European Journal of Health Economics最新文献

We study the effect of education on health (hospital stays, number of diagnosed conditions, poor or bad self-rated health, and body mass index) over the life cycle, using German compulsory schooling reforms as a source of exogenous variation. Our results show clear correlations between educational attainment and better health across all age groups (30 to 74). However, we do not find causal relationships between additional schooling and health or health care utilization, neither earlier nor later in life. A simulated ex-post power analysis shows that this is not due to a lack of statistical power. One reason for the absence of effects may be that the studied compulsory schooling reforms succeeded in raising the educational attainment of the target group - individuals at the lowest educational margin - but did not lead to healthier employment opportunities.

Introduction: Value sets for the EQ-5D-3L have been developed since the 1990's, using methods that are now considered outdated. The Dutch EQ-5D-3L value set was developed using data collected in 2003, and population's preferences may have shifted over time. Consequently, the existing value set may no longer accurately represent the preferences of the Dutch general population. This study aims to develop a new EQ-5D-3L value set using state-of-the-art methods and compare it with the existing value set.

Methods: A nationally representative sample of 417 Dutch adults, stratified by age and sex, completed 12 composite time trade-off (cTTO) tasks via online EuroQol Valuation Technology interviews. The data were modelled using a Tobit model that accounts for heteroskedasticity and the censored nature of cTTO data. Agreement between the new and existing value set was assessed using Bland-Altman and scatter plots.

Results: Pain/discomfort and mobility were the most important dimensions in the new value set, whereas pain/discomfort and anxiety/depression were most important in the existing value set. The lowest health state value was - 0.723, considerably lower than the - 0.329 of the existing value set. The Bland-Altman and scatter plots indicated limited agreement between the two value sets.

Conclusion: The new Dutch EQ-5D-3L value set differs substantially from the existing value set. We recommend its adoption and replacement of the previous value set. Our findings suggest that other countries with older value sets should consider similar updates to ensure accurate representation of contemporary societal preferences.

Postponements of non-acute care during the COVID-19 pandemic commonly raised concerns about harmful health consequences and increased healthcare costs, particularly among older individuals. Using nationwide register data from Finland, we employ a regression discontinuity design to examine the effect of an age-specific stay-at-home recommendation on healthcare utilization during the first wave of the pandemic. We find that the recommendation reduced non-acute visits, such as dental care, physiotherapy, and specialized care visits, but had no effect on acute care use, including emergency department visits or inpatient stays. The reductions in dental care use were partly compensated for after the lockdown was lifted, but not in other non-acute services. Additionally, we find indicative evidence of a slight increase in mortality during the three-months post-period after the lockdown. Our findings suggest that a Scandinavian-type social distancing recommendation targeting the elderly may reduce non-acute healthcare use in the short term, thereby temporarily alleviating pressure on healthcare resources during a pandemic. However, the absence of rebound in some non-acute services highlight potential unmet needs, which may imply longer-term risks of functional decline, preventable hospitalizations, and associated healthcare costs. These findings point to the importance of policies that ensure continued access to essential non-acute care for older populations.

Objectives: Methodological approaches for incorporating the external effects resulting from climate impacts into health economic evaluation (HEE) are a vivid field of research. Combining established standards for reporting HEE and climate footprints (CF), our aim is to develop a structured list of points to consider for reporting full HEE that combines the two methodologies, referred to as climate-extended HEE METHODS: We mapped a transparency catalogue with methodological items for estimating CF to the reporting items described in the Consolidated Health Economic Evaluation Reporting Standards (CHEERS). We identified synergies and developed a proposal of methodological points to report for climate-extended HEE, structured by the CHEERS items. The proposal was validated using three published climate-extended HEEs and a hypothetical case study..

Results: We proposed extensions to 18 reporting items of CHEERS, for example, adding more detail to the measurement and valuation of resources and costs to facilitate a process- or cost-based estimation of CF. Using three identified publications and a hypothetical case study, examples on how all items could be addressed are provided, including a presentation of climate-extended versions of the standard summary measures of HEE.

Conclusions: The proposed catalogue can be used for reporting and reviewing climate-extended HEEs. Further work is necessary to include planetary boundaries beyond climate change. Future steps could be, first, to develop a reporting standard within a formal Delphi process of all relevant stakeholders. Second, the catalogue can be used to develop standards of analytic choices for specific decision makers or problems.

Mental illnesses impose substantial burdens on individuals, families, and society, encompassing both severe personal consequences and high societal costs. This study examines whether improved continuity of care with regular general practitioners (RGP-CoC) is associated with better labour market outcomes for individuals diagnosed with common mental disorders (CMDs). Using administrative registry data for 139,873 individuals with CMDs (N = 371,825 observations) from 2014/15 to 2017/18, we construct RGP-CoC indices within rolling two-year windows and track labour market outcomes over subsequent one-year periods. We employ a lagged design and high-dimensional fixed-effects models to robustly assess the association between RGP-CoC and labour market outcomes over the period 2016-2019. Our findings show that higher RGP-CoC is associated with improved labour market outcomes, with stronger and more robust effects observed for wage income than for employment probability. We also find a significant negative association between RGP-CoC and the likelihood of sickness absence. While the effects vary across education levels, no significant gender differences are observed. These findings highlight the vital role of RGP continuity of care in improving labour market participation and earnings, especially for individuals with CMDs. Enhancing continuity with a regular GP as a core quality metric in primary care can inform healthcare policy and support broader goals of economic inclusion.

Introduction: Acute myocardial infarction is one of the leading causes of death in Spain and a contributor to productivity loss. This condition represents an economic burden, involving significant indirect costs. Our objective here is to estimate premature deaths and productivity losses due to acute myocardial infarction in Spain during the period 2013-2022.

Methods: Productivity costs were estimated using a simulation model based on the human capital method. Mortality rates, average salaries, and employment rates were collected for the entire study period.

Results: After the analysis, acute myocardial infarction was identified as the leading cause of premature deaths related to cardiovascular diseases, accounting for 24% over the 10-year period. Additionally, an annual average of 26,935 YPLPLL was determined, with total productivity losses estimated at €5574.31 million, showing an upward trend over the reference period 2013-2022.

Conclusions: The study concludes by emphasizing the economic burden associated with acute myocardial infarction, which can assist decision-makers in allocating resources more efficiently.

In this paper we assess the extent to which patient and physician preferences determine birth timing manipulation in public and private hospitals, among white and black mothers, using data from approximately 37 million births in Brazil. Our findings show that manipulation is markedly salient in the private sector and among white women. While the timing of births in the public sector is also influenced by specific incentives, their impact is less pronounced and more evenly distributed across racial groups. The analysis provides a comprehensive and integrated assessment of how treatment decisions respond to different individual incentives, for different population groups, and within distinct institutional settings, thus allowing for comparison of magnitude of estimates across health systems and populations.

This paper examines vaccine hesitancy from a behavioral economics perspective, focusing on how parental risk preferences, altruism, and vaccine distrust affect children's vaccination rates. A model of parental investment in children's health is developed and expanded using empirical data from WHO, UNICEF, the World Bank, and the Global Preferences Survey. The study utilizes a fractional response probit model to analyze data from 69 countries, accounting for both stringent and non-stringent vaccination policies. Results show that risk aversion, altruism, and trust are positively associated with vaccination coverage, with the impact varying by policy stringency. In countries with stringent policies, risk aversion is the most significant factor, while altruism and distrust are more influential in countries with less strict policies. However, the effects of these factors are modest, with income levels accounting for most cross-country differences. The study calls for further research using more recent, individual-level data. Highlights We develop a theoretical framework suggesting that parents with higher risk aversion and altruism are more likely to invest in their children's health, particularly in vaccination decisions, extending current literature insights. Our model is empirically tested using macro-level data on parental risk preferences and altruism from the Global Preferences Survey (GPS), combined with WHO and UNICEF vaccination coverage data for ten diseases in one-year-old children. The analysis reveals a positive association between parental risk aversion, altruism, and vaccination coverage across 69 countries, moderated by the stringency of national vaccination policies. In countries with stringent vaccination policies, risk aversion predominantly drives vaccination coverage, whereas in less stringent environments, altruism and vaccine distrust play a more significant role. Vaccination coverage is notably lower in low-income countries.

This study examines the relevance of governance quality in shaping the effect of economic policy uncertainty on several health expenditure indicators, including external health expenditure, national health expenditure, public health expenditure, and private health expenditure. The analysis is based on a sample of fifty-three African countries spanning 2005 to 2022. The adopted empirical strategy comprises the interactive dynamic two-step System Generalized Method of Moments (SGMM). The analysis is structured such that various governance dimensions-economic, political, and institutional governance moderate economic policy uncertainty to reduce health expenditure. Overall, governance dynamics do not effectively moderate economic policy uncertainty to negatively influence health expenditure dynamics. Specifically, a corresponding aggregated governance threshold of 2.2264, is needed to completely mitigate the positive effect of economic policy uncertainty on external health expenditure. Furthermore, improved infrastructure, employment, and foreign direct investment are potent channels for reducing some health expenditure dynamics within the continent. The associated policy implications of this study are discussed within the framework of the African Union's Agenda 2063 and the United Nations Sustainable Development Goals (SDGs).