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At least 1,063 records · Page 59Linked to original sources
PubMed1994

Agency relationships in psychotherapy: an economic analysis.

This paper takes the economist's point of view for explaining why psychotherapy seems to be a particularly difficult discipline and what could be done about it. Whereas the so-called agency relationship (i.e. a specialized agent acting on behalf of an uninformed client) can be counted upon to resolve some of the problems in somatic care, it risks to fail in psychic care because the client frequently expresses inconsistent preferences. For this reason, family members and general practitioners may serve as comparatively good agents in ambulatory care, while in the inpatient segment of psychotherapy, patient-oriented objectives tend to be thwarted. An important condition for agency relationships to perform well, however, is that the client carry a sufficient 'price tag', implying that his treatment contributes to the economic objectives of the agent in charge. The conclusion is that choice of agency relationships, even if resulting in seemingly wasteful parallel treatment, gives rise to competition between agents for patients and thus may serve as one of the best safeguards of patients' interests in psychotherapy.

Ambulatory Care↗
PubMed2002

The development of a successful physician compensation plan.

Physician compensation plans are critical to the success of a physician group or may lead to the demise of the group. Essential components of the development and implementation of a successful physician compensation plan include: strategic planning, physician understanding and buy-in, appropriate incentives, objective performance measurement, and a specific funding source or mechanism. There are two basic philosophies to consider for use: the market-based model and the net economic contribution model. Advantages and disadvantages of each are discussed. Methods of incorporating these multiple aspects into a single plan are described.

Efficiency, Organizational↗
PubMed2006

Fees or refuges: which is better for the sustainable management of insect resistance to transgenic Bt corn?

The evolution of resistance in insect pests will imperil the efficiency of transgenic insect-resistant crops. The currently advised strategy to delay resistance evolution is to plant non-toxic crops (refuges) in close proximity to plants engineered to express the toxic protein of the bacterium Bacillus thuringiensis (Bt). We seek answers to the question of how to induce growers to plant non-toxic crops. A first strategy, applied in the United States, is to require Bt growers to plant non-Bt refuges and control their compliance with requirements. We suggest that an alternative strategy is to make Bt seed more expensive by instituting a user fee, and we compare both strategies by integrating economic processes into a spatially explicit, population genetics model. Our results indicate that although both strategies may allow the sustainable management of the common pool of Bt-susceptibility alleles in pest populations, for the European corn borer (Ostrinia nubilalis) one of the most serious pests in the US corn belt, the fee strategy is less efficient than refuge requirements.

Animals↗
PubMed2000

Discounting compensation for injuries.

The reasons commonly given for discounting future costs and benefits are doubtfully applicable to future injuries: in particular, time preference justifies neither inter- nor intragenerational discounting. The cost of future injuries could be discounted on grounds that a smaller sum, invested at interest, is needed to pay a given level of ex post monetary compensation the further in the future the injury occurs. This effect is offset, however, by the diminishing marginal utility of compensation, if consumption is otherwise increasing. Depending on the elasticity of marginal utility of consumption, on whether consumption is growing at an optimal rate, and on the time period considered, the implicit discount rate may be positive, zero, or negative (even indefinitely so). There is no prospect of conventional discounting dealing appropriately with the cost of injuries to either future or present generations.

Cost-Benefit Analysis↗
PubMed2006

Using the Delphi technique in economic evaluation: time to revisit the oracle?

BACKGROUND AND OBJECTIVE: Although the Delphi technique has been commonly used as a data source in medical and health services research, its application in economic evaluation of medicines has been more limited. The aim of this study was to describe the methodology of the Delphi technique, to present a case for using the technique in economic evaluation, and to provide recommendations to improve such use. METHODS: The literature was accessed through MEDLINE focusing on studies discussing the methodology of the Delphi technique and economic evaluations of medicines using the Delphi technique. RESULTS AND DISCUSSION: The Delphi technique can be used to provide estimates of health care resources required and to modify such estimates when making inter-country comparisons. The Delphi technique can also contribute to mapping the treatment process under investigation, to identifying the appropriate comparator to be used, and to ensuring that the economic evaluation estimates cost-effectiveness rather than cost-efficacy. CONCLUSION: Ideally, economic evaluations of medicines should be based on real-patient data. In the absence of such data, evaluations need to incorporate the best evidence available by employing approaches such as the Delphi technique. Evaluations based on this approach should state the limitations, and explore the impact of the associated uncertainty in the results.

Delphi Technique↗
PubMed2006

Proposed drug-drug cost effectiveness methodology.

The advent of prospective reimbursement in hospitals has forced hospital administrators, pharmacy directors, and pharmacy and therapeutic committees to carefully compare the cost and benefits of similar drugs. Accomplishing this task is difficult. This paper reviews the literature on drug-drug cost effectiveness procedures and outlines a methodology that might be used to contrast and compare two drugs with similar therapeutic outcomes. The data to conduct this analysis can be obtained from published articles on clinical studies and company sources and entered into a microcomputer electronic spreadsheet. The study discusses the implications and use of cost effectiveness analysis to evaluate drugs by hospital formulary committees.

Cost-Benefit Analysis↗
PubMed2006

Economic evaluation of sustained sedation/analgesia in the intensive care unit.

Lorazepam, midazolam, propofol and opioids are the primary agents that are used for sustained sedation and analgesia of critically ill patients. The choice of agent depends on safety profiles, expected outcomes, cost, patient characteristics and clinical experience. Few studies have comparatively evaluated the sedatives in terms of cost. Many factors, aside from drug costs, influence the total cost of sedation in the intensive care unit. This article reviews the cost parameters of intensive care unit sedation that are specific to the characteristics of commonly used sedatives and analgesics, evaluates economic studies and cost models, summarises alternative methods of sedation and analgesia, and provides practical recommendations for methods of cost containment, including daily sedation interruption, sedation monitoring and protocol implementation.

Analgesics, Opioid↗
PubMed1989

Economic theory and international migration.

The modern literature on the economics of immigration focuses on 3 related issues: 1) what determines the size and skill composition of immigrants flows to any particular host country; 2) how do the immigrants adapt to the host country's economy; and 3) what is the impact of immigrants on the host country's economy? This article reviews the theoretical framework and empirical evidence provided by the economics literature on these questions. It demonstrates that the economic approach, using the assumption that migration behavior is guided by the search for better economic opportunities and that the exchanges among the various players are regulated by an immigration market, leads to substantial insights in to these issues.

Behavior↗
PubMed1981

Demographic-economic forecasting within an activity-commodity framework: some theoretical considerations and empirical results.

"This paper presents a methodology which allows demographic and economic forecasting models to be integrated in a consistent manner. By embedding a conventional static Leontief input-output model within an activity analysis framework, a number of interesting results are obtained. First, a new series of production, income, and employment multipliers is derived which offers considerable advantages over those currently in use. Second, partitioning the framework provides fresh insights into the complex relationships between demographic and economic variables. These developments in methodology are tested in a case study of Merseyside where an operational version of the framework is applied in a forecasting context."

Developed Countries↗
PubMed1989

An economic approach to fertility in Britain since 1860.

This paper utilizes a dynamic economic approach to examine movements in fertility in Britain since 1860. The analysis and results indicate that fertility has responded positively to change in incomes. However, this positive effect has been more than offset by the increase in the opportunity cost of female time which has followed closely the educational attainment of women.

Adolescent↗