European Journal of Health Economics最新文献

Medical teleconsultation is a tool that is here to stay among the services offered by health systems. Therefore, it is important to understand the process of adopting this technology. However, most studies have endorsed the point of view of health professionals. Our research adopts the patient's point of view with a sample of 1500 patients who have used teleconsultation in Spain between May and November 2022, therefore, in a post-COVID-19 scenario. We started from a technology acceptance model, UTAUT, and applied a novel segmentation technique: Pathmox. As a result, we have obtained six segments of patients using teleconsultation with differentiated technology acceptance processes, and we also propose strategies adapted to each of them.

Introduction: Cesarean deliveries account for approximately one-third of all births in Germany, prompting ongoing discussions on cesarean section rates and their connection to medical staffing and birth volume. In Germany, the majority of departments integrate obstetric and gynecological care within a single department.

Methods: The analysis utilized quality reports from German hospitals spanning 2015 to 2019. The outcome variable was the annual risk-adjusted cesarean section ratio-a metric comparing expected to observed cesarean sections. Explanatory variables included annual counts of physicians, midwives, and births. To account for case number-related staffing variations, full-time equivalent midwife and physician staff positions were normalized by the number of deliveries. Uni- and multivariate panel models were applied, complemented by multiple instrument variable analyses, including two-stage least square and generalized method of moments models.

Results: Incorporating data from 509 integrated obstetric departments and 2089 observations, representing 2,335,839 deliveries with 720,795 cesarean sections (over 60% of all inpatient births in Germany), multivariate model with fixed effects revealed a statistically significant positive association between the number of physicians per birth and the risk-adjusted cesarean section ratio (0.004, p = 0.004). Two-stage least square instrument variable analysis (0.020, p < 0.001) and a system GMM estimator models (0.004, p < 0.001) validated these results, providing compelling evidence for a causal relationship.

Conclusion: The study established a robust connection between the number of physicians per birth and the risk-adjusted cesarean section ratio in integrated obstetric and gynecological departments in Germany. While the cause of the effect remains unclear, one possible explanation is a lack of specialization within these departments due to the combined provision of both obstetric and gynecological care.

This paper examines whether the expansion of Medicaid under the Affordable Care Act (ACA), which increases access to contraceptives to low-income childless women and allows them more autonomy to determine the timing of their pregnancies and births, is associated with lower abortion rates during the period 2008-2017. Using state-level data from the Guttmacher Institute and employing a difference-in-differences method, we find that Medicaid expansion is associated with a meaningful reduction in the abortion rate among women ages 18-24, presumably through increased use of contraceptives among low-income young adults. Our estimates imply that Medicaid expansion is associated with a relative decrease in the abortion rate among this age group, approximately 1-2 per 1000 women. By expanding access to contraceptives, Medicaid expansion may be an effective tool for preventing unplanned pregnancies and, consequently, reducing the number of abortions.

Background: Health economic evaluations require cost data as a key input, and reimbursement policies and systems should incentivize valuable care. Subfertility is a growing global phenomenon, and Dutch per-treatment DRGs alone do not support value-based decision-making because they don't reflect patient-level variation or the impact of technologies on costs across entire patient pathways.

Methods: We present a real-world micro-costing analysis of subfertility patient pathways (n = 4.190) using time-driven activity-based costing (TDABC) and process mining in the Dutch healthcare system, and built a scalable and granular costing model.

Results: We find that pathways (13.203 treatments, 4.190 patients, 10 years) from referral to pregnancy and birth vary greatly in costs (mean €6.329, maximum €36.976) and duration (mean 25,5 months, maximum 8,59 years), with structural variation within treatments (and DRGs) of up to 65%. Patient-level variation is highest in laboratory phases, and causally related to patients' cycle volume, type, and treatment methods. Large IVF or IVF-ICSI cycles are most common, and most valuable to patients and the healthcare system, but exceed their DRGs significantly (33%). We provide recommendations that reduce costs across patient pathways by €1.3 m in the Netherlands, to support value-based personalized care strategies. These findings are relevant to clinics following European protocols.

Conclusions: Fertility treatments like IVF feature significant cost variation due to the personalization of treatments, and rapidly evolving laboratory technologies. Incorporating cost granularity at the patient and treatment level (cycle volume, type, method) is critical for decision-making, economic analyses, and policy as both subfertility rates and treatment demand are rising.

Patient organisations are increasingly involved in HTA. Given this, it is important to understand what these organisations contribute and how their voices are accounted for in the decision-making process. This study characterises inputs from patient organisations and/or their nominated patient experts in technology appraisals for ultra-rare diseases in England and Wales and seeks to understand how these are considered in NICE final recommendations. We thematically analysed all HST appraisals completed between January 2022 and August 2024 (N = 15). We appraised inputs from patient organisations' and experts' written submissions, the novelty of patient inputs, as well as financial ties between contributing organisations and the manufacturer of the technology being appraised. We compared themes identified with those found in the Final Evaluation Determination documents to understand how and to what extent patients' inputs were considered in NICE final recommendations. We found that patient submissions mainly focused on disease aspects (54%). Patients raised concerns on access challenges, caregiver burden, and mental health impacts. Most patient themes overlapped with manufacturers' submissions (82%) and doctors' testimonies (45%), with most novel insights focusing on access issues and mental health. Patient organisations reported receiving funding from the technology manufacturer in most appraisals, with amounts ranging from £5,000 to £74,113. Approximately half of patient inputs were explicitly mentioned in NICE final decision documents, with some considerations being neglected despite being raised by patients. While NICE incorporates many issues of importance to patients, there is room for improvement to ensure all aspects patients deem important are captured. Further research could pinpoint optimal areas for patient contributions and assess their impact.

Antimicrobial resistance (AMR) represents a major threat to medical practice, complicating infection management, and increasing mortality and healthcare costs. Macro estimations of this health issue remain underexplored because data are currently limited to hospital systems. This study aims to estimate the economic and human burden of AMR in Spain at a macro level. An economic model was constructed based on prevalence rates, premature deaths and published literature to assess costs. Methodology was based on several techniques depending on the type of cost to be estimated: hospital inpatient care costs (based on extra hospital days); outpatient care costs (employing reimbursement rates from regional health services); productivity losses due to premature deaths (using the Human Capital Approach) and morbidity (based on days absent from work). Using data from EARS-NET, ESAC-NET and GBD, a total of 30 bacteria-drug resistance combinations were analysed. The results showed that 77,870 infections, 6,199 premature deaths, and 426,495 extra hospital days were attributable to AMR in Spain, mostly due to Gram-negative bacteria. AMR was also responsible for 3,112 years of working life lost. The costs reached EUR 338.6 million (0.03% of GDP), costing each Spaniard EUR 7.15 per year. Direct costs accounted for 72% of total costs, while indirect costs represented 28%. To date, this is the first study that evaluates the cost of AMR across such a wide range of bacteria and infection sites. These estimates are useful for approximating the problem and for planning containment and action strategies.

This study investigates the elasticity of healthcare expenditures (HCE) with respect to income growth using a balanced panel of 177 economies from 2001 to 2020. Applying a panel local projections (LP) model, we examine both global and heterogeneous effects across income groups, as defined by the World Bank income classification. The model is further extended to estimate the relationship between income and HCE during changing economic conditions. Accordingly, we find that the elasticity weakens during non-expansionary periods, while high-income countries exhibit a minimal contemporaneous response. In contrast, low-income countries exhibit a heightened contemporaneous response to income fluctuations during non-expansionary phases, revealing a hidden vulnerability to economic growth.

Introduction: Asthma is a prevalent chronic respiratory condition that significantly impacts public health, with severe asthma subtypes, such as severe eosinophilic asthma, imposing substantial socioeconomic burdens.

Methods: Real-world data from the Italian Health Information System were analyzed to evaluate the economic consequences of asthma in Italy. An in-depth comparative analysis was conducted to investigate the economic implications of various asthma subtypes, focusing on severe eosinophilic asthma. Additionally, the study projected the potential cost-effectiveness of novel treatments aimed at reducing hospitalization rates, specialist visits, and oral corticosteroid use for patients with severe eosinophilic asthma in Italy.

Results: The analysis revealed that severe asthma, and notably severe eosinophilic asthma, places a substantial economic burden on the Italian National Health System. Estimates demonstrated that implementing innovative treatments to mitigate the risks of hospitalization and specialist visits, as well as reducing oral corticosteroid usage in severe eosinophilic asthma patients, could lead to significant cost savings. The cost-consequence analysis indicated potential yearly reductions of €50.0 million (27%) for the treatment of severe asthma and €31.7 million (26%) for severe eosinophilic asthma.

Conclusions: This study presents a comprehensive evaluation of the economic repercussions of severe asthma in Italy. The findings emphasize the necessity of identifying and developing effective therapeutic strategies to improve the management of severe asthma while simultaneously reducing the economic burden on the healthcare system. These results offer valuable insights for healthcare policymakers and practitioners, facilitating evidence-based decisions in asthma management and healthcare policy in Italy.

Health care reforms introduced interprofessional team-based primary care to optimize access to health care and preventive services. In this context, preventive cancer screening represents an important measure as it is essential for the early detection of cancer and treatment. We investigated the effects of Family Health Teams (FHTs), an interprofessional team-based primary care practice setting, on cancer screening rates in Ontario, Canada. By utilizing comprehensive health administrative data from April 1st 2011 to March 31st 2023, we determined the effect of FHT on screening rates for breast, cervical, and colorectal cancer while controlling for relevant physician and patient characteristics. Our analytical framework employs fractional probit models, including the Mundlak procedure, and generalized estimating equations to assess the impact of practicing in FHTs on cancer screening rates, while accounting for unobserved physician heterogeneity. Our results indicate that compared to non-FHTs, physicians practicing in FHTs have higher breast (2.4%), cervical (2%), and colon (0.8%) cancer screening rates per physician per year. The effectiveness of FHTs in promoting cancer screenings is particularly pronounced in smaller practices and among populations in rural and economically deprived areas. Our findings highlight the role of teams in enhancing preventive health care services potentially through task shifting mechanisms and suggest that such models may offer a pathway to improving access to preventive health care, especially in marginalized populations. Our research contributes to the literature by providing empirical evidence on the benefits of interprofessional team-based primary care in improving cancer screening.