Health Economics Review最新文献

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.

Background: The goal of this study is to estimate the association between hospital system market share and negotiated prices. Hospital system consolidation has led to many highly concentrated markets where systems can leverage their market share to negotiate higher commercial prices. Recently, the Centers for Medicare & Medicaid Services, under its Transparency in Coverage initiative, required health insurers to release all negotiated commercial prices, providing, for the first time, publicly available, nationally representative data on commercial rates. We utilize this newly available data on negotiated prices of healthcare services to show that a hospital with 10% higher market share charges 880-1,180 more per admission.

Study design: We used commercial price data for national networks of three large, national insurers and performed a linear regression based on more than 1.3 million negotiated rates across 1,784 hospitals to estimate the association between a hospital's system-level market share and commercial negotiated rates, adjusting for service (DRG), health system, and area level time-invariant characteristics.

Results: We find that a one percentage point increase in hospital system market share is associated with an $88 to $118 higher negotiated rate per admission. All else equal, a hospital that is part of a system with a 10-percentage point higher market share can expect from $880 to $1,180 more per admission relative to a hospital with lower system market share (5.4% to 6.2% of the median price).

Conclusion: These findings confirm that higher hospital system market share is strongly associated with higher commercial negotiated prices and should aid policymakers and decisionmakers in assessing the impact of various policy options aimed at reducing provider consolidation in the healthcare market.

Trial registration: Not applicable.

Background: Healthcare-associated infections (HCAI) are common in long-term care facilities (LTCF) and cause significant burden. Infection prevention and control (IPC) measures include the clinical best practices (CBP) of hand hygiene, hygiene and sanitation, screening, and basic and additional precautions. Few studies demonstrate their cost-effectiveness in LTCF, and those that do, largely focus on one CBP. An overarching synthesis of IPC economic analyses in this context is warranted. The aim of this paper is to conduct a systematic review of economic evaluations of CBP applied in LTCF.

Methods: We twice queried CINAHL, Cochrane, EconLit, Embase, Medline, Web of Science and Scopus for studies published in the last three decades of economic evaluations of CBP in LTCF. We included controlled and randomized clinical trials, cohort, longitudinal, follow-up, prospective, retrospective, cross-sectional, and simulations studies, as well as those based on mathematical or statistical modelling. Two reviewers conducted study selection, data extraction, and quality assessment of studies. We applied discounting rates of 3%, 5% and 8%, and presented all costs in 2022 Canadian dollars. The protocol of this review was registered with Research Registry (reviewregistry1210) and published in BMC Systematic Reviews.

Findings: We found 3,331 records and then 822 records; ten studies were retained. The economic analyses described were cost-minimization (n = 1), cost-benefit (n = 1), cost-savings (n = 2), cost-utility (n = 2) and cost-effectiveness which included cost-utility and cost-benefit analyses (n = 4). Four studies were high quality, three were moderate, and three were low quality. Inter-rater agreement for quality assessment was 91⋅7%. All studies (n = 10) demonstrated that CBP associated with IPC are clinically effective in LTCF and many (n = 6) demonstrated their cost effectiveness.

Interpretation: Ongoing economic evaluation research of IPC remains essential to underpin healthcare policy choices guided by empirical evidence for LTCF residents and staff.

Background: Acute stroke treatment is time-critical. To provide qualified stroke care in areas without 24/7 availability of a stroke neurologist, the concept of teleneurology was established, which is based on remote video communication through telemedicine organized by telestroke networks. Data on the effectiveness and efficiency of stroke treatment via teleneurology is very scarce and is therefore partly questioned in the healthcare sector. The aim was to evaluate stroke care in hospitals with and without teleneurology in Northern Germany.

Methods: We conducted a retrospective case-control data analysis using health insurance claims data for the years 2018 to 2021. Based on pre-defined criteria, two models were defined and clinical as well as health economic parameters were compared. In model 1, we compared patients from hospitals with and without support by a telestroke network, while in model 2, we compared patients from hospitals with and without support by a telestroke network, including only districts without a certified stroke unit. Assessed parameters were age, length of stay, patients' comorbidities, inpatient costs, reasons for discharge, qualified stroke care treatment according to operation and procedure codes (OPS) and intravenous thrombolysis (IVT) rates.

Results: Hospitals supported by a telestroke network improved their rate of stroke care according to OPS and increased more than three-fold their IVT rate (p = 0.042). In comparison, patients from hospitals with support by a telestroke network had a higher number and rate of qualified stroke care according to OPS (model 1: 73.6% vs 2.2%, p < 0.001 and model 2: 57.0% vs 3.8%, p < 0.001), higher rate of IVT (model 1: 9.5% vs. 0.0%, p = 0.027 and model 2: 10.3% vs 0.0%, p = 0.056) and a lower rate of secondary transfers to another hospital (model 1: 5.9% vs. 28.9%, p < 0.001 and model 2: 5.6% vs 30.1%, p < 0.001). Inpatient costs were lower in cases treated in hospitals with support by a telestroke network (model 1: 4,476€ vs. 5,549€, p = 0.03 and model 2: 4,374€ vs. 5,309€, p = 0.02). In multivariate analysis costs were independently associated with length of stay and patient transfer to another hospital but not with support by a telestroke network.

Conclusion: Hospitals with support by a telestroke network are associated with improved qualified stroke care resulting in higher rates of IVT and stroke care according to OPS codes as well as lower rates of onward transfers. Costs per patient were independently associated with transfer rates and length of hospital stay.

Background & aim: Hepatitis B is globally recognized as a major public health problem that imposes a huge economic burden on society. China is a major country with hepatitis B infection; however, an updated overview of the economic burden of hepatitis B and related diseases in China has not been provided. This study aimed to provide a comprehensive understanding of the economic burden and factors influencing hepatitis B and related diseases by synthesizing the available evidence, with the aim of informing clinical treatment and health decisions.

Methods: Two researchers systematically searched relevant literature published in PubMed, Web of Science, China Knowledge Network, Wanfang Database, and Vip Database from 2002 to 2022, and conducted title and abstract reviews according to the PRISMA guidelines for the development of nerfing criteria, as well as quality evaluation of the included literature.

Results: Thirty-three studies were included in the literature. The quality of the included literature was average, with the majority being individual studies and a few group studies, which showed that the annual economic burden per capita of hepatitis B-related diseases was 92,978.34 RMB, with a high proportion of direct and hidden costs, and a large disparity in economic burden between related diseases, with the greatest burden for primary hepatocellular carcinoma and the smallest burden for acute hepatitis B. The study found that the main factors affecting the cost of disease were sex, age, occupational classification, place of residence, health insurance conditions, hospital class, length of hospitalization, use of antiviral drugs, comorbidities, and complications.

Conclusion: Hepatitis B has caused a huge economic burden on Chinese society, and hidden costs also respond to a great psychological burden on patients and their families. Based on existing studies, there is an urgent need for high-quality, multicenter, population-level studies to inform clinical treatment and health policy decisions.

Background: The health of migrants and refugees is a key component in achieving Universal Health Coverage (UHC). This paper aims to assess the scale of financing mobilized by the Moroccan government for migrants and refugees health, and addressing health issues related to these populations within the ongoing health reforms.

Methods: The primary objective of this study was to estimate the financial resources allocated by the government for migrants' and refugees' healthcare. A bottom-up approach was used to assess the unit costs of all services provided across five primary healthcare (PHC) centers and three hospitals in two regions of Morocco. A detailed costing methodology was applied, accounting for all cost components at the health facility level, including depreciation of capital assets. By combining unit costs and service volumes, we estimated the total government expenditure on healthcare for migrants and refugees. As the free service provision shifts to a third-party payment system with the expansion of health insurance, this financing must be accounted for. To better prepare for future contracting, we also calculated the disease-specific costs for migrants and refugees using activity-based costing (ABC) methods, which allowed us to develop a database of costs per disease associated with migrant and refugee healthcare. Data from 2022 were used for the analysis.

Results: The study found that the government mobilizes approximately 5% of its total annual primary healthcare budget for migrants and refugees, amounting to $141,652.66. For secondary-level care, the cost was $184,921.92 (3% of total hospital costs) for one hospital, $46,778.20 (0.37% of the total cost) for a second hospital, and $78,193.53 for a teaching hospital. These findings are crucial for informing the development of alternative financing mechanisms following the expansion of health insurance coverage, with the cost per pathology serving as a foundation for designing these mechanisms.

Conclusion: The study also highlighted that hospitals across different levels of care manage costly diseases, further underscoring the importance of government investment in migrant and refugee healthcare. The nondiscriminatory access to healthcare services and the model of care established in Morocco could serve as a foundation for developing sustainable healthcare financing models for migrants and refugees.

Background: The incomplete immunization has potentially exposed vulnerable children, especially from the socioeconomically disadvantage group, to vaccine preventable diseases. The schemes would maximize social benefit only when the immunization is effectively distributed on an equitable principle.

Method: The empirical study is based on unit level data from India's National Sample Survey: "Social Consumption: Health Survey- NSS 75th Round (2017-18) database. The nationwide survey is designed on the stratified multi-stage sampling method with an objective to make the sample representative. The egalitarian equity principle requires that distribution of vaccine should be based on health needs of children, irrespective of their socioeconomic and regional factors and the principle is broadly based on two aspects - horizontal and vertical equity. The horizontal inequity (HI) is a direct form of injustice, when children with equal needs of routine immunisation are treated differentially due to their socioeconomic status, while vertical inequity (VI) is indirect form of injustice when children with differential health needs and risks exposure do not receive appropriately unequal but equitable immunisation. Using Indirect Standardisation Method and Erreygers' Corrected Concentration Index, we measure the degree of horizontal and vertical inequities, and then linearly decompose them to identify the major factors contributing towards the respective indices.

Conclusion: Our findings show that incomplete immunization is significantly concentrated among children belonging to poorer households. After controlling for the confounding effects of need factors, the inequity is still significantly pro-poor (i.e., horizontal inequity). The decomposition reveals that lower education, lower consumption and rural habitation are the major factors driving the corresponding inequity. Further, the differential effect of the needs between all and the target groups (at least based on education), is observed, however, is not statistically significant enough to realize inequity (i.e., no vertical inequity). Overall, the inequity is being induced via non-need factors. We further find that community health services (like anganwadi) have contributed towards reducing the inequity in child immunization significantly. The paper highlights the policy recommendation that the child immunisation program should target factors driving HI and need to align their distribution in terms of risks exposures.

Background: In this paper, we propose a novel model that allows us to understand the effect of hospital readmissions on technology and costs. To do this, we consider that hospitals may experience heterogeneous discharges: on the one hand, discharges corresponding to patients who have completed their healing process in hospital and, on the other hand, discharges resulting from patients who have been discharged too early and are therefore required to be readmitted to hospital. In the first case, discharges involve more resources; in the second case, the patient returns implying an additional use of resources. In tandem, two new issues arise which need to be addressed: a) Does a trade-off exist between the decision to discharge at the finalisation of fully completed treatment or the decision to discharge taken at an earlier stage; b) Readmissions may prove endogenous and if so, their econometric treatment must be considered in order to obtain unbiased results. Our study contributes to the literature by proposing a novel model which estimates the marginal cost of readmissions, thus allowing us to understand the effect of readmission on technology and hospital costs.

Methods: To resolve the foregoing concerns, this paper proposes a theoretical and empirical model based on the dual theory, which combines cost and input-oriented distance functions to obtain the marginal cost of readmissions. Our empirical application uses a panel of Spanish public hospitals observed over the period 2002-2016.

Results: Results indicate that the treatment required by a patient who is readmitted proves more expensive than keeping the patient under observation for a few extra days in order to achieve a definitive discharge. Moreover, this additional cost follows an increasing temporal trend, especially in times of expansion when the availability of resources is greater.

Conclusions: Given that the results indicate that readmissions imply an additional cost for the hospital system, they must be contained. In fact, readmission rates are a significant component of current hospital sector activity improvement strategies. Therefore, knowing the cost which readmission implies is relevant for the design of policies that seek to penalize those hospitals with high readmission rates.