International Journal of Health Economics and Management最新文献

The expansion of public health insurance programs affects payers as well as the behavior of service providers. In this paper, we study the expansion of Swiss mandatory health insurance in 2012 to include complementary and alternative medicine physician services. The policy change provides a quasi-experimental design that allows us to estimate the causal effects on the payer and physician behavior using a difference-in-differences framework. First, we find that from the payer's perspective, expanding coverage to complementary and alternative medicine increases physician costs per patient by about 7 percent. Second, we find that the increase in physician service costs per patient in mandatory health insurance is almost exactly offset by a decrease in supplementary health insurance costs. Thus, suggesting that the behavior of physicians was unchanged by the coverage expansion.

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.

The rising number of older adults with limitations in their daily activities has major implications for the demands placed on long-term care (LTC) systems across Europe. Recognizing that demand can be both constrained and encouraged by individual and country-specific factors, this study explains the uptake of home-based long-term care in 18 European countries with LTC policies and pension generosity along with individual factors such as socioeconomic status. Using data from the Survey of Health, Ageing and Retirement in Europe conducted in 2019, we apply a two-part multilevel model to assess if disparities in use of LTC are driven by disparities in needs or disparities in use of care when in need. While individual characteristics largely affect the use of care through its association with disparities in need, country-level characteristics are important for the use of care when in need. In particular, the better health of wealthier and more educated individuals makes them less likely to use any type of home-based personal care. At the country level, results show that the absence of a means-tested benefit scheme and the availability of cash-for-care benefits (as opposed to in-kind) are strongly associated with the use of formal care, whether it is mixed (with informal care) or exclusive. LTC policies are, however, shown to be insufficient to significantly reduce unmet needs for personal care. Conversely, generous pensions are significantly associated with lower unmet needs, underscoring the importance of considering the likely adverse effects of future pension reforms.

To assess the impact on pharmaceutical wholesalers' financial viability and efficiency of the reform of the wholesalers' and pharmacies' margins on reimbursable drugs enacted in 2010 that halved the distributors' margins. We perform a stochastic frontier analysis on a large original dataset comprising financial and production data from 2009, a year prior to the reform, to 2019 gathered in order to assess the impact of the reform on firms' profitability and efficiency. The implemented policies have not been successful in fostering the development of a more efficient market that would ultimately benefit social welfare. Overall, our findings indicate that bigger firms lag behind their smaller counterparts in terms of efficiency, even in the long run. Our findings also suggest that an efficient pharmaceutical wholesaler is currently unable to generate normal profit from the distribution of reimbursable drugs. Compared to the other European countries, that seem to have a cost oriented approach, Italy provides one of the lowest margins to pharmaceutical wholesalers without properly considering the costs of the drugs' distribution. A new regulatory approach to wholesaling margins is needed in order to improve efficiency and welfare.

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.

Most part of the literature has highlighted the detrimental effects of discrimination on health. However, the influence of past and perceived discrimination on older workers' self-assessed health has been understudied. Firstly, we aim at studying whether reported discrimination is associated with self-assessed health among adults of working ages (50-65 years of age). Secondly, we analyze the existence of differences by gender. Data was retrieved from the seventh wave of the Survey of Health, Ageing and Retirement in Europe (SHARE) to obtain the regular panel of questions, and the third and seventh waves of the SHARELIFE questionnaire, that includes information about discrimination (n = 30,019). We develop logistic regression models to determine the relationship of discrimination on male and female workers' self-assessed health separately. Our results show that 49.0% of our sample was composed of highly discriminated women, while the remaining percentage covered men and women (42.3% males and 8.7% females) that reported lower levels of discrimination. Our estimations reveal a significant association between discrimination and poor health status, especially in the case of men ranging from OR = 1.802 (95% CI 1.502-2.163) to OR = 1.565 (95% CI 1.282-1.910). In the case of women our results range from OR = 1.728 (95% CI 1.463-2.040) to OR = 1.196 (95% CI 0.992-1.442). These findings are essential to highlight the importance of tackling discrimination as a determinant of health that negatively affects both sexes, men and women.

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.

The aim of this paper is to shed light on the economic and epidemiological trade-offs that emerge when choosing between different vaccination strategies. For that purpose we employ a setting with three age groups that differ with respect to their fatality rates. The model also accounts for heterogeneity in the transmission rates between and within these age groups. We compare the results for two different contact patterns, in terms of the total number of deceased, the total number of infected, the peak infection rate and the economic gains from different vaccination strategies. We find that fatalities are minimized by first vaccinating the elderly, except when vaccination is slow and the general transmission rate is relatively low. In this case deaths are minimized by first vaccinating the group that is mainly responsible for spreading of the virus. With regard to the other outcome variables it is best to vaccinate the group that drives the pandemic first. A trade-off may therefore emerge between reducing fatalities on the one hand and lowering the number of infected as well as maximizing the economic gains from vaccinations on the other hand.

Our study evaluates the liquidation effect of a health insurer from a subsidized scheme, with the largest number of members in Colombia, on restrictions to future access to user care. Based on the information regarding complaints and judicial claims about healthcare, the effect of this government decision is estimated using a dynamic econometric model of differences in differences. Our results suggest that the liquidation of the Health-Promoting Entity (EPS, its acronym in Spanish) CAPRECOM has a negative effect, specifically, it led to an increase of 0.32 and 0.21 in complaints rates per 1,000 members in the receiving EPSs during the first and second quarters after the intervention, respectively. However, this effect does not persist over time and becomes diluted in the following quarters. There is no evidence of a relationship between the magnitude of the effect and the EPSs performance ranking. Additionally, we do not find significant effects on judicial claims. Our results are important concerning the design and implementation of public policies for EPSs liquidation. We demonstrate the necessity of implementing actions to incorporate guidelines and strategic plans during the transition period. Such actions would enable safeguarding the right to health for the affected population in a liquidation insurer case.

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.