Health Economics Policy and Law最新文献

In the Dutch health care system of regulated competition, health insurers are assigned the crucial role of prudent purchasers and expected to critically contract providers based on the quality and prices of their services. Thus far, however, these organisations have struggled to fulfil this role. This study sheds new light on the purchasing behaviour of Dutch health insurers. We examine how insurers perceive the context in which the value-based purchasing of hospital care should take shape, and we draw on insights from institutional theory to frame our analysis. Our findings are based on a series of semi-structured interviews (n = 18) with employees and representatives of several insurer companies whose combined market shares add up to over 90 per cent of all premium payers. Our analysis highlights an environment in which market mechanisms are tangled up with historically rooted budgeting practices, where insurers are pressured to sustain rather than critique hospitals, and where self-regulating medical professionals are firmly supported by society's deep-seated belief in the quality of their services. Like many other organisations, Dutch health insurers tend to conform to their institutional environment. While this conformity may aid them in organisational stability and survival, it also restricts their ability to purchase prudently.

Background: Health insurers' role in healthcare systems based on managed competition comprises various tasks. Misconceptions about these tasks may result in low public trust, which may hamper health insurers in performing their tasks. This study examines the relationship between enrollees' perceptions of health insurers' tasks and their trust in them.

Methods: A questionnaire in November 2021 asked respondents to indicate to what extent health insurers have to perform certain tasks, whether they actually perform them, and whether they think these tasks are important. Trust was measured using a validated multiple-item scale. The results from 837 respondents (56 per cent response rate) were analysed using multivariate regression models.

Results: A larger mismatch between enrollees' expectations about health insurers' tasks and their actual statutory tasks is related to less trust regarding the categories 'controlling healthcare costs' and 'mediation and quality of care'. Second, a larger mismatch between expectations and actually performed tasks is related to less trust for all categories. Importance of tasks only affects this relationship concerning 'informing about price and availability of care'.

Conclusions: This study emphasises the importance of reducing enrollees' misconceptions as trust in health insurers is necessary to fulfil their role as purchaser of care.

While the literature has largely focused on legal challenges to public healthcare rationing decisions, claims against private insurance companies in voluntary health insurance (VHI) schemes have received less attention. This paper aims to fill this gap by analysing a representative sample of 1,547 court of appeal decisions related to treatment funding claims filed against private insurance companies in Brazil from 2018 to 2021. Courts decided 83.6% of cases in favour of patients, ordering VHI companies to fully fund the claimed treatment. Patients´ rate of success is even higher (96%) in the cases in which insurance companies denied coverage on the grounds that the claimed treatment was not listed in the benefits package mandated by regulation. Court decisions present additional challenges to setting priorities through health technology assessment and explicit packages in the VHI sector. This has broader implications for health care equality and access in Brazil.

The standard analytical framework of insurance markets by Einav and Finkelstein (EF) focuses on the problem of welfare loss for low-risk individuals. A key assumption of this framework is that demand and cost curves are tightly linked, meaning that people are willing to pay a price equal to their expected cost plus a risk premium. Using data from the German risk-adjustment system we show that the distribution of expected health care costs is extremely skewed. We show that incorporating the extreme skewness of predictable individual health care expenses in the EF framework has important welfare consequences, which are typically overlooked when using this framework for analysing the negative welfare effects of voluntary health insurance markets with asymmetric information. Rather than the welfare loss of low-risk individuals due to underinsurance, the main problem of voluntary health insurance markets is the welfare loss of high-risk individuals not getting access to health insurance and affordable health care. We discuss that among the policy approaches to reduce this problem, mandatory health insurance with mandatory cross subsidies is likely to be the most effective, which is typically not recognised when focusing primarily on the welfare loss for low-risk individuals.

Reforms to the means tests in England for state-financed long-term care were planned for implementation in 2025. They included a lifetime limit (cap) on how much an individual must contribute to their care, with the state meeting subsequent care costs. We present projections of the costs and distributional impacts of these reforms for older people, using two linked simulation models which draw on a wide range of data. We project that by 2038 public spending on long-term care for older people in England would be about 14% higher than without the reforms. While the main direct beneficiaries of the lifetime cap would have been the better off who currently receive no state help with their care costs, the reforms also treated capital assets more generously than the current system, helping people with more modest incomes and wealth. When analysing the impacts of the reforms it is therefore important to consider the whole reform package. Our results depend on a range of assumptions, and the impacts of the reforms would be sensitive to the levels of the cap and other reformed parameters of the means test on implementation.

Conducting scientific medical research with human subjects presents risks that raise both ethical and human rights concerns. We argue in this article that applying a human rights framework to the problems that arise in the context of scientific medical research can contribute to a better understanding of the impact on individuals, the related obligations of the State, and the avenues to make the State accountable when things go wrong. We start our analysis with a case brought to the European Court of Human Rights, which we use as an illustration throughout the article. We then discuss the relevance of human rights to the field of scientific medical research with a focus on the right to life and the right to health. The article draws on international human rights jurisprudence that deals with concrete disputes arising from the clinical reality. We use case law to highlight the role of human rights law in tackling the real-life problems that may occur during scientific medical research. Our analysis contends that human rights law can provide valuable guidance for healthcare professionals and equip them to handle concrete situations in the clinical reality when the safety of research subjects is at stake.

In health care systems based upon the principles of managed competition, health insurers are expected to act as prudent buyers of care. Consumers are expected to switch between insurers based upon the performance of insurers in this role. Yet, the Dutch experience shows that trust of consumers in health insurers is low and that switching consumers focus primarily on price. The question arises if consumers do in fact perceive and trust insurers as prudent buyers of care. We addressed this question by using a mixed-method approach. The results show that most people know that insurers buy health care and feel that the purchasing tasks suit their role. They even have reasonable, though fragile, trust in the purchasing competencies of the insurer. However, the results also revealed that consumers have insufficient information to cast a judgement about insurers as purchasers and incorrectly think that insurers are commercial organisations. Hence, improving the public information about insurers and their purchasing role seems to be crucial. Given the inherent complexity in the system, it remains to be seen if this objective can be reached in the (near) future. For that reason, policymakers should also consider additional measures to encourage that insurers will take integral purchasing responsibility.

The increasing use of real-world evidence (RWE) and real-world data (RWD) to assess post-market medical devices (MDs) might satisfy the urgent need for data sharing and traceability. This study sought to (i) get an overview of current practice in post-market assessments of MDs reporting on RWE/RWD; (ii) draw policy recommendations for governments and health organisations and identify a research agenda for scholars.A systematic review was undertaken until February 2024 following the PRISMA guidelines. Original peer-reviewed articles in English and incorporating RWE/RWD into any sort of post-market assessment strategy for an MD were included and their reference lists manually checked. A narrative synthesis was employed to describe evidence retrieved.Totally, 145 research articles were identified. Administrative databases were mostly utilised; clinical and/or economic evidence gathered in a short/medium time horizon the most frequently reported; other evidence types (e.g., organisational) underreported; patient perspectives rarely incorporated; the innovation complexity of MDs relatively low.To our knowledge, this study is the first in its kind to provide a comprehensive picture of how non-randomised evidence has been used when assessing MDs working in real-life conditions. The implications of this review might help health policy scholars in addressing the avenues for research in RWE for MDs and policy-makers to better understand the risks and benefits of medium and long-term use of MDs alongside clinical practice and make more informed decisions about adoption and use.

The policy-making process for health financing in most places lacks equity, failing to adequately consider the voices of ordinary citizens, residents, and especially those facing significant disadvantage. Procedural fairness is about addressing this imbalance, which requires a recalibration of power dynamics, ensuring that decision-making incorporates a more diverse range of perspectives. In this comment, we highlight the important contributions made by the report 'Open and inclusive: Fair processes for financing universal health coverage' in furthering the understanding and importance of procedural fairness in health financing decision-making especially as it relates to the three sub-functions of financing - revenue raising, pooling, and purchasing. We also argue for the importance of conceptual clarity - especially as to the added value of procedural fairness vis-à-vis accountability - and critically review the proposed framework for procedural fairness, emphasising the role of voice as the linchpin to advancing equity in influence.