Multi-layer health insurance coverage, medical services use and health in a Universal National Health System, the case of Portugal
AbstractThe Portuguese health system has the peculiar characteristic of being a Beveridge –Bismarck type aiming at universal coverage. On top of the national health system coverage, there is a second coverage provided to some professionals, plus a third layer of coverage that can be acquired by taking out voluntary private health insurance. The aim of this work is to ascertain whether people benefiting from supplemental multi-layer health coverage (on top of the existing National Health System) have more consultations, either with general practitioners or with specialists, and enjoy better health status. We used data...
Source: The European Journal of Health Economics - November 27, 2020 Category: Health Management Source Type: research

More room for telemedicine after COVID-19: lessons for primary care?
(Source: The European Journal of Health Economics)
Source: The European Journal of Health Economics - November 24, 2020 Category: Health Management Source Type: research

Accreditation as a quality-improving policy tool: family planning, maternal health, and child health in Egypt
AbstractAccreditation of healthcare providers has been established in many high-income countries and some low- and middle-income countries as a tool to improve the quality of health care. However, the available evidence on the effectiveness of this approach is limited and of questionable quality, especially in low- and middle-income countries. We exploit the interventions introduced under Egypt ’s health sector reform program between 2000 and 2014 to estimate the effect of health facility accreditation on family planning, maternal health, and child health outcomes. We use difference-in-differences fixed-effects and p...
Source: The European Journal of Health Economics - November 20, 2020 Category: Health Management Source Type: research

Do discontinuities in marginal reimbursement affect inpatient psychiatric care in Germany?
AbstractThis paper examines the behaviour of mental health care providers in response to marginal payment incentives induced by a discontinuous per diem reimbursement schedule with varying tariff rates over the length of stay. The analyses use administrative data on 12,627 cases treated in 82 psychiatric hospitals and wards in Germany. We investigate whether substantial reductions in marginal reimbursement per inpatient day led to strategic discharge behaviour once a certain length of stay threshold is exceeded. The data do not show gaps and bunches at the duration of treatment when marginal reimbursement decreases. Using ...
Source: The European Journal of Health Economics - November 9, 2020 Category: Health Management Source Type: research

A comparison of published time invariant Markov models with Partitioned Survival models for cost effectiveness estimation; three case studies of treatments for glioblastoma multiforme
ConclusionTIMMs delivered different cost-effectiveness estimates to PSMs; in two cases, TIMMs produced substantially lower ICER values than PSMs. Model output differences appear attributable to less realistic cost-and-benefit estimates generated in TIMMs due to rapid depletion from the stable disease state and/or accumulation in the dead state. (Source: The European Journal of Health Economics)
Source: The European Journal of Health Economics - November 1, 2020 Category: Health Management Source Type: research

Correction to: Healthcare expenditure and carbon footprint in the USA: evidence from hidden cointegration approach
The author would like to correct the errors in the publication of the original article. (Source: The European Journal of Health Economics)
Source: The European Journal of Health Economics - October 21, 2020 Category: Health Management Source Type: research

Cost-effectiveness of hepatitis C virus screening, and subsequent monitoring or treatment among pregnant women in the Netherlands
ConclusionUniversal screening for HCV among all pregnant women in the Netherlands is cost-effective. However, it would be reasonable to consider smaller risk groups in view of the budget impact of the intervention. (Source: The European Journal of Health Economics)
Source: The European Journal of Health Economics - October 16, 2020 Category: Health Management Source Type: research

General practitioners ’ income and activity: the impact of multi-professional group practice in France
AbstractFrance has first experimented, in 2009, and then generalized a practice level add-on payment to promote Multi-Professional Primary Care Groups (MPCGs). Team-based practices are intended to improve both the efficiency of outpatient care supply and the attractiveness of medically underserved areas for healthcare professionals. To evaluate its financial attractiveness and thus the sustainability of MPCGs, we analyzed the  evolution of incomes (self-employed income and wages) of General Practitioners (GPs) enrolled in a MPCG, compared with other GPs. We also studied the impacts of working in a MPCG on GPs&rsq...
Source: The European Journal of Health Economics - October 14, 2020 Category: Health Management Source Type: research

Economic evaluation of culprit lesion only PCI vs. immediate multivessel PCI in acute myocardial infarction complicated by cardiogenic shock: the CULPRIT-SHOCK trial
ConclusionsThe estimates of cost-effectiveness for CO-PCI vs. MV-PCI have been shown to change depending on the time horizon and type of economic evaluation performed. The results favoured a long-term horizon analysis for avoiding underestimation of QALY gains from the CO-PCI arm. (Source: The European Journal of Health Economics)
Source: The European Journal of Health Economics - October 6, 2020 Category: Health Management Source Type: research

Costs and where to find them: identifying unit costs for health economic evaluations of diabetes in France, Germany and Italy
ConclusionsThis review provides a comprehensive account of available costs and cost sources in France, Germany and Italy to support health economists and increase transparency in health economic evaluations in diabetes. (Source: The European Journal of Health Economics)
Source: The European Journal of Health Economics - October 5, 2020 Category: Health Management Source Type: research

Mapping of the EORTC QLQ-C30 to EQ-5D-5L index in patients with lymphomas
ConclusionThe mapping algorithms  enable the EQ-5D-5L index scores to be predicted by QLQ-C30 subscale/item scores with good precision in patients living with lymphomas. (Source: The European Journal of Health Economics)
Source: The European Journal of Health Economics - September 21, 2020 Category: Health Management Source Type: research

No gain in pain: psychological well-being, participation, and wages in the BHPS
AbstractAccounting for endogeneity, unobserved heterogeneity, and sample selection in an unified framework, we investigate the effect of psychological well-being on wages and labour market participation using a panel from the British Household Panel Survey. We find the effect of psychological well-being on labour market outcomes to differ across gender. In particular, psychological distress significantly reduces participation across genders, but, conditional on participation, has a significant negative effect on hourly wages only in the female sample. (Source: The European Journal of Health Economics)
Source: The European Journal of Health Economics - September 21, 2020 Category: Health Management Source Type: research

Estimating the monetary value of health and capability well-being applying the well-being valuation approach
ConclusionWhile the applied approach is not without limitations, the generated insights, especially concerning the relative magnitude of valuations, may be useful for decision-makers having to decide based on economic evaluations using the ICECAP-A measure or, to a lesser extent, other (capability) well-being outcome measures. (Source: The European Journal of Health Economics)
Source: The European Journal of Health Economics - September 15, 2020 Category: Health Management Source Type: research

Timing matters: worker absenteeism in a weekly backward rotating shift model
ConclusionsWhen designing new shift models, firms should try to anticipate their workers ’ reaction to avoid unintended incentives. (Source: The European Journal of Health Economics)
Source: The European Journal of Health Economics - September 14, 2020 Category: Health Management Source Type: research

A MEA is a MEA is a MEA? Sequential decision making and the impact of different managed entry agreements at the manufacturer and payer level, using a case study for an oncology drug in England
ConclusionEach MEA type has a different implication. The impact of different MEAs on the NMB is more noteworthy than on the DCF, in relative terms, hence payers will benefit from the early participation of the MEA design rather than leaving this up to the prerogative of the manufacturer. While simple discount might be practical for implementation purposes, other MEAs can provide additional benefits to the payer in terms of increased NMB, reduced decision risk and reduced uncertainty. MEA performance should be investigated not only under parametric uncertainty, but also under-identified structural uncertainty, and the barri...
Source: The European Journal of Health Economics - September 7, 2020 Category: Health Management Source Type: research

Modelling the cost-effectiveness of person-centred care for patients with acute coronary syndrome
AbstractBackgroundPerson-centred care has been shown to be cost-effective compared to usual care for several diseases, including acute coronary syndrome, in a short-term time perspective (
Source: The European Journal of Health Economics - September 6, 2020 Category: Health Management Source Type: research

Investigating the geographic disparity in quality of care: the case of hospital readmission after acute myocardial infarction in Italy
AbstractUnwarranted variation in the quality of care challenges the sustainability of healthcare systems. Especially in decentralised healthcare systems, it is crucial to understand the drivers behind regional differences in hospital qualities such as unplanned readmissions. This paper examines the factors that influence the risk of unplanned hospital readmission and the geographic disparity of readmission rate in Italy. We use hospital discharge data from 2010 to 2015 for patients above 65 years old admitted with Acute Myocardial Infarction. Employing hierarchical models, we identified the patient and hospital-level deter...
Source: The European Journal of Health Economics - September 6, 2020 Category: Health Management Source Type: research

Multiplicative modelling of EQ-5D-3L TTO and VAS values
ConclusionUsing EQ-5D-3L valuation data, multiplicative modelling was shown to improve out-of-sample predictive accuracy of TTO models but not of VAS models. (Source: The European Journal of Health Economics)
Source: The European Journal of Health Economics - September 4, 2020 Category: Health Management Source Type: research

Very high and low residual spenders in private health insurance markets: Germany, The Netherlands and the U.S. Marketplaces
AbstractWe study the extremely high and low residual spenders in individual health insurance markets in three countries. A high (low) residual spender is someone for whom the residual —spending less payment (from premiums and risk adjustment)—is high (low), indicating that the person is highly underpaid (overpaid). We begin with descriptive analysis of the top and bottom 1% and 0.1% of residuals building to address the question of the degree of persistence in membership at th e extremes. Common findings emerge among the countries. First, the diseases found among those with the highest residual spending are also...
Source: The European Journal of Health Economics - August 28, 2020 Category: Health Management Source Type: research

Increasing respondent engagement in composite time trade-off tasks by imposing three minimum trade-offs to improve data quality
ConclusionsBoth online arms had poor quality data. A minimum trade-off threshold did not improve engagement nor face validity of the data, indicating that modifications to the number of iterations are insufficient alone to improve data quality/validity of online TTO studies. (Source: The European Journal of Health Economics)
Source: The European Journal of Health Economics - August 27, 2020 Category: Health Management Source Type: research

EQ-5D-5L Bulgarian population norms
ConclusionsBulgarian population norms, which were developed for the descriptive part of the EQ-5D-5L and EQ VAS, can be used as reference values. The availability of such normative data should encourage the use of the EQ-5D-5L questionnaire in health-related quality-of-life studies in Bulgaria. (Source: The European Journal of Health Economics)
Source: The European Journal of Health Economics - August 18, 2020 Category: Health Management Source Type: research

HTA methodology and value frameworks for evaluation and policy making for cell and gene therapies
AbstractThis last decade has been marked by significant advances in the development of cell and gene (C&G) therapies, such as gene targeting or stem cell-based therapies. C&G therapies offer transformative benefits to patients but present a challenge to current health technology decision-making systems because they are typically reviewed when clinical efficacy data are very limited and when there is uncertainty about the long-term durability of outcomes. These challenges are not unique to C&G therapies, but they face more of these barriers, reflecting the need for adapting existing value assessment frameworks. ...
Source: The European Journal of Health Economics - August 12, 2020 Category: Health Management Source Type: research

Costs and benefits of interventions aimed at major infectious disease threats: lessons from the literature
AbstractPandemics and major outbreaks have the potential to cause large health losses and major economic costs. To prioritize between preventive and responsive interventions, it is important to understand the costs and health losses interventions may prevent. We review the literature, investigating the type of studies performed, the costs and benefits included, and the methods employed against perceived major outbreak threats. We searched PubMed and SCOPUS for studies concerning the outbreaks of SARS in 2003, H5N1 in 2003, H1N1 in 2009, Cholera in Haiti in 2010, MERS-CoV in 2013, H7N9 in 2013, and Ebola in West-Africa in 2...
Source: The European Journal of Health Economics - August 12, 2020 Category: Health Management Source Type: research

How French general practitioners respond to declining medical density: a study on prescription practices, with an insight into opioids use
AbstractDisparities in physicians' geographical distribution lead to highly unequal access to healthcare, which may impact quality of care in both high and low-income countries. This paper uses a 2013 –2014 nationally representative survey of French general practitioners (GPs) matched with corresponding administrative data to analyze the effects of practicing in an area with weaker medical density. To avoid the endogeneity issue on physicians' choice of the location, we enriched our variable of interest, practicing in a relatively underserved area, with considering changes in medical density between 2007 and 2013, th...
Source: The European Journal of Health Economics - August 2, 2020 Category: Health Management Source Type: research

The role of income disparities on survival in metastatic clear cell renal cell carcinoma in the targeted therapy era
This study aimed to assess the role of income disparities on prognosis of mRCC in the targeted therapy era.Patients and methodsData of patients with mRCC were extracted from the Surveillance, Epidemiology, and End Results (SEER) database. Median household income (MHI) was used to represent patients ’ socioeconomic status, and its role on overall survival (OS) and cancer-specific survival (CSS) was evaluated.ResultsA total of 3791 patients with clear cell mRCC diagnosed between 2010 and 2015 were enrolled in cohort one. There was an obvious imbalance of race and insurance status in patients with difference MHI. Compar...
Source: The European Journal of Health Economics - July 28, 2020 Category: Health Management Source Type: research

The impact of the diabetes management incentive on diabetes-related services: evidence from Ontario, Canada
AbstractFinancial incentives have been introduced in several countries to improve diabetes management. In Ontario, the most populous province in Canada, a Diabetes Management Incentive (DMI) was introduced to family physicians practicing in patient enrollment models in 2006. This paper examines the impact of the DMI on diabetes-related services provided to individuals with diabetes in Ontario. Longitudinal health administrative data were obtained for adults diagnosed with diabetes and their family physicians. The study population consisted of two groups: DMI group (patients enrolled with a family physician exposed to DMI f...
Source: The European Journal of Health Economics - July 15, 2020 Category: Health Management Source Type: research

The effect of long-term care public benefits and insurance on informal care from outside the household: empirical evidence from Italy and Spain
This article uses cross-sectional data from the Survey of Health, Ageing, and Retirement in Europe (SHARE) database to test the effect of both long-term care (LTC) public benefits and insurance on the receipt of informal care provided by family members living outside the household in Italy and Spain. The choice of Italy and Spain comes from the fact that informal care is rather similar in these two countries while their respective public LTC financing systems are different. Our results support the hypothesis of LTC public support decreasing the receipt of informal care for Spain while reject it for Italy. They tend to conf...
Source: The European Journal of Health Economics - July 10, 2020 Category: Health Management Source Type: research

Budget impact analysis of the use of oral and intravenous therapy regimens for the treatment of relapsed or refractory multiple myeloma in Germany
ConclusionAmong the regimens of interest, the oral-based therapy regimens offered cost advantages over intravenous-based therapy regimens. The higher overall costs of intravenous therapy regimens were attributed primarily to higher drug acquisition  costs. (Source: The European Journal of Health Economics)
Source: The European Journal of Health Economics - July 10, 2020 Category: Health Management Source Type: research

‘Relative Consent’ or ‘Presumed Consent’? Organ donation attitudes and behaviour
AbstractLegislation, in the form of presumed consent, has been argued to boost organ donation but most evidence disregards the practice of seeking relative ’s consent, which can either ‘veto’ donation decisions, or ‘legitimize them’, by removing any possible conflict with the donor’s family. We study the effect of presumed consent alongside family consent on individuals’ willingness to donate (WTD) one’s own and relatives’ organs, and on actual organ donation behaviours. Using data from 28 European countries for the period 2002–2010, we found that presumed consent...
Source: The European Journal of Health Economics - July 9, 2020 Category: Health Management Source Type: research

Cost and effects of integrated care: a systematic literature review and meta-analysis
ConclusionOur findings suggest that integrated care is likely to reduce cost and improve outcome. However, existing evidence varies largely and is of moderate quality. Future economic evaluation should target methodological issues to aid policy decisions with more robust evidence on the cost-effectiveness of integrated care. (Source: The European Journal of Health Economics)
Source: The European Journal of Health Economics - July 5, 2020 Category: Health Management Source Type: research

Correction to: Defensive medicine in Europe: a ‘full circle’?
The Editorial “Defensive medicine in Europe: a ‘full circle’?” (Source: The European Journal of Health Economics)
Source: The European Journal of Health Economics - June 30, 2020 Category: Health Management Source Type: research

Using machine learning to assess the predictive potential of standardized nursing data for home healthcare case-mix classification
DiscussionThe existing preliminary Dutch case-mix system distinguishes client needs to some degree, but not sufficiently. The results indicate that routinely collected SNT data contain sufficient additional predictive value to warrant further research for use in case-mix system design. (Source: The European Journal of Health Economics)
Source: The European Journal of Health Economics - June 28, 2020 Category: Health Management Source Type: research

Once we have it, will we use it? A European survey on willingness to be vaccinated against COVID-19
(Source: The European Journal of Health Economics)
Source: The European Journal of Health Economics - June 25, 2020 Category: Health Management Source Type: research

Pricing vaccines and drugs in Europe: worth differentiating?
(Source: The European Journal of Health Economics)
Source: The European Journal of Health Economics - June 22, 2020 Category: Health Management Source Type: research

Something borrowed, something new: measuring hospital performance in the context of value based health care
(Source: The European Journal of Health Economics)
Source: The European Journal of Health Economics - June 15, 2020 Category: Health Management Source Type: research

The impact of the great economic crisis on mental health care in Italy
AbstractThe great economic crisis in 2008 has affected the welfare of the population in countries such as Italy. Although there is abundant literature on the impact of the crisis on physical health, very few studies have focused on the causal implications for mental health and health care. This paper, therefore, investigates the impact of the recent economic crisis on hospital admissions for severe mental disorder at small geographic levels in Italy and assesses whether there are heterogeneous effects across areas with distinct levels of income. We exploit 9-year (2007 –2015) panel data on hospital discharges, which ...
Source: The European Journal of Health Economics - June 12, 2020 Category: Health Management Source Type: research

Which multi-attribute utility instruments are recommended for use in cost-utility analysis? A review of national health technology assessment (HTA) guidelines
ConclusionsThe EQ-5D, HUI, and SF-6D were the three MAUIs most frequently mentioned in guidelines. The most commonly cited MAUI (in 85% of PE guidelines) was EQ-5D, either as a preferred MAUI or as an example of a suitable MAUI for use in CUA in HTA. (Source: The European Journal of Health Economics)
Source: The European Journal of Health Economics - June 7, 2020 Category: Health Management Source Type: research

An exploration of methods for obtaining 0  = dead anchors for latent scale EQ-5D-Y values
DiscussionThere was broad agreement across methods. Potential criteria for selecting a preferred anchoring method are presented. We conclude by discussing the decision-making circumstances under which utilities and QALY estimates for children and adults need to be commensurate to achieve allocative efficiency. (Source: The European Journal of Health Economics)
Source: The European Journal of Health Economics - June 5, 2020 Category: Health Management Source Type: research

Cost-utility analysis of inotuzumab ozogamicin for relapsed or refractory B cell acute lymphoblastic leukemia from the perspective of Taiwan ’s health care system
ConclusionsINO versus SOC has higher costs but is more effective. The use of INO is favorable for patients in the early treatment course and when more future benefit associated with INO is considered. (Source: The European Journal of Health Economics)
Source: The European Journal of Health Economics - June 5, 2020 Category: Health Management Source Type: research

Historical evidence for economic effects of COVID-19
AbstractLike wars and socio-politic shifts, contagious diseases have changed the economics and politics of the world throughout history. In 2020, the world faced COVID-19, a globally effective virus leading to mass losses and socio-economic panic. Due to apparent psycho-social conditions, analyzing the potential economic effects of the COVID-19 pandemic was inevitable. Thus, discussing economic effects of previous global and regional epidemics is considered beneficial. This research evaluated most of the known epidemics and their effects on economics and socio-politics by reviewing scientific literature. In addition to the...
Source: The European Journal of Health Economics - June 3, 2020 Category: Health Management Source Type: research

The “red herring” after 20 years: ageing and health care expenditures
(Source: The European Journal of Health Economics)
Source: The European Journal of Health Economics - June 3, 2020 Category: Health Management Source Type: research

Modelling Covid-19 under uncertainty: what can we expect?
(Source: The European Journal of Health Economics)
Source: The European Journal of Health Economics - June 2, 2020 Category: Health Management Source Type: research

How expensive are post-traumatic stress disorders? Estimating incremental health care and economic costs on anonymised claims data
ConclusionsIndividuals with PTSD seem to suffer from far more impairments in their general health conditions and incur many more costs than average insurants. Most of these seem to be caused by co-occurring mental disorders and show their maximum in the index year. Nevertheless, as costs decrease to their initial level, treatments seem to have counterbalanced the impairments due to PTSD. Thus, treatments for PTSD can be considered as beneficial and their cost-effectiveness should be further investigated. (Source: The European Journal of Health Economics)
Source: The European Journal of Health Economics - May 25, 2020 Category: Health Management Source Type: research

The excess economic burden of mental disorders: findings from a cross-sectional prevalence survey in Austria
This study provides the first representative estimates about the overall utilisation of resources by people with MDs and the excess healthcare and productivity loss costs associated with MDs in Austria. Data were collected in a cross-sectional survey conducted on a representative sample (n = 1008) between June 2015 and June 2016. Information on mental health diagnoses, 12-month health and social care use, medication use, comorbidities, informal care, early retirement, sick leave and unemployment was collected via face-to-face interviews. Generalised linear model was used to asses s the excess cost of MDs. The...
Source: The European Journal of Health Economics - May 25, 2020 Category: Health Management Source Type: research

Modeling Personalized Adjuvant TreaTment in EaRly stage coloN cancer (PATTERN)
ConclusionThis model can be used to evaluate strategies for the allocation of adjuvant chemotherapy in stage II CC patients. In future studies, the model will be used to estimate population-level long-term health gain and cost-effectiveness of biomarker-based selection strategies. (Source: The European Journal of Health Economics)
Source: The European Journal of Health Economics - May 25, 2020 Category: Health Management Source Type: research

Predictors of negotiated prices for new drugs in Germany
ConclusionsThe analysis was able to confirm that variables whose consideration is mandated by law are, in fact, the key drivers of negotiated prices. Somewhat puzzling, the analysis also found an increase in AEs to move prices significantly upward. (Source: The European Journal of Health Economics)
Source: The European Journal of Health Economics - May 24, 2020 Category: Health Management Source Type: research

Measuring intangible cost-of-morbidity due to substance dependence: implications of using alternative preference-based instruments
ConclusionsThe SF-6DPG instrument emerges as a good candidate to avoid under-estimating intangible costs within the cost-of-illness framework. However, further research is needed to assess the validity of our results in the context of other health problems. (Source: The European Journal of Health Economics)
Source: The European Journal of Health Economics - May 16, 2020 Category: Health Management Source Type: research

Impacts of air pollution on health: evidence from longitudinal cohort data of patients with cardiovascular diseases
This study uses longitudinal cohort data to estimate the impacts of air pollution on health outcomes among people first hospitalised with heart diseases. Despite the generally low level of pollution in Australia, we find that acute exposure to pollution increases readmissions to hospitals within 3 –12 months after discharge and is more evident among those suffering from heart failure. We further show that chronic exposure to air pollution increases the risk of death within 72 months, hospital admissions and general practitioner (GP) visits. Patients with coronary heart disease or cerebrov ascular disease ar...
Source: The European Journal of Health Economics - May 14, 2020 Category: Health Management Source Type: research

Patterns of care and cost profiles of women with breast cancer in Italy: EPICOST study based on real world data
ConclusionsThis paper represents the first attempt in Italy to estimate the economic burden of cancer at population level taking into account the entire disease pathway and using multiple current health care databases. The evidence produced by the study can be used to better plan resources allocation. The model proposed is replicable to countries with individual health care information on services and claims. (Source: The European Journal of Health Economics)
Source: The European Journal of Health Economics - May 11, 2020 Category: Health Management Source Type: research

Quantifying the economic impact of caregiving for Duchenne muscular dystrophy (DMD) in Spain
AbstractAimTo establish the potential economic burden in caregivers to patients with DMD and the potential causative factors.MethodCaregivers to patients with DMD were recruited through the DMD patients Register and questioned about several economic aspects using “ad-hoc” questionnaires.ResultsAll families, apart from one (97.2%n = 36), incurred in monthly medical costs (44% of the families more than 50 euros/month). 97.2% of the households considered looking after a patient of DMD as financially burdensome, and 80.5% of households declared to have suffered work changes, especially the mother...
Source: The European Journal of Health Economics - May 11, 2020 Category: Health Management Source Type: research