International Journal of Health Economics and Management最新文献

Objective: To quantify socioeconomic inequities of complete continuity of maternal healthcare service over time using Ethiopian Demography and Health Survey data from 2011 to 2019.

Methods: A total of 10,768 women who had at least one antenatal care visit during their most recent childbirth were included for the analysis. Concentration index and concentration curve were used to assess wealth-based inequities. A generalized linear model with binomial distribution and a logit link function was used to decompose the Erreygers concentration index and measure each determinant's contribution.

Results: Complete continuum of maternal health service utilization in 2011, 2016, and 2019 among the wealthiest women were 25.9%, 33.7%, and 50.8%, respectively. In contrast, the corresponding continuum of maternal health service utilisation was 3.0%, 6.1%, and 11.2% among the lowest wealth categories. The Erreygers concentration indices of complete continuum of maternal health service utilization in 2011, 2016, and 2019 surveys were 0.203, 0.195, and 0.311, respectively, with the highest inequity observed in 2019. Concentration curves in each survey showed a pro-rich distribution of complete continuum of maternal health service utilisation. A unit percentage change in women's education, early initiation of antenatal care, being informed about pregnancy-related complications, and blood pressure monitoring during pregnancy increased their probability of completing continuum of maternal health service utilization. Specifically, a 1% increase in the proportion of secondary or higher education corresponded to a 0.02%, 0.01%, and 0.07% increase in the probability of completing continuum of maternal health service utilisation in 2011, 2016, and 2019, respectively. Conversely, in 2011, a 1% increase in the proportion of rural women and those with more than four parities led to a 0.11% and 0.05% decrease in the probability of completing continuum of maternal health service utilisation, respectively.

Conclusion: Complete continuum of maternal health service utilization was more likely amongst women without disadvantage, demonstrating wealth-based inequities in continuum of maternal health service utilization continue in Ethiopia. In this analysis, continuum of maternal health service utilisation remains inelastic across all surveys highlightsits the service is an essential form of care for women. Provision of maternal healthcare services targeting women from low household wealth status, residing in rural communities, and uneducated women must be prioritised by policymakers.

The study aims to analyze the impact of Medicaid Expansion on hospital finances. Medicaid eligibility may increase hospital reimbursements and lower uncompensated care costs if patients are moving from no insurance coverage to Medicaid. However, if patients taking up Medicaid are moving from a private insurance plan to Medicaid, then it is also possible that hospital reimbursements may be lower under Medicaid expansion. Medicaid expansion increased the eligibility for Medicaid coverage to a broader group of people and raised the income threshold to 138% of the federal poverty level. Some states chose to expand Medicaid while others did not. Using a natural experiment, I compare hospital revenues and uncompensated care costs in Eastern Washington, which chose to expand Medicaid in 2014, and in Idaho, which chose not to expand until 2020. Medicaid expansion may be associated with lower net revenues, higher Medicaid received, and lower uncompensated care costs per hospital bed, ceteris paribus. I find no significant impact on operating margins. This study adds to the current literature looking at Medicaid Expansion and hospital finances by looking at a different region than has been previously studied. This region offers similar demographic and economic situations in both states. These areas are more rural areas and have less populated cities, which allows for a unique perspective and contributes to the understanding of how Medicaid Expansion may impact hospital finances.

This study aims to investigate the factors associated with self-reported unmet healthcare needs among individuals aged 65 and older in France, as well as to determine whether healthcare expenditure and its determinants differ based on self-reported unmet needs. We use data from the 2012 Health and Welfare Survey, matched with health insurance records. Healthcare expenditure for ambulatory care-excluding inpatient care-is modeled using a regime-switching regression approach. Our findings highlight that social and behavioral disparities are the primary factors influencing self-reported unmet needs. The determinants of healthcare expenditure are generally similar, regardless of whether individuals report unmet needs, except for pre-frailty and the number of medical conditions. Surprisingly, we do not find a significant marginal effect of self-reported unmet needs on healthcare expenditure. In our view, this challenges the use of self-reported unmet needs as an indicator of access to care.

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.

Based on the belief that fee-for-service reimbursement contributes to the overuse of costly medical procedures, policymakers have sought to cut payments for low-value services. Using a difference-in-differences model and Medicare claims linked with cancer registry records, we evaluate the impact of a large payment reduction for an imaging procedure commonly used in prostate cancer patients. We find that the payment cut did not affect imaging use, even in low-risk patients for whom imaging is not recommended. Our results suggest that supply may be relatively insensitive to fee levels when decisions about the use of a service are made exclusively by referring physicians, not the physicians who deliver and receive payment for it.

Expanding explicit Health Benefit Plans (HBP) is a key strategy for achieving universal health coverage while maintaining financial sustainability. However, little is known about the broader effects of periodic updates to these plans on healthcare utilization, expenditures, and market dynamics. This study examines the impact of including new health technologies in Colombia's HBP covered by the Capitation Payment Unit (CPU) between 2012 and 2019, using administrative data and a difference-in-differences approach with multiple periods. Our results indicate that inclusion in the HBP-CPU led to a substantial increase in utilization and access, particularly in remote areas, but had mixed effects on expenditures. While the number of unique users and prescription frequency rose significantly, the cost per user remained stable for procedures but increased for medications, likely due to higher demand and market structures. These findings suggest that although periodic HBP updates enhance access and effective coverage, they do not necessarily generate cost savings. Strengthening health technology assessment processes, integrating price regulation policies, and implementing cost-containment mechanisms are essential for ensuring the financial sustainability of health systems that regularly update benefit plans.

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.

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.

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.