Health Economics Review最新文献

Background: Healthcare expenditures have risen in middle- and high-income countries. One of the potential contributors is the overuse of diagnostics. I explore whether medical imaging is overused when privately owned clinics in Finland treat patients with voluntary private health insurance (VPHI).

Methods: I employ administrative insurance claims data from a major Finnish insurance company, covering 2016-2019, and exploit two market entries of clinics owned by the company in 2017. The underlying assumption is that the insurance company's own clinics had weaker incentives to overuse imaging than other privately owned clinics because the payer and the provider belonged to the same entity. I identify the overuse using the staggered difference-in-differences (DID) strategy, in which I consider patients from cities with a market entry as the treatment group and compare them to patients in other similar cities.

Results: I find that the market entries decreased the use of radiography and ultrasound imaging in the treatment of VPHI policyholders, suggesting that private clinics overused these imaging technologies. The more expensive computed tomography (CT) and magnetic resonance imaging (MRI) were, however, not overused.

Conclusions: The results show that private clinics in Finland overused some imaging technologies when treating VPHI policyholders. The extent and magnitude of overuse can, however, vary considerably between imaging technologies and medical ailments.

Background: In their interesting systematic review, Gallehzan et al. quoted our article Cost-utility analysis of teriflunomide in naïve vs. previously treated patients with relapsing-remitting multiple sclerosis (RRMS) in Italy. While we are grateful to Gallehzan et al. for their interest in the aim of our research, we would like to clarify some points.

Methods: We compare Gallehzan et al.'s statements about our article with the original publication.

Results: Gallehzan et al. omitted or misreported some relevant methodological issues and findings presented in our article. As far as methods are concerned, the main omissions were the 7-year time horizon of our study (that falls in between the 5-10 years range mentioned by Gallehzan et al. for other contributions) and the number of simulated RRMS naïve patients (1000). Regarding findings, Gallehzan et al. mistook the 0.480 incremental Quality-Adjusted Life Year gained by RRMS naïve patients vs. RRMS experienced patients on teriflunomide for the base case Incremental Cost-Utility Ratio (ICUR) calculated according to the societal viewpoint. In fact, for both the healthcare sector and societal perspectives adopted in our Markov model-based cost-utility analysis, the baseline results showed teriflunomide in RRMS naïve patients to be strongly dominant (that is, producing more QALYs and being, at the same time, cost-saving) vs. RRMS experienced patients. Therefore, the calculation of the two ICURs was not necessary.

Conclusions: As systematic reviews play a remarkable role in disseminating health economic research, a careful description of the methods and the findings reported in the included studies is of paramount importance.

Background: The ORIENT-15 double-blind randomized controlled trial demonstrated that the addition of sintilimab to chemotherapy for locally advanced or metastatic oesophageal squamous cell carcinoma (OSCC) resulted in better clinical outcomes. In this analysis, we sought to evaluate the cost-effectiveness of sintilimab as a first-line treatment for locally advanced or metastatic OSCC from a healthcare system perspective in China.

Methods: A partitioned survival model was constructed to perform a cost-effectiveness analysis comparing chemotherapy alone with sintilimab for locally advanced or metastatic OSCC patients. Clinical data were obtained from the ORIENT-15 trial and extrapolated to 10 years. Health state utilities and costs were sourced from the literature and from public healthcare institutions. The primary outcomes included the incremental cost-effectiveness ratio (ICER) and quality-adjusted life-years (QALYs). Two different sensitivity analyses, one-way and probabilistic, were performed to assess model uncertainty.

Results: Sintilimab-based chemotherapy was more costly ($31699.21 vs. $20687.42) and more effective (0.74 vs. 0.53) than placebo-based chemotherapy, resulting in an ICER of $51908.19 /QALY, which is greater than the willingness-to-pay (WTP) threshold of China ($38223/QALY). Sensitivity analysis demonstrated that the PFS and cost of sintilimab were the major influencing factors affecting the results.

Conclusions: In patients with locally advanced or metastatic OSCC, sintilimab chemotherapy could improve survival time and health benefits compared with traditional chemotherapy, but the present analysis suggests that sintilimab is not a cost-effective treatment option in China.

Background: Poverty remains a key barrier to accessing essential maternal health services, particularly in low- and middle-income countries like Malawi. Despite the recognised importance of antenatal care (ANC) in ensuring healthy pregnancies as well as improving maternal and child health outcomes, ANC services remain underutilised by many women living in poverty. This underutilisation is not solely driven by a lack of financial resources but also by a range of non-monetary factors that constitute multidimensional poverty, such as limited access to education, healthcare services, and infrastructure. While much of the existing literature focuses on monetary poverty, this study explores how multidimensional poverty impacts ANC utilisation. By examining how various deprivations intersect to limit access to ANC, this research contributes to understanding the broader issue of healthcare inequality.

Aim: We assess the impact of multidimensional poverty (non-monetary) on antenatal care use in Malawi.

Method: Multidimensional poverty was constructed using the Forster-Akire method of the Oxford Poverty and Human Initiative (OPHI). We use data from the 2015-16 Demographic Health Survey (DHS), which includes information on women aged 15-49 who gave birth within five years of the survey. To mitigate selection bias, we use Propensity Score Matching (PSM) techniques for our principal analysis.

Results: Our findings reveal that 52% of women adequately utilised ANC services. About 8,428 women were identified as multidimensionally poor, and 4,685 were classified as non-poor. The results of our PMS analysis show a significant negative relationship between ANC utilisation and multidimensional poverty (B = 0.52; P < 0.008), indicating that multidimensionally poor women are less likely to use ANC services. Similarly, the timing of ANC visits also showed a negative relationship with multidimensional poverty (B = 0.26; P < 0.04), highlighting that multidimensionally poor women are less likely to attend ANC visits within the recommended first trimester.

Conclusion: The findings suggest that there is a need for sustainable investments in poverty alleviation programs to address and reduce multidimensional poverty as well as raise awareness of sexual and reproductive health concerns among adolescents and women in Malawi to improve maternal health outcomes.

Background: The Statutory Health Insurance scheme is one of two main schemes of health care system financing in Europe. This scheme mainly relies on wage-based contributions from employers and employees and is thus prone to business cycle fluctuations. This turned out to be a problem especially after the 2008 crisis. We estimate the magnitude of the effect of the business cycle on health insurance funds' revenues in the Czech Republic where the health care system financing is based on the Statutory Health Insurance scheme. The relationship between the business cycle and healthcare system's revenues has not been quantified to this date.

Methods: We use static and lagged regression models to estimate the impact of business cycle on health care system's revenues. The business cycle is proxied by eight different indicators (nominal GDP, unemployment, industrial production, recession index, business cycle index, GDP gap, consumer price index and consumer expenditure). Using quarterly data from 2000-2017, we examine the effect of business cycle on total revenues and its two main components: the employer-employee contributions and state contributions.

Results: Health insurance funds' revenues display significant pro-cyclicality, which is mainly driven by employer-employee contributions. Out of all eight business cycle indicators, nominal GDP has the largest effect. In particular, the model estimates that if quarter-over-quarter GDP increases by 1%, then quarter-over-quarter healthcare system's revenues increase by 0.7% and quarter-over-quarter employer-employee contributions increase by 1.1%. The lagged effect of business cycle on healthcare system's revenues is smaller in magnitude. State contributions on behalf of economically inactive people do not display a significant relationship with business cycle in the static nor lagged model. The effect is consistent across different business cycle indicators, although the magnitudes of the effect vary.

Conclusion: The results show large pro-cyclicality in healthcare system's revenues in Statutory Health Insurance schemes. Counter-cyclical mechanisms are needed to offset this loss of revenues during economic downturns to ensure sufficient resources in healthcare.

Background: Given the significant impact of the COVID-19 pandemic, it is imperative to examine the economic response policies implemented by governments. This study aims to review evidence from the Middle East and North Africa (MENA) region, including Iran, on COVID-19 economic response policies designed to protect households, vulnerable groups, and businesses.

Methods: Utilizing Arksey and O'Malley's scoping review methodology, electronic search engines and databases were systematically searched to identify published studies within the timeframe of December 31, 2019, to 2022. Additionally, a gray literature search for relevant policy documents and reports was conducted. The following six-step approach was employed: (1) defining the review questions, (2) identifying relevant studies through database searches, (3) screening studies for inclusion, (4) extracting and charting data, (5) analyzing and presenting results, and (6) providing guidance and suggestions. Narrative synthesis was utilized for data analysis.

Results: After a rigorous screening process, 53 studies were selected from a pool of 3392 search results. The findings are categorized into three primary groups: Households, vulnerable groups, and economic businesses. The majority of MENA countries implemented economic and social measures to support these groups, including stimulus packages, tax deferrals and exemptions, wage subsidies, and debt obligation deferments. The size of stimulus packages in MENA countries varied significantly, ranging from 0 to 14% of real Gross Domestic Product (GDP). The average stimulus package size in MENA countries was 3.67%, notably lower than the global average of 11%. Among the 64 selected countries, the average government support as a share of GDP was 6.3%, with Ecuador at the lowest (0.05%) and Germany at the highest (23%). In Iran, government financial support contributed approximately 7% to the Gross National Product.

Conclusion: MENA countries, including Iran, implemented diverse economic strategies and policies in response to the critical circumstances of the COVID-19 pandemic, tailored to their specific conditions. Assessing the effectiveness of these policies and the extent of the pandemic's long-term economic, health, and lifestyle impacts requires a more extended timeframe.

With the rising spread of Assisted Reproductive Technology (ART), it becomes imperative to understand the determinants of resource utilization in ART versus spontaneous pregnancies to enhance policies directed to pregnancy care. The focus of our study is to examine the costs associated with ART from the perspective of the Italian NHS and to investigate in depth the contributing social and clinical factors.Using the healthcare informative system of Lombardy, a Region of Northern Italy, we gathered individual-level information for a cohort of women who experienced either spontaneous pregnancies or pregnancies following ART from 2007 until 2020. The information covered multiple healthcare services, and we used a propensity score matching technique to match couples of ART/No ART women based on a comprehensive set of confounders. We then applied statistical tests and regression models to identify the impact of ART on the reported cost differences.Our cohort was composed of 44652 women and results revealed significantly higher costs for ART pregnancies, especially in terms of hospital admissions (additional 1611€, 95% CI 1558-1666) and drug prescriptions (additional 216 €, CI 95% 204-228) occurring before delivery. In-depth analysis showed for ART pregnancies, i) a higher likelihood of incurring expenses related to complications and ii) higher costs associated with two established clinical practices that lack scientific evidence supporting their efficacy.Our study sheds light on the complex interplay of clinical and social factors influencing the ART burden, emphasizing the importance of tailored support and evidence-based practices in optimizing outcomes and resource allocation.

Background: The literature on care coordination refers to high service costs, low quality, and consumer dissatisfaction, as the consequences of institutional fragmentation and uncoordinated care.

Objectives: In this work we are concerned with the role financial incentives (reimbursement schemes) might play in promoting coordinated care when providers are organized sequentially along a care pathway and the clients (patients) are transferred from one caregiver to another.

Methods: We apply a game-theoretic framework to analyze the situation where three providers provide services to a patient group and there are interdependencies between the providers in terms of cost-externalities and altruistic patient preferences.

Results: For activity-based contracts, the incentives for cost containment are efficient (internal efficiency), while the incentives for quality provision are inefficient due to preference misalignments and poor coordination that derive from funding costs, imperfect altruism, the presence of externalities and strategic behavior. The optimal cost-based contracts are mixed contracts that vary across providers according to their position in the production chain, and they consist of the following three elements; (i) fixed budgets, (ii) payments contingent upon the treatment costs of production chain followers (integrated penalties), and (iii) payments contingent upon the providers' own treatment costs (positive or negative cost-sharing). For these contracts, the providers are typically internally inefficient, while the inefficiencies associated with preference misalignments and poor coordination are solved.

Conclusions: Our production chain perspective, when compared to single-provider approaches, enhances the appeal of cost-based contracts relative to pure prospective contracts.

China's primary healthcare (PHC) system, together with rural healthcare services, remains the Achilles' heel in the national healthcare system. Healthcare workers, specifically village doctors, are an integral part of the healthcare system. Using the two-stage data envelopment analysis (DEA) and Tobit regression analysis, this study aims to investigate the efficiency of healthcare expenditures on medical resources and services in China, as well as determine how different types of healthcare work influence efficiency. Compared with other types of healthcare workers, village doctors exerted a prominent impact on provincial and rural efficiency at all stages and played a key role in augmenting the efficiency of healthcare expenditures on health outcomes. Besides, township health centers (THCs) and village clinics (VCs) faced administrative overstaffing, mainly involving pharmacists, other nonmedical technologists, and health administrators, which adversely affected the efficiency of healthcare expenditures. This study suggests that the higher the proportion of these non-village doctor positions (e.g., pharmacists, health administrators, and nonmedical technologists) in THCs and VCs, the lower the efficiency of China's PHC system. Overall, the priority should be enhancing the training and remuneration of village doctors and other healthcare workers in rural areas to further enhance their performance and increase the overall efficiency of China's healthcare system.

Background: The occurrence of health shocks affects households economically in various ways. It most often leads to missed work, thus inducing a decrease in productivity and a loss of income. These effects are even more significant if the extent of absenteeism is high or if its duration is long.

Purpose: This study aims to analyse the effects of health shocks on the magnitude of absenteeism and to highlight the potential mitigating effect of health insurance on the magnitude of absenteeism among households affected by the shocks.

Methodology/approach: Absenteeism at work was measured here by the number of days lost due to health problems. Data from the Harmonised Survey on Household Living Conditions (EHCVM) 2019 were used for this purpose. To account for the endogeneity problem in this context, we use Two-Stage Least Square (2SLS) model to achieve our objectives.

Results: Our results suggest that health shocks significantly increase the magnitude of absenteeism from work by increasing the probability of a longer duration of absenteeism. Health insurance mitigates the magnitude of absenteeism by significantly reducing the probability of moving from short to long absenteeism by 3.27.

Conclusion: Health shocks have a significant effect on the magnitude of absenteeism. Given the role of health insurance in mitigating the effect of health shocks, this study highlights the need for an extension of health insurance to a greater number of people for a more significant effect.