Health Economics Policy and Law最新文献

During the 1970s and 1980s, over 30,000 people in the UK were infected with HIV and/or hepatitis C because of treatment with blood and blood products for conditions such as haemophilia or through blood transfusion. We used the social harms perspective to understand the experiences of those affected. We conducted in-depth interviews with 41 infected people and 11 family members and analysed the data according to five dimensions of social harm: physical harms, psychological harms, cultural harms, economic harms, and harms of misrecognition. We found that people were harmed by the medical system, the social context that perpetuated stigma and shame against them, and successive governments being largely unwilling to address the many health, social, and economic impacts of infection on families. What stood out were the many reports of harms of misrecognition, which were often experienced as more irreconcilable than the circumstances of infection itself. They were also harms that have been largely ignored.While patient safety encompasses a broad field of work, much of the research focuses on physical harm and medical error. The social harms lens can provide important insights into patient safety incidents as it can help explain the complexity of the different dimensions of harm that individuals and their families experience.

Despite the tremendous waste due to Medicaid fraud and abuse, not much scholarly attention has been paid to state variation in the investigations. This study explores the factors influencing variations in Medicaid fraud and abuse investigations across U.S. states, with a focus on the role of All-Payer Claims Databases (APCDs) and state political context. To test the impacts of price transparency and political factors, we built a dataset spanning eight years (2014 to 2021) and covering 49 states, excluding North Dakota. We then conducted a fixed-effects panel data analysis based on the results of a Hausman test. The impact of APCDs is statistically significant, suggesting its association with more fraud and abuse detection. A Democratic governor tends to be associated with fewer Medicaid fraud investigations. The findings of this research demonstrate that the operation of APCDs can influence the number of Medicaid fraud investigations conducted by Medicaid Fraud Control Units (MFCUs). Moreover, political discretion plays a role in the number of state investigations into Medicaid fraud and abuse.

The Making Care Primary (MCP) model represents a sharp shift in Medicare's approach to primary care, yet its current design risks duplicating failures from prior alternative payment models. Our editorial suggests refinements to address these gaps. To prevent early provider dropout from MCP's rigid track-based system, we propose a sliding-scale infrastructure payment model that adjusts based on practice needs rather than abrupt phase-outs. Given MCP's reliance on community-based organisations (CBOs) for social determinants of health interventions, we also advocate for direct, outcomes-based contracts between providers and CBOs, ensuring accountability for patient outcomes rather than passive referrals. We recommend that MCP enforce data-sharing mandates for commercial insurers and Medicaid agencies, drawing from Washington State's successful Multi-Payer Collaborative, to avoid payer disengagement that plagued previous multi-payer models. To expand beyond conventional quality measures, we propose integrating patient-centred outcomes from the International Consortium for Health Outcomes Measurement, making sure MCP captures meaningful clinical impact. Finally, we propose programme adjustments frequently at two- to three-year intervals to refine risk adjustment methodologies. These approaches could enhance MCP's sustainability, preventing the financial instability and misaligned incentives that undermined past value-based care initiatives.

This study estimates productivity losses resulting from intellectual decrement due to paediatric lead exposure in low- and middle-income countries (LMICs). The published literature on blood lead levels in LMICs was reviewed and summarised. Intelligence Quotient decrement and consequent productivity losses were calculated for a one-year cohort of 5-year-old children in each country. We calculated the present value of lifetime earnings as the discounted average earning potential for workers in a specific economy. Blood lead level (BLL) data for children were available for 39 countries and could be interpolated for additional 82 countries, resulting in 121 countries in the final analysis. Total lead-attributable productivity losses in LMICs ranged from USD 305 billion in our high discount scenario to USD 499 billion in our low discount scenario for each one-year cohort of 5-year-old children (2019 USD). As a share of GDP, these costs ranged from 0.7 to 4.2% by region, depending on discount scenario used. Total economic impacts were generally consistent with previous estimates and further validate those efforts with a substantially expanded dataset. Differences in the findings resulted primarily from the use of a more conservative dose-response model in the present study. Improved reporting of BLLs is essential and could be facilitated through a centralised registry of study results.

Therapeutic positioning reports (IPTs, Spanish acronym) are a crucial tool for informing funding and pricing decisions for drugs in the Spanish healthcare system. In 2020, for the first time the inclusion of economic evaluations (EEs) was explicitly set as a primary objective in a new Action Plan aimed at consolidating IPTs. This paper seeks to examine the uptake of EE into IPTs and to compare the methods and techniques employed in the EEs conducted during the two-year pilot phase following the reform, i.e., from June 2021 to July 2023. During this period, a total of 181 IPTs were published, with 19 (10.5%) incorporating an EE section. However, out of these 19 identified IPTs, six did not actually conduct a de novo EE, and four only performed a drug cost minimisation analysis. Six IPTs conducted EE analyses following international methodological standards. Based on this review, we observe that the percentage of IPTs incorporating EEs had remained low and exhibited significant heterogeneity. The experience of these two years must be translated into lessons that can serve to reinforce the evaluation of the efficiency of medicines in Spain in the coming years.

Although the criteria that support reimbursement decisions for medicines are often set by legislation, as is the case in Spain, in many cases neither the definition nor the measurement methods for these criteria are provided. Our goal was to elicit the views of a large sample of Spanish technical specialists on how to evaluate each one of the criteria that inform pricing and reimbursement decisions in Spain. Professionals from various stakeholder groups involved in health economics, health technology assessment, and industry participated in a survey. Participants recommended that reimbursement decisions should take specific account of unmet medical need and rare diseases. Health benefit should be measured using quality-adjusted life-years. There should be an explicit cost-effectiveness threshold, and this threshold should take account of population groups and special situations.

This editorial introduces the special issue dedicated to commemorating the life and scholarly achievements of Professor Joan Rovira Forns, a distinguished health economist whose pioneering work continues to influence global health policy and research. We discuss why Professor Rovira was a prominent figure in the field and summarise some of his key contributions. Next, we highlight the collection of papers featured in this issue, explaining how they connect to his work and contribute to his lasting legacy by celebrating his interdisciplinary approach and dedication to societal impact.

We examine the impact of decentralisation on COVID-19 mortality and various health outcomes. Specifically, we investigate whether decentralised health systems, which facilitated greater regional participation and information sharing, were more effective in saving lives. Our analysis makes three contributions. First, we draw on evidence from several European countries to assess whether the decentralisation of health systems influenced COVID-19 mortality rates. Second, we explore the regional disparities in one of the most decentralised health systems, Spain, to untangle some of the determinants shaping health outcomes. Third, we estimate the regional loss of Quality Adjusted Life Years (QALYs) due to COVID-19 mortality, broken down by the wave of the pandemic. Our findings suggest that coordinated decentralisation played a critical role in saving lives throughout the COVID-19 pandemic.