International Journal of Health Economics and Management最新文献

Home hospice services contribute to dying in dignity by addressing medical and social needs at the end of life. The respective monetary valuation in a sense of willingness to pay is not available yet. We aim to quantify the benefits of home hospice services to society using society's monetary valuation and examine the influence of prior knowledge and experience on willingness to pay for home hospice services. A nationwide cross-sectional contingent valuation study was conducted in Austria. We analyzed the impact of the determinants of interest on having a positive willingness to pay for home hospice services via multivariate Probit regression. Stated willingness to pay was analyzed using interval regression. Variable selection of potential influence factors and confounders was based on the literature. The variables of interest, prior knowledge of and experience with home hospice services, were represented by twelve related variables. We included 1262 respondents in the analysis. The two-part regression analysis showed a statistically significant positive impact on the probability of having a positive willingness to pay by prior knowledge of home hospice services, prior donations, and the wish of not dying alone. Prior donations also increase the level of willingness to pay. The probability of a positive willingness to pay was statistically significantly lower for respondents that stated to have experienced the death of more than ten close persons and perceived spending time with dying persons as burden than their respective counterparts. Our study provides evidence that information campaigns to increase the recognition and awareness of existing home hospice services could increase their perceived value in society.

Alcohol deregulation has recently been a topic of debate in Thailand, with policymakers weighing the potential economic benefits against public health harms and social concerns. This study estimates the impact on alcohol consumption levels in Thailand if barriers to producing alcoholic beverages are removed. Since the deregulation has not yet been implemented, we employed a randomized survey design for a Volumetric Choice Experiment administered to 1220 individuals, both drinkers and non-drinkers. The "treatment" group (with deregulation) was compared to the "control" group (without deregulation). While respondents in the control group were presented with existing drinks supplied by large producers, respondents in the treatment group were presented with new drinks supplied by small local producers alongside the existing options. Deregulation would introduce a wider variety of drinks, including cheaper local craft beer, white spirits, and brown spirits. Various scenarios of product availability and pricing were validated by experts. Our analysis reveals a 19.93% rise in total annual alcohol per capita consumption (APC), with a statistically significant difference between the treatment and control groups at a 90% confidence level. Further exploration into cross-price elasticities of demand suggests new drinks would partly substitute current options. Policymakers should carefully consider the public health implications, including increased risks of alcohol-related harms, as well as potential economic benefits from market liberalization. Regulatory measures, such as taxation, age restrictions, and public awareness campaigns, may be necessary to mitigate the projected consumption increase and associated social costs.

How performance pay affects physicians' medical service provision and the quality of care is relevant for researchers and policy-makers alike. This paper systematically studies how performance pay, complementing either fee-for-service or capitation, affects physicians' medical service provision and the quality of care for heterogeneous patients. Using a series of controlled behavioral experiments with physicians and students, we test the incentive effect of performance pay at a within-subject level. We consider a performance pay scheme which grants a discrete bonus if a quality threshold is reached, which varies with the patients' severity of illness. We find that performance pay significantly reduces non-optimal service provision and enhances the quality of care. Effect sizes depend on the patients' severity of illness and whether performance pay is blended with fee-for-service or capitation. Health policy implications, including a cost benefit analysis of introducing performance pay, are discussed.

Depression is a common disorder that impacts on individuals' ability to perform daily activities, including those required for working. People with poor health tend to have problems needing medical care and therefore need time away from their work. This paper considers a structural model of labor absenteeism, considering the effect of depression. Our objective is to estimate the effects that depressive symptoms (among other factors) have on absenteeism while avoiding inconsistency in estimators due to sample selection and endogenous regressor. We are unwilling to impose strong assumptions, which are sometimes not required by theory, so our model is semiparametric. Based on microdata from the European Health Survey in Spain, our results indicate that depressive symptoms have a negative effect on working time and increase absenteeism. We conclude that depressed workers lose on average around 12 more days per year than non depressed ones. Levels of absenteeism are also estimated to be higher on average among obese people and among older people (the effect of age is positive). On the other hand, non-college education, being male and being self-employed are factors related to lower levels of absenteeism.

Baumol's (Am Econ Rev 57: 415-426, 1967) model of 'unbalanced growth' yields a supply-side explanation for the 'cost explosion' in health care. Applying a testing strategy suggested by Hartwig (J Health Econ 27: 603-623, 2008), a sprawling literature affirms that the 'Baumol effect' has both a statistically and economically significant impact on health care expenditure growth. Skeptics maintain, however, that the proliferation of hi-tech medicine in acute care is clearly at odds with the assumption underlying Baumol's model that productivity-enhancing machinery and equipment is only installed in the 'progressive' (i.e. manufacturing) sector of the economy. They argue that Baumol's cost disease may affect long-term care, but not acute care. Our aim in this paper is to test whether Baumol's cost disease affects long-term care and acute care differently. Our testing strategy consists in combining Extreme Bounds Analysis (EBA) with an outlier-robust MM estimator. Using panel data for 23 OECD countries, our results provide robust and statistically significant evidence that expenditures on both acute care and long-term care are driven by Baumol's cost disease, even though the effect on long-term care expenditures is more pronounced.

Public expenditure for the improvement of maternal health is crucial in addressing the major social and demographic challenges in developing countries like India. Accordingly, the Government of India initiated the Janani Suraksha Yojana (JSY) in 2005 as a flagship conditional cash transfer scheme to encourage institutional delivery in the country. While the provisions under the JSY remain uniform throughout the country, there are apprehensions that the impact would differ across the states as well as between the rural and urban setups depending on varied socio-economic conditions and local level dynamics. Besides, households' choice of the type of institution (i.e., government versus private healthcare centres) may also change following the implementation of the JSY. This paper examines these two critical but interrelated aspects. Using secondary data compiled mainly from the last two rounds of the National Family Health Survey and estimating panel data econometric models, the paper finds that interactions with health facilitators during pregnancy, and per capita income contribute positively to the increase in institutional delivery in India irrespective of whether the households are located in rural or urban areas. Importantly, the paper does not find any significant role of the JSY in this regard. On the contrary, the JSY encourages households to prefer public to private hospitals in both rural and urban areas, whereas preference for private hospitals is positively associated with the household head literacy rate in urban area and health insurance coverage and per capita income in rural areas. The findings suggest greater emphasis on quality enhancement of the government healthcare centres. Besides, active engagement of the health workers should also be encouraged, particularly in mobilising the community towards institutional delivery and linking them effectively with the related initiatives of the government.

This paper analyzes the impact of flat premiums on equity and efficiency within a regulated market. We examine the consequences of shifting from a risk-adjusted premium model to a flat premium system, particularly focusing on how this shift affects different income groups and market efficiency. Using a combination of theoretical modeling and empirical analysis, we find that flat premiums may lead to increased cross-subsidization among participants, with notable effects on both equity and efficiency. Our results suggest that while flat premiums simplify the regulatory framework, they also introduce trade-offs that policymakers must carefully consider.

Overdose deaths from prescription opioids remain elevated, and policymakers seek solutions to curb opioid misuse. Recent proposals call for price-based solutions, such as opioid taxes and removal of opioids from insurance formularies. However, there is limited evidence on how opioid consumption responds to price stimuli. This study addresses that gap by estimating the effects of prices on the utilization of opioids, as well as other prescription painkillers. I use nationally representative individual-level data on prescription drug purchases and exploit the introduction of Medicare Part D in 2006 as an exogenous change in out-of-pocket drug prices. I find that new users have a relatively high price elasticity of demand for prescription opioids, and that consumers treat over-the-counter painkillers as substitutes for prescription painkillers. My results suggest that increasing out-of-pocket prices of opioids, through formulary design or taxes, may be effective in reducing new opioid use.

The widespread use of Internet has substantially influenced adolescents' lifestyles. This paper systematically explored the impact of Internet use on adolescent obesity and unveiled the underlying mechanism in China. We discussed the relationship among Internet use, dietary habits and obesity, and estimated the impact using panel data collected by the China Health and Nutrition Survey. Results indicated that increased Internet use significantly raised the risk of obesity among adolescents by changing their dietary habits. With a longer time of Internet use, adolescents would increase more proportion of snacks, and choose food with higher fat and protein. This paper offers a new empirical evidence for understanding the mechanism of Internet use on adolescent obesity, and provides a reference for developing countries to guide adolescents toward moderate Internet use and lower the risk of obesity.

Despite the devastating effects of out-of-pocket healthcare expenditures on households' financial outlays, which potentially stifle household resources needed for food consumption, the health financing program-food insecurity nexus is yet to receive much needed attention in the literature. This study makes a significant contribution by investigating the effect of health financing program, conceptualised as membership of a National Health Insurance Scheme, on household food insecurity using the food insecurity experience scale (FIES) and several quasi-experimental methods. Using data from the seventh round of the Ghana Living Standards Survey, our endogeneity-corrected results indicate that membership of a health financing program can contribute to reduction in household food insecurity. The results are robust to alternative conceptualisations of food insecurity and different quasi-experimental methods. The effect of health financing programme membership on food insecurity is more pronounced among urban and female-headed households. Our findings further point to household savings as an important channel through which membership of health financing program reduces food insecurity.