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At least 361 records · Page 20Linked to original sources
PubMedDate not supplied

Age related health dynamics and changes in labour market status.

We focus on aspects of health changes, the importance of cohort effects, age related health changes and the effect of labour market status and work history on health. We moreover assess the relative importance of gradual changes and sudden shocks in health changes and the role of work status on the likelihood of experiencing a health shock. A fixed effect panel data model is estimated on two waves of a survey of Dutch elderly. We find strong differences in health outcomes for different age cohorts and gender. We also find that health deteriorates with employment and labour market history.

Adult↗
PubMedDate not supplied

The impact of health on retirement behaviour: empirical evidence from West Germany.

In this paper, the relative importance of an individual's health status on retirement behaviour is analysed within the framework of a structural, discrete-time hazard rate model which is estimated using a balanced panel of elderly West German men. The results obtained reveal that the presence of chronic complaints or disability have a significant positive impact on the probability of early retirement. Moreover, the relative intensity of the individual preference for leisure appears to be, ceteris paribus, below average among public sector employees. Education, too, is shown to exert considerable influence on retirement behaviour, but the relationship between an individual's educational status and the probability of early retirement appears to be rather complex. A policy-related simulation experiment based on the estimates is carried out in order to assess the effects of changes in the incentive structure of the existing pension scheme.

Aged↗
PubMedDate not supplied

Relative inefficiencies in production between solo and group practice physicians.

Health economists have hypothesized for some time that physicians produce medical care in an inefficient manner. Further, whether solo or group practice physicians are relatively more inefficient has been a question of particular interest. Theoretical considerations suggest that solo and group practice physicians face different behavioural and production constraints, implying that they may produce care at different levels of efficiency; which is more efficient is an empirical question. We employed stochastic production frontier estimation to address this issue.

Cost-Benefit Analysis↗
PubMedDate not supplied

An incentive approach to physician implementation of medical practice guidelines.

We propose a probabilistically based incentive payment system for guideline implementation that provides rewards for physicians who follow practice guidelines and additional remuneration for physician leaders who engage in information sharing. All payments are based on observed outcomes of patient treatment. A fixed base payment forms the core of the system with probabilistic offsets calculated from the chance that a 'good' outcome occurs without optimal treatment or information. The system pays different physician types for different task sets.

Cost Control↗
PubMedDate not supplied

Lifetime costs of lung transplantation: estimation of incremental costs.

Despite an expanding number of centres which provide lung transplantation, information about the incremental costs of lung transplantation is scarce. From 1991 until 1995, in The Netherlands a technology assessment was performed which provided information about the incremental costs of lung transplantation. Costs in the situation with and without a transplantation programme were compared from a lifetime perspective. Because randomization was ethically inadmissible, only costs in the situation with the programme were observed. Both conventional treatment costs and costs of the transplantation programme were registered. Costs in the situation without the programme were based on the conventional treatment costs in the situation with the programme. Due to the study period of four years, long term follow-up costs were estimated. The total incremental costs per transplanted patient were estimated at Dfl 466,767 (5% discounted costs). The main part of these costs was caused by the high costs during the lifetime follow-up of the patients.

Cost of Illness↗
PubMedDate not supplied

Trying to do better than average: a commentary on 'statistical inference for cost-effectiveness ratios'.

In a recent paper, Laska, Meisner and Siegel address issues concerning hypothesis testing in cost-effectiveness analysis. They relate the relative magnitude of two average cost-effectiveness ratios to the incremental cost-effectiveness ratio and go on to propose a statistical procedure for testing the equality of two average ratios. In this paper, we show why the use of average cost-effectiveness ratios is misleading and argue that the appropriate focus for cost-effectiveness analysis is the estimation of confidence intervals around incremental cost-effectiveness ratios.

Confidence Intervals↗
PubMedDate not supplied

The usefulness of average cost-effective ratios.

We demonstrate that average cost-effectiveness ratios (CERs) play an important role in the evaluation of the cost-effectiveness of treatments. Criticisms of the usefulness of CERs derive mostly from the context of resource allocation under a constrained budget in which some decisions are based on incremental CERs. However, we show that in many cases, these decision rules are equivalent to decision rules on CERs. This follows for mutually exclusive treatments first, because a treatment is eliminated by extended dominance if and only if there is a mixed treatment with a smaller CER, where the mixing parameter lies in a certain interval. Second, after elimination of treatments by dominance and by extended dominance, resources can be allocated in order of increasing CERs. Moreover, the CER is a parameter that characterizes clinical and economical properties of a treatment independent of its comparators.

Confidence Intervals↗
PubMedDate not supplied

Productivity costs in cost-effectiveness analysis: numerator or denominator: a further discussion.

In this response we concentrate on what Weinstein et al. call the 'major disagreement' between the Erasmus group and the US Panel, which concerns the measurement of productivity losses during illness. We consider the consequences for the individual, for the employer and for the rest of society and argue that when following the Panel's propositions for measuring these consequences, major theoretical and practical difficulties are encountered.

Cost of Illness↗
PubMedDate not supplied

Economic modelling of the gateway effect.

Although a significant number of empirical studies provide evidence of sequencing in drug use, economic theory remains focused on addiction to a single substance. This paper presents a general model of substance use that allows for the possibility of multi-commodity habit formation and can be used to analyse the intertemporal relationship between the consumption of legal and illicit drugs, or the gateway effect. A simple two-drug model is analysed and conditions for the existence of multi-commodity habit formation are examined. It is found in the case of multi-commodity habit formation that the marginal utility of initiating a new drug is higher when there is prior consumption of the other drug. Further, it is found that the individual will initiate drug consumption with that drug that has the lowest marginal cost. The particular sequencing of drug use that is observed in empirical data is explained by differences in the marginal cost of consuming legal and illegal drugs.

Alcoholism↗
PubMedDate not supplied

Multilevel models and health economics.

Multilevel analyses have become an accepted statistical technique in the field of education where over the past decade or so the methods have been developed to explore the relationships between pupil characteristics and the characteristics of the schools they attend. More recently, widespread use has extended to other social sciences and health research. However, to date, little use has been made of these techniques within the health economics literature. This paper presents an introductory account of multilevel models and describes some of the areas of health economics research that may benefit from their use.

Adult↗
PubMedDate not supplied

Analysing the effect of competition on general practitioners' behaviour using a multilevel modelling framework.

This paper examines the effect of competition on the behaviour of Australian general practitioners. The paper represents a considerable improvement on the methods of previous studies by using a random effects probit model in a multilevel modelling framework to obtain a more robust estimate of the effect of GP density, by including data on GP and practice characteristics and by using data with the actual GP consultation as the unit of observation which are disaggregated by medical condition. This latter characteristic enables us to test the hypothesis that the effect of competition varies across medical conditions. The main hypothesis tested is that GPs in areas of high competition are more likely to recommend a follow-up consultation compared to GPs in areas of low competition. The results suggest that the density of GPs influences the decision to follow up for one out of the four medical conditions analysed. However, there are other issues to be resolved before such results can be confidently interpreted as evidence of the effect of competition and as evidence of supplier-induced demand.

Adolescent↗
PubMedDate not supplied

Aiding priority setting in health care: is there a role for the contingent valuation method?

The paper discusses some methodological and measurement aspects with the contingent valuation (CV) method which appear to create problems when eliciting preferences for the relative social valuation of alternative health care programmes. After pointing to biases which tend to exaggerate the true valuations, emphasis is placed on framing issues when applied to health care. Thereafter the paper discusses the extent to which preferences elicited through one's willingness to pay can be used to infer how the respondent would prioritize between the health care programmes in question. New empirical evidence is presented which suggest discrepancies between a CV ranking and the ranking expressed when making a direct ordinal comparison.

Bias↗
PubMedDate not supplied

The interpretation of results of economic evaluation: explicating the value of health.

Theoretically it can be proven that an optimal allocation of resources within a constrained budget can be reached by considering cost-effectiveness ratios (CERs). In this paper, the complex priority setting process regarding compatible and incompatible alternatives of medical interventions is clarified. Priority setting in the context of compatible alternatives may refer to the selection of more than one, possibly all, alternatives. Inherent to a set of incompatible alternatives is that only one alternative can be selected. This latter situation frequently occurs in health care. The value that society attaches to a unit of effectiveness (e.g. a QALY) has an important impact on the priority ranking of medical interventions. By explicating this value and by using the 'net-value' approach, a graphical framework is presented that allows decision-makers a better understanding on the impact of particular levels of these values on their optimal policy choices. For illustrative purposes, it is shown that by the erroneous application of decision rules, some recent papers have provided sub-optimal recommendations for health care policy.

Adult↗
PubMedDate not supplied

Contingent valuation with an open-ended follow-up question: a test of scope effects.

It has been suggested that an open-ended follow-up question should be added to the binary contingent valuation question. Before this is generally recommended, it is important to evaluate the properties of such follow-up questions. Using a split sample approach, we test whether the open-ended follow-up is sensitive to the scope of the commodity being valued. No significant scope effects were detected. It is concluded that the results obtained do not support the use of an open-ended follow-up in contingent valuation applications.

Esophagitis, Peptic↗
PubMed1998

Faecal occult blood screening for colorectal cancer: is it cost-effective?

Recently published evidence from two large-scale clinical trials conducted in England and in Denmark suggests that faecal occult blood screening for colorectal cancer significantly reduces mortality. However, before screening can be advocated as part of national health policy, its cost-effectiveness must be demonstrated. The English screening trial has been the subject of a detailed economic evaluation over the past 10 years In this paper, cost-effectiveness estimates of screening are presented, based on cost and outcome data combined in a mathematical model developed from the trial's clinical findings The estimates of cost per quality-adjusted life-year gained from colorectal cancer screening show the procedure to be of similar cost-effectiveness to breast cancer screening in the short term. Over the longer term, however, the estimates for colorectal cancer screening appear superior.

Aged↗
PubMed1998

Colorectal cancer screening: efficiency and effectiveness.

The cost-effectiveness of a series of mutually exclusive colorectal cancer screening programmes with varying screening interval and target group are analysed. Costs and effects for 60 possible screening programmes are simulated on the basis of data collected from a randomized trial initiated in 1985 in Funen County, Denmark. The screening test applied is the unhydrated Hemoccult-II. The analysis identifies six efficient programmes with cost-effectiveness estimates ranging from 17000 to 42500 Danish kroner (DKK) per life-year.

Aged↗
PubMed1998

Bootstrap confidence intervals for cost-effectiveness ratios: some simulation results.

Recently, a number of papers have brought up the issue of how to make cost-effectiveness (CE) studies stochastic, i.e. how to obtain confidence intervals for CE ratios. In this note we present a bootstrap procedure for estimating bias-corrected confidence intervals for CE ratios. The bootstrap procedure is tested in a simulation study based on the assumptions made in a recent paper by Wakker and Klaassen in this journal. We test two variants of CE ratio bootstrap confidence intervals. The first is a bootstrap analogue of the parametric method proposed by Wakker and Klaassen which gives results similar to those obtained with the parametric method. However, computing bootstrap confidence intervals directly for the CE ratio produce results closer to the predetermined significance level.

Algorithms↗