Health Economics Review最新文献

Background: Performance evaluation is a critical aspect of managing organizations, especially in the healthcare sector, where financial and resource management have direct implications on public health. The Iran Health Insurance Organization (IHIO), responsible for covering over half of the Iranian population, faces challenges due to rising healthcare costs and international sanctions. This study focuses on identifying performance evaluation indicators for the IHIO, aiming to provide a systematic framework to assess the organization's efficiency and accountability, aligning with the national health policies of Iran.

Methods: This study employed a multi-method approach, including content analysis, scoping review, and expert consensus, and was conducted in four phases: (1) content analysis of policies, (2) scoping review of the literature, (3) pooling and screening of indicators, and (4) development of indicator metadata. The content analysis involved examining legal documents and policies governing IHIO from 1994 to 2024. A scoping review was conducted using keywords related to health insurance evaluation, and 40 relevant studies were selected from international databases. The indicators were screened in three round through expert panels and the Delphi method, focusing on technical competence, feasibility, and coherence. The indicators were prioritized and detailed metadata profiles were created for each.

Results: A total of 544 performance evaluation indicators were initially identified. After the first screening, 339 indicators were excluded, leaving 205 indicators classified into 12 thematic areas. Subsequent screening phases further refined this list to 78 indicators, of which 26 were ultimately prioritized based on their relevance to the IHIO's performance. Among these, the "Percentage of the Population Covered by the Health Insurance Organization" emerged as the highest-priority indicator, demonstrating exceptional technical competence and coherence. These findings underscore the critical role of transparent reporting and strategic resource management in improving performance and promoting equity in Iran's health insurance coverage.

Conclusion: The study successfully identified 26 key performance indicators for evaluating IHIO, highlighting the importance of insurance coverage and financial management. Strengthening collaboration with healthcare providers and improving transparency will enhance public trust and improve the organization's performance and productivity. The findings emphasize the need for strategic collaboration between IHIO and healthcare providers and suggest improving resource allocation and policy implementation for better healthcare outcomes in Iran.

Vaccines are widely acknowledged as one of the most efficient and effective strategies for preventing diseases. This study, based on two waves of public survey data and complemented by incentivized experiments, investigates how behavioral preferences shape actual decisions to receive COVID-19 vaccinations. By combining these methods, the research aims to enhance both internal and external validity. Our findings indicate that individuals with elevated levels of prosociality show a greater propensity to receive the initial dose of the vaccine, a pattern that holds across both the general public and university students. In contrast, parental decisions regarding child vaccination are significantly associated with greater risk taking and lower omission bias, but not with prosocial preferences.

Background: The gluten-free diet (GFD) has gained interest in recent years. While evidence showing that the GFD has a positive impact on everybody's health is weak, people with specific gluten-related disorders may benefit from it. As the only available treatment for celiac disease, the GDF can however not be followed without any additional cost.

Method: To measure it, we collected a rich database of gluten-free and gluten-containing products on the Swiss retail market. Using a hedonic pricing method, we disentangled the price of these products and estimated the gluten-free premium.

Results: We show that gluten-free products are on average 79% more expensive than regular products, which leads to an annual food-budget increase of CHF 421 (approx. the same in USD) (+ 77%) per patient.

Conclusion: These results highlight the need to reflect on the social policies accompanying celiac disease in Switzerland, as there is currently no support from the disability or health insurance for these patients.

Background: In Ethiopia, limited use of long-acting reversible contraceptives (LARCs) contributes to unintended pregnancies, unsafe abortions, and preventable maternal deaths. Despite their proven effectiveness, LARCs remain underutilized. Evidence on women's preferences and willingness to pay (WTP) is scarce. This study examined women's stated preferences, WTP, and trade-offs regarding LARC use in Gondar.

Methods: An institution-based cross-sectional study was conducted among 344 contraceptive users, generating 8,256 observations. A discrete choice experiment (DCE) with 24 choice tasks, divided into two blocks, was employed. Each task presented two unlabeled alternatives defined by six key attributes, identified through literature review and expert consultation. Data were analyzed using mixed logit models to estimate preference strength and WTP based on model coefficients.

Results: The analysis revealed that provider type significantly influenced women's preferences. Women showed the highest WTP for LARCs provided by midwives [528 ETB (10.15 USD)], compared to services offered by doctors [285 ETB (5.48 USD)] and health officers [215 ETB (4.13 USD)]. Preferences were also shaped by side-effect profiles: methods associated with slight weight gain [155 ETB (2.98 USD)], high effectiveness [80 ETB (1.54 USD)], and absence of bleeding [74 ETB (1.43 USD)] were positively valued. Conversely, heavy menstrual bleeding led to the largest reduction in WTP [-688 ETB (-13.24 USD)], indicating a significant barrier to LARC uptake. Longer-acting methods also reduced WTP [-139 ETB (-2.68 USD)], possibly reflecting concerns about long-term commitment or side effects. Cost sensitivity was evident, as increases of 100 ETB (1.92 USD) or 500 ETB (9.92 USD) further reduced uptake likelihood.

Conclusion: Women's preferences for LARCs are influenced by provider type, side effects, and cost. Enhancing LARC services by prioritizing midwife-led delivery, addressing side effects such as heavy menstrual bleeding, and considering women's WTP can increase uptake. These findings highlight the need for affordable, user-centered contraceptive services in Ethiopia.

Background: Head and neck cancer (HNC) caused substantial morbidity and mortality. Despite advances in treatment modalities, the evolving burden and risk factor profiles of head and neck cancer may contribute to escalating health inequalities. The primary objective of this study is to quantitatively evaluate the degree of SDI-related health inequalities in head and neck cancer and to analyze the evolution of these health inequality trends between 1992 and 2021.

Methods: Using Global Burden of Disease 2021 data, we extracted disability-adjusted life years (DALYs), DALY rates and age-standardized DALY rates (ASDR) for HNC and its five subtypes across 204 countries/territories (1992-2021). Temporal trends stratified by sex and Sociodemographic Index (SDI) levels were assessed using estimated annual percentage change (EAPC) modeling. Socioeconomic health inequalities were further measured through complementary metrics: the Slope Index of Inequality (SII) and Concentration Index (CIX).

Results: From 1992 to 2021, the global ASDR for HNC declined from 228.1 to 179.37 per 100,000 (EAPC: -0.95, 95% CI: -1.05 to -0.84). The low-middle SDI region exhibited the highest ASDR (294.46 per 100,000), while the high SDI region recorded the lowest ASDR (107.97 per 100,000). The CIX indicated a progressive deterioration, decreasing from - 0.11 (95% CI: -0.15 to -0.08). in 1992 to -0.16 (95% CI: -0.22 to -0.11) in 2021. The inequality was particularly pronounced among females, where CIX values decreased from - 0.21 (95% CI: -0.25 to -0.17) to -0.24 (95% CI: -0.30 to -0.17) during the same period, consistently remaining at a relatively high level.

Conclusion: The persistent and widening inequalities in HNC, particularly those affecting females and low SDI regions, call for equitable global governance. particularly affecting females and low-SDI regions, necessitate equitable global governance. Addressing this issue necessitates the establishment of robust data systems, the implementation of gender- and region-specific interventions, the bridging of technological and resource gaps, and enhanced cross-sectoral collaboration. This integrated approach is essential for disrupting the low-SDI/high-burden cycle and promoting health equity as a fundamental right.

Background: The COVID-19 pandemic, declared in March 2020, caused significant morbidity and mortality globally. This study aims to estimate the costs associated with managing COVID-19 infected patients in Regina.

Method: The study focuses on the direct and indirect healthcare costs of managing a COVID-19 case. Costing elements included are diagnostic, public health, inpatient and outpatient management costs. The costing analysis estimates the total cost of COVID-19 case management in Regina, the average cost per case based on disease severity, and the costs for diagnostics, public health management, and clinical areas.

Results: Severe cases, representing 1.3% of cases, accounted for a quarter of the total cost of illness, while moderate cases (1.8%) contributed to less than 5% of the overall cost. Mild cases (96.9%) were responsible for three-quarters of the associated illness costs. Over two years, approximately $85 million was spent on the care of 28,733 cases, primarily due to hospitalization costs. Annual per-patient expenses increased from $45 in 2020 to $183 in 2021, reflecting a higher case burden and greater health care utilization. Furthermore, the Omicron variant accounted for 44% of the disease burden and 36% of the illness costs. Patients older than 80 accounted for 10% of illness costs, while children aged less than 18 accounted for about 17%.

Conclusion: The primary costs were human resources and hospitalizations for older individuals, significantly impacting the Saskatchewan Health Authority's budget due to the pandemic. This analysis does not fully capture the effects in Regina.

Introduction: Corruption is a major factor that influences health seeking behaviour. However, there is paucity of empirical evidence from research on how corruption affects different population groups when they seek healthcare services from formal healthcare facilities. The paper presents new evidence on how informal payments, which is a major form of corruption, affect health-seeking behaviour people and how household economic status has sustained it in Nigeria.

Methods: We used a pre-tested interviewer-administered questionnaire to conduct interviews in 1,652 households in Enugu and Kano states, in the south and north of Nigeria, respectively. Descriptive statistics was used to estimate household health-seeking behaviour and Ordinary Least Square, binary logistic and multinomial logistic regression analyses to assess how experience of informal payment and economic status (quintiles: extremely poor, poor, average, rich, extremely rich quintiles) affect household health-seeking behaviour.

Results: Poorer households were most likely to attend health posts and health centres, while extremely rich households disproportionately used hospitals (59%). Household economic status determines the likelihood of paying informally, with richer ones paying more (p < 0.05). Household size, age of the patient, sex, years spent on formal education and state were other identified determinants of informal payments. Experience of informal payment in public facilities significantly reduces household use of tertiary hospitals compared to primary health centres or health posts by 58% (p < 0.05). The choice of tertiary hospital compared to a primary health centre or health post is significantly reduced by 31% because of informal payments (p < 0.01).

Conclusion: Informal payments in public facilities negatively affect health seeking, driving the poorest households to use low-quality care services. This problem needs to be widely recognised and sufficiently tackled in order for the country to reduce the economic burden of health seeking and achieve equitable access and utilisation of high-quality health services.

Objective: The main purpose of this study is to examine the effects of health expenditures and wealth on cancer treatment success in European countries. Cervical cancer data were used for this purpose.

Methods: Cervical cancer incidence/death rate (CANCER), Gross Domestic Product per capita (GDPP) and Current health expenditure (HEXP) were included as predictors. Cancer data was obtained from WHO European Data Warehouse while health expenditure and wealth datas were obtained from World Bank Development Indicators. Panel regression models, panel ARDL cointegration analysis and Dumitrescu-Hurlin causality analysis were used to define the existence of a statistical relationship between variables.

Results: The result obtained in the model shows the existence of a positive relationship between cervical cancer and all independent variables (health expenditures and wealth). While cervical cancer treatment success in the European countries is highly sensitive to health expenditure, the effect of wealth on cervical cancer is very weak. According to the findings of the causality analysis, a unidirectional causal relationship from HEXP to CANCER and a unidirectional causal relationship from GDPP to CANCER was determined in analysis. So, independent variables in the model are the cause of cervical cancer.

Conclusion: This study provides important evidence for policy makers to allocate relevant and economic resources to healthcare services to succeed in cervical cancer. The determination that health expenditures have a positive effect on the treatment of cervical cancer provides a clue that more efforts should be made regarding the economic accessibility of health services in european countries.

Objective: This study examines the incidence, intensity, and inequality of catastrophic health expenditure (CHE) among households with hypertension and type 2 diabetes mellitus (T2DM) in cold regions of China. It also explores key drivers of CHE and compares across diseases.

Methods: Using data from the 2023 Seventh Health Services Survey in Heilongjiang Province, this study applies the World Health Organization's (WHO) normative algorithm for basic food needs to analyze CHE incidence, average gap (G_cat), and mean positive gap (MPG) in 1,051 hypertension households and 294 T2DM households. The concentration curve and concentration index (CI) are used to quantify CHE inequality. Key drivers of CHE are analyzed through univariate analysis, Logistic regression, and Tobit regression models.

Results: The CHE incidence for hypertension and T2DM households were 31.11% and 34.69%, respectively. The G_cat was 6.38% for hypertension households and 7.02% for T2DM households, while the MPG was 20.51% and 20.24%, respectively. The CI for hypertension and T2DM households were - 0.2541 and - 0.2762. CHE decreased as economic status improved but increased with the number of chronic conditions. Under different CHE thresholds, the incidence and G_cat of CHE in T2DM households are generally higher than in hypertension households, but the MPG in hypertension households is slightly higher than in T2DM households. Determinant analysis revealed that low household economic status, multiple chronic conditions, and utilization of outpatient and inpatient services are significant drivers of CHE in chronic disease households, while being employed and having a larger household size are important protective factors.

Conclusion: Households with hypertension and T2DM in cold regions of China face a high risk of CHE, particularly among those with lower economic status. There is a pressing need for a more equitable healthcare financing system and improved management of chronic diseases in these populations.

Background: Obesity is a chronic condition with significant health and economic impact worldwide. While conventional treatments, including dietary changes, lifestyle modifications, and non-targeted pharmacotherapy, are widely used, their long-term effectiveness in sustaining weight loss remains limited. Metabolic and bariatric surgery has shown superior clinical benefits, including comorbidity remission and increased life expectancy, but its initial cost raises concerns about its economic viability compared to non-surgical treatments. Therefore, this study assesses the long-term cost-effectiveness of bariatric surgery versus conventional treatment, considering health outcomes and economic impact within the Portuguese healthcare.

Methods: The patient journey was mapped based on clinical guidelines and adapted to the Portuguese context via stakeholder interviews. Obesity prevalence and associated comorbidities were estimated using epidemiological data. A Markov model was created to simulate obesity progression over ten, twenty years, and lifetime horizons, using monthly cycles. The model accounts for weight regain, complications, and different health states, including obesity with diabetes, cardiovascular diseases, stroke, cancer, and death. It was implemented in R Studio using heemod package. Direct healthcare costs and health outcomes were calculated. A probabilistic sensitivity analysis (PSA), with 500 iterations, was conducted to assess uncertainty.

Results: The results demonstrate that bariatric surgery, compared to conventional treatment, enhances life expectancy, quality-adjusted life years (QALYs), and reduces obesity-related comorbidities. Over 10 years, surgery yields 6 QALYs to each patient costing 9243€, compared to 4.9 QALYs and a cost of 6328€ for the non-surgical arm. The cost-effectiveness analysis shows that, despite higher initial costs, bariatric surgery is cost-effective over time. The incremental cost per QALY gained is estimated at 2756€, positioning bariatric surgery as an economically advantageous intervention at commonly accepted willingness-to-pat thresholds (WTP). After 20 years, this strategy emerges as dominant, improving health outcomes while reducing overall costs. On the lifetime horizon, surgical patients gain 7 additional QALYs and cost 4534€ less than non-surgical patients. PSA shows that the cost-effectiveness of this strategy is maintained.

Conclusion: The analysis suggests that surgery is an effective strategy to improve outcomes and managing expenses. Future research should refine the model exploring upcoming treatment strategies as additional evidence on its outcomes becomes available.