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PubMed2000

[Mortality socio-economic inequalities for small-areas in Belgium: assessing concentration].

BACKGROUND: The reduction of socio-economic inequality in mortality is an important public health goal. Previous ecological studies aimed at studying the relationship between mortality rate and socio-economic factors have paid little attention to mortality causes avoidable by primary or secondary prevention. Furthermore, these studies do not make the distinction between, on the one hand, the strength of the relationship mortality/socio-economic deprivation and, on the other hand, the significance of the unequal distribution of mortality. The present work is aimed at measuring the strength of this relationship and the concentration of mortality in relation to socio-economic deprivation for both overall mortality and mortality avoidable by primary and secondary prevention. METHOD: Standardised mortality ratios were computed at the community level in Belgium (1985-93 period) for all causes and for 11 mortality causes avoidable by primary and secondary prevention. A deprivation index was elaborated using a factorial principal component analysis on 11 socio-economic indicators. The mortality/deprivation relationship was assessed by way of a standardised regression coefficient (B) while socio-economic concentration of mortality was estimated using the Concentration Illness Index (Cii) and the P90/P10 ratio. RESULTS: A strong positive relationship was found between mortality and deprivation for under 65 years all-causes mortality (B =0.71; CI [0.66; 0.76]), mortality for cirrhosis of the liver (B =0.56; CI [0.51; 0.62]), lung cancer (B =0.49; CI [0.42; 0. 56]), suicide (B =0.35; CI [0.29; 0.42]) and falls (B =0.34; CI [0. 28; 0.41]). However, the concentration of mortality was more limited: 14% (CI [11%-17%]) of cirrhosis of the liver mortality, 7% of fall (CI [5%-10%]) and suicide mortality (CI [4%-9%]), 6% (CI [5%-7%]) of lung cancer mortality is unequally distributed. CONCLUSION: Socio-economic deprivation is positively associated with mortality. This association is more pronounced for tobacco, alcohol and mental health related mortality. However, the strength of the relationship between socio-economic deprivation and mortality is not a good indicator of unequal distribution.

Age Factors↗
PubMed2000

[Economic aspects of epilepsy].

INTRODUCTION: The economic magnitude of epilepsy is determined by its effect on the employment status of the patients, the cost of drug treatment for them and the healthcare system and the repercussion worldwide. DEVELOPMENT: Studies of the cost of the disease show that it has economic importance due to the sum of the direct and indirect costs caused by it. In the case of epilepsy, the results of studies in various countries led to the creation of a Commission on Economic Aspects of Epilepsy. The lack of epidemiological studies regarding epilepsy in Spain may explain the lack of publications on this subject in our country. The percentage of the total cost due to antiepileptic drugs is considerable and will probably increase in the future. The pharmaco-economic evaluation made by cost-benefit, cost-effectiveness, cost-usefulness analysis and studies to minimize costs should serve to use healthcare resources in the most effective manner and justify the rational use of the new antiepileptic drugs. CONCLUSIONS: The economic impact of epilepsy is added to the repercussion of the disease itself on the patient and his family. The different distribution of costs in children and adults with epilepsy suggest the need for intervention at an early age to try to reduce the long term economic and personal repercussions. The pharmaco-economic evaluation of the new antiepileptic drugs will make it clear whether their considerable cost is worth paying for their greater effectivity.

Adult↗
PubMed2001

Disproportion of economic impact, research achievements and research support in digestive diseases in Canada.

OBJECTIVES: To assess the economic impact, research output and research support of digestive diseases, and to compare them to those of other common disease entities, specifically mental, cardiovascular, respiratory, and central nervous system diseases. METHODS: Economic burden was assessed with the use of (a) published Canadian government data of direct cost from 1963 to 1993, (b) data from the Canadian Institute of Health Information and (c) recent Canadian economic studies. Research achievements were assessed on the basis of (a) research training in Canadian units, (b) individual achievements by Canadian investigators and (c) contribution to meetings and reception of awards. Research support was assessed by reviewing (a) Canadian government publications, (b) the Association of Canadian Medical Colleges, (c) the Medical Research Council (MRC) of Canada, (d) charitable organizations and (e) the Canadian Association of Gastroenterology (CAG). RESULTS: Digestive diseases are responsible for 15% of the total direct economic burden of Canadian health costs, and this figure exceeds those for mental, cardiovascular, respiratory and central nervous system diseases. Hospital discharges for digestive diseases contribute 12% of all hospitalizations and 20% of all neoplasias. Digestive diseases cause short-term loss of productivity, costing $1.14 billion/yr and exceeding the costs of mental, cardiovascular, respiratory and central nervous system diseases. Eighty-one percent of Research Fellows trained in Canadian units entered academic positions, and 63% obtained operating grants. Canadian investigators made important contributions in all areas of digestive science and received major international awards. Government support for digestive diseases was less than that for cardiovascular and neurologic research. In contrast to the highest economic burden, university staffing and residents were fewer for digestive than for mental, cardiovascular, respiratory and neurologic diseases. The number of MRC grants decreased, mainly because of organizational problems. Most charitable organizations support research specifically oriented to the disease of their interest. The CAG was the major supporter of non-specified research. CONCLUSIONS: Digestive diseases are responsible for a major economic burden. Scientists in this field have established international recognition, but research support lags behind the need to correct the economic burden and to provide future generations of scientists in the digestive sciences. There is need for government to readdress this shortcoming and to review its method of support.

Canada↗
PubMedDate not supplied

Using economic evidence in clinical practice.

Clinicians and health policy decision makers find themselves increasingly interested in economic evaluations. The purposes of this article are to review the types of economic analyses available to clinicians, discuss the measurement of costs in economic evaluations, review recommendations for standardization of cost-effectiveness analyses, and review strategies to integrate economic evidence in the establishment of evidence-based practice. A worksheet is presented that may be useful in the critiquing of economic evaluations for validity and applicability to clinical settings. Increased understanding of the methods employed to assess the rigor of the economic evaluations is needed by busy clinicians and health policy decision makers for economic evidence to be routinely applied in practice.

Cost-Benefit Analysis↗
PubMed2003

The economic burden of depression with painful symptoms.

The economic burden of depression is substantial. The condition is highly prevalent, with both psychiatric and physical symptoms that often inflict pain. The chronic and often debilitating nature of depression results in costly medical therapies, as well as impaired workplace productivity. As a result, the overall economic burden of depression is comparable to that of serious physical illnesses, such as cancer and heart disease. This article presents an overview of the economic burden of depression and provides background on the relationship between depression and pain in this context. Research findings are also presented on the economic burden associated with a particular manifestation of pain among depressed patients, fibromyalgia. When painful physical symptoms accompany the already debilitating psychiatric and behavioral symptoms of depression, the economic burden that ensues for patients and their employers increases considerably. On purely economic grounds, more aggressive outreach may be warranted for patients with depression and comorbid pain to initiate treatment before symptoms are allowed to persist. However, more research is needed to assess the comprehensive economic impact that depression with painful physical symptoms can have on society.

Absenteeism↗
PubMed2003

[Studies on direct and indirect economic burden of disease and related factor in countryside of Qingdao city in 2001].

OBJECTIVE: To study the condition of economic burden of disease in the countryside and to explore the related factors. METHODS: Human capital method and two-step method were used in the calculation of economic burden of disease. RESULTS: The total economic burden of disease among 3359 persons was 3072 225 Yuan. Noncommunicable conditions were accounted for 62.95%, while communicable disease, maternal and perinatal conditions accounted for 24.25%, and injury accounted for 9.83% respectively. The direct economic burden of disease was 1,559,619 Yuan and the indirect economic burden of disease was 1,472,606 Yuan. The economic burden of disease for each person was 914 Yuan. The equal burden of disease among patients with disability and without disability were 3070 Yuan and 680 Yuan respectively (P < 0.001). There was significant difference among different age groups. The influencing factors were found to include having noncommunicable disease, age, disability and the condition of marriage. CONCLUSION: Corresponding policy to cope with conditions of different age groups needs to be developed to reduce the economic burden of disease in the countryside.

Absenteeism↗
PubMed2004

Trends in paediatric health economic evaluation: 1980 to 1999.

BACKGROUND: Although standard methods for conducting economic evaluations have evolved, little attention has been paid to their application in paediatrics. The Paediatric Economic Database Evaluation (PEDE) Project was conceived to promote research into paediatric health economic methods. AIM: To examine trends in paediatric economic evaluation between 1980 and 1999. METHODS: A comprehensive literature database created for the PEDE project was the source of the data. Descriptive statistics were used to summarise trends. Publication volume, study outcome category, analytical technique, and journal type were examined over the study period. RESULTS: The literature search resulted in 787 full paediatric economic evaluations. The volume of publications increased from 61 to 440 citations per 5 year period. The most common health outcome category was cases of disease/condition/abnormality. Cost-effectiveness analysis (CEA) was the most common technique used, accounting for a majority of evaluations in all time periods. The proportion of studies using CEA increased by 23 percentage points, while the proportion using cost-benefit analysis decreased from 31% in 1980-84 to 12% in 1995-99. Cost-utility analysis was the least common analytical technique. Publication in journals of paediatrics/perinatal medicine was the most common venue for all intervals and increased as a proportion of the total over time. CONCLUSIONS: The growth in publication of paediatric economic evaluations suggests that increasing attention should be paid to the application of health economic methods to a paediatric population to ensure high quality allocation decisions.

Child↗
PubMed1996

Forum on economic credentialing (E.C.).

What is economic credentialing? The California Medical Association defines economic credentialing as follows: "The use of economic criteria that do not apply to quality for granting or renewing medical staff pr ivileges?" The American Medical Association defines economic credentialing as " ... the use of economic criteria unrelated to quality of care or professional competency in determining an individual's qualification for initial or continuing hospital medical staff membership or pr-ivileges?" The Florida Medical Association defines economic credentialing as " ... any practice that denies access to hospitals based on eco- nomic criteria unrelated to the clinical qualifications or professional responsibilities of the physician." It also defines economic credentialing as " ... fiscal responsibility in practicing quality healthcare," and specifically notes that the governing body of a hospital has the right to discipline physicians (and presumably, exclude them) on the basis of resource utilization.

Journal Article↗
PubMed2005

Behavioral economics and health policy: understanding Medicaid's failure.

This Article employs a behavioral economic analysis to understand why Medicaid has failed to improve the health outcomes of its beneficiaries. It begins with a formal economic model of health care consumption and then systematically incorporates a survey of psychosocial variables to formulate explanations for persistent health disparities. This methodology suggests that consulting the literature in health psychology and intertemporal decision theory--empirical sources generally excluded from orthodox economic analysis--provides valuable material to explain certain findings in health econometrics. More significantly, the lessons from this behavioral economic approach generate useful policy considerations for Medicaid policymakers, who largely have neglected psychosocial variables in implementing a health insurance program that rests chiefly on orthodox economic assumptions. The Article's chief contributions include an expansion of the behavioral economic approach to include a host of variables in health psychology, a behavioral refinement of empirical health economics, a behavioral critique of Medicaid policy, and a menu of suggested Medicaid reforms.

Behavioral Medicine↗
PubMed2006

Socio-economic factors in obesity: a case of slim chance in a fat world?

The global obesity pandemic has been well-documented and widely discussed by the public, the media, health officials, the food industry and academic researchers. While the problem is widely recognised, the potential solutions are far less clear. There is only limited evidence to guide decisions as to how best to manage obesity in individuals and in populations. While widely viewed as a clinical and public health problem in developed countries, it is now clear that many developing countries also have to grapple with this problem or face the crippling healthcare costs resulting from obesity-related morbidity. There is also abundant evidence that obesity is socio-economically distributed. In developed countries persons of lower socio-economic position are more likely to be affected, while in developing countries, it is often those of higher socio-economic position who are overweight or obese. The aim of this paper is to briefly review the evidence that links socio-economic position and obesity, to discuss what is known about underlying mechanisms, and to consider the role of social, physical, policy and cultural environments in explaining the relationships between socio-economic position and obesity. We introduce the concept of 'resilience' as a potential theoretical construct to guide research efforts aimed at understanding how some socio-economically disadvantaged individuals manage to avoid obesity. We conclude by considering an agenda to guide future research and programs focused on understanding and reducing obesity among those of low socio-economic position.

Cost of Illness↗
PubMed1994

Economic aspects of the care of patients in the vegetative state.

The raising of economic issues related to the care of patients in the vegetative state (V.S.) is troublesome to both health-care practitioners and to the public opinion, given the general perception that economics and ethics are incompatible. The main purpose of this article is to show that economic considerations are not merely reconcilable with ethical concerns, they nourish, enrich, and complement them. Three areas of intersection between ethics and economics are described: economic considerations can help bring to the surface the choices involved in decision-making, whether they are explicit or not; these considerations are a natural outgrowth of a well thought-out ethical approach; an economic analysis can accommodate and take into consideration ethical criteria. The second part presents the results of a study conducted in France between 1987 and 1993 which attempted to evaluate the costs of hospital care of comatose patients hospitalized for short and medium term periods. The article concludes with an examination of the economic issues that may be raised in future debates about how much effort should be expended in the care of patients afflicted by V.S.

Adult↗
PubMed1995

Socio-economic aspects of animal diseases in southern Africa: research priorities in veterinary science.

During May 1995, members of organisations with a vested interest in the socio-economic aspects of animal diseases in southern Africa met for a one-day workshop. This was the first activity of a proposed three-year Forum and programme in this area under discussion. The workshop was sponsored by the Foundation for Research Development, the Agricultural Research Council and the University of Pretoria. The individuals who attended were representatives of academic and government institutions and included veterinarians, veterinary scientists, animal health officers, administrators from the region and abroad, economists, sociologists and animal welfare experts. The aims of the workshop were fourfold: 1. to define what is meant by socio-economic aspects of animal diseases in southern Africa; 2. to identify the socio-economic factors which influence occurrence and consequences of animal diseases; 3. to learn of methods which are used to assess socio-economic needs, and 4. to initiate an ongoing network and research programme in this area. Two key questions were considered and discussed by the participants, and a consensus reached for each. The first question considered the link between community development and socio-economic aspects of animal diseases. This included the role of production animals, companion animals and game in developing communities and factors influencing these roles, as well as constraints to this development. The second question concerned the gaps in our understanding of the socio-economic aspects of animal diseases in southern Africa which would lead to research opportunities. Six areas identified were were the collection of disease information, education and communication, policy, economics, community needs and technology.(ABSTRACT TRUNCATED AT 250 WORDS)

Africa, Southern↗
PubMedDate not supplied

Is economic hardship on the families of the seriously ill associated with patient and surrogate care preferences? SUPPORT Investigators.

BACKGROUND: Serious illness often causes economic hardship for patients' families. However, it is not known whether this hardship is associated with a preference for the goal of care to focus on maximizing comfort instead of maximizing life expectancy or whether economic hardship might give rise to disagreement between patients and surrogates over the goal of care. METHODS: We performed a cross-sectional study of 3158 seriously ill patients (median age, 63 years; 44% women) at 5 tertiary medical centers with 1 of 9 diagnoses associated with a high risk of mortality. Two months after their index hospitalization, patients and surrogates were surveyed about patients' preferences for the primary goal of care: either care focused on extending life or care focused on maximizing comfort. Patients and surrogates were also surveyed about the financial impact of the illness on the patient's family. RESULTS: A report of economic hardship on the family as a result of the illness was associated with a preference for comfort care over life-extending care (odds ratio, 1.26; 95% confidence interval, 1.07-1.48) in an age-stratified bivariate analysis. Similarly, in a multivariable analysis controlling for patient demographics, illness severity, functional dependency, depression, anxiety, and pain, economic hardship on the family remained associated with a preference for comfort care over life-extending care (odds ratio, 1.31; 95% confidence interval, 1.10-1.57). Economic hardship on the family did not affect either the frequency or direction of patient-surrogate disagreements about the goal of care. CONCLUSIONS: In patients with serious illness, economic hardship on the family is associated with preferences for comfort care over life-extending care. However, economic hardship on the family does not appear to be a factor in patient-surrogate disagreements about the goal of care.

Aged↗
PubMedDate not supplied

Between economics and ecology: some historical and philosophical considerations for modelers of natural capital.

Natural capital models attempt to remediate the relationship between economics and ecology either by conjoining models and theories from each discipline or by finding a type of phenomena that can be meaningfully measured by both fields. The development of a widely accepted model that integrates economics and ecology has eluded researchers since the early 1970s. This paper offers an historical and philosophical perspective on some of the conceptual problems or obstacles that hinder the development of natural capital models. In particular, the disciplinary assumptions of economic science and ecological science are examined and it is argued that these assumptions are antithetical. Hence, the development of an effective and accepted natural capital model will require that economics and ecology reconsider their self-conceptions as sciences. For the purposes of theoretical research and practical policy, the paper cautions against confusing the issue of whether or not economic models accord with ecological models with the issue of whether or not economic activities accord with ecological realities.

Conservation of Natural Resources↗
PubMed2005

Economic evaluation: what does a nurse manager need to know?

This paper considers how health economists can assist nurse managers, using the concepts and tools of economic evaluation. We aim to clarify these and also explode some of the myths about economic evaluation and its role in health care decision-making. Economic evaluation techniques compare alternative courses of action in terms of their costs and consequences. There are four principal methods; cost-minimization, cost-effectiveness, cost-utility and cost-benefit analysis, all of which synthesize costs and outcomes, at different levels of outcome. Economic evaluation is an intrinsic part of national decision-making about the efficient provision of effective treatments and services, and increasingly, organizational matters. In the UK, such technology evaluation is disseminated in guidelines from the National Institute for Clinical Effectiveness (NICE), having a top-down impact on the nurse manager. But economic evaluation is increasingly relevant to the nurse manager at local level, through newer techniques such as Programme Budgeting Marginal Analysis (PBMA), which facilitates explicit, transparent decisions, from the bottom-up. Nurse managers need to weigh up competing demands on resources and decide in ways which maximize health gain. Economic evaluation can help here because it presents evidence to challenge or support existing allocations, and provides a systematic framework to analyse health care decisions. In the current context of competition for scarce resources, we suggest that nurse managers need to embrace these techniques, or be marginalized from the resource allocation process.

Cost Control↗
PubMed2004

Incorporation of statistical uncertainty in health economic modelling studies using second-order Monte Carlo simulations.

Health economic modelling studies are of interest to many parties with different responsibilities and diverging interests. Therefore, it is obvious that recognising the relevance of statistical uncertainty and dealing with it appropriately are required to obtain unbiased results from health economic modelling studies, especially when those data are being used for reimbursement decisions. In this manuscript we explore the relevance of the incorporation of statistical uncertainty in a health economic model and identify various types of statistical uncertainty. The concepts were applied to a hypothetical Markov model for a hypothetical antiparkinsonian (AP) product. The method was based on the incorporation of probability distributions in the input variables using a second-order Monte Carlo simulation and the definition of minimum relevant differences for clinical and economic input variables and outcomes. Our paper shows that the outcomes of a health economic model might be severely biased when statistical uncertainty is not taken into account, which justifies the need for the incorporation of statistical uncertainty in a health economic model.

Antiparkinson Agents↗
PubMedDate not supplied

Some economic and technical factors affecting use of phosphate raw materials.

In comparison with phosphate resources most of the other industrial minerals essential to man have much higher unit values. Furthermore, they generally have more narrowly defined geochemical origins, concentration requirements, and end-use markets. Consequently, an economic assessment of their mined production cost in relation to market value is more easily and reliably defined. Thus, the mere knowledge of existing or newly discovered ore bodies provides economic incentives for exploitation plans--even in the most remote geographical location (as is well illustrated by iron, copper, tin, lead, and similar mineral commodities). Unfortunately, this is not the case for phosphate resources. Much of the known vast reserves of more than 1 X 10(11) tons, which are favourably dispersed among the worldwide markets, remains uneconomical to recover, despite the growing need for phosphate in world food production. A complex set of interrelated technical and economic factors decide the economic potential of any particular phosphate reserve. Although technical similarities may exist among deposits, economic analogies are rare. The economic evaluation of the mineability of the ore and the mill preparation of the concentrates must also take into account the geological setting and character of the ore deposit as well as the eventual end-use markets and their locations.

Aluminum↗
PubMed1998

From private club to professional network: an economic history of the Health Economists' Study Group, 1972-1997.

HESG was founded in 1972 as part of a conscious effort to establish health economics as an identifiable sub-discipline. It is debatable whether the growth of health economics was demand-led or supplier-driven, but in either case the existence of a HESG played a vital role. HESG was founded as a private club, in the tradition of English gentlemen's clubs, designed to provide a forum for debate and an invisible, supportive faculty for health economists dispersed between different organisations throughout the UK. It was given impetus by public economists at the University of York, who were effectively academic entrepreneurs, motivated in part by private gain, but by their actions overcoming the free-rider problem that might otherwise have retarded the development of health economics. Over the course of its first 25 years, HESG has changed and its membership has grown and altered in composition - over this period, HESG has evolved from a private club to a professional network. It has made a vital contribution to the existence and form of health economics as a subdiscipline in the United Kingdom, and has in turn itself been influenced by the subdiscipline. As a subdiscipline, UK health economics in the 1990s generally draws on a small body of economic theory and is practised by a distinct, identifiable group of economists. This paper was commissioned by HESG, as a history of the organisation. It also analyses the foundation and evolution of HESG as an institutional arrangement designed to overcome a collective action problem.

Congresses as Topic↗