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PubMed2005

The effects of economic instability on infant, neonatal, and postneonatal mortality rates: evidence from Taiwan.

This paper uses a panel data set comprising 23 cities for the years 1979-2002 in Taiwan and a fixed-effects model to find evidence of the effect of economic instability on infant, neonatal, and postneonatal mortality rates. In addition, the effects of income, demographic factors, and the availability of medical resources are also examined in relation to the mortalities. The most important finding is that infant, neonatal, and postneonatal mortality rates move counter-cyclically with the city unemployment rate in Taiwan. The provision of national health insurance is also found to have a positive impact on the health of infants in Taiwan. Finally, the impact of economic instability on the infant, neonatal, and postneonatal mortality rates is found to be the strongest in the eastern part of Taiwan, which is the region with the fewest health care resources. The analysis provides evidence of the effects of economic instability on the infant, neonatal, and postneonatal mortality rates in a developing country, which are comparable to those of other countries and may provide some important insights into this issue.

Humans↗
PubMed2006

Health disparities between racial groups in South Africa: a decomposition analysis.

This article explores the sources of self-rated health status inequalities among South Africans. We propose a decomposition of observed health disparities between racial groups using a procedure based on an extended version of Oaxaca-Blinder decomposition methods which addresses explicitly the specificities associated with the analysis of subjective measures. This method allows for a decompositions of differences in self-rated health status between races and isolates what may be due to observed socioeconomic inequality between racial groups, i.e. an "indirect racial effect" (Whites and Africans with different socio-economical characteristics have different health), from what could be due to unexplained racial differences, i.e. a "direct racial effect" (Whites and Africans with similar socio-economical characteristics have different health). Unsurprisingly, we find a strong indirect racial effect in favor of Whites. However, our analysis tends to show that the issue of direct racial discrimination on health is more complex and closely linked with that of economical inequality and discrimination. Our results thus stress the necessity not only to open access for Africans to the more sophisticated sector of health care but also to provide them with the economical opportunity to use it.

Adult↗
PubMed2006

The pervasiveness of pharmaceutical expenditure inertia in the OECD countries.

This paper constructs and estimates an economic model for testing statistically the strength of possible 'expenditure inertia' as a plausible reason for rising drug expenditures of the Organization for Economic Cooperation and Development (OECD) countries. The ethical drugs sector in the OECD health care systems is increasingly targeted as the major culprit in the rising cost. Using multiple regression analysis, and the maximum likelihood estimation method, the data of each country (taken from OECD Health Data, 1997) were first tested for functional form optimality with the Box-Cox power family transformations model. Drug expenditure elasticities, at data means, were computed using each country's optimal regression model estimates. The results indicate that the traditionally fitted a priori limited functional form models (e.g., linear, log-log) are not globally consistent with data across countries. The effect of a one-period lagged real per-capita drug expenditure (capturing inertia or habit persistence) on current period real per-capita prescription expenditure is statistically significant in most countries. Pharmaceutical demands are inelastic, and tend to behave like a necessity, as expected. Since the significant effects of economic, demographic, and other drivers of high drug spending differ across countries, country-specific implications and policy suggestions for cost controls ought to differ.

Aged↗
PubMed2006

Does village inequality in modern income harm the psyche? Anger, fear, sadness, and alcohol consumption in a pre-industrial society.

Researchers have found a positive association between income inequality and poor individual health. To explain the link, researchers have hypothesized that income inequality erodes community social capital, which unleashes negative emotions, stress, and stress behaviors that hurt health. Few studies have tested the hypothesized path. Here we estimate the association between (a) village income inequality and social capital, and (b) three distinct negative emotions (anger, fear, sadness) and one stress behavior (alcohol consumption). We use four quarters of panel data (2002-2003) from 655 adults in 13 villages of a foraging-farming society in the Bolivian Amazon (Tsimane'). We found that: (1) village income inequality was associated with more negative emotions but with less alcohol consumption, (2) social capital always bore a negative association with outcomes, and (3) results held up after introducing many changes to the main model. We conclude that village income inequality probably affects negative emotions and stress behaviors through other paths besides social capital because we conditioned for social capital. One such path is an innate dislike of inequality, which might have pre-human origins. Our prior research with the Tsimane' suggests that village income inequality bore an insignificant association with individual health. Therefore, village income inequality probably affects negative emotions and stress behaviors before undermining health.

Adult↗
PubMed2006

On the dynamics of health capital accumulation.

This paper presents a key model from the economics literature that has been adjusted and reinterpreted as a simple, formal, quantitative tool for formalising the inputs and outputs involved in personal health regimes undertaken to accumulate Grossman's health capital. Implications of the model fit with commonsensical clinical results. We find that higher variance of previous health capital increases leads to higher "good health" needed before health regimes are undertaken permanently. Conversely, the higher the target amount of health capital the lower the health capital "trigger" level for instigating the regime. Indeed, we find that the higher an individuals motivation is, as measured by a personal discount rate, the lower this personal "trigger" health capital level is. It is theorised that such a model can be used as a clinical application, whereby a patient's personal health history can generate the "motivation" and instigate health capital levels in a quantitative, as opposed to qualitative manner. Further implications are discussed.

Attitude to Health↗
PubMed2006

Health care costs in the last year of life--the Dutch experience.

Health expenditure depends heavily on age. Common wisdom is that the age pattern is dominated by costs in the last year of life. Knowledge about these costs is important for the debate on the future development of health expenditure. According to the 'red herring' argument traditional projection methods overestimate the influence of ageing because improvements in life expectancy will postpone rather than raise health expenditure. This paper has four objectives: (1) to estimate health care costs in the last year of life in the Netherlands; (2) to describe age patterns and differences between causes of death for men and women; (3) to compare cost profiles of decedents and survivors; and (4) to use these figures in projections of future health expenditure. We used health insurance data of 2.1 million persons (13% of the Dutch population), linked at the individual level with data on the use of home care and nursing homes and causes of death in 1999. On average, health care costs amounted to 1100 Euro per person. Costs per decedent were 13.5 times higher and approximated 14,906 Euro in the last year of life. Most costs related to hospital care (54%) and nursing home care (19%). Among the major causes of death, costs were highest for cancer (19,000 Euro) and lowest for myocardial infarctions (8068 Euro). Between the other causes of death, however, cost differences were rather limited. On average costs for the younger decedents were higher than for people who died at higher ages. Ten per cent of total health expenditure was associated with the health care use of people in their last year of life. Increasing longevity will result in higher costs because people live longer. The decline of costs in the last year of life with increasing age will have a moderate lowering effect. Our projection demonstrated a 10% decline in the growth rate of future health expenditure compared to conventional projection methods.

Age Factors↗
PubMed2006

The influence of health insurance on hospital admission and length of stay--the case of Vietnam.

Few studies analyze the effects of health insurance on inpatient care in low income countries. This paper provides an empirical assessment of the influence of Vietnam's health insurance schemes on both hospital admission and the length of stay (LOS) using the Vietnam National Health Survey 2001-2002 and an appropriate count data regression model. Our findings suggest that the influence of health insurance on hospital admission and the LOS varies across insurance schemes. The compulsory insurance scheme and the insurance scheme for the poor increase the expected LOS by factors of 1.18 and 1.39, respectively, while the voluntary insurance scheme has minimal effect on the expected LOS. Insurance also increases the likelihood of hospital admission far more for compulsory members than for members of the other two insurance schemes. The positive influence of insurance on hospital admission and the LOS also varies across income quintiles, regions and types of health facilities. While the compulsory and voluntary schemes increase the likelihood of hospital admission more for lower and middle income individuals, the influence of the compulsory scheme on the expected LOS is more pronounced for patients in the middle income groups. The influence of insurance on the LOS is also found to be stronger in the North than in the South and stronger for patients admitted to provincial hospitals rather than district hospitals.

Adolescent↗
PubMed2006

Decentralisation and convergence in health among the provinces of Spain (1980-2001).

This study measures the process of convergence in the state of health among the provinces and regions of Spain during 1980-2001 in order to analyse the possible influence of the decentralisation of healthcare management to the regions in this period. Sigma and beta convergence models, traditionally employed in macroeconomics, have been used, taking Life Expectancy at Birth (LEB) and Infant Mortality (IM) as health indicators. The analysis was carried out at two territorial levels: provinces and regions. The results reveal that the process of decentralisation either does not affect convergence or leads to divergence in health. Indeed, in the case of IM the so-called change of role scenario seems to have occurred. Thus, certain provinces with initially poor indicators have improved, overtaking those that were originally in a better position. The final result, however, is of greater dispersion than initially.

Empirical Research↗
PubMed2006

Modelling covariates for the SF-6D standard gamble health state preference data using a nonparametric Bayesian method.

It has long been recognised that respondent characteristics can impact on the values they give to health states. This paper reports on the findings from applying a non-parametric approach to estimate the covariates in a model of SF-6D health state values using Bayesian methods. The data set is the UK SF-6D valuation study, where a sample of 249 states defined by the SF-6D (a derivate of the SF-36) was valued by a sample of the UK general population using standard gamble. Advantages of the nonparametric model are that it can be used to predict scores in populations with different distributions of characteristics and that it allows for an impact to vary by health state (whilst ensuring that full health passes through unity). The results suggest an important age effect, with sex, class, education, employment and physical functioning probably having some effect, but the remaining covariates having no discernable effect. Adjusting for covariates in the UK sample made little difference to mean health state values. The paper discusses the implications of these results for policy.

Adult↗
PubMed2005

An economic analysis of annual influenza vaccination of children.

We used a Monte Carlo mathematical model to calculate the net economic returns (cost-benefit analysis) from annually vaccinating children against influenza. The model included cohorts of 1000 children in three different age groups (6-23 months, 6-59 months, and 5-14 years), with different proportions of children with high risk conditions (100, 10, and 0%). Vaccinating cohorts of 100% high risk children in all three age groups produced median net savings, regardless of cost of vaccination examined (US dollar 30-60/dose administered). Median threshold vaccination costs for cohorts containing 10% high risk children were US dollar 48, 46, and 45 per dose administered for age groups 6-23 months, 6-59 months, and 5-14 years, respectively (US dollar/dose administered below these thresholds generate net savings). For all cohorts, for the range of cost per dose administered examined, the 5th percentiles were net costs. The probability of death, though rare, was the most influential distribution in the model. The number of high-risk children that receive influenza vaccine should be maximized to achieve improved health outcomes as well as cost savings.

Adolescent↗
PubMed2005

Influence of clinical outcome and outcome period definitions on estimates of absolute clinical and economic benefits of influenza vaccination in community dwelling elderly persons.

Studies assessing the clinical and economic benefits of vaccination in the elderly have used different clinical outcomes (e.g. hospitalizations for pneumonia or influenza versus hospitalizations for respiratory and cardiovascular causes) and different outcome periods (e.g. peak versus total influenza season) on which to base estimates of clinical effectiveness and cost effectiveness. We explored the implications of these varying approaches by comparing two health economic analysis models of influenza vaccination of community-dwelling elderly persons. We developed computerized models using clinical data from 3 large US HMOs for the 1998-1999 and 1999-2000 influenza seasons. The primary health economic model used a broad definition of clinical events and outcome period and included hospitalizations for all respiratory and cardiovascular events that occurred during the entire influenza season. The alternative model used more restrictive definitions and included pneumonia or influenza hospitalizations occurring during the peak influenza season. The results of Monte Carlo simulation showed that, with the more inclusive primary model, influenza vaccination resulted in net medical care cost savings due to fewer respiratory or cardiovascular hospitalizations of Dollars 71/person vaccinated (5th-95th percentile Dollars 32-118) and net savings of Dollars 809/year of life saved (5th-95th percentile Dollars 331-1450). In contrast, the alternate model found costs of Dollars 3.50/person vaccinated (5th-95th percentile Dollars -11 to 5) and net costs of Dollars 91/year of life saved (5th-95th percentile Dollars -309 to 126). Our findings confirm that influenza vaccination of the elderly is most likely cost saving and supports policies and programs that advocate routine immunization of all persons 65 and older. They also highlight how different outcome definitions can influence the results of health economic analyses.

Aged↗
PubMed2004

Management of recycling in the Gulf Co-operation Council states.

Although some of the Gulf Co-operation Council (GCC) member states have placed recycling at the top of their waste management priorities, the low cost of landfill and the availability of land, usually old sand or gravel quarries, make recycling programs infeasible, uneconomical and unachievable. The only comprehensive form of recycling available within the GCC states is recycling of paper and cartons. The majority of the GCC states never set national or regional recycling targets. The cost of recycling in the GCC states region could be moderate to high depending on the collection system selected for the recycling program. Almost all of the cities within the GCC states use mechanised systems for daily collection of municipal solid waste (MSW). Therefore, the same daily collection system used for MSW might well be used for collection of recyclable materials, both on the same day and at the same time, or according to a different timetable. This paper provides strategies for developing an effective recycling marketing program and discusses regional co-ordination options.

Conservation of Natural Resources↗
PubMed2006

Confronting the realities of wastewater aquaculture in peri-urban Kolkata with bioeconomic modelling.

Wastewater reuse for aquaculture is a reality in several Asian countries, however, traditional practices face constraints including inadequate or contaminated wastewater inputs and growing concern over health risks. Based on Kolkata and a wastewater flow of 550,000m(3)d(-1), rational and conventional designs for lagoon-based wastewater treatment and reuse through aquaculture were compared using bioeconomic modelling. Outcomes showed the rational design required a larger area than the conventional or traditional systems, but that financial returns, nutrient retention and fish production were higher; gross fish production employing rational and conventional designs was 45,500 and 11,560t, respectively. However, limited land availability and constraints to reconfiguring the existing system make implementation of the rational design unlikely. Findings suggest traditional practices could be enhanced by adopting wastewater treatment prior to reuse, modifying fish production strategies, and monitoring to safeguard health. Bioeconomic modelling constitutes a useful tool in comparing treatment and reuse options, permitting the sensitivity of financial returns to changing costs and recent revisions to WHO guidelines for safe wastewater reuse to be assessed, however, social and environmental consequences demand consideration.

Aquaculture↗
PubMed2005

Management strategies for stage IB2 cervical cancer: a cost-effectiveness analysis.

OBJECTIVE: To assess the potential effectiveness and medical costs of three common strategies to manage Stage IB2 squamous cell carcinoma of the cervix (CXCA). METHODS: A decision analysis model compared three strategies to manage Stage IB2 CXCA: (1) radical hysterectomy with pelvic and para-aortic lymphadenectomy followed by tailored chemoradiation therapy for high-risk patients (RHYST); (2) primary chemoradiation therapy for all patients (CTRT); and (3) neoadjuvant chemotherapy followed by radical hysterectomy and tailored chemoradiation therapy for high-risk patients (NAC). RESULTS: RHYST was the least expensive strategy with a cost of 284 Million (M) per 10,000 women and a 5-year disease free survival (5-DFS) of 69%. Both NAC and CTRT had similar 5-DFS (69.3% and 70%, respectively); however, both NAC and CTRT were more expensive than RHYST at 299 M and 508 M, respectively. This translated into a higher cost-effectiveness ratio for NAC and CTRT ($43,197 and $72,613, respectively) when compared to RHYST ($41,212). NAC yielded 30 additional survivors compared to RHYST but at a cost of $499,783 per survivor. CTRT was more effective than RHYST with 100 additional survivors but at a substantial cost of $2,240,000 per survivor. CONCLUSIONS: RHYST is the most cost-effective strategy to manage Stage IB2 CXCA and would be favored in settings where resources are limited. Although NAC and CTRT are reasonable treatment strategies, policymakers must be willing to spend approximately $500,000 per additional survivor (NAC) or $2.2 M per additional survivor (CTRT).

Carcinoma, Squamous Cell↗
PubMed2005

Pressing the key pad: trial of a novel approach to health promotion advice.

BACKGROUND: A relatively simple procedure, the Pap test, is effective in detecting early changes in the cervix; however, many at-risk women, even in developed countries, do not have regular Pap tests. METHODS: A randomized controlled trial of an interactive voice response (IVR) cervical screening brief advice involving 17,008 households is described. The IVR system automatically made calls to households and explained the nature of the call; selected one eligible woman aged 18-69 years; determined her screening status; delivered a message appropriate to her screening status; offered additional messages to counter common barriers; offered additional information on cervical screening and cancer; offered additional contact numbers; and offered to arrange for someone to call back. Cervical screening rate data were obtained from the Australian Health Insurance Commission (HIC) for 6 months before and following the intervention. RESULTS: The cervical screening rate was found to have increased by 0.43% in intervention compared to the control postcodes, and the increase was greater for older women at 1.34%. CONCLUSIONS: The overall conclusion was that IVR technology was a feasible means to contact women to deliver brief interventions aimed at increasing cervical screening rates and could economically target at-risk groups. The potential for linking IVR to centralized Pap test Registers to issue Pap test reminders should be explored.

Adolescent↗
PubMed2001

Multiple state hazard models and workers' compensation claims: an examination of workers compensation data from Ontario.

The recurrent nature of some workplace injuries has led some researchers to conclude that the first absence from work does not provide an accurate picture of an individual's claim, or employment history, after a workplace injury. In this paper I estimate a multiple state hazard which estimates the transitions between spells where the individual receives workers' compensation benefits and spells where the individual does not receive any workers' compensation benefits. I apply this model to a sample of claims from Ontario's Workplace Safety and Insurance Board.

Accidents, Occupational↗
PubMed2002

International comparison of costs of a fatal casualty of road accidents in 1990 and 1999.

The purpose of this study is to assemble information of costs per fatal casualty in traffic accidents, adopted by authorities in different countries. analyse and compare these figures as well as the methods used for estimating these values. A questionnaire was sent to 19 countries from which 11 gave information on cost per fatality and methods of valuation. The costs per fatality, usually defined as direct and indirect costs plus a value of safety per se, are compared both between countries and over time, 1990 and 1999, for each country. The average cost per fatality has increased between 1990 and 1999 (fixed prices) due to both changes in the methodology and changes of valuations. Great Britain, New Zealand, Sweden and the US conduct own willingness-to-pay (WTP) surveys, while the Netherlands and Norway make reviews of these studies. In Finland, the cost per fatality is a combination of the value of lost productivity and the cost of care for an institutionalised disabled person. In Australia, Austria, Germany and Switzerland, the cost per fatality is estimated as a value of lost productivity and an addition of a human cost based on compensation payments or insurance payments. Estimates from recently conducted WTP surveys or meta-analyses are considered in Austria, Finland and Sweden, however, not yet adopted as official values for use in road traffic planning.

Accidents, Traffic↗
PubMed2002

A model of traffic crashes in New Zealand.

The aim of this study was to examine the changes in the trend and seasonal patterns in fatal crashes in New Zealand in relation to changes in economic conditions between 1970 and 1994. The Harvey and Durbin (Journal of the Royal Statistical Society 149 (3) (1986) 187-227) structural time series model (STSM), an 'unobserved components' class of model, was used to estimate models for quarterly fatal traffic crashes. The dependent variable was modelled as the number of crashes and three variants of the crash rate (crashes per 10,000 km travelled, crashes per 1,000 vehicles, and crashes per 1000 population). Independent variables included in the models were unemployment rate (UER), real gross domestic product per capita, the proportion of motorcycles, the proportion of young males in the population, alcohol consumption per capita, the open road speed limit, and dummy variables for the 1973 and 1979 oil crises and seat belt wearing laws. UERs, real GDP per capita, and alcohol consumption were all significant and important factors in explaining the short-run dynamics of the models. In the long-run, real GDP per capita was directly related to the number of crashes but after controlling for distance travelled was not significant. This suggests increases in income are associated with a short-run reduction in risk but increases in exposure to a crash (i.e. distance travelled) in the long-run. A 1% increase in the open road speed limit was associated with a long-run 0.5% increase in fatal crashes. Substantial reductions in fatal crashes were associated with the 1979 oil crisis and seat belt wearing laws. The 1984 universal seat belt wearing law was associated with a sustained 15.6% reduction in fatal crashes. These road policy factors appeared to have a greater influence on crashes than the role of demographic and economic factors.

Accidents, Traffic↗