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Health Economics, Policy, and Law

Mishal Khan, Imara Roychowdhury, Ankita Meghani, Farah Hashmani, Josephine Borghi, Marco Liverani
This study qualitatively investigates what factors apart from or in addition to financial incentives can encourage better performance of frontline health care providers. We interviewed health sector managers in Pakistan, Cambodia and China, and they highlighted many potential limitations in the applicability of financial incentives in their contexts. There was a consistent view that providers are not always primarily driven by monetary rewards and that non-monetary rewards - such as recognition from direct supervisors and career development - could have a greater influence on performance...
January 31, 2019: Health Economics, Policy, and Law
Emma Frew, Katie Breheny
Local authorities in England have responsibility for public health, however, in recent years, budgets have been drastically reduced placing decision makers under unprecedented financial pressure. Although health economics can offer support for decision making, there is limited evidence of it being used in practice. The aim of this study was to undertake in-depth qualitative research within one local authority to better understand the context for public health decision making; what, and how economics evidence is being used; and invite suggestions for how methods could be improved to better support local public health decision making...
January 11, 2019: Health Economics, Policy, and Law
Thomas May, James P Evans
In this paper, we ask whether or not we can afford to realize the potential benefits of genetic testing as a screening tool for adoptees. Our method is to provide reasonable cost and savings estimates. We argue that the prospect of cost neutrality should be sufficient to explore the targeted screening for a population who will otherwise suffer an avoidable health disparity in access to inherited disease information. Our goal here is to establish that the investment needed to attain these benefits is not beyond our means...
December 20, 2018: Health Economics, Policy, and Law
Federico Toth
This article proposes a classification of the different national health care systems based on the way the network of health care providers is organised. To this end, we present two rivalling models: on the one hand, the integrated model and, on the other, the separated model. These two models are defined based on five dimensions: (1) integration of insurer and provider; (2) integration of primary and secondary care; (3) presence of gatekeeping mechanisms; (4) patient's freedom of choice; and (5) solo or group practice of general practitioners...
December 11, 2018: Health Economics, Policy, and Law
Antonio J Trujillo, Taruja Karmarkar, Caleb Alexander, William Padula, Jeremy Greene, Gerard Anderson
Using dual-entitlement theory as the guide, we conducted a survey of economists from the National Bureau of Economic Research asking them a series of questions about the fairness of drug prices in the United States. Public opinion surveys have repeatedly shown that the public perceives drug prices to be unfair, but economists trained in laws of supply and demand may have different perceptions. Three hundred and ten senior economists responded to our survey. Forty-five percent agreed that drug prices were unfair when people, specifically low-income individuals, could not afford their prescription medications...
December 4, 2018: Health Economics, Policy, and Law
Michael K Gusmano, Jan-Kees Helderman
No abstract text is available yet for this article.
April 2019: Health Economics, Policy, and Law
Eduardo J Gómez
In the Americas, next to the United States, Brazil and Mexico have the highest prevalence of type-2 diabetes. In contrast to most studies, this article compares and analyzes the politics behind the implementation of type-2 diabetes self-care management programs (DSM), which is a new area of scholarly research. This article claims that Brazil outpaced Mexico with respect to the implementation of effective DSM programs, the product of positive policy spillover effects associated with the president and governing political party's popular anti-poverty programs, and the enduring legacy of centralized ministry of health financial and human resource assistance to primary care programs in a context of decentralization...
November 5, 2018: Health Economics, Policy, and Law
Micaela Pinho, Pedro Veiga
This paper tests the factorial structure of a questionnaire comprising seven health care rationing criteria (waiting time, 'rule of rescue', parenthood of minors, health maximization, youngest first, positive and negative version of social merit) and explores the adherence to them of 254 Portuguese health care professionals, when considered individually and when confronted with two-in-two combinations. Data were collected through a self-administered questionnaire where respondents faced hypothetical rationing dilemmas comprising one rationing criterion and dichotomous options pairs with two rationing criteria...
October 15, 2018: Health Economics, Policy, and Law
Robert A Nathenson
Parity in coverage for mental health services has been a longstanding policy aim at the state and federal levels and is a regulatory feature of the Affordable Care Act. Despite the importance and legislative effort involved in these policies, evaluations of their effects on patients yield mixed results. I leverage the Employee Retirement Income Security Act and unique claims-level data that includes information on employers' self-insurance status to shed new light in this area after the implementation of two state parity laws in 2007 and federal parity a few years later...
October 12, 2018: Health Economics, Policy, and Law
Daniëlle Cattel, Frank Eijkenaar, Frederik T Schut
Worldwide, policymakers and purchasers are exploring innovative provider payment strategies promoting value in health care, known as value-based payments (VBP). What is meant by 'value', however, is often unclear and the relationship between value and the payment design is not explicated. This paper aims at: (1) identifying value dimensions that are ideally stimulated by VBP and (2) constructing a framework of a theoretically preferred VBP design. Based on a synthesis of both theoretical and empirical studies on payment incentives, we conclude that VBP should consist of two components: a relatively large base payment that implicitly stimulates value and a relatively small payment that explicitly rewards measurable aspects of value (pay-for-performance)...
September 27, 2018: Health Economics, Policy, and Law
Zuzana Nordeng, Frode Veggeland
This article studies the implementation of the European Union (EU)'s Patients' Rights Directive in Germany and Norway. The objective of the Directive was to allow EU member states to have a say in the regulatory work, ensure predictability and uniformity in the application of EU rules on cross-border care, and enhance a move towards EU harmonisation in this area. So far, the implementation processes in Norway and Germany have mixed results regarding the likelihood of achieving uniformity and harmonisation. Although the Directive has had convergent effects on certain areas of cross-border care, such as setting up National Contact Points and providing patients with the basic right to treatment abroad, implementation also shows divergent patterns...
August 30, 2018: Health Economics, Policy, and Law
Jianxing Yu, Yue Qiu, Ziying He
China has achieved nearly universal social health insurance (SHI) coverage by implementing three statutory schemes, but gaps and differences in benefit levels are apparent. There is wide agreement that China should merge the three schemes into a universal and uniform SHI. However, data on the medical expenses of all inpatients in 2014 at a public Tier-three hospital suggests that supply-induced demand (SID) is a serious concern and that, under the design of the current schemes, a higher benefit level has a greater impact on the total expenses of insured patients...
August 6, 2018: Health Economics, Policy, and Law
Caroline Hoffstedt, Magnus Fredriksson, Håkan Lenhoff, Ulrika Winblad
Improving the ability of patients to make informed choices of health care provider can give providers more incentive to compete based on quality. Still, it is not evident to what extent and when people search for information when choosing a provider. The aim of this study is to identify under what circumstances individuals seek information when choosing a primary care provider. Research to date has mostly focused on individuals' demographic and socio-economic characteristics and the poor availability of information as barriers to information-seeking and use...
August 3, 2018: Health Economics, Policy, and Law
Stephen Birch
Models for projecting the demand for and supply of health care workers are generally based on objectives of meeting demands for health care and assumptions of status quo in all but the demographic characteristics of populations. These models fail to recognise that public intervention in health care systems arises from market failure in health care and the absence of an independent demand for health care. Hence projections of demand perpetuate inefficiencies in the form of overutilisation of services on the one hand and unmet needs for care on the other...
August 2, 2018: Health Economics, Policy, and Law
Richard M Scheffler, Daniel R Arnold
No abstract text is available yet for this article.
August 2, 2018: Health Economics, Policy, and Law
Sheena Asthana, Alex Gibson
Explanations of the state of 'crisis' in the English National Health Service (NHS) generally focus on the overall level of health care funding rather than the way in which funding is distributed. Describing systematic patterns in the way different areas are experiencing crisis, this paper suggests that NHS organisations in older, rural and particularly coastal areas are more likely to be 'failing' and that this is due to the historic underfunding of such areas. This partly reflects methodological and technical shortcomings in NHS resource allocation formulae...
August 2, 2018: Health Economics, Policy, and Law
Jaime Pinilla, Beatriz G López-Valcárcel, Miguel A Negrín
In January 2006, the Spanish government enacted a tobacco control law that banned smoking in bars and restaurants, with exceptions depending on the floor space of the premises. In January 2011, further legislation in this area was adopted, removing these exceptions. We analyse the effect produced on cigarette sales by these two bans. We approach this problem using an interrupted time series analysis while accounting for the potential effects of autocorrelation and seasonality. The data source used was the official data on legal sales of tobacco in Spain, from January 2000 to December 2015 (excluding the Canary Islands and the autonomous cities of Ceuta and Melilla)...
July 30, 2018: Health Economics, Policy, and Law
Stefanie Ettelt
Health technology assessment is frequently credited with making difficult resource allocation decisions in health care fairer, more rational and more transparent. In Germany, a constitutional 'right to health' allows patients to challenge decisions by sickness funds to withhold reimbursement of treatment excluded from public funding because of insufficient evidence of effectiveness. The ability to litigate was qualified by the Constitutional Court in its 2005 'Nikolaus decision' that sets out criteria to be applied to these cases...
July 27, 2018: Health Economics, Policy, and Law
Sam van Herwaarden, Iris Wallenburg, Joris Messelink, Roland Bal
While we know that upcoding of diagnosis-related groups (DRGs) regularly occurs, we have little knowledge of the role of the technical features of coding systems in inducing coding behaviour. This paper presents methods for investigating the financial structure of the Dutch DRG system, and more in particular the grouper software, to gain such insight. The paper describes a system for investigating the robustness of the reward structure, by simulating the response of the DRG system to small changes in individual coding...
July 27, 2018: Health Economics, Policy, and Law
Dayashankar Maurya, M Ramesh
Published works on health insurance tend to focus on program design and its impact, neglecting the implementation process that links the two and affects outcomes. This paper examines the National Health Insurance [Rashtriya Swasthya Bima Yojana (RSBY)] in India with the objective of assessing the role of implementation structures and processes in shaping performance. The central question that the paper addresses is: why does the performance of RSBY vary across states despite similar program design? Using a comparative case study approach analyzing the program's functioning in three states, it finds the answer in the differences in governance of implementation...
July 27, 2018: Health Economics, Policy, and Law
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