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At least 1,423 records · Page 79Linked to original sources
PubMed2007

A multilevel analysis on the determinants of regional health care expenditure: a note.

Health care in most countries is a rather "local good" for which the fiscal decentralization theory applies and heterogeneity is the result. In order to address the issue of multijurisdictional health care in estimating income elasticity, we constructed a unique sample using data for 110 regions in eight Organisation for Economic Co-operation and Development (OECD) countries in 1997. We estimated this sample data with a multilevel hierarchical model. In doing this, we tried to identify two sources of random variation: within- and between-country variation. The basic purpose was to find out whether the different relationships between health care spending and the explanatory variables are country specific. We concluded that to take into account the degree of fiscal decentralization within countries in estimating income elasticity of health expenditure proves to be important. Two plausible reasons lie behind this: (a) where there is decentralization to the regions, policies aimed at emulating diversity tend to increase national health care expenditure and (b) without fiscal decentralization, central monitoring of finance tends to reduce regional diversity and therefore decrease national health expenditure. The results of our estimation do seem to validate both these points.

Age Factors↗
PubMed1989

Methodologic issues in policy modeling for cardiovascular disease.

Clinical decision models are intended to guide the choices of individual clinicians; policy models are intended to guide the choices of persons and organizations that affect the aggregate allocations of resources to health care problems. Although it is difficult to identify any single policymaker in the United States who can alter the aggregate effect of the millions (or billions) of individual clinical decisions, there are many potential users of policy models: payers, providers, state and local health departments, the National Institutes of Health, professional organizations, hospitals and producers of medical devices, among others. Policy models deal with populations of individuals, may be static or dynamic and may be descriptive or prescriptive. Two types of policy models that have been applied to cardiovascular disease with a focus on coronary artery bypass surgery are discussed: 1) economic evaluation models, specifically cost-effectiveness, cost utility and cost-benefit analyses; and 2) population simulation models. Cost-effectiveness models are preferable for reasons that are discussed.

Adult↗
PubMed2005

Cost-effectiveness of universal pneumococcal vaccination for infants in Italy.

This study aimed at estimating the health and economic outcomes of universal infant vaccination with seven-valent pneumococcal conjugate vaccine (PCV-7) in Italy. A Markov model simulated lifetime evolution of a birth cohort (538,138 children): universal vaccination would avert 769 invasive infections, 18 deaths and 1323 life years. At base-case analysis, universal three-dose vaccination would cost euro 26,449 (95% CI: 1975-62,075) and euro 38,286 (95% CI: 22,164-70,801) per life year-saved in the societal and the NHS perspective, respectively. In the hypothesis of a 5-year long protection period, vaccination would cost euro 32,694 and euro 43,115 per life-year saved. Considering yearly incidence of invasive pneumococcal disease reported for Veneto and Sardinia regions, PCV-7 vaccination would result highly cost-effective determining a cost of euro 10,479 and euro 16,890 per life year-save in the NHS and the societal perspective, respectively.

Adolescent↗
PubMed1996

Income dynamics and health.

The focus of this article is the economic dimension of socioeconomic status as it relates to health. In contrast to the assumptions of many life cycle models, the author finds household income to be quite volatile for many families, even during periods of macroeconomic growth. Income inequality has increased dramatically in the last 20 years. Studies relating various measures of health (e.g., low birth weight; cognitive development, stunting, wasting in early childhood; mortality in later adult years) to longitudinal measures of family income often find quite powerful effects of income, even after controlling for correlated aspects of socioeconomic status and baseline health status. The author discusses strategies for modeling income effects.

Adolescent↗
PubMed2006

[Health economic evaluation of low-dose acetylsalicylic acid in the primary prevention of cardiovascular disease].

INTRODUCTION AND OBJECTIVES: Low-dose aspirin is standard treatment for patients with a history of cardiovascular disease. Its use in primary prevention is more controversial. However, recent studies also support the use of aspirin in high-risk individuals with no history of cardiovascular disease. This study investigated the health economic implications of using low-dose aspirin in the primary prevention of cardiovascular disease in Spain. METHODS: A model was developed to predict the cost-effectiveness of low-dose aspirin in the primary prevention of cardiovascular disease over a period of 10 years. The direct costs used were those of the Spanish National Health Service (NHS). Results were expressed as cost per life-year gained and per quality-adjusted life-year gained. RESULTS: Administering low-dose aspirin to an individual with a 10-year risk of coronary heart disease > or =15% resulted in an average net saving of e 797 (95% CI, e 263-1331) over the 10-year period, with savings starting in the first year. For an annual risk > or =0.24%, this form of treatment would reduce NHS costs. Treating all at-risk individuals in the Spanish population with aspirin would save e 26.5 million from the healthcare budget, starting in the first year. CONCLUSIONS: Administering low-dose aspirin to individuals with a 10-year risk of coronary heart disease > or =15% would result in significant cost savings for the Spanish NHS. Sensitivity analysis confirmed the robustness of these findings.

Adult↗
PubMed2006

[Emergy value evaluation on rice-duck organic farming mode].

Employing emergy value evaluation method, this paper compared the ecological and economic benefits of rice-duck organic farming system (mode I) and conventional rice-wheat rotation system (mode II) in Shanghai suburb. The results showed that mode I had better emergy benefits, higher self-organizing ability and sustainability, and higher product safety. The net emergy yield ratio (EYR), feedback ratio of yield emergy (FYE), and emergy sustainable index (ESI) of mode I were respectively 1.57, 14.1, and 8.71 times as much as those of mode II, and the emergy index of product safety (EIPS) was 0 in mode I but -0.66 in mode II. The emergy investment ratio (EIR) and environmental loading ratio (ELR) of mode I were 40.1% and 18.3% of mode II, respectively, suggesting that mode I had less environmental pressure than mode II. Mode I had lower economic benefits than mode II. The economic output, gross income, and net income of mode I were 15.7%, 9.6%, and 29.6% less than those of mode II , respectively. As for Em dollars, the output, gross income, and net income of mode I were respectively 50%, 102.6%, and 136.4% higher than those of mode II. With the system optimization and the development of organic food market, mode I had the potential to improve its economic benefits.

Animals↗
PubMed1999

Convenient murine pneumoperitoneal model for the study of laparoscopic cancer surgery.

To investigate the effects of laparoscopic surgery on the progression of cancers, it is necessary to establish a reliable and economical animal model. We describe a convenient murine pneumoperitoneal model for the study of laparoscopic cancer surgery. Under anesthesia using diethyl ether, peritoneal cavity was insufflated with gas through an intravenous catheter placed in the left lower quadrant. Syringe pump was used for continuous gas insufflation, and intraperitoneal pressure was measured. Intraperitoneal pressure increased and reached 10 cm H2O when 15 mL of CO2 gas was injected, but fell to 1 cm H2O 5 min after stopping the injection. When the continuous flow was adjusted by syringe pump between 20 and 160 mL/hour, intraperitoneal pressure was easily maintained at 8 cm H2O for >60 min. We believe that this murine model for pneumoperitoneum may be useful for the study of laparoscopic cancer surgery.

Animals↗
PubMed1993

Demographics, political power and economic growth.

"Growth theory may be used to predict the response of saving, capital formation, and output growth to large demographic shifts. Such large shifts would also be expected to alter the demand for government services and the desired levels of taxation in the population. This paper extends the overlapping-generations model of economic growth to predict the evolution of government tax and spending policy through the course of a major demographic shift. Simulations suggest that this approach may yield valuable insights into the evolution of policy in the United States and other industrialized economies."

Americas↗
PubMedDate not supplied

Indirect cost in economic evaluation: the opportunity cost of unpaid inputs.

Unpaid time represents a potentially significant input into the health production function. The paper sets out the basis for valuation of time inputs consistent with the notion of opportunity cost. Such analysis requires consideration of whether time displaced in the production of health involves lost work or lost leisure. Furthermore, because valuation of opportunity cost requires the consistent treatment of costs and benefits, the study also considers the valuation of outputs. The basis for valuing the shadow price of work time is examined by firstly assuming perfect competition. The analysis then considers the presence of monopoly and monopsony in product markets and income and sales taxes. The basis for valuing the shadow price of leisure ("leisure' being all uses of time except paid employment) is restricted to an examination of methods previously used to value unpaid housework. The two methods examined are the replacement cost and the opportunity cost method. As the methods are not equivalent, the circumstances where each is appropriate vary depending on whether the output lost in producing health is replaced. Although not set out as the primary focus of the paper, the issues surrounding the valuation of outputs generated by non-market and quasi-market activity are examined. In particular, where activities such as informal care result in indirect utility to the carers (and patients) themselves, it is likely the full market wage provides a lower bound estimate of the value of marginal benefit. Finally the paper provides a practical approach to examining opportunity cost of unpaid inputs consistent with the concepts set out in preceding sections.

Caregivers↗
PubMed2005

Determinants of physicians' decisions to specialize.

In this paper, we study physician specialty decisions using several unique data sets which include information on almost all Canadian physicians who practised in Canada between 1989 and 1998. Unlike previous studies, we use a truly exogenous measure of potential income across general and specialty medicine to estimate the effect of income on physicians' specialty choices. Furthermore, our estimation procedure allows us to purge the income-effect estimates of non-pecuniary specialty attributes which may be correlated with higher paying specialties. Understanding the effect of potential income (and other variables) on choices is necessary if the desired mix across generalists and specialists as well as across specialties is to be achieved. Our results show that physicians respond to differences in income when making their specialty decisions.

Age Factors↗
PubMed2003

Hospital selective contracting without consumer choice: what can we learn from Medi-Cal?

In the selective contracting era, consumer choice has generally been absent in most state Medicaid programs, including California's (called Medi-Cal). In a setting where beneficiary exit is not a threat, a large payer may have both the incentives and the ability to exercise undue market power, potentially exposing an already vulnerable population to further harm. The analyses presented here of Medi-Cal contracting data, however, do not yield compelling evidence in favor of the undue market power hypothesis. Instead, hospital competition appears to explain with greater consistency why certain hospitals choose to contract with Medi-Cal while others do not, the trends in inpatient prices paid by Medi-Cal over time, and the effect of price competition on service cutbacks, such as emergency room closures.

California↗
PubMed2006

[Usability of databases in health economics].

In the health care system, there is increasing demand for health economic analyses to achieve cost reductions or increase efficiency. Apart from classical literature or study-based analyses in health economics, routinely obtained data may complement hitherto missing information for the general medical care situation. By analysing care structures and comparing applied or newly introduced technologies, results can be achieved faster and the significance for payers increased as compared to primary studies. Routinely obtained and potentially usable databases are frequently generated from surveys or from administrative data sources. In spite of clear limitations, these data are interesting in health economics based upon reflection of reality in utilization of services. They can contribute to improved understanding of general medical care and aid in identifying economically appropriate technologies and therapeutic strategies.

Cost-Benefit Analysis↗
PubMed1994

The effect of competitive pressure on charity: hospital responses to price shopping in California.

Since higher charges to private patients are a major source of financing for hospital care to the uninsured, increased price shopping by private payers may mean that hospitals are less able to provide such care. I study the effect of increased price shopping on California hospital markets over the 1984-1988 period. I find that there was a large fall in net private revenues and net income in the least concentrated hospital markets in the state after the advent of price shopping. Perhaps as a result, care to the uninsured fell dramatically in these markets as well, relative to more concentrated markets.

California↗
PubMed2005

The neural basis of financial risk taking.

Investors systematically deviate from rationality when making financial decisions, yet the mechanisms responsible for these deviations have not been identified. Using event-related fMRI, we examined whether anticipatory neural activity would predict optimal and suboptimal choices in a financial decision-making task. We characterized two types of deviations from the optimal investment strategy of a rational risk-neutral agent as risk-seeking mistakes and risk-aversion mistakes. Nucleus accumbens activation preceded risky choices as well as risk-seeking mistakes, while anterior insula activation preceded riskless choices as well as risk-aversion mistakes. These findings suggest that distinct neural circuits linked to anticipatory affect promote different types of financial choices and indicate that excessive activation of these circuits may lead to investing mistakes. Thus, consideration of anticipatory neural mechanisms may add predictive power to the rational actor model of economic decision making.

Adult↗
PubMed2000

Making exchange entitlements operational: the food economy approach to famine prediction and the RiskMap computer program.

The effect of production failure or some other shock on household income and food supply depends upon: (a) the pattern of household income, and (b) its ability to compensate for any deficit which may have occurred, for example, by the sale of assets or finding additional paid employment. The corollary is that the prediction of the likely effect of some event on the future state of the economy or food supply of a population of households requires an understanding of the economy of the households concerned and the economic context to which these relate. This paper describes an attempt to develop an approach to prediction using a dynamic model of economy based on quantitative descriptions of household economy obtained by systematic rapid field-work and summarises the experience of the use of this approach to date.

Computer Simulation↗