Health Economics Review最新文献

Risk adjustment formulas are essential in health insurance markets, as they mitigate risk selection incentives by aligning revenues with expected healthcare expenses based on enrollee characteristics. However, current formulas can underpredict spending for certain groups, leading to under-compensation for insurers and potentially affecting fairness, quality, and access to care. Many countries are exploring the addition of new variables to improve accuracy, but this can also weaken incentives for cost control. This paper illustrates a methodology approach to risk adjuster selection by using a penalized regression framework that explicitly incorporates the potential downsides of including specific variables. Drawing on a large dataset of over 10 million Colombian health insurance enrollees, we combine statistical estimation with expert assessment of each variable's susceptibility to gaming to construct a specification that limits gaming and maintains predictive accuracy.

Nigeria's growing digital health startup ecosystem has a lot of potential to fill in gaps in healthcare delivery, but many of these businesses fail to get off the ground after getting initial funding. This narrative review examines funding patterns from 2019 to 2025 and investigates why seed-stage investment often fails to translate into scaled impact. Investment reports, case studies of prominent Nigerian health-tech startups, and comparative insights from peer markets were synthesized. The analysis finds that despite a surge of seed funding and a record venture capital peak in 2021, few Nigerian digital health startups convert initial success into sustainable growth. Constraining factors include regulatory hurdles, infrastructural deficiencies, market trust barriers, talent gaps, and systemic health-sector limitations, challenges that mere capital infusion cannot overcome. Case narratives (e.g., Helium Health's regional expansion and 54gene's post-pandemic collapse) illustrate these dynamics. Key mechanisms to bridge the "post-seed" gap are discussed, ranging from strategic public-private partnerships to specialized follow-on funds, with lessons drawn from ecosystems like Kenya and India. Strengthening support beyond seed stages and addressing non-financial frictions will be crucial for Nigerian health-tech innovators to realize their full scale-up potential.

This paper examines how rural primary care physicians in China adjusted their practice patterns to pandemic-related financial pressures under a capitated global-budget model. Using township-hospital data, we find increased prescribing of Traditional Chinese Medicine (TCM) decoction pieces, with effects concentrated among habitual prescribers rather than converting occasional users into regular prescribers. Physicians also reduced both the number of drugs prescribed and the volume of services provided to cost-sharing outpatients, producing a 5% decline in average insurance payments per outpatient visit and potentially generating a greater surplus within the global-budget pool. By contrast, we observe no significant changes for self-paying outpatients, suggesting limited scope for physician-induced demand. These results underscore the role of physician agency in healthcare provision and highlight the importance of aligning financial incentives with policy goals. While drug reforms and managed-care models have contained expenditures, challenges remain in achieving adequate coverage for rural residents.

The pricing of new drugs plays a critical role in patient access by influencing where and when pharmaceutical companies choose to launch their products. The United States (US) operates a predominantly market-based pricing system, in which pharmaceutical companies set and manage drug prices under private health insurance. In contrast, Japan has a government-regulated drug pricing system under its National Health Insurance (NHI). On average, drug prices in the US are 3.2 times higher than those in Japan. The US system facilitates faster patient access to new drugs through rapid market entry, whereas market entry in Japan has often been delayed. To address this issue, the Japanese government introduced the Rapid Introduction Premium in April 2024, aiming to promote earlier launches of new drugs by narrowing the price gap with higher-priced markets such as the US. In this review, we provide an overview of the new drug pricing framework associated with the Rapid Introduction Premium.

Background and objective: In recent years, spending on orphan drugs in Italy has seen a significant rise. The analysis aims to estimate future spending for medicines for rare diseases (RDs) in Italy.

Methods: A forecasting model was developed over a three-year time frame. New drugs were selected according to specific criteria, using Biomedtracker and clinical trial databases. For each therapeutic indication, comparators were identified to estimate the average cost per patient. Overall expenditure was projected by applying prevalence data to the eligible population, and considering expected drug uptake trends over the study period. Additionally, a deterministic sensitivity analysis was performed to assess the influence of price fluctuations on total pharmaceutical spending.

Results: Overall, a total of 137 pipeline drugs for RDs were identified, covering 74 indications. The model estimated a total spending on RD treatments equal to €2.08 billion in 2024, corresponding to an average cost of €24,777 per patient. The projection indicates an increase by 1.9% in 2025, 4.0% in 2026, and 7.1% in 2027 compared to 2024. Focusing on orphan designation drugs (n = 115), the 2024 expenditure was estimated at €1.93 billion, with an average patient cost of €22,984. The introduction of new orphan drugs is expected to drive further increases in spending by 1.1% in 2025, 2.2% in 2026, and 3.7% in 2027.

Conclusions: The results underscore the growing financial impact of orphan drugs on Italy's healthcare budget. This analysis offers a quantitative projection of the resources required to ensure continued access to innovative therapies for RDs.

Background: Currently, the Indonesian National Health Insurance (NHI) covers over 90% of the population. However, around 18% of the enrolees are inactive, failing to pay premiums regularly, with proportions varying across membership types. This situation could impede access to health services and influence overall enrolees' health. This study seeks to assess the ability and willingness to pay, and to identify the factors influencing them among informal workers in relation to compliance and commitment to NHI premium payments.

Methods: This nation-wide survey covered fifteen districts and 4,059 respondents, examining the ability to pay and willingness to pay among informal sector workers under the NHI scheme. Willingness to pay was calculated using a bidding game, while ability to pay was calculated as 5% of disposable income, using household expenditure as a proxy for income. Logistic regression was used to explore factors influencing compliance. Variables of interest included household expenditure, membership class, regional area, payment commitment, risk aversion, and out-of-pocket expenses, while control variables comprised demographic characteristics, family medical history, healthcare utilisation, and satisfaction rate.

Results: The ability to pay the premium among enrolees was generally below the current premium level, except for active enrolees in the third class. While active enrolees expressed a willingness to pay about 10% more than the existing premium, inactive enrolees were only willing to pay about 50% of it. Compliance to pay the premium was influenced by non-food and tobacco expenditures, willingness to pay, risk aversion, catastrophic illness, healthcare utilization, size of household members, and patient satisfaction. Additional factors positively influencing compliance included food and non-food expenditures, NHI literacy, and enrolee class. CONCLUSION AND RECOMMENDATION: To enhance health care access, policy efforts must address the disparity between current premium levels and informal sector workers' financial capacity and willingness to pay. Given constrained government budgets, cross-sector collaboration is necessary to support stable incomes for these workers. Furthermore, strategies that foster risk awareness and payment commitment, through targeted outreach and improved health insurance literacy, may enhance long-term compliance and coverage.

Background: Faecal microbiota transplantation (FMT) for recurrent Clostridioides difficile infection (CDI) is used in less than 10% of the patients in Europe who meet the indication. Encapsulated FMT allows increased use for CDI because capsules can be safely shipped to local healthcare facilities and administered orally to patients without use of e.g. colonoscopy. The aim of this study was to calculate and compare the costs of alternative ways of delivering encapsulated FMT to patients with CDI in Denmark, including outpatient treatment at a specialised FMT centre, outpatient treatment at local hospitals including remote delivery to the Faroe Islands, and home-based care.

Methods: Applying a healthcare perspective, we used an activity-based costing approach, combining data from a pragmatic clinical randomised trial with the best available literature and expert input. Only relevant costs were included. The main outcome was the average cost of delivering outpatient, encapsulated FMT treatment at an FMT centre, at a local hospital, or in the patient's home, only including additional costs related to delivery. An 8-week time horizon was applied for the analysis. Probabilistic and deterministic sensitivity analyses were applied to evaluate decision uncertainty and the robustness of the results.

Results: In a pragmatic randomised trial including 217 patients with CDI, 135 patients received FMT. Analysing relevant costs in a base case analysis, local outpatient treatment (€145) was cost-saving compared with both treatment at the FMT centre (€209) and home-based treatment (€353). These differences remained robust across sensitivity analyses, including those accounting for patients' time costs. In the Faroe Islands case, shipment to remote locations added an average cost of €54 per FMT to the cost for the local outpatient treatment.

Conclusion: Capsule-based FMT treatment has made it clinically and economically feasible to administer FMT in contextual settings outside of specialised hospitals. Our findings highlight the importance of local hospital-based treatment for increasing patient access to FMT, the ability to ship FMT to remote locations lacking a FMT centre, and the option of home-based treatment for a selected group of patients who may not tolerate transport to hospital.

Background: Improving efficiency is one of the high-potential options for expanding fiscal space for health. During the pandemic, as health systems' financial challenges intensify, the importance of utilizing resources efficiently also increases. Therefore, this study was conducted to estimate the efficiency of Iran's public hospitals in treating COVID-19 inpatient cases.

Methods: This descriptive-analytical study was based on administrative claims data from the Iran Health Insurance Organization and included 439,327 COVID-19 inpatient cases across 493 public hospitals in 2021. Epidemic waves were first identified using time-series data on daily admissions, and each patient was assigned to the corresponding wave. A logistic regression model was then fitted to estimate the probability of death based on age, sex, ICU admission, and epidemic wave. From this, a risk-adjusted survival variable (RA_surv) was calculated at the individual level and subsequently aggregated at the hospital level. Hospital efficiency was assessed using input-oriented data envelopment analysis (DEA) under variable returns to scale, with total inpatient billed charges for COVID-19 as the input and RA_surv as the output. Finally, to account for structural and contextual differences, DEA efficiency scores were adjusted using a fractional logit regression model that incorporated teaching status, specialty type, hospital size, and province fixed effects.

Results: The mean of per-patient charge for COVID-19 treatment was estimated at USD 236.46 (SD = 234.48; median = 185.73), and the mean daily hospital charge was USD 46.34 (SD = 26.41; median = 41.62). These figures varied considerably across provinces, with the highest per-patient charge observed in Tehran (USD 364.98) and the lowest in South Khorasan (USD 171.37). Overall hospital efficiency scores before contextual factors adjustment ranged from 0.083 to 1.00. After adjustment, the national mean remained 0.49, although the distribution and ranking of hospitals shifted. A strong positive correlation was found between non-adjusted and adjusted efficiency scores (Spearman's rho = 0.707, p < 0.001).

Conclusion: This study indicated significant variation in hospital charges in COVID-19 inpatient bills in Iran's public hospitals, and there was a relatively significant potential to save resources during the financial difficulties of Iran's health system during the pandemic. Adopting appropriate strategies to reduce variation in clinical practice, for example, promoting the use of clinical guidelines, can significantly help reduce variation in hospital charges and subsequently improve the system's efficiency.