Staniscia, F. Romano","doi":"10.2139/ssrn.3130284","DOIUrl":"https://doi.org/10.2139/ssrn.3130284","url":null,"abstract":"Cost-effectiveness analysis (CEA) has been widely applied to compare alternative options when a difference in health effects is observed. In contrast, a cost-minimization analysis (CMA) must be performed if the health effects of the alternatives can be considered reasonably similar. However, several authors have been suggested the death of CMA and supported the use of CEA alongside registrative clinical trials, even if the clinical end points of a study fail to demonstrate a statistically significant difference. The aim of the article is to discuss the potentially misleading implications of the inadequate use of CEA in translating results into clinical recommendations. A case study based on main findings from a published CEA evaluating the use of direct acting oral anticoagulants (DOACs), vitamin K antagonists, or antiplatelet drugs for the prevention of stroke in patients with atrial fibrillation, has been considered. \u0000The CEA recommends the use of apixaban as the first choice among DOACs, since it ranks the highest on the balance of efficacy, safety, and cost. However, no clinical evidence supporting this recommendation is available. In contrast, from a therapeutic perspective, several aspects support the preferential use of the other DOACs as a better first choice. \u0000In the case-study discussion, the step in which the incremental net benefit is calculated in the absence of at least one better alternative option either in regard to QALYs or total cost is critical and may promote incorrect conclusions and misleading clinical recommendations. \u0000The article proposed synoptic framework of the adequate use of economic evaluations based on the endpoints of registrative clinical trials, considering limitations on the use of CEAs and the expansion of CMA applications. Thus, CMAs should not only be limited to comparisons of products with evidence of efficacy from studies using an equivalence hypothesis test.","PeriodicalId":396916,"journal":{"name":"Health Economics Evaluation Methods eJournal","volume":"32 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124873526","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}
Abstract In this paper, I propose an economic theory of depression and its impact on health behavior and longevity. Based on studies from happiness research, depression is conceptualized as a drastic loss of utility and value of life for unchanged fundamentals. The model is used to explain how untreated depression leads to unhealthy behavior and adverse health outcomes: depressed individuals are predicted to save less, invest less in their health, consume more unhealthy goods, and exercise less. As a result, they age faster and die earlier than non-depressed individuals. I calibrate the model for an average American and discus how depression enlarges the socioeconomic gradient of health and consider feedback effects of depression on earnings and of physical exercise on depression as well as a variety of depression shocks. Delays in treatment for depression in young adulthood are predicted to have significant repercussions on late-life health outcomes and longevity.
{"title":"An Economic Theory of Depression and its Impact on Health Behavior and Longevity","authors":"H. Strulik","doi":"10.2139/ssrn.3117040","DOIUrl":"https://doi.org/10.2139/ssrn.3117040","url":null,"abstract":"Abstract In this paper, I propose an economic theory of depression and its impact on health behavior and longevity. Based on studies from happiness research, depression is conceptualized as a drastic loss of utility and value of life for unchanged fundamentals. The model is used to explain how untreated depression leads to unhealthy behavior and adverse health outcomes: depressed individuals are predicted to save less, invest less in their health, consume more unhealthy goods, and exercise less. As a result, they age faster and die earlier than non-depressed individuals. I calibrate the model for an average American and discus how depression enlarges the socioeconomic gradient of health and consider feedback effects of depression on earnings and of physical exercise on depression as well as a variety of depression shocks. Delays in treatment for depression in young adulthood are predicted to have significant repercussions on late-life health outcomes and longevity.","PeriodicalId":396916,"journal":{"name":"Health Economics Evaluation Methods eJournal","volume":"228 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-02-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130755112","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}
Professor Alain Ndedi, Annita C Metha, Florence Nisabwe
Health expenditure consists of all expenditures or costs for medical care, prevention, promotion, rehabilitation, community health activities, health administration and regulation and capital formation with the predominant objective of improving health in a country or region. According to WHO (2015), globally in 2006, expenditure on health was about 8.7% of gross domestic product, with the highest level in the Americas at 12.8% and the lowest in the South-East Asia Region at 3.4%. This translates to about US$ 716 per capita on the average but there is tremendous variation ranging from a very low US$ 31 per capita in the South-East Asia Region to a high of US$ 2636 per capita in the Americas. This paper intends to shows that health expenditure is a fundamental determinant of economic growth of every nation and that increasing expenditure on health leads to higher growth rates. Cameroon should therefore endeavor to meet and surpass the target of the Abuja declaration of 2001. One possible measure that could be taken to raise funds to meet this target could be by increasing for examples taxes on products such as cigarettes and other products of ostentation and rechanneling the extra revenue generated to investment in healthcare. One of the important drawbacks to funding to Cameroon is poor governance, thus measures to assure a fluid target based expenditure is imperative. In countries where poor governance is alarming, as the World Bank states, increasing public spending both from external donors and the government does not necessarily lead to the desired development outcomes. (WHO, 2013) Performance based financing can be an important mechanism that potential donors and government agencies can use. It is also believed to increase transparency and accountability in achieving targets. (Meessen, Hercot, Noirhomme, Ridde, Tibouti, Tashobya et al. 2011) Meessen et al. also argues that it improves the allocative efficiency of resources especially in low-income developing countries like Cameroon where resources are quite limited. Thus an efficient financing mechanism with greater emphasis on the processes leading to the performance goal is then necessary and imperative. This paper attempts just to show the linkages between increasing health care expenditures and economic growth.
{"title":"The Impact of Health Expenditures on Economic Growth of Cameroon: A Literature Review Perspective","authors":"Professor Alain Ndedi, Annita C Metha, Florence Nisabwe","doi":"10.2139/ssrn.3036510","DOIUrl":"https://doi.org/10.2139/ssrn.3036510","url":null,"abstract":"Health expenditure consists of all expenditures or costs for medical care, prevention, promotion, rehabilitation, community health activities, health administration and regulation and capital formation with the predominant objective of improving health in a country or region. According to WHO (2015), globally in 2006, expenditure on health was about 8.7% of gross domestic product, with the highest level in the Americas at 12.8% and the lowest in the South-East Asia Region at 3.4%. This translates to about US$ 716 per capita on the average but there is tremendous variation ranging from a very low US$ 31 per capita in the South-East Asia Region to a high of US$ 2636 per capita in the Americas. This paper intends to shows that health expenditure is a fundamental determinant of economic growth of every nation and that increasing expenditure on health leads to higher growth rates. Cameroon should therefore endeavor to meet and surpass the target of the Abuja declaration of 2001. One possible measure that could be taken to raise funds to meet this target could be by increasing for examples taxes on products such as cigarettes and other products of ostentation and rechanneling the extra revenue generated to investment in healthcare. One of the important drawbacks to funding to Cameroon is poor governance, thus measures to assure a fluid target based expenditure is imperative. In countries where poor governance is alarming, as the World Bank states, increasing public spending both from external donors and the government does not necessarily lead to the desired development outcomes. (WHO, 2013) Performance based financing can be an important mechanism that potential donors and government agencies can use. It is also believed to increase transparency and accountability in achieving targets. (Meessen, Hercot, Noirhomme, Ridde, Tibouti, Tashobya et al. 2011) Meessen et al. also argues that it improves the allocative efficiency of resources especially in low-income developing countries like Cameroon where resources are quite limited. Thus an efficient financing mechanism with greater emphasis on the processes leading to the performance goal is then necessary and imperative. This paper attempts just to show the linkages between increasing health care expenditures and economic growth.","PeriodicalId":396916,"journal":{"name":"Health Economics Evaluation Methods eJournal","volume":"15 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2017-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"121133251","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}
English Abstract: This paper examines the role of social networks as a potential mechanism in the relationship between retirement and cognitive decline. In a first step, I analyze the effect of retirement on different social network characteristics using novel panel data of 19,999 respondents on social networks from wave 4 and wave 6 of the Survey of Health, Ageing and Retirement in Europe (SHARE). In a second step, I estimate the effect of retirement on cognition under consideration of changing social network sizes. Applying instrumental variable fixed effects regressions based on country-specific statutory eligibility ages allows controlling for unobserved individual heterogeneity and endogeneity of the retirement decision. The results suggest that retirement leads to an increase in the number of close family members named as confidants indicating that the social network becomes more kin-oriented after retirement. However, adding close family members to the social network does not have a significant effect on cognition. In turn, adding non-family members like friends or colleagues to the social network has a positive impact on the cognitive performance. Since I do not find that retirement impacts the number of friends or colleagues significantly, I cannot claim social networks to be the explaining underlying mechanism in the relationship between retirement and cognitive decline. German Abstract: Ich untersuche die Rolle von sozialen Netzwerken als moglichen Mechanismus in dem Zusammenhang zwischen Ruhestand und dem Ruckgang kognitiver Fahigkeiten. Im ersten Schritt analysiere ich den Effekt von Ruhestand auf verschiedene Eigenschaften des sozialen Netzwerkes mithilfe von Langsschnittdaten 19.999 Befragten des Survey of Health, Ageing and Retirement in Europe (SHARE). Im zweiten Schritt untersuche ich den Effekt von Ruhestand auf Kognition unter Berucksichtigung der Grosenanderung des sozialen Netzwerkes. Durch die Anwendung eines Paneldatenmodells mit fixen Individualeffekten und durch den Einsatz von Instrumentvariablen kann fur Endogenitatsprobleme kontrolliert werden. Die Ergebnisse zeigen, dass Ruhestand zu einem Anstieg in der Anzahl der nahen Familienmitglieder im sozialen Netzwerk fuhrt. Allerdings hat dieser Anstieg keinen signifikanten Einfluss auf die kognitiven Fahigkeiten. Im Gegensatz dazu finde ich einen signifikant positiven Effekt auf Kognition, wenn Nicht-Familienmitglieder wie Freunde oder Kollegen neu in das soziale Netzwerk aufgenommen werden. Allerdings ist dieser Anstieg von Nicht-Familienmitgliedern nicht mit dem Eintritt in den Ruhestand verbunden, sodass ich die sozialen Netzwerke nicht als den erklarenden Mechanismus zwischen Ruhestand und Kognition herausstellen kann.
摘要:本文探讨了社会网络在退休与认知能力下降之间的潜在作用机制。在第一步中，我分析了退休对不同社会网络特征的影响，使用了来自欧洲健康、老龄化和退休调查(SHARE)第4波和第6波社会网络上19,999名受访者的新颖面板数据。在第二步，我估计退休对认知的影响下考虑变化的社会网络规模。应用基于国家特定法定资格年龄的工具变量固定效应回归可以控制未观察到的个人异质性和退休决定的内生性。研究结果表明，退休导致被称为知己的亲密家庭成员数量增加，这表明退休后的社会网络变得更加以亲属为导向。然而，将亲密的家庭成员加入社会网络对认知没有显著影响。反过来，将朋友或同事等非家庭成员加入社交网络对认知表现有积极影响。由于我没有发现退休对朋友或同事的数量有显著影响，所以我不能声称社交网络是解释退休与认知能力下降之间关系的潜在机制。摘要:Ich untersuche die Rolle von sozialen Netzwerken als moglichen Mechanismus in dem Zusammenhang zwischen Ruhestand and dem Ruckgang kognitiver Fahigkeiten。1999年，《欧洲健康、老龄化和退休调查》(SHARE)。我是Schritt，我是Schritt，我是Schritt，我是Schritt，我是Schritt，我是Schritt，我是Schritt，我是Schritt。对于内生问题和内生问题的控制，面板模型具有固定的个体效应和固定的工具变量效应。在社会网络的未来，我们将在未来的未来中找到我们的家庭。在认知性fahikeen中，有一些提示表明，在认知性fahikeen中存在显著的缺陷。2003年，研究人员在社交网络研究中发现了认知的显著正效应，并在社交网络研究中发现了认知的显著正效应。【译】“家庭”是指家庭，“家庭”是指家庭，“家庭”是指家庭，“家庭”是指家庭，“家庭”是指家庭，“家庭”是指家庭，“家庭”是指家庭，“家庭”是指家庭，“家庭”是指家庭，“家庭”是指家庭，“家庭”是指家庭，“家庭”是指家庭，“家庭”是指家庭，“家庭”是指家庭，“家庭”是指家庭。
{"title":"Influence of Social Networks on the Effect of Retirement on Cognition","authors":"F. Hanemann","doi":"10.2139/ssrn.2979265","DOIUrl":"https://doi.org/10.2139/ssrn.2979265","url":null,"abstract":"English Abstract: This paper examines the role of social networks as a potential mechanism in the relationship between retirement and cognitive decline. In a first step, I analyze the effect of retirement on different social network characteristics using novel panel data of 19,999 respondents on social networks from wave 4 and wave 6 of the Survey of Health, Ageing and Retirement in Europe (SHARE). In a second step, I estimate the effect of retirement on cognition under consideration of changing social network sizes. Applying instrumental variable fixed effects regressions based on country-specific statutory eligibility ages allows controlling for unobserved individual heterogeneity and endogeneity of the retirement decision. The results suggest that retirement leads to an increase in the number of close family members named as confidants indicating that the social network becomes more kin-oriented after retirement. However, adding close family members to the social network does not have a significant effect on cognition. In turn, adding non-family members like friends or colleagues to the social network has a positive impact on the cognitive performance. Since I do not find that retirement impacts the number of friends or colleagues significantly, I cannot claim social networks to be the explaining underlying mechanism in the relationship between retirement and cognitive decline. \u0000German Abstract: Ich untersuche die Rolle von sozialen Netzwerken als moglichen Mechanismus in dem Zusammenhang zwischen Ruhestand und dem Ruckgang kognitiver Fahigkeiten. Im ersten Schritt analysiere ich den Effekt von Ruhestand auf verschiedene Eigenschaften des sozialen Netzwerkes mithilfe von Langsschnittdaten 19.999 Befragten des Survey of Health, Ageing and Retirement in Europe (SHARE). Im zweiten Schritt untersuche ich den Effekt von Ruhestand auf Kognition unter Berucksichtigung der Grosenanderung des sozialen Netzwerkes. Durch die Anwendung eines Paneldatenmodells mit fixen Individualeffekten und durch den Einsatz von Instrumentvariablen kann fur Endogenitatsprobleme kontrolliert werden. Die Ergebnisse zeigen, dass Ruhestand zu einem Anstieg in der Anzahl der nahen Familienmitglieder im sozialen Netzwerk fuhrt. Allerdings hat dieser Anstieg keinen signifikanten Einfluss auf die kognitiven Fahigkeiten. Im Gegensatz dazu finde ich einen signifikant positiven Effekt auf Kognition, wenn Nicht-Familienmitglieder wie Freunde oder Kollegen neu in das soziale Netzwerk aufgenommen werden. Allerdings ist dieser Anstieg von Nicht-Familienmitgliedern nicht mit dem Eintritt in den Ruhestand verbunden, sodass ich die sozialen Netzwerke nicht als den erklarenden Mechanismus zwischen Ruhestand und Kognition herausstellen kann.","PeriodicalId":396916,"journal":{"name":"Health Economics Evaluation Methods eJournal","volume":"26 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2017-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124727808","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}
I study the effect of the 1973 expansion of Medicare coverage to individuals with End-Stage Renal Disease (ESRD) on insurance coverage, health care utilization, and mortality. Between the ESRD expansion and a simultaneous expansion of Medicare coverage to long-term Social Security Disability Insurance (SSDI) recipients, insurance coverage increased by 4.4 to 8.3 percentage points and the bulk of the increase in insurance coverage was due to an increase in Medicare coverage. The expansion was also associated with an increase in physician visits and a seven log point reduction in mortality from kidney disease, which I replicate in cross-country comparisons. Lastly, I provide evidence for two mechanisms that affected mortality: 1) an increase in access to and use of treatment, which is plausibly driven by changes in insurance coverage; and 2) an increase, by 1975, in entry of dialysis clinics in areas with a greater burden of kidney disease in 1971. Based on changes in the ages at which people died form kidney disease and all other causes, the ESRD program cost between $29000 and $245000 per life year saved, which includes a range of welfare improving values.
{"title":"Effects of Medicare Coverage for the Chronically Ill on Health Insurance, Utilization, and Mortality","authors":"M. Andersen","doi":"10.2139/ssrn.2937364","DOIUrl":"https://doi.org/10.2139/ssrn.2937364","url":null,"abstract":"I study the effect of the 1973 expansion of Medicare coverage to individuals with End-Stage Renal Disease (ESRD) on insurance coverage, health care utilization, and mortality. Between the ESRD expansion and a simultaneous expansion of Medicare coverage to long-term Social Security Disability Insurance (SSDI) recipients, insurance coverage increased by 4.4 to 8.3 percentage points and the bulk of the increase in insurance coverage was due to an increase in Medicare coverage. The expansion was also associated with an increase in physician visits and a seven log point reduction in mortality from kidney disease, which I replicate in cross-country comparisons. Lastly, I provide evidence for two mechanisms that affected mortality: 1) an increase in access to and use of treatment, which is plausibly driven by changes in insurance coverage; and 2) an increase, by 1975, in entry of dialysis clinics in areas with a greater burden of kidney disease in 1971. Based on changes in the ages at which people died form kidney disease and all other causes, the ESRD program cost between $29000 and $245000 per life year saved, which includes a range of welfare improving values.","PeriodicalId":396916,"journal":{"name":"Health Economics Evaluation Methods eJournal","volume":"97 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2017-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128807283","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}
Most prescription purchases in the US are covered by health insurance. Insurance companies typically develop a formulary structure to reduce the drug costs and improve patients’ access to drugs. In this paper, we study how the formulary structure affects price competition between competing drugs, which in turn affects market shares and the total market size. We characterize an insurance plan’s optimal strategy in terms of the number of drugs in the formulary, patients’ copay amount, and the structure of the bargaining process. We develop a game-theoretic model of strategic interactions among an insurance plan and two manufacturers of competing patent-protected drugs. The insurance plan in our model can negotiate prices with each drug company in return for providing insurance coverage to their products. We show that the insurance plan’s ability to accomplish cost- and access-related objectives varies significantly across different formulary structures and bargaining processes. Specifically, the insurance plan can better meet its objectives by putting both drugs in the formulary when the cross-price effects are not very large. On the other hand, when the cross-price effects are sufficiently strong, the insurance plan’s optimal strategy is to include only one drug in the formulary. Our analysis further suggests that sequential bargaining is better for the insurance plan than simulatenous bargaining. Although some of the gains to the insurance plan come at the expense of drug companies, there are cases in which the creation of a formulary may also benefit one or both drug companies, resulting in a win-win situation.
{"title":"How to Organize Tiered Competition for Prescription Drugs?: Formulary Structure and Bargaining Process","authors":"T. Cui, Preyas S. Desai, Huihui Wang","doi":"10.2139/ssrn.2891566","DOIUrl":"https://doi.org/10.2139/ssrn.2891566","url":null,"abstract":"Most prescription purchases in the US are covered by health insurance. Insurance companies typically develop a formulary structure to reduce the drug costs and improve patients’ access to drugs. In this paper, we study how the formulary structure affects price competition between competing drugs, which in turn affects market shares and the total market size. We characterize an insurance plan’s optimal strategy in terms of the number of drugs in the formulary, patients’ copay amount, and the structure of the bargaining process. \u0000We develop a game-theoretic model of strategic interactions among an insurance plan and two manufacturers of competing patent-protected drugs. The insurance plan in our model can negotiate prices with each drug company in return for providing insurance coverage to their products. We show that the insurance plan’s ability to accomplish cost- and access-related objectives varies significantly across different formulary structures and bargaining processes. Specifically, the insurance plan can better meet its objectives by putting both drugs in the formulary when the cross-price effects are not very large. On the other hand, when the cross-price effects are sufficiently strong, the insurance plan’s optimal strategy is to include only one drug in the formulary. Our analysis further suggests that sequential bargaining is better for the insurance plan than simulatenous bargaining. Although some of the gains to the insurance plan come at the expense of drug companies, there are cases in which the creation of a formulary may also benefit one or both drug companies, resulting in a win-win situation.","PeriodicalId":396916,"journal":{"name":"Health Economics Evaluation Methods eJournal","volume":"46 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2016-12-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127892095","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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